JP2017169932A - Insertion apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an insertion apparatus eliminating a selection of a size as much as possible and flattening a part of a duct.SOLUTION: The insertion apparatus includes: a first flexible tube to be inserted from a distal side along a longitudinal axis to the inside of a duct; a second flexible tube with an overhang part elastically deformed between a non-overhang position along the longitudinal axis of the first flexible tube, and an overhang position arcuately overhanging from the first flexible tube in a direction crossing with the longitudinal axis of the first flexible tube, outward pressing an inner wall of the duct at the overhang position and flattening at least a part of the duct; and a fixing part provided at a distal side with respect to the overhang part and fixing a part of the first flexible tube and a part of the second flexible tube.SELECTED DRAWING: Figure 1A

Description

  The present invention relates to an insertion device that can be inserted into a duct such as a body cavity.

  Patent Document 1 discloses a balloon that expands into a flat shape. By inflating the balloon, the inside of the pipeline can be made flat. By the way, left atrial ablation treatment is known in which atrial fibrillation causing thrombus or the like is treated with heat using a catheter inserted into a heart from a blood vessel. The balloon of Patent Document 1 is inflated in a flat shape while controlling the direction, thereby moving away the esophagus located at the rear of the heart when performing left atrial ablation treatment.

US Patent Application Publication No. 2011/82338

  The inner diameter of the esophagus varies from patient to patient. For this reason, when using the apparatus of patent document 1, it is necessary to select the balloon of optimal size before arrange | positioning in a patient's esophagus. In addition, when flattening a part of the pipeline using the balloon of Patent Document 1 in a part other than the esophagus, the size needs to be selected in advance.

  An object of the present invention is to provide an insertion device capable of flattening a part of a pipe line while minimizing the size selection.

  An insertion device according to an aspect of the present invention has a distal end and a proximal end, and is inserted into a conduit from the distal end side along the longitudinal axis defined by the distal end and the proximal end. A flexible tube, a non-extending position along the longitudinal axis of the first flexible tube, and an arcuate shape projecting from the first flexible tube in a direction intersecting the longitudinal axis of the first flexible tube A second flexible pipe having an overhanging portion that elastically deforms between the overhanging positions and presses an inner wall of the pipe line outward at the overhanging position to flatten at least a part of the pipe line; A fixing portion that is provided on a distal end side of the projecting portion and fixes a part of the first flexible tube and a part of the second flexible tube;

  According to the present invention, it is possible to provide an insertion device that makes it possible to flatten a part of a pipeline without making selection of size as much as possible.

FIG. 1A is a schematic diagram illustrating an insertion device according to the first embodiment. FIG. 1B is a schematic diagram illustrating a state in which the vicinity of the locking portion of the insertion device according to the first embodiment is viewed from the direction of the arrow 1B in FIG. 1A. FIG. 2A schematically shows the insertion device according to the first embodiment, and shows a state in which the overhanging portion of the second flexible tube is arranged at the non-extending position with respect to the second tube portion of the first flexible tube. FIG. FIG. 2B is a schematic view showing a portion including an overhang portion of the insertion device as seen from the direction of arrow 2B in FIG. 2A. 2C is a schematic cross-sectional view taken along line 2C-2C in FIGS. 2A and 2B. FIG. 2D is a schematic longitudinal sectional view showing a state in which the overhanging portion of the second flexible tube is disposed at the overhanging position with respect to the second tube portion of the first flexible tube. FIG. 2E is a schematic longitudinal sectional view showing a state in which the second tube portion of the first flexible tube is disposed at a protruding position with respect to the second flexible tube. FIG. 3 is a schematic diagram illustrating an endoscope used when the distal end member of the insertion device according to the first embodiment is inserted into a conduit. FIG. 4A is a schematic diagram showing a state where the distal end of the insertion portion of the endoscope is inserted into a site (duct) from the esophagus to the stomach. FIG. 4B is a schematic diagram showing a state where a guide wire is inserted through a channel in a state where the distal end of the insertion portion of the endoscope is inserted into a portion (duct) from the esophagus to the stomach. FIG. 4C shows a state in which the insertion portion of the endoscope is removed from the site from the esophagus to the stomach while maintaining the position of the tip of the guide wire with respect to the site (duct) from the esophagus to the stomach. FIG. FIG. 4D shows a state where the insertion device is inserted from the distal end side into the esophagus along the guide wire while maintaining the position of the distal end of the guide wire with respect to the site (duct) from the esophagus to the stomach. It is the schematic which shows the state which has the left atrium in the near side of. FIG. 4E shows that the insertion device is inserted into the esophagus from the distal end side, while maintaining the position of the first flexible tube as much as possible, the second flexible tube is operated so that the overhanging portion is in the overhanging position. It is the schematic which shows the state which maintained the amount of overhang | projection of the overhang | projection part while pressing an inner wall toward the outer side. FIG. 4F is a schematic view showing a state where the esophagus is flattened by the overhanging portion of the insertion device shown in FIG. 4E and the esophagus is separated from the left atrium. FIG. 4G is a schematic view showing a state in which the first flexible tube is twisted by 180 ° with respect to the central axis in a state where the insertion device is inserted into the esophagus from the distal end side and the overhanging portion is in the overhanging position. . FIG. 4H is a schematic diagram illustrating a state in which the guide wire is inserted through the second flexible tube of the insertion device in the state illustrated in FIG. 4E and the stiffness of the second flexible tube is increased. FIG. 4I shows a state in which the protruding portion of the first flexible tube protrudes by operating the second flexible tube while maintaining the position of the first flexible tube as much as possible with the insertion device inserted into the esophagus from the distal end side. It is the schematic which shows the state which maintained the protrusion amount of the protrusion part while pressing the inner wall of an esophagus toward a position in the position. FIG. 4J is a schematic view showing a state where the esophagus is flattened by the protrusion of the insertion device shown in FIG. 4I and the esophagus is separated from the left atrium. FIG. 4K shows a state in which the stenosis portion of the stenosis part is released by disposing the bulge part of the insertion device by placing the bulge part or projecting the esophagus. FIG. FIG. 5A is a schematic view showing a state in which the insertion device is inserted into the large intestine (duct) from the distal end side. FIG. 5B is a schematic view showing a state in which the overhanging portion of the insertion device shown in FIG. 5A is overhanging. FIG. 5C is a schematic view showing a state where the protruding portion of the insertion device shown in FIG. 5A is extended to the state shown in FIG. 5B and the mucosal tissue is changed from a curved surface to a flat surface. FIG. 6A is a schematic diagram showing the duodenum (duct). FIG. 6B shows that the insertion device is moved along the duodenum with the insertion device inserted into the duodenum (duct) from the distal end side, and the gallstone is dropped from the bile duct through the nipple into the duodenum. It is the schematic which shows the state which is going to be made to do. FIG. 7A is a schematic longitudinal sectional view showing a balloon unit attached to an insertion device. FIG. 7B is a schematic diagram showing a state seen from the direction of arrow 7B in FIG. 7A. FIG. 7C is a schematic longitudinal cross-sectional view showing a state where the balloon is inflated in a state where the balloon unit tube is passed through the second flexible tube of the insertion device and the tubular body of the balloon unit is attached to the distal end member of the insertion device. is there. FIG. 8A is a schematic view showing a balloon unit. FIG. 8B shows a state where the endoscope insertion portion is placed from the esophagus to the stomach in a state where the balloon unit tube is passed through the endoscope channel and the balloon unit cylindrical body is attached to the distal end portion of the endoscope insertion portion. It is the schematic which shows the state inserted in the site | part (duct). FIG. 8C shows the state where the balloon of the balloon unit is inflated to maintain the position of the balloon with respect to the esophagus, and the insertion portion of the endoscope is removed from the esophagus, and the balloon unit tube is inserted into the second flexible tube of the insertion device. It is the schematic which shows the state. FIG. 8D shows a state in which the second flexible tube is operated by the balloon while maintaining the position of the first flexible tube while the insertion device is inserted into the esophagus from the distal end side with respect to the tube of the balloon unit. It is the schematic which shows the state which maintained the amount of overhang | projection of the overhang | projection part while pressing the inner wall of an esophagus toward an outer side by making a part into an overhang | projection position. FIG. 8E shows a state in which the protruding portion becomes the protruding portion while maintaining the state where the protruding portion is extended by bringing the locking portion of the first flexible tube of the insertion device in the state shown in FIG. 8D close to the tip member. It is the schematic which shows the state protruded on the opposite side with respect to it. FIG. 9A is a schematic longitudinal sectional view showing an insertion device and a balloon unit attached to the insertion device. FIG. 9B is a schematic diagram showing a state of the balloon unit in FIG. 9A viewed from the direction of arrow 9B. FIG. 9C is a schematic longitudinal sectional view showing a state in which the tubular body of the balloon unit is fitted to the distal end member of the insertion device shown in FIG. 9A and the tube of the balloon unit is inserted through the tube guide. . FIG. 10A is a schematic view showing a balloon unit. FIG. 10B shows an endoscope insertion portion in a state where a tube of the balloon unit is arranged along the insertion portion of the endoscope and a cylindrical body of the balloon unit is attached to the distal end portion of the insertion portion of the endoscope. It is the schematic which shows the state which inserted in the site | part (duct) from the esophagus to the stomach. FIG. 10C shows a state where the balloon of the balloon unit is inflated and the position of the balloon with respect to the esophagus is maintained, the insertion portion of the endoscope is removed from the esophagus, and the tube of the balloon unit is inserted through the tube guide of the insertion device. FIG. FIG. 11A is a schematic longitudinal sectional view showing an insertion device and a balloon unit attached to the insertion device. FIG. 11B is a schematic longitudinal cross-sectional view showing a state in which the tubular body of the balloon unit is fitted to the distal end member of the insertion device shown in FIG. 11A and the balloon unit tube is inserted through the second pipe portion. It is. FIG. 12A is a schematic longitudinal sectional view showing the insertion device in a state where a balloon is arranged so as to cover the overhanging portion and the protruding portion. FIG. 12B is a schematic longitudinal sectional view showing a state in which the overhanging portion of the insertion device is overhanged to inflate the balloon, and cooling water is supplied into the balloon to cool the living tissue in contact with the balloon. . FIG. 12C shows a state in which the esophagus is flattened by the overhanging portion of the insertion device shown in FIG. 12B and the esophagus is separated from the left atrium, and the esophagus adjacent to the left atrium is cooled by the cooling effect of the balloon FIG. FIG. 12D shows a state in which the overhanging portion of the insertion device is overhanged to inflate the balloon, and cooling water (physiological saline) injected into the balloon is leaked from the hole to cool the living tissue in contact with the balloon. It is a schematic longitudinal cross-sectional view shown. FIG. 13A schematically illustrates an insertion device according to the second embodiment, in which a protruding portion of the second flexible tube is disposed at a non-extended position with respect to the second tube portion of the first flexible tube. FIG. FIG. 13B is a schematic diagram showing a portion including an overhang portion of the insertion device as seen from the direction of arrow 13B in FIG. 13A. FIG. 13C is a schematic longitudinal sectional view showing a state in which the overhanging portion of the second flexible tube is disposed at the overhanging position with respect to the second tube portion of the first flexible tube. FIG. 13D is a schematic longitudinal sectional view showing a state in which the second tube portion of the first flexible tube is disposed at a protruding position with respect to the second flexible tube. FIG. 14A shows an insertion device according to the third embodiment, schematically showing a state in which an overhanging portion of the second flexible tube is arranged at a non-extending position with respect to the second tube portion of the first flexible tube. FIG. FIG. 14B is a schematic view showing a portion including an overhang portion of the insertion device viewed from the direction of arrow 14B in FIG. 14A. FIG. 14C is a schematic longitudinal sectional view showing a state in which the overhanging portion of the second flexible tube is arranged at the overhanging position with respect to the first flexible tube. FIG. 14D is a schematic longitudinal sectional view showing a state in which the protruding portion of the first flexible tube is disposed at the protruding position with respect to the second flexible tube. FIG. 15 shows a first modification of the base end portion of the first flexible tube of the insertion device, and schematically shows the relationship between the locking portion of the base end portion of the first flexible tube and the second flexible tube. FIG. FIG. 16: shows the 2nd modification of the base end part of the 1st flexible tube of an insertion apparatus, and is a schematic which shows the relationship between the latching | locking part of the base end part of a 1st flexible tube, and a 2nd flexible tube. FIG. FIG. 17A shows a third modification of the proximal end portion of the first flexible tube of the insertion device, and the second flexible tube is movable relative to the locking portion of the proximal end portion of the first flexible tube. It is a schematic longitudinal cross-sectional view which shows this. FIG. 17B is a schematic cross-sectional view taken along line 17B-17B in FIG. 17A. FIG. 17C shows a third modification of the proximal end portion of the first flexible tube of the insertion device, in which the second flexible tube is locked to the locking portion of the proximal end portion of the first flexible tube. It is a schematic longitudinal cross-sectional view which shows a state.

  Hereinafter, embodiments for carrying out the present invention will be described with reference to the drawings.

(First embodiment)
A first embodiment will be described with reference to FIGS. 1A to 6B.

  An insertion device 10 according to this embodiment shown in FIG. 1A is used by being inserted into a body cavity. The insertion device 10 can press the inner wall of the pipe line outward. The insertion device 10 includes a first flexible tube (base tube) 12 and a second flexible tube (work tube) 14. As shown in FIGS. 1A and 2A, the first flexible tube 12 defines a central axis (longitudinal axis) C by a distal end 13a and a proximal end 13b. The first flexible tube 12 is inserted along the central axis C from the distal end side to the inside of the conduit. In this embodiment, the second flexible tube 14 is on the central axis C except for an overhang portion 52 described later. The 2nd flexible tube 14 forms the channel | path 14a connected from the front-end | tip to the base end in the internal peripheral surface.

  For example, when the first flexible tube 12 is inserted orally or nasally, the total length of the first flexible tube 12 is such that the distal end 13a reaches the stomach S through the esophagus E and the proximal end 13b. Is not inserted into the mouth or nose. The total length of the second flexible tube 14 is longer than that of the first flexible tube 12, and the base end 15 b of the second flexible tube 14 is further on the base end side than the base end 13 b of the first flexible tube 12. Is preferred. Of course, the lengths of the first flexible tube 12 and the second flexible tube 14 can be changed depending on the patient and the treatment site.

  As shown in FIGS. 1A and 2A to 2D, the first flexible tube 12 includes, in order from the distal end 13a toward the proximal end, a distal end member 20, a first tubular portion (distal end side tubular portion) 22, A first guide part (extension direction defining part) 24, a second pipe part (working pipe part) 26, a second guide part (extruding direction defining part) 28, and a third pipe part (base end side pipe part). ) 30 and a locking portion (base) 32. The tip member 20 is formed in a cylindrical shape, and has a tip opening 20a at the tip. The distal end of the first tube portion 22 is fixed to the distal end member 20. A first guide part (front end side guide part) 24 is fixed to the proximal end of the first pipe part 22. The distal end of the second pipe portion 26 is fixed to the first guide portion 24. A second guide part (base end side guide part) 28 is fixed to the base end of the second pipe part 26. The distal end of the third tube portion 30 is fixed to the second guide portion 28. At the proximal end of the third tube portion 30, a locking portion 32 that holds the positional relationship between the first flexible tube 12 and the second flexible tube 14 is disposed.

  In this embodiment, the second tube portion 26 is formed as a closed tube by the first guide portion 24 at the distal end and the second guide portion 28 at the proximal end. The first guide portion 24 forms a first guide opening 24 a between the proximal end of the first tube portion 22 and the distal end of the second tube portion 26. The second guide portion 28 forms a second guide opening 28 a between the proximal end of the second tube portion 26 and the distal end of the third tube portion 30. The first guide opening 24 a and the second guide opening 28 a are formed on the side surface of the first flexible tube 12. The first guide opening 24a and the second guide opening 28a communicate the inside and the outside of the first flexible tube 12. The first guide part 24 has a first inclined surface (guide surface) 24b. The 2nd guide part 28 has the 2nd inclined surface (guide surface) 28b.

  As shown in FIGS. 2A and 2B, the first guide opening 24 a and the second guide opening 28 a are separated from each other in a state parallel to the central axis C on the outer surface of the first flexible tube 12. As shown by a broken line in FIG. 2C, the central angles θ in the direction (circumferential direction) around the central axis C of the first guide opening 24a and the second guide opening 28a are each smaller than 180 °. The four circumferential edges (two pairs) of the first guide opening 24a and the second guide opening 28a are preferably parallel. The length in the direction parallel to the central axis C of the first guide opening 24a and the second guide opening 28a (the distance between the edges of the first guide opening 24a and the distance between the edges of the second guide opening 28a) is the second. It is larger than the diameter of the flexible tube 14. Further, the shape of the openings of the first guide opening 24a and the second guide opening 28a may be an oval shape that is long along the direction of the central axis C. If it is this shape, since the area where the edge part of opening 24a, 28a contacts the 2nd flexible tube 14 increases, it can suppress that the force applied to the 2nd flexible tube 14 concentrates.

  The first inclined surface 24b intersects the central axis C, and guides the second flexible tube 14 from the distal end side toward the outside of the first guide portion 24 through the first guide opening 24a. At this time, in the first inclined surface 24b, the angle α in the direction from the distal end side to the proximal end side along the central axis C is larger than 90 ° and smaller than 180 °. For this reason, the first inclined surface 24b can prevent the second flexible tube 14 from being loaded.

  The second inclined surface 28b intersects the central axis C and guides the second flexible tube 14 from the distal end side toward the inside of the second guide portion 28 through the second guide opening 28a. At this time, in the second inclined surface 28b, the angle β in the direction from the base end side toward the tip end side along the central axis C is larger than 90 ° and smaller than 180 °. For this reason, the second inclined surface 28b can prevent the second flexible tube 14 from being loaded.

  The locking portion 32 includes a male screw cylinder (tubular body) 42 that is fixed to the proximal end of the third pipe portion 30, a nut 44, and an O-ring 46. The O-ring 46 is disposed between the base end of the male screw cylinder 42 and the nut 44. The inner diameter of the O-ring 46 is the same as or slightly larger than the outer diameter of the second flexible tube 14. For this reason, in a state where the nut 44 is loosened with respect to the male screw cylinder 42, the second flexible tube 14 can be moved along the central axis C with respect to the locking portion 32. When the O-ring 46 is screwed onto the male screw cylinder 42, the O-ring 46 is elastically deformed by the pressure between the male screw cylinder 42 and the nut 44, and strongly against the outer peripheral surface of the second flexible tube 14. In close contact. For this reason, the second flexible tube 14 can be locked to the locking portion 32 at an appropriate position. Therefore, the second flexible tube 14 can be held in an appropriate positional relationship with respect to the first flexible tube 12.

  The second flexible tube 14 has a distal end 15 a fixed to the inner peripheral surface of the distal end member 20 of the first flexible tube 12. That is, the tip member 20 of the first flexible tube 12 is also used as the tip member of the second flexible tube 14. The tip member 20 of the first flexible tube 12 is used as a fixing portion that fixes a part of the first flexible tube 12 and a part of the second flexible tube 14.

  The first guide portion 24 and the second guide portion 28 of the first flexible tube 12 may be formed of an elastically deformable material such as a rubber material, for example, and may be formed of a hard material such as a stainless alloy material. May be.

  The first tube portion 22, the second tube portion 26, and the third tube portion 30 of the first flexible tube 12 are the same as the flexible tube 62c or the universal cable 66 of the known insertion portion 62 of the endoscope 60 shown in FIG. It is preferable to be formed. That is, the 1st pipe part 22, the 2nd pipe part 26, and the 3rd pipe part 30 are each formed with the spiral tube, the braid | blade, and the outer skin from the inner side toward the outer side. For this reason, the first flexible tube 12 is prevented from being crushed and has an appropriate flexibility (elasticity) while suppressing a change in length.

  For this reason, for example, when the locking part 32 is held horizontally with respect to the ground, the first pipe part 22, the second pipe part 26, and the third pipe part 30 can each maintain an internal pipe line (passage). . When the first tube portion 22, the second tube portion 26, and the third tube portion 30 are formed in the same manner as the flexible tube 62 c or the universal cable 66 of the insertion portion 62 of the endoscope 60, the locking portion 32. The axial movement operation along the central axis C of the first flexible tube 12 and the rotation or rotation operation around the central axis C in the vicinity of the first flexible tube 12 are reliably transmitted to the tip member 20. That is, when the surgeon tries to move the vicinity of the locking portion 32 to the distal end side along the central axis C, the locking portion 32, the third tube portion 30, the second guide portion 28, the second tube portion. 26, the first guide portion 24, the first tube portion 22, and the tip member 20 are reliably transmitted in this order, and the tip member 20 moves approximately the same as the amount of movement of the locking portion 32. Further, when the surgeon tries to rotate the vicinity of the locking portion 32 around the axis of the central axis C, the locking portion 32, the third tube portion 30, the second guide portion 28, and the second tube portion 26. The force is reliably transmitted in the order of the first guide portion 24, the first tube portion 22, and the tip member 20, and the tip member 20 is rotated to the same extent as the amount of rotation of the locking portion 32.

  The second flexible tube 14 may be formed in the same manner as the first flexible tube 12. That is, the first flexible tube 12 and the second flexible tube 14 may be formed of the same material with the same structure, or may be formed of other materials with other structures. It is preferable that the first flexible tube 12 and the second flexible tube 14 have a difference in flexibility. The second flexible tube 14 has, for example, a structure formed by a mesh tube (blade) of metal yarn and an outer skin covered on the outside thereof. In this case, the second flexible tube 14 is softer than the first flexible tube 12 by the amount of the helical tube. For this reason, for example, a protruding portion 52 described later of the second flexible tube 14 is softer than a protruding portion 54 described later of the first flexible tube 12. Applications can be divided depending on whether the overhanging portion 52 is arranged at an overhanging position to be described later or the protruding portion 54 is arranged at a protruding position to be described later. For example, the insertion device 10 is used to treat an adult, a child, or the extension portion 52 should be moved to the extension position depending on the flexibility of a duct such as the esophagus E. It is possible to select whether the protrusion 54 should be in the protrusion position.

  In any case, the second flexible tube 14 can prevent the passage 14a from being crushed, can maintain the passage 14a, and has appropriate flexibility (elasticity).

  The distal end portion of the second flexible tube 14 is fixed to the distal end portion of the first flexible tube 12 by a common distal end member 20. For this reason, the second flexible tube 14 moves following the movement of the first flexible tube 12. At this time, since the second flexible tube 14 is inside the first flexible tube 12 except for the overhanging portion 52, the second flexible tube 14 is prevented from being twisted with respect to the first flexible tube 12. Has been.

  The first flexible tube 12 and the second flexible tube 14 are partly made of a metal material such as stainless steel and have radiopacity that can be observed by X-ray observation. Alternatively, it is also preferable that the resin material used for the first flexible tube 12 and / or the second flexible tube 14 is mixed with a radiopaque metal material.

As shown in FIG. 2A, when the nut 44 of the locking portion 32 is loosened with respect to the male screw cylinder 42, the O-ring 46 is not in a flat state but in a natural state. At this time, since the inner peripheral surface of the O-ring 46 does not inhibit or hardly inhibit the movement of the outer peripheral surface of the second flexible tube 14, the second flexible tube 14 is moved with respect to the locking portion 32 by the arrow m1. , M0.
The tip of the first flexible tube 12 and the tip of the second flexible tube 14 are fixed to a common tip member 20. For this reason, if the 2nd flexible tube 14 is moved to the direction of arrow m1 with respect to the latching | locking part 32 of the state shown to FIG. 2A, as shown to FIG. 2D, the force loaded on the front-end | tip member 20 will be released. Therefore, the second flexible tube 14 protrudes outward with respect to the second guide portion 28 of the first flexible tube 12. At this time, the second flexible tube 14 is separated from the first flexible tube 12 and has an arcuate shape (or an arch shape or a U shape) in a direction intersecting the longitudinal axis C of the first flexible tube 12. The overhanging portion 52 that is elastically deformed is formed. The state of the overhang portion 52 at this time is defined as an overhang position. The overhanging portion 52 changes the amount of overhanging according to the amount of movement along the central axis C of the second flexible tube 14. The non-overhanging position is the state in which the overhanging portion 52 of the second flexible tube 14 is in the state shown in FIGS. 2A and 2E. In other cases, the overhanging position is the overhanging position regardless of the overhanging amount of the overhanging portion 52. is there. The non-extending position is not limited to the case where the overhanging portion 52 is closest to the protruding portion 54 of the first flexible tube 12, but the length of the overhanging portion 52 (between the guide openings 24a and 28a). (Distance) is the shortest state. For this reason, the openings 24a and 28a are used for inserting and removing the second flexible tube 14.
That is, the fixing portion 20 is provided on the distal end side with respect to the protruding portion 52 of the second flexible tube 14 and fixes a part of the first flexible tube 12 and a part of the second flexible tube 14. The overhanging portion 52 of the second flexible tube 14 intersects the non-overhanging position along the longitudinal axis C of the first flexible tube 12 and the longitudinal axis C of the first flexible tube 12. The first flexible tube 12 is elastically deformed between the projecting positions projecting in an arcuate shape, and the inner wall of the conduit is pressed outward at the projecting position to flatten at least a part of the conduit.

  Note that the distance between the openings 24 a and 28 a can be appropriately changed depending on the materials of the first flexible tube 12 and the second flexible tube 14. If the distance between the openings 24a and 28a is too long, the possibility that the second flexible tube 14 is twisted with respect to the first flexible tube 12 in the overhanging portion 52 and the overhanging portion 52 meanders increases. For this reason, the distance between the openings 24 a and 28 a is appropriately set so that the second flexible tube 14 can be prevented from being twisted with respect to the first flexible tube 12 in the overhanging portion 52.

  The first guide part 24 and the second guide part 28 that are separated from each other in the first flexible tube 12 define the extension direction of the extension part 52 of the second flexible tube 14. Among these, in particular, the spaced openings 24 a and 28 a of the first flexible tube 12 define the extending direction of the protruding portion 52 of the second flexible tube 14. As shown in FIG. 1B, an index 48 is attached to the male screw cylinder 42 of the locking portion 32. When the first flexible tube 12 is in the state shown in FIG. 2A, the index 48 is opened from the distal end side of the first flexible tube 12 along the central axis C and opened with respect to the central axis C. 24a and 28a are attached in the same direction. For this reason, even if the openings 24a, 28a and the overhanging portion 52 are disposed in the body cavity and cannot be visually recognized, when the operator looks at the index 48, the first flexible tube 12 twists the locking portion 32. Since it is easy to follow the tip member 20, the direction of the overhanging portion 52 can be estimated.

  On the other hand, when the second flexible tube 14 is moved relative to the locking portion 32 from the state shown in FIG. 2D in the direction of the arrow m0 in FIG. 2A, the force loaded on the tip member 20 is released, The state shown in FIG. 2A is restored. At this time, the overhanging portion 52 of the second flexible tube 14 is in a state along the longitudinal axis C of the first flexible tube 12 (a state parallel or substantially parallel to the longitudinal axis C). The state of the overhanging portion 52 at this time is a non-overhanging position.

  That is, when the portion of the second flexible tube 14 on the proximal end side with respect to the locking portion 32 is advanced and retracted (proximity and separation) with respect to the locking portion 32 along the central axis C, the extension portion 52 The overhang changes.

  The second flexible tube 14 shown in FIG. 2A further pulls a portion of the second flexible tube 14 closer to the proximal end than the locking portion 32 toward the proximal end from the non-extending position (straight state). At this time, it is necessary not to move the tip member 20 as much as possible. For this reason, while further pulling the base end side portion of the second flexible tube 14 relative to the locking portion 32 toward the proximal end, the locking portion 32 of the first flexible tube 12 is moved with respect to the distal end member 20. Approach along the central axis C. At this time, when the overhanging portion 52 is on the upper side in the drawing as shown in FIG. 2E, the distal end member 20 is pulled by the second flexible tube 14, and is more proximal than the overhanging portion 52. The second tube portion 26 of the first flexible tube 12 is deformed into an arcuate shape (which may be arched or substantially U-shaped) while moving upward as compared with the portion. At this time, the second tube portion 26 of the first flexible tube 12 forms a protruding portion 54 that is elastically deformed in a direction away from the overhanging portion 52 of the second flexible tube 14. The state of the protruding portion 54 at this time is defined as a protruding position. The non-projecting position is a state in which the projecting portion 54 of the first flexible tube 14 is shown in FIGS. 2A and 2D. When the projecting portion 54 is in the non-projecting position, the projecting portion 52 of the second flexible tube 14 can be disposed at the non-projecting position and can be disposed at the projecting position.

  When the projecting portion 54 is in the projecting position, tension is applied to the second flexible tube 14, so that an appropriate bending difficulty is exhibited, and the first inclined surface 24 b and the second guide of the first guide portion 24 are exhibited. The second inclined surface 28b of the portion 28 is pressed. For this reason, the 2nd pipe part 26, ie, the protrusion part 54, of the 1st flexible pipe 12 protrudes in the opposite direction with respect to the extension direction (refer FIG. 2D) of the extension part 52, as shown to FIG. 2E. That is, when the projecting portion 54 is in the projecting position, it is separated from the projecting portion 52 of the second flexible tube 14 and is elastically deformed into an arcuate shape (which may be an arch shape or a U shape) to It is possible to flatten at least a part of the pipe E by pressing outward. The protruding amount of the protruding portion 54 can also be adjusted as appropriate.

  As shown in FIG. 2A, here, the tip 15 a of the second flexible tube 14 is fixed to the tip member 20 of the tip 13 a of the first flexible tube 12. The second flexible tube 14 may be fixed at the position.

  Next, the effect | action of the insertion apparatus 10 which concerns on this embodiment is demonstrated using FIGS. 3-4K.

  Here, the esophagus E will be described as an example of the duct (passage). It is known that there is an esophagus E at the back of the heart. Here, the action of the insertion device 10 on the esophagus E in the case of ablation treatment of a thrombus (not shown) in the left atrium LA will be described. In this embodiment, it is assumed that the upper endoscope of the endoscope 60 is used together with the insertion device 10.

  As shown in FIGS. 3 to 4K, the insertion device 10 according to this embodiment includes a guide wire (insertion body) that can be inserted into the endoscope 60 and the channel 63 of the insertion portion 62 of the endoscope 60. 70 is used. As the endoscope 60 and the guide wire 70, known ones can be used as appropriate.

  As shown in FIG. 4A, the operator inserts the endoscope 60 orally or nasally while observing a range of an appropriate observation field F with an observation optical system (not shown) of the endoscope 60. The distal end constituting portion 62a of the portion 62 is made to reach the vicinity of the entrance of the stomach S through the esophagus E. At this time, a portion of the insertion portion 62 of the endoscope 60 that is close to the bending portion 62b of the bending portion 62b and the flexible tube 62c is inside the esophagus E.

  As shown in FIG. 4B, the operator causes the distal end of the guide wire 70 to protrude from the distal end constituting portion 62 a of the insertion portion 62 through the channel 63 from the forceps plug 68 (see FIG. 3) of the endoscope 60. The distal end of the guide wire 70 may be in the esophagus E or in the stomach S.

  As shown in FIG. 4C, the operator pulls out the insertion portion 62 of the endoscope 60 from the esophagus E while maintaining the position of the distal end of the guide wire 70 as much as possible.

  While maintaining the position of the distal end of the guide wire 70 as much as possible, the surgeon moves the distal end 15a of the second flexible tube 14 of the insertion device 10 of the guide wire 70 through the passage 14a as shown in FIG. 4D. Move from the proximal end toward the distal end of the guide wire 70. And the protrusion part 54 of the 1st flexible tube 12 and the overhang | projection part 52 of the 2nd flexible tube 14 are arrange | positioned in the position close to the left atrium LA in the esophagus E. In this state, the guide wire 70 is removed from the second flexible tube 14 while maintaining the distal member 20 of the insertion device 10 so as not to move as much as possible with respect to the esophagus E.

  As shown in FIG. 4E, the surgeon moves the second flexible tube 14 along the central axis C with respect to the locking portion 32 while maintaining the position of the first flexible tube 12 with respect to the esophagus E. Move in the direction of m1. The overhanging portion 52 of the second flexible tube 14 is overhanging. The inner diameter of the esophagus E may be, for example, about 20 mm to 25 mm. While observing X-rays, the amount of overhang of the overhanging portion 52 is determined by the state of the patient's esophagus E, the size of the inner diameter, age, and sex. It is possible to adjust according to the above. At this time, as shown in FIG. 4F, the insertion device 10 can flatten a part of the esophagus E by adjusting the overhang amount of the overhang portion 52 regardless of the size in the esophagus E.

  After appropriately flattening a part of the esophagus E, the surgeon operates the nut 44 of the locking portion 32 in the direction of the arrow r as shown in FIG. The second flexible tube 14 is held at the position of the locking portion 32. For this reason, as shown in FIG. 4E and FIG. 4F, the state in which the projecting portion 52 of the second flexible tube 14 projects from the second tube portion 26 of the first flexible tube 12 is maintained.

  At this time, the surgeon confirms the index 48 shown in FIG. 1B and recognizes the direction of the overhang portion 52. And since a part of material of the 1st flexible tube 12 and the 2nd flexible tube 14 is formed with the material of a radiopaque material, the position of the overhang | projection part 52, the protrusion part 54, and X-ray | X_line The direction can be recognized. That is, it can be confirmed by X-ray observation whether a part of the esophagus E is flat. Then, the surgeon rotates the first flexible tube 12 about the central axis C until the relationship between the esophagus E and the left atrium LA is in the state shown in FIG.

At this time, as shown in FIG. 4F, the esophagus E is flattened from the state shown by the broken line to the state shown by the solid line, and can be separated from the left atrium LA into the state of the gap d. That is, the esophagus E can avoid the proximity state with the left atrium by using the insertion device 10. In this state, ablation treatment is performed on the left atrium LA. In addition, by ablation treatment, it is possible to prevent noise from occurring in heart motion by burning a portion causing arrhythmia inside the heart with a high-frequency current or the like. At this time, since the left atrium LA and the esophagus E are separated from each other by a gap d, the influence of the treatment (the influence of heat) on the left atrium LA is prevented from reaching the esophagus E as much as possible.
In addition, ablation treatment may be performed on the left atrium LA in a state where a temperature sensor (not shown) is disposed in the esophagus E. In this case, it is possible to further suppress the influence of the ablation treatment on the esophagus E by proceeding with the ablation treatment while detecting the wall surface temperature of the esophagus E one by one with the temperature sensor.

  When the esophagus E is flattened and the esophagus E is separated from the left atrium LA in a gap d, the overhanging portion 52 may be in the state shown in FIG. 4G. In other words, the first flexible tube 12 of the insertion device 10 may be rotated around the central axis C in the direction of the arrow R to the state shown in FIG. 4G. Thus, when the first flexible tube 12 is rotated in the direction of the arrow R, the second flexible tube 14 is rotated together with the first flexible tube 12, and the esophagus E is similar to that shown in FIG. 4F. Is separated from the left atrium LA, for example, in a gap d.

  As shown in FIG. 4H, the guide wire 72 may be inserted into the second flexible tube 14 from the state shown in FIG. 4E. At this time, due to the stiffness of the guide wire 72, the overhanging portion 52 can be hardly deformed by an external force. That is, the difficulty of deformation of the overhanging portion 52 can be adjusted by the guide wire 72. Or you may adjust the overhang | projection amount of the overhang | projection part 52 for every guide wire 70 from the state shown to FIG. 4D. The guide wire 70 shown in FIGS. 4B to 4D and the guide wire 72 shown in FIG. 4H may be different in stiffness, or the same.

  As shown in FIGS. 4I and 4J, in the first flexible tube 12, when the overhanging portion 52 is set to the non-overhanging position and the protruding portion 54 on the opposite side of the overhanging portion 52 is protruded, the esophagus While maintaining the position of the tip member 20 with respect to E, the second flexible tube 14 is moved in the direction of the arrow m0. At this time, the locking portion 32 of the first flexible tube 12 is brought close to the tip member 20 while moving the second flexible tube 14 in the direction of the arrow m0. For this reason, tension is applied to the second flexible tube 14, and the second tube portion 26 of the first flexible tube 12 protrudes on the opposite side to the protruding direction of the protruding portion 52. At this time, the amount of protrusion of the protrusion 54 can be adjusted in the same manner as the amount of protrusion of the protrusion 52 is adjusted. For this reason, the insertion device 10 flattens a part of the esophagus E by adjusting the protrusion amount of the protrusion 54 regardless of the size in the esophagus E.

  4E, while maintaining the position of the first flexible tube 12 with respect to the esophagus E, the second flexible tube 14 is moved along the center axis C along the center axis C with the arrow m1. Move in the direction. For this reason, the tension | tensile_strength to the 2nd flexible tube 14 is released, and the 2nd tube part 26, ie, the protrusion part 54, of the 1st flexible tube 12 is returned to a non-projection position again.

  As shown in FIG. 4K, when the stenosis N exists in the esophagus E, the insertion device 10 is arranged inside the stenosis N using the endoscope 60 and the guide wire 70 (see FIGS. 4A to 4C). be able to. And the overhang | projection part 52 is protruded as shown to FIG. 4E, or the protrusion part 54 is protruded as shown to FIG. 4I. For this reason, the stenosis state of the stricture part N of the esophagus E can be relieved by using the insertion apparatus 10.

  As described above, according to the insertion device 10 according to this embodiment, the following can be said.

  For example, with the guide wire 70 or the like as a guide, the overhanging portion 52 and the protruding portion 54 can be inserted at appropriate positions in the duct such as the esophagus E. And the overhang | projection part 52 can be overhang | projected and / or the protrusion part 54 can be protruded, and a pipe line can be deform | transformed suitably. At this time, the insertion device 10 adjusts the protruding amount of the protruding portion 52 and / or the protruding amount of the protruding portion 54, thereby eliminating the need for selecting a size as much as possible and ensuring a part of the pipeline. Can be flattened.

  The protruding direction of the protruding portion 52 and the protruding direction of the protruding portion 54 have directions. For this reason, it is possible to appropriately control how the pipe line is deformed. Accordingly, the duct (esophagus E) is flattened by appropriately adjusting the projecting direction and the projecting amount of the projecting part 52 and / or the projecting direction and the projecting amount of the projecting part 54, and the left atrium LA. You can keep away. Since the esophagus E can be separated from the left atrium LA by the insertion device 10, even if a treatment such as ablation is performed on the left atrium LA, the influence of the treatment of the left atrium LA on the esophagus E is prevented. can do.

  In addition, before performing treatment such as ablation on the left atrium LA, the state of the insertion device 10 partially formed of a radiopaque material can be confirmed by, for example, X-rays. For this reason, the surgeon can observe the relationship between the esophagus E and the left atrium LA in a state where the overhanging portion 52 is overhanging or in a state where the protruding portion 54 is protruding. If necessary, when the first flexible tube 12 is rotated about the central axis C, the projecting portion 52 and the protruding portion 54 are also rotated as they are. For this reason, the direction of the overhang | projection part 52 and the protrusion part 54 can be adjusted with operation of the latching | locking part 32 vicinity of the 1st flexible tube 12. FIG. Therefore, by appropriately rotating the first flexible tube 12 around the axis of the central axis C, the distance between the esophagus E and the left atrium LA can be appropriately ensured.

  In this embodiment, an indicator 48 is attached to the first flexible tube 12. Since the index 48 is outside the patient's body, the operator can estimate the protruding direction of the protruding portion 52 and / or the protruding direction of the protruding portion 54 without using X-rays.

  The insertion device 10 according to this embodiment appropriately adjusts the protruding direction and the protruding amount of the protruding portion 52 and / or the protruding direction and the protruding amount of the protruding portion 54 by operating the locking portion 32. Can be maintained. For this reason, even if the operator removes his / her hand from the second flexible tube 14, the protruding direction and the protruding amount of the protruding portion 52 and / or the protruding direction and protruding amount of the protruding portion 54 can be maintained. it can.

  The insertion device 10 according to this embodiment includes an overhanging portion 52 and a protruding portion 54 at a position 180 ° symmetrical with respect to the central axis C. Since the protruding portion 52 and the protruding portion 54 function in the same manner, the maximum amount of rotation for rotating the insertion device 10 can be set to an angle smaller than 180 °. Therefore, the amount of the surgeon twisting the first flexible tube 12 can be reduced, and the burden on the patient can be reduced.

  In addition, although this embodiment demonstrated the example which arrange | positions the parameter | index 48 in the latching | locking part 32, it is also suitable that it forms in the 3rd pipe part 30, for example. That is, the indicator 48 that allows the operator to recognize the overhanging direction of the overhanging portion 52 is formed at a position on the proximal end side of the overhanging portion 52 and at a position outside the body in the first flexible tube 12. It only has to be done. Of course, it is preferable that the index 48 is not only visually recognized but also allows the operator to recognize the orientation by touching the index 48. Alternatively, the index 48 may be a position where it is inserted into the body, or an indicator that allows the operator to check the light through the skin of the patient by light emission or the like.

  For example, the mucosal tissue D of the large intestine I shown in FIGS. 5A and 5B may be treated using the lower endoscope 60 and the treatment tool 74 shown in FIG. 5B, for example. In this case, as shown in FIG. 5A, if the large intestine I is substantially circular and the mucosal tissue D is curved, the operation of moving the distal end of the treatment instrument 74 becomes a circular shape, which requires skill. When the large intestine I is flattened in the state shown in FIG. 5C and the mucosal tissue D becomes flat, the movement of the distal end of the treatment tool 74 becomes flat, and the treatment with the treatment tool 74 is easier than in the state shown in FIG. 5A. That can be easily imagined. Therefore, an appropriate treatment can be performed using the treatment tool 74 passed through the channel 63 while observing the mucosal tissue D using the insertion portion 62 of the endoscope (lower endoscope) 60. For example, when the mucosa tissue D is excised with the electric knife as the treatment tool 74, the treatment is easily performed.

  As shown schematically in FIG. 6A, there may be gallstones G in the bile duct B. In this case, the insertion device 10 is placed in the duodenum ID, and the protruding amount of the protruding portion 52 is adjusted as shown in FIG. 6B. In this state, the entire insertion device 10 is moved in the direction of the arrow M, and pressure is applied to the bile duct B. Then, the gallstone G in the bile duct B is discharged from the nipple DP of the duodenum ID.

  As described above, the insertion device 10 according to this embodiment can be used not only for the esophagus E but also for various ducts such as the large intestine I and the duodenum ID. The insertion device 10 can be used not only with an upper endoscope but also with a lower endoscope. Although not shown, generally, a side-viewing endoscope is inserted into the duodenum ID. For this reason, the insertion apparatus 10 can be used with a side-view type endoscope.

(First modification)
A first modification will be described with reference to FIGS. 7A to 8E. In this modification, an example in which a balloon unit (holding unit) 80 is used together with the insertion device 10 described in the first embodiment will be described.

  As shown in FIGS. 7A and 7B, the balloon unit 80 preferably includes a cylindrical tubular body (balloon fixing ring) 82, a balloon 84 fixed to the outer periphery of the tubular body 82, and a flexible tube (insertion). Body) 86 and a connecting portion 88 for connecting the balloon 84 and the tube 86 to each other. The cylindrical body 82 can be fitted to the distal end member 20 of the insertion device 10. The connecting portion 88 is formed, for example, integrally with the cylindrical body 82 and is connected to the distal end of the tube 86 on the central axis of the cylindrical body 82. The balloon 84 is preferably formed in a substantially donut shape, but other shapes are also acceptable, such as a flattened shape. As shown in FIG. 7C, the tube 86 can be inserted through the passage 14 a of the second flexible tube 14.

  The tube 86 is preferably formed long with respect to the second flexible tube 14.

  The second tube portion 26 of the first flexible tube 12 is formed to be softer than the first tube portion 22 and the third tube portion 30 and is easily bent. Therefore, when an external force (compression force) is applied along the central axis C of the first flexible tube 12, the second tube portion 26 can be bent as shown in FIG. 8E. Here, the 2nd pipe part 26 is more than the 1st pipe part 22 and the 3rd pipe part 30 only in a specific direction (as shown to FIG. 8E, a direction opposite to the overhang direction of the overhang part 52). It is easy to bend.

  Next, the operation of this modification will be described with reference to FIGS. 8A to 8E.

  As illustrated in FIG. 8B, the balloon unit 80 illustrated in FIG. 8A is disposed at the distal end of the distal end configuration portion 62 a of the insertion portion 62 of the endoscope 60. At this time, the balloon unit 80 projects the proximal end of the tube 86 with respect to the forceps plug 68 through the channel 63. And the front-end | tip structure part 62a of the insertion part 62 of the endoscope 60 is inserted in the esophagus E as demonstrated in 1st Embodiment.

  As shown in FIG. 8C, the balloon 84 is inflated in the esophagus E, for example. At this time, the balloon 84 is fixed by friction between the balloon 84 and the inner peripheral surface of the esophagus E. In this state, the insertion portion 62 of the endoscope 60 is removed. The proximal end of the tube 86 is inserted into the distal end opening 20 a of the insertion device 10.

  The balloon 84 may be inflated after the proximal end of the tube 86 is inserted through the distal end opening 20a of the insertion device 10.

  Then, the distal end member 20 of the insertion device 10 is fitted to the cylindrical body 82. At this time, since the balloon 84 is inflated, the position of the first flexible tube 12 with respect to the esophagus E is maintained. The distal end member 20 of the insertion device 10 can rotate about the central axis C with respect to the cylindrical body 82.

  As shown in FIG. 8D, in this state, the second flexible tube 14 is moved in the direction of the arrow m1 to change the amount of overhang of the overhang portion 52. At this time, since the state where the balloon 84 is inflated is maintained, the displacement of the overhanging portion 52 with respect to the left atrium LA can be suppressed. In this state, the locking portion 32 is appropriately operated to adjust the protruding amount of the protruding portion 52 as appropriate. Although not shown, the first flexible tube 12 is appropriately rotated around the central axis C to separate the esophagus E from the left atrium LA (see FIG. 4F).

  Note that the tube 86 preferably has an appropriate stiffness. In this case, as shown in FIG. 4H, the overhanging portion 52 can be hardly deformed by an external force due to the elasticity of the tube 86.

  As shown in FIG. 8E, when the first flexible tube 12 is moved in the direction of the arrow m2 with the second flexible tube 14 held by the locking portion 32, the balloon 84 moves relative to the esophagus E. Since it is not moved, the tip member 20 is also not moved. For this reason, the latching | locking part 32 approaches the front-end | tip member 20, and the protrusion part 54 protrudes in the direction opposite to the overhang | projection part 52. FIG. At this time, the overhanging portion 52 also has a large amount of overhanging on the side opposite to the protruding direction of the protruding portion 54.

  As described above, the insertion device 10 described in the first embodiment can be used together with the balloon unit 80. The balloon unit 80 according to this modification is supported by the second flexible tube 14 and presses the inner wall of the pipeline E toward the outside to hold the first flexible tube against the pipeline E. Can do. In this case, since the position of the first flexible tube 12 can be appropriately maintained by the balloon unit 80, the operability of the insertion device 10 can be improved.

(Second modification)
A second modification will be described with reference to FIGS. 9A to 10C. This modification is a further modification of the first modification.

  9A and 9B, the balloon unit 80 includes a cylindrical body 82, a balloon 84 fixed to the outer periphery of the cylindrical body 82, a flexible tube 86, and the balloon 84 and the tube 86. And a connecting portion 88 for connecting the two. In this modified example, the cylindrical body 82 is not cylindrical, and a part of the wall is thick, and a connecting portion 88 is provided at the thick part. The connecting portion 88 is integrally formed with the cylindrical body 82, for example. The connecting portion 88 is connected to the distal end of the tube 86 at a position deviating from the central axis of the cylindrical body 82.

  Further, a tube guide 25 for guiding the tube 86 is formed at a position away from the guide opening 24 a of the first guide portion 24 of the first flexible tube 12. When the proximal end of the tube 86 is inserted into the tube guide 25, the cylindrical body 82 of the balloon unit 80 with respect to the distal end member 20 of the insertion device 10 as shown in FIG. 9C as described in the first modification. Can be fitted.

  In the first modification, the tube 86 is inserted through the passage 14 a of the second flexible tube 14. For this reason, it is difficult to use the passage 14a of the second flexible tube 14 for a treatment instrument (not shown). In this modification, the tube 86 is not disposed in the passage 14 a of the second flexible tube 14. For this reason, the channel | path 14a of the 2nd flexible tube 14 can be used for a treatment tool (not shown).

  Next, the operation of this modification will be described with reference to FIGS. 10A to 10C.

  As shown in FIG. 10B, the balloon unit 80 shown in FIG. 10A is disposed at the distal end of the distal end constituting portion 62a of the insertion portion 62 of the endoscope 60. At this time, the balloon unit 80 arranges the tube 86 along the outside of the insertion portion 62. And the front-end | tip structure part 62a of the insertion part 62 of the endoscope 60 is inserted in the esophagus E as demonstrated in 1st Embodiment.

  The insertion of the endoscope 60 while maintaining the position of the tubular body 82 with respect to the esophagus E by releasing the fitting of the distal end constituting portion 62a of the insertion section 62 of the endoscope 60 with respect to the tubular body 82 of the balloon unit 80. The part 62 is removed.

  As shown in FIG. 10C, the proximal end of the tube 86 is inserted through the tube guide 25 of the insertion device 10. Then, after the proximal end of the tube 86 is inserted into the distal end opening 20a of the insertion device 10, the balloon 84 is inflated. For this reason, the position of the balloon 84 with respect to the esophagus E is fixed. Although not shown, the distal end member 20 of the insertion device 10 is fitted to the cylindrical body 82. At this time, since the balloon 84 is inflated, the position of the first flexible tube 12 with respect to the esophagus E is maintained.

  Thereafter, as shown in FIGS. 8D and 8E, the insertion device 10 can be appropriately operated.

  As described above, the insertion device 10 with the tube guide 25 attached to the insertion device 10 described in the first embodiment can be used together with the balloon unit 80. The balloon unit 80 according to this modification is supported with respect to the first flexible tube 12 and presses the inner wall of the conduit E toward the outside to hold the first flexible tube 12 with respect to the conduit E. be able to. In this case, since the position of the first flexible tube 12 can be appropriately maintained by the balloon unit 80, the operability of the insertion device 10 can be improved.

(Third Modification)
A third modification will be described with reference to FIGS. 11A and 11B. Here, the balloon unit 80 described in the second modification (see FIGS. 9A and 9B) is used. For this reason, this modification is a further modification of the second modification.

  As shown in FIG. 11A, the first guide portion 24 of the first flexible tube 12 has a third guide opening 24c. The second guide portion 28 of the first flexible tube 12 has a fourth guide opening 28c. The second pipe portion 26 forms a passage 26a continuous with the third guide opening 24c and the fourth guide opening 28c. The third guide opening 24c of the first guide portion 24 is preferably formed at a position symmetrical to the center axis C with respect to the first guide opening 24a. Similarly, the fourth guide opening 28c of the second guide portion 28 is preferably formed at a position symmetrical to the center axis C with respect to the second guide opening 28a.

  The first guide portion 24 has a third inclined surface (guide surface) 24d. The third inclined surface 24d is formed on the back surface of the first inclined surface 24b. The third inclined surface 24d intersects the central axis C, and guides the tube 86 of the balloon unit 80 from the distal end side toward the inside of the first guide portion 24 (inside of the second tube portion 26) through the third guide opening 24c. . At this time, in the third inclined surface 24d, the angle γ in the direction from the base end side toward the tip end side along the central axis C is larger than 90 ° and smaller than 180 °. For this reason, the 3rd inclined surface 24d tends to guide the tube 86 to the 2nd pipe part 26 from the outer side.

  The second guide portion 28 has a fourth inclined surface (guide surface) 28d. The fourth inclined surface 28d is formed on the back surface of the second inclined surface 28b. The fourth inclined surface 28d intersects the central axis C and guides the tube 86 of the balloon unit 80 from the distal end side toward the outside of the second guide portion 28 (outside of the second tube portion 26) through the fourth guide opening 28c. . At this time, in the fourth inclined surface 28d, the angle δ in the direction from the distal end side to the proximal end side along the central axis C is larger than 90 ° and smaller than 180 °. For this reason, the 4th inclined surface 28d tends to guide the tube 86 from the inner side of the 2nd pipe part 26 to the outer side.

  For this reason, the passage 26 a of the second pipe portion 26 is formed as a tube guide for guiding the tube 86 of the balloon unit 80.

  And the balloon unit 80 of this modification can be used similarly to the balloon unit 80 of a 2nd modification.

  In this modification, the insertion device 10 arranges the tube 86 of the balloon unit 80 inside the second pipe portion 26 of the insertion device. For this reason, when the insertion device 10 is used together with the balloon unit 80, the diameter of the insertion device 10 can be reduced by the amount of the tube 86 compared to the second modification.

  When the balloon unit 80 is not used, the guide wire 70 described in the first embodiment may be inserted through the passage 26a of the second pipe portion 26 instead of the passage 14a of the second flexible tube 14. In this case, an appropriate treatment can be performed by inserting a treatment tool (not shown) through the passage 14 a of the second flexible tube 14.

(Fourth modification)
A fourth modification will be described with reference to FIGS. 12A to 12D. This modification is a further modification of the first embodiment and the first to third modifications.

  As shown in FIG. 12A, a balloon (exclusion portion) 16 is fixed between the proximal end portion of the first tube portion 22 of the first flexible tube 12 and the distal end portion of the third tube portion 30. The balloon 16 covers not only the outside of the second tube portion 26 of the first flexible tube 12 but also the overhanging portion 52 and the protruding portion 54 of the second flexible tube 14. The balloon 16 is disposed on the outer periphery of a portion including a part of the first flexible tube 12 and the overhanging portion 52 of the second flexible tube 14, and expands and contracts in accordance with the overhanging of the overhanging portion 52. It expands and contracts according to the protrusion of 54. The balloon 16 follows and deforms even when the protruding amount of the protruding portion 52 is maximized and the protruding amount of the protruding portion 54 is maximized. An appropriate space 16a can be formed inside the balloon 16. The space 16a in the balloon 16 can be filled with a cooling fluid. The cylindrical body 42 of the locking portion 32 has an inlet 42 a for taking in and out the fluid filled in the space 16 a in the balloon 16.

  As shown in FIGS. 12B and 12C, when the overhanging portion 52 is disposed at the overhanging position, the balloon 16 also follows and inflates, and the esophagus E is flattened. The balloon 16 is also used to prevent the wall of the esophagus E from being caught. By using the balloon 16, the wall of the esophagus E can be prevented from being caught between the openings 24 a and 28 a of the first flexible tube 12 and the second flexible tube 14.

  When liquid (cooling liquid) is injected from the injection port 42a, the balloon 16 is filled with the liquid 16b. The liquid 16b is, for example, physiological saline, and is preferably lower than the normal temperature of the esophagus E. For this reason, the part which touched the balloon 16 among the esophagus E is cooled. That is, the cooling water 16b is supplied into the balloon 16 to cool the living tissue in contact with the balloon 16.

  Even if the left atrium LA during ablation treatment approaches the esophagus E from the state shown in FIG. 12C, the temperature of the esophagus E can be lowered by the liquid 16b. For this reason, it is possible to further suppress the influence on the esophagus E due to the treatment for the left atrium LA.

  As shown in FIG. 12D, the balloon 16 may have a hole 16c. In this case, the balloon 16 is inflated by adjusting the amount of the overhanging portion 52 of the insertion device 10, and the cooling water (physiological saline) 16 b injected into the balloon 16 is leaked from the hole 16 c to the balloon 16. The contacted living tissue can be cooled. As described above, in the state shown in FIG. 12D, the ducts such as the esophagus E can be cooled more efficiently than the state shown in FIG. 12B.

  What flows out of the holes 16c is not limited to physiological saline, and may be an appropriate chemical solution or the like. A chemical solution or the like can also be used as a refrigerant. Further, the balloon 16 is not limited to liquid but may be gas. That is, the balloon 16 is filled with an appropriate fluid.

(Second Embodiment)
Next, a second embodiment will be described with reference to FIGS. 13A to 13D. This embodiment is a modification of the first embodiment including each modification. The same members or members having the same functions as those described in the first embodiment are denoted by the same reference numerals as much as possible. Description is omitted. The insertion device 110 according to this embodiment is also preferably used with the balloon unit 80 and / or the balloon 16 as necessary.

  As shown in FIGS. 13A to 13D, the insertion device 110 according to this embodiment includes a first flexible tube 12 and a second flexible tube 14. The first flexible tube 12 includes a tip member 20, a first tube portion (tip-side tube portion) 22, a second tube portion (working tube) 126 having a side opening (notch portion) 126a, and a third tube. A portion (base end side tube portion) 30 and a locking portion 32 are included. The first flexible tube 12 of the insertion device 110 according to this embodiment differs from the insertion device 10 described in the first embodiment in that the first guide portion 24 and the second guide portion 28 are removed. Between the 1st pipe part 22 and the 2nd pipe part 126, and between the 2nd pipe part 126 and the 3rd pipe part 30 may be connected, and may be integral. For this reason, the base end of the 1st pipe part 22 and the front-end | tip of the 2nd pipe part 126 are connected, and the base end of the 2nd pipe part 126 and the front-end | tip of the 3rd pipe part 30 are connected.

  And the 2nd pipe part 126 has the continuous side surface opening 126a which can withdraw / insert the overhang | projection part 52 of the 2nd flexible pipe 14 instead of the obstruction | occlusion pipe | tube. As shown in FIG. 13B, the side opening 126a is formed straight and parallel to the central axis C.

  The tip of the first flexible tube 12 and the tip of the second flexible tube 14 are fixed to a common tip member 20. For this reason, if the 2nd flexible tube 14 is moved to the direction of arrow m1 with respect to the latching | locking part 32 of the state shown to FIG. 13A, as shown to FIG. 13C, the force loaded on the front-end | tip member 20 will be released. Therefore, the second flexible tube 14 protrudes outward with respect to the side opening 126a of the first flexible tube 12. At this time, the second flexible tube 14 is arcuate (may be arched or U-shaped) in a direction separated from the first flexible tube 12 and intersecting the longitudinal axis C of the first flexible tube 12. The overhanging portion 52 that is elastically deformed is formed. The state of the overhang portion 52 at this time is defined as an overhang position. The overhanging portion 52 changes the amount of overhanging according to the amount of movement along the central axis C of the second flexible tube 14. The non-overhanging position is the state in which the overhanging portion 52 of the second flexible tube 14 is in the state shown in FIGS. 13A and 13B. In other cases, the overhanging position is the overhanging position regardless of the overhanging amount of the overhanging portion 52. is there. The non-overhanging position is not limited to the case where the overhanging portion 52 is closest to the projecting portion 54 of the first flexible tube 12 and is housed in the second tube portion 126. The state where the length of is the shortest.

  The spaced apart side opening 126a of the first flexible tube 12 defines the protruding direction of the protruding portion 52 of the second flexible tube 14. Since the first flexible tube 12 can easily follow the tip member 20 due to the twist of the locking portion 32, when the operator looks at the index 48 (see FIG. 1B) described in the first embodiment, The direction can be inferred.

  When the second flexible tube 14 is moved in the direction of the arrow m0 in FIG. 13A from the state shown in FIG. 13C with respect to the locking portion 32, the force applied to the tip member 20 is released, and FIG. The state shown in FIG. At this time, the overhanging portion 52 of the second flexible tube 14 is in a state along the longitudinal axis C of the first flexible tube 12 (a state parallel or substantially parallel to the longitudinal axis C). The state of the overhanging portion 52 at this time is a non-overhanging position.

  That is, when the portion of the second flexible tube 14 on the proximal end side with respect to the locking portion 32 is advanced and retracted (proximity and separation) with respect to the locking portion 32 along the central axis C, the extension portion 52 The overhang changes.

  From the non-extending position (straight state), the second flexible tube 14 shown in FIG. 13A further pulls the portion of the second flexible tube 14 closer to the proximal end than the locking portion 32 toward the proximal end. While the second flexible tube 14 is further pulled toward the base end side with respect to the base end side of the locking portion 32, the locking portion 32 of the first flexible tube 12 is centered on the distal end member 20 with the central axis C. Approach along. At this time, when the overhanging portion 52 is on the upper side in the drawing as shown in FIG. 13D, the distal end member 20 is pulled by the second flexible tube 14, and is more proximal than the overhanging portion 52. The second tube portion 126 of the first flexible tube 12 is deformed into an arcuate shape (which may be arched or substantially U-shaped) while moving upward as compared with the portion. At this time, the second tube portion 126 of the first flexible tube 12 forms a protruding portion 54 that elastically deforms in a direction away from the overhanging portion 52 of the second flexible tube 14. The state of the protruding portion 54 at this time is defined as a protruding position. The non-projecting position is a state where the projecting portion 54 of the first flexible tube 14 is shown in FIG. 13A.

  When the projecting portion 54 is in the projecting position, the second flexible tube 14 is under tension, and thus exhibits an appropriate bending difficulty. For this reason, the 2nd pipe part 126, ie, the protrusion part 54, of the 1st flexible tube 12 protrudes in the opposite direction with respect to the extension direction (refer FIG. 13C) of the extension part 52, as shown to FIG. 13D.

  Since the operation of the insertion device 110 according to this embodiment is the same as that described in the first embodiment, a description thereof will be omitted. For example, with the guide wire 70 and the tube 86 of the balloon unit 80 as a guide, the overhanging portion 52 and the protruding portion 54 can be inserted at appropriate positions in the duct such as the esophagus E. And the overhang | projection part 52 is overhang | projected and / or the protrusion part 54 is protruded, and a pipe line can be deform | transformed suitably. At this time, the insertion device 110 makes the selection of the size as small as possible by adjusting the protruding amount of the protruding portion 52 and / or the protruding amount of the protruding portion 54, and flattens a part of the pipeline. be able to.

  In the first and second embodiments, as shown in FIGS. 2A and 13A, the tip 15a of the second flexible tube 14 is fixed to the tip member 20 of the tip 13a of the first flexible tube 12. The second flexible tube 14 may be fixed to the first tube portion 22.

(Third embodiment)
Next, a third embodiment will be described with reference to FIGS. 14A to 14D. This embodiment is a modification of the first and second embodiments, and the same members or members having the same functions as those described in the first and second embodiments are given the same reference numerals as much as possible. Detailed description is omitted. The insertion device 210 according to this embodiment is also preferably used with the balloon unit 80 and / or the balloon 16 as necessary.

  As shown in FIGS. 14A to 14D, the insertion device 210 according to this embodiment includes a first flexible tube 12 and a second flexible tube 14. The first flexible tube 12 includes a distal end member 220, a working tube portion 226, a proximal end side guide portion (second guide portion) 28, a proximal end side tube portion 30, and a locking portion 32. The first flexible tube 12 of the insertion device 210 according to this embodiment is different from the insertion device 10 described in the first embodiment in that the first tube portion 22 and the first guide portion 24 are removed. That is, the first pipe part (tip-side pipe part) 22 described in the first and second embodiments is not necessarily required. Further, unlike the tip member 20 described in the first and second embodiments, the tip member 220 has the tip portion of the first flexible tube 12 and the tip portion of the second flexible tube 14 arranged side by side. .

  The tip of the first flexible tube 12 and the tip of the second flexible tube 14 are fixed to a common tip member 220. For this reason, if the 2nd flexible tube 14 is moved to the direction of the arrow m1 with respect to the latching | locking part 32 of the state shown to FIG. 14A, as shown to FIG. 14C, the force loaded on the front-end | tip member 20 will be released. Therefore, the second flexible tube 14 protrudes outward with respect to the proximal end side guide portion 28 of the first flexible tube 12. At this time, the second flexible tube 14 is arcuate (may be arched or U-shaped) in a direction separated from the first flexible tube 12 and intersecting the longitudinal axis C of the first flexible tube 12. The overhanging portion 52 that is elastically deformed is formed. The state of the overhang portion 52 at this time is defined as an overhang position. The overhanging portion 52 changes the amount of overhanging according to the amount of movement along the central axis C of the second flexible tube 14. The non-extended position is the state in which the extended portion 52 of the second flexible tube 14 is in the state shown in FIG. 14A, and is the extended position regardless of the amount of extension of the extended portion 52 in other cases. The non-extending position is not limited to the case where the overhanging portion 52 is closest to the protruding portion 54 of the first flexible tube 12, and the length of the overhanging portion 52 (the length of the second flexible tube 14). The distance between the tip and the guide opening 28a) is the shortest. The opening 28a is used to insert and remove the second flexible tube 14.

  The distal end member (fixed portion) 220 of the distal end 15 a of the second flexible tube 14 and the opening 28 a of the first flexible tube 12 define the projecting direction of the projecting portion 52 of the second flexible tube 14. Since the first flexible tube 12 easily follows the tip member 220 due to the twist of the locking portion 32, when the operator looks at the index 48 (see FIG. 1B) described in the first embodiment, The direction can be inferred.

  On the other hand, when the second flexible tube 14 is moved in the direction of the arrow m0 in FIG. 14A from the state shown in FIG. 14C with respect to the locking portion 32, the force applied to the tip member 220 is released, The state shown in FIG. 14A is restored. At this time, the overhanging portion 52 of the second flexible tube 14 is in a state along the longitudinal axis C of the first flexible tube 12 (a state parallel or substantially parallel to the longitudinal axis C). The state of the overhanging portion 52 at this time is a non-overhanging position.

  That is, when the portion of the second flexible tube 14 on the proximal end side with respect to the locking portion 32 is advanced and retracted (proximity and separation) with respect to the locking portion 32 along the central axis C, the extension portion 52 The overhang changes.

  The second flexible tube 14 shown in FIG. 14A further pulls a portion of the second flexible tube 14 closer to the proximal end than the locking portion 32 toward the proximal end from the non-extending position (straight state). While the second flexible tube 14 is further pulled toward the base end side with respect to the base end side of the locking portion 32, the locking portion 32 of the first flexible tube 12 is center axis C with respect to the distal end member 220. Approach along. At this time, assuming that the overhanging portion 52 is on the upper side in the drawing as shown in FIG. 14D, the distal end member 220 is pulled by the second flexible tube 14, and is closer to the proximal end than the overhanging portion 52. The working tube portion 226 of the first flexible tube 12 is deformed into an arcuate shape (may be an arch shape or a substantially U shape) while moving upward as compared with the portion. At this time, the working tube portion 226 of the first flexible tube 12 forms a protruding portion 54 that is elastically deformed in a direction away from the overhanging portion 52 of the second flexible tube 14. The state of the protruding portion 54 at this time is defined as a protruding position. The non-projecting position is a state where the projecting portion 54 of the first flexible tube 14 is shown in FIG. 14A.

  When the projecting portion 54 is in the projecting position, the second flexible tube 14 is under tension, and thus exhibits an appropriate bending difficulty. Therefore, the working tube portion 226 of the first flexible tube 12, that is, the protruding portion 54 protrudes in the opposite direction to the protruding direction of the protruding portion 52 (see FIG. 14C), as shown in FIG. 14D.

  Since the operation of the insertion device 210 according to this embodiment is the same as that described in the first embodiment, a description thereof will be omitted. For example, with the guide wire 70 and the tube 86 of the balloon unit 80 as a guide, the overhanging portion 52 and the protruding portion 54 can be inserted at appropriate positions in the duct such as the esophagus E. And the overhang | projection part 52 can be overhang | projected and / or the protrusion part 54 can be protruded, and a pipe line can be deform | transformed suitably. At this time, the insertion device 210 adjusts the protruding amount of the protruding portion 52 and / or the protruding amount of the protruding portion 54, thereby making the selection of the size unnecessary and flattening a part of the pipeline. be able to.

(Modification 1 of the locking portion 32)
As shown in FIG. 15, the locking portion 32 includes a cylindrical body 342 and an opening / closing clip (pinch body) 344. The cylindrical body 342 is fixed to the proximal end of the third pipe portion 30. The cylindrical body 342 has a substantially C-shaped opening edge portion 342a between which the opening / closing clip 344 is disposed between the distal end and the proximal end.

  As indicated by a broken line in FIG. 15, the second flexible tube 14 is movable along the central axis C with respect to the first flexible tube 12 when the opening / closing clip 344 is in the open state. On the other hand, as shown by a solid line in FIG. 15, when the opening / closing clip 344 is in the closed state, the opening / closing clip 344 is fixed to the second flexible tube 14. The opening / closing clip 344 is restricted from moving in the direction and the circumferential direction along the central axis C of the first flexible tube 12 by the opening edge 342a of the cylindrical body 342.

  Accordingly, the locking portion 32 allows the second flexible tube 14 to move with respect to the first flexible tube 12 when the clip 344 is in the open state, and allows the second flexible tube 12 to move with respect to the first flexible tube 12 when the clip 344 is in the closed state. The movement of the second flexible tube 14 can be restricted.

(Modification 2 of the locking portion 32)
As shown in FIG. 16, the locking portion 32 includes a first cylindrical body 442, a second cylindrical body 444, and an opening / closing clip 446. The first tubular body 442 is fixed to the proximal end of the proximal end side tube portion (third tube portion) 30. The second cylindrical body 444 is fixed to the base end portion of the first cylindrical body 442. The first cylindrical body 442 is preferably formed of a hard material that maintains its shape even when an appropriate force is applied. The second cylindrical body 444 is preferably softer than the first cylindrical body 442 and can be expanded and contracted in the radial direction of the central axis C. The opening / closing clip 446 functions in the same manner as the opening / closing clip 344 described in Modification 1 of the locking portion 32.

  As indicated by a broken line in FIG. 16, the second flexible tube 14 can move along the central axis C with respect to the first flexible tube 12 when the opening / closing clip 446 is in the open state. On the other hand, as shown by a solid line in FIG. 16, when the opening / closing clip 446 is in the closed state, the opening / closing clip 446 fixes the second cylindrical body 444 to the second flexible tube 14. For this reason, the movement of the opening / closing clip 446 in the direction and the circumferential direction along the central axis C of the first flexible tube 12 is restricted by the second cylindrical body 444.

  Therefore, the locking portion 32 allows the second flexible tube 14 to move with respect to the first flexible tube 12 when the clip 446 is in the open state, and allows the second flexible tube 12 to move with respect to the first flexible tube 12 when the clip 446 is in the closed state. The movement of the second flexible tube 14 can be restricted.

(Modification 3 of the locking portion 32)
As shown in FIGS. 17A to 17C, the locking portion 32 includes a connecting portion 542 and a soft cylindrical body 544. The connecting portion 542 includes a rigid tubular body 542a fixed to the proximal end portion of the proximal end side tube portion (third tube portion) 30, an extension portion 542b formed integrally with the rigid tubular body 542a, And an engaging arm 542c formed integrally with the extending portion 542b.

  The hard cylindrical body 542a is preferably formed of a hard material that maintains its shape even when an appropriate force is applied. The soft tubular body 544 is softer than the hard tubular body 542a, and can be elastically deformed between the state shown in FIG. 17A and the state shown in FIG. 17C.

  In the state shown in FIG. 17A, the second flexible tube 14 is movable along the central axis C with respect to the first flexible tube 12. On the other hand, as shown in FIG. 17C, the second flexible tube 14 is bent into a substantially U shape together with the soft cylindrical body 544 at the base end side relative to the hard cylindrical body 542a, and the soft cylinder together with the second flexible tube 14 The state body 544 is engaged with the engagement arm 542c. At this time, along the central axis C of the second flexible tube 14 with respect to the first flexible tube 12 due to friction between the soft cylindrical body 544 and the second flexible tube 14 at a position indicated by reference numeral 546. And circumferential movement are restricted.

  When the soft tubular body 544 is not engaged with the engagement arm 542c, the elasticity of the second flexible tube 14 (and the soft tubular body 544) causes the first flexible tube 12 to move. It is difficult to restrict movement in the direction and the circumferential direction along the central axis C of the second flexible tube 14.

  Accordingly, the locking portion 32 allows the movement of the second flexible tube 14 relative to the first flexible tube 12 when the soft cylindrical body 544 is not engaged with the engagement arm 542c, and the soft cylindrical shape When the body 544 is engaged with the engagement arm 542c, the movement of the second flexible tube 14 relative to the first flexible tube 12 can be restricted.

  In this manner, the locking portion 32 of the insertion device 10 is allowed to have an appropriate configuration.

  Although several embodiments have been specifically described so far with reference to the drawings, the present invention is not limited to the above-described embodiments, and all the embodiments performed without departing from the scope of the present invention. including.

  DESCRIPTION OF SYMBOLS 10 ... Insertion device, 12 ... Flexible pipe, 14 ... Flexible pipe, 14a ... Passage | path, 20 ... Tip member, 20a ... Tip opening, 22 ... 1st pipe part (tip side pipe part), 24 ... 1st guide part 24a ... 1st guide opening, 24b ... 1st inclined surface, 26 ... 2nd pipe part (working tube part), 28 ... 2nd guide part, 28a ... 2nd guide opening, 28b ... 2nd inclined surface, 30 ... 3rd pipe part (base end side pipe part), 32 ... locking part, 42 ... male screw cylinder (tubular body), 44 ... nut, 46 ... O-ring, 48 ... index, 52 ... overhang part, 54 ... Projection part, 60 ... endoscope, 62 ... insertion part, 62a ... tip component part, 62b ... bending part, 62c ... flexible tube, 63 ... channel, 70 ... guide wire, C ... central axis (longitudinal axis), E ... esophageal (duct), S ... stomach, F ... field of view, LA ... left atrium.

Claims (16)

A first flexible tube having a distal end and a proximal end, the first flexible tube being inserted from the distal end side to the inside of the conduit along a longitudinal axis defined by the distal end and the proximal end;
A non-extending position along the longitudinal axis of the first flexible tube and an overhanging position projecting from the first flexible tube in an arcuate shape in a direction intersecting the longitudinal axis of the first flexible tube; A second flexible tube having an overhanging portion that is elastically deformed and presses an inner wall of the pipe line outward at the overhanging position to flatten at least a part of the pipe line;
An insertion device that includes a fixing portion that is provided on a distal end side with respect to the overhang portion and fixes a part of the first flexible tube and a part of the second flexible tube. The second flexible tube is movable at a base end side of the fixed portion with respect to the longitudinal axis of the first flexible tube,
The projecting portion of the second flexible tube is such that a portion of the second flexible tube closer to the proximal end than the projecting portion is located along the longitudinal axis of the first flexible tube. The insertion device according to claim 1, wherein the insertion device is changed to the overhanging position when approaching toward the position and to the non-extending position when separated from the fixing portion.   The insertion device according to claim 2, wherein the second flexible tube is capable of adjusting an overhang amount protruding from the first flexible tube.   The insertion device according to claim 1, wherein the fixing portion is disposed at the tip of the first flexible tube.   The first flexible tube has a protruding direction defining portion that defines a protruding direction of the protruding portion of the second flexible tube in a part of a side surface between the distal end and the proximal end. Item 2. The insertion device according to Item 1.   The insertion device according to claim 5, wherein the projecting direction defining portion has an opening through which the second flexible tube is taken in and out of the first flexible tube.   The insertion device according to claim 6, wherein the protruding direction defining portion includes a guide surface that guides the second flexible tube with respect to the opening.   2. The insertion device according to claim 1, wherein the first flexible tube is provided with an index for recognizing a protruding direction of the protruding portion at a position closer to a proximal end than the protruding portion.   The first flexible tube is separated from the projecting portion of the second flexible tube and has an arcuate shape with respect to the non-projecting position where the projecting portion of the second flexible tube can be disposed at the projecting position. The insertion device according to claim 1, further comprising: a projecting portion that is deformable between a projecting position that is elastically deformed and presses an inner wall of the conduit toward the outside to flatten at least a part of the conduit.   The insertion device according to claim 9, wherein the protruding portion is deformed to an opposite side with respect to the protruding position of the protruding portion when the protruding portion is in the protruding position.   The insertion device according to claim 1, further comprising a locking portion that holds a positional relationship between the first flexible tube and the second flexible tube.   The first flexible tube is supported against at least one of the first flexible tube and the second flexible tube, and the inner wall of the conduit is pressed outward to hold the first flexible tube against the conduit. The insertion device according to claim 1, comprising a holding unit.   The holding unit includes a balloon that holds at least one of the first flexible tube and the second flexible tube with respect to the conduit at a position closer to the distal end than the overhang portion, and a fluid in the balloon. The insertion device according to claim 12, further comprising: a tube that supplies the tube.   It is arranged on the outer periphery of a portion including a part of the first flexible tube and the overhanging portion of the second flexible tube, and expands and contracts according to the overhanging of the overhanging portion, and is filled with a cooling fluid. The insertion device according to claim 1, comprising a possible balloon.   The insertion device according to claim 14, wherein the balloon has a hole through which fluid filled inside the balloon leaks into the conduit.   The insertion device according to claim 1, wherein the second flexible tube has a passage through which the insertion body can be inserted.