JP4025905B2

JP4025905B2 - Anoscope

Info

Publication number: JP4025905B2
Application number: JP2002036787A
Authority: JP
Inventors: 幸康奥村
Original assignee: 幸康奥村
Priority date: 2002-02-14
Filing date: 2002-02-14
Publication date: 2007-12-26
Anticipated expiration: 2022-02-14
Also published as: JP2003235799A

Description

【０００１】
【発明の属する技術分野】
本発明は、肛門鏡、特に照明機能を備える巾着縫合時の使用に適する肛門鏡に関するものである。
【０００２】
【従来の技術】
痔核治療法として、種々の方法が提案されているが、術前の弛緩したアナルクッションＡｃ（図１Ａ）を巾着縫合して吊り上げ、解剖学的位置に復元するとともに（図２）、下部直腸粘膜環状切除Ｂにより痔核組織Ｃへの血流を減らすことにより（図１Ｂ術後肛門部断面図）、手技上歯状線Ｄより肛門側に創部を形成せず、もって術後の疼痛、晩期の出血が少なく、早期退院、早期社会復帰が可能な手術方法として環状吻合式肛門形成術、即ちPPH（Procedure For Prolapse And Hemorrhoids）法が推奨されている。
【０００３】
【発明が解決しようとする課題】
この手術方法においては、下部直腸粘膜を環状切除Ｂするにあたり、図２に示すように、かかる部分を巾着縫合する必要がある。図２は巾着縫合の終了後、巾着縫合用肛門鏡を抜去して、肛門拡張器Ｎに、アンビルを最大に開いた吻合器Ｍを挿入し、次に巾着縫合糸Ｆを締めて一度よりをかけた後、縫合糸通し器Ｇを用いて吻合器のポートから縫合糸Ｆの両端を引き出した状態を示す。現在、術者頭部より無影灯の照明で肛門内部の巾着縫合部を照明し、これを縫合するようにしている。しかしながら、術者頭部によりどうしても肛門部への照明が遮断されるため、手暗がりとなって迅速にかつ正確を期することが難しい。そこで、本発明は肛門鏡自体を介して肛門内縫合部を照明することができる照明機能を備えた肛門鏡を提供することを目的とする。
また、無影灯の無い簡易手術ベッドでも痔疾患の手術を行える肛門鏡を提供することを目的とする。
【０００４】
【課題を解決するための手段】
種々の形態の肛門鏡があるが、肛門鏡は、少なくとも円筒状の、肛門内に挿入可能な筒体部と、該筒体部の後端外周から筒体半径方向に延びる少なくとも１本のハンドル部とを備える。上記筒体部が長尺の場合は、肛門内への挿入を容易にするため、少なくとも先端から後方に向けて胴径が拡大する部分を有するが、この筒体部の胴体部分の少なくとも４分の１から２分の１周、好ましくは３分の１周程度の領域を切り欠いておくと、吊り上げられた組織の垂れ等による肛門鏡の回転に支障をきたすことなく、該切り欠き部を介して肛門管の奥の直腸粘膜に巾着縫合可能に接近できる。しかも、該切り欠き部と対向する筒体部内面に少なくとも１個のＬＥＤを巾着縫合部位に対向するように配置することにより、巾着縫合部がきれいに照明でき、しかもＬＥＤは肛門鏡壁部に埋設して配置できるため、巾着縫合の支障とならないことを見出し、本発明は完成されたもので、
本発明の第１の形態の肛門鏡は、肛門内に挿入可能な筒体部１と、該筒体部の後端から筒体部半径方向に延び、肛門内に挿入された筒体部をその軸線周りに回転させる１または複数のハンドル部２とからなり、上記筒体部１は、肛門内への挿入を容易にする胴体部が先端に向けて径部が縮小された先端部１１と、該先端部に続く胴体部分がその少なくとも４分の１周の領域が切り欠かれ、術者が肛門管より奥の直腸粘膜に巾着縫合可能に接近するための切り欠き部１２と、該切り欠き部と対向する筒体部内面に１個または複数個のＬＥＤ３が上記切り欠き部１２から巾着縫合部位４を照明可能に配置されていることを特徴とする（図３参照）。好ましくは、先端部１１を円錐形または円錐台形とし、後端部にはラッパ状に湾曲するフランジ部１０を設け、併用される肛門拡張器Ｎの鍔部との接触抵抗を減少させるのが好ましい（図４参照）。また、図５のように筒体部１をロケット形式とし、その胴体部の一部を切り欠いて切り欠き部１２を形成するようにするとともに、ハンドル部２を半径方向４方向に形成するように設計変更してもよい。
【０００５】
上記切り欠き部は、上記筒体部の切り欠き部１２が巾着縫合部位に近接できる領域において、少なくとも筒体部の回転方向後方部位がさらに切り欠かれ、円周方向に３分の１周から２分の１周域まで拡大された、拡大部１２ａが形成されると、巾着縫合後の針抜きを容易にするので好ましい。この拡大部１２ａは筒体部が樹脂成形される場合は、成形時に取り外しを可能とする切り取り線を設け、成形後必要に応じて取り外し可能であるのが好ましい。老年痔疾患の場合、直腸部の垂れ下がりが大きい時があり、拡大部がないのが好ましい場合があるからである。
かかる巾着縫合位置は歯状線から前方長さ２〜４ｃｍに、位置するので、縫合位置を示す目盛１５を設けるのが好ましい（図４および図６参照）。
【０００６】
上記切り欠き部１２と対向する筒体内面に複数のＬＥＤ３を段階的に配置することにより、上記切り欠き部を介して肛門管からその奥の直腸部位を至って照明可能となる。巾着縫合には、図１１に示すように、巾着縫合位置４より肛門鏡の入口側寄りの位置から前方の照明をするのが好ましい（これを照射領域１という）。これを主ＬＥＤ光源３−１とし、補助ＬＥＤ光源３−２を巾着縫合位置の直下から広角度で巾着縫合位置を照射するようにするのがよい（これを照射領域２という）。ＬＥＤ光源は白色系ＬＥＤが使用されるのが好ましく、３．６Ｖから４．５Ｖで作動させるのが強い発光を長期間得ることができるので、好ましい。また、動脈血と静脈血を見分けやすいように色温度６０００から３０００度とするのがよい。補助光源は複数とし、その一つを４００ｎｍ以下、好ましくは３６０から３８０ｎｍにピーク波長を有する近紫外ＬＥＤを用いることにより術中の殺菌効果を持たせるようにすることができる。
【０００７】
上記ＬＥＤ光源からの照射光は、切り欠き部を介して巾着縫合部を照明するのであるが、切り欠き部と対向する筒体内面が鏡面処理されると、湾曲した鏡面処理部で上記ＬＥＤからの光を前方に反射させることができ、ＬＥＤ照明光を無駄なく術部に集光させることができる。
【０００８】
また、上記肛門鏡は、樹脂成形とすると安価に製造される。また、樹脂成形時に二酸化チタンなどの光触媒を含有またはコーテイングさせると、上記近紫外ＬＥＤとの相乗効果ににより汚染防止、殺菌効果を高めることができる。また、樹脂成形時にＬＥＤを所定の位置に埋め込み、筒体部にＬＥＤ配線を埋め込むことによりコンパクトに成形することができ、外部電源に容易に接続することができる。
【０００９】
上記肛門鏡ではＬＥＤを筒体部に埋設したが、本発明の第２の形態では、これに代えて、少なくとも一つのＬＥＤが埋設された、例えば樹脂製カートリッジを、上記切り欠き部と対向する筒体内面に装着するようにして、カートリッジに埋設されたＬＥＤが上記切り欠き部から巾着縫合部位あるいは巾着縫合部位から肛門管に至って照明するようにすることも可能である（図６および図７、図９Ａ、Ｂ参照）。上記カートリッジは鏡面処理することにより前方での集光を容易にする。カートリッジ本体は筒体部に沿って湾曲させ、断面Ｕ字形状とすることもできるし（図６参照）、切り欠き部に沿って延びるように帯状体とすることもできる（図７参照）。また、環状体（図９Ａ、Ｂ）とすることもできる。ＰＰＨに用いられる肛門鏡は使い捨て形式であるので、このようなカートリッジ形式として取替え繰り返し使用可能とすることができる。
【００１０】
また、上記肛門鏡では筒体部を全体として前方から後端まで切り欠き形成したが、筒体部の一部に開口部を形成するようにすることもできる（図５および図１０参照）。
【００１１】
また、用途に応じて全体の形状も変え得る。上述した肛門鏡は巾着縫合に適するものであるが、巾着縫合用肛門鏡と同時に使用される拡張用肛門鏡では、肛門内に内挿可能な筒体部と筒部後端外周から放射状に延びる鍔部とを有してなる。したがって、本発明の第３の形態では、該鍔部から筒体部に至る湾曲接合部又はそれより前方の筒部に円周方向に所定間隔で複数のＬＥＤを埋設し、少なくとも上記筒部を透明樹脂で形成して上記ＬＥＤからの発光を透明樹脂筒部を介して導光し、肛門内を照明可能とするのがよい。かかる肛門鏡は前記巾着縫合用肛門鏡を内挿可能な筒径とすることにより同時に肛門拡張器として使用可能である。また、砲弾形状の肛門挿入器を併用することにより、巾着縫合用肛門鏡として使用することができる（図１０参照）。その際、筒体部の先端延長部に開口部または切り欠き部を設けることにより、巾着縫合部に接近可能となる。
【００１２】
この場合、前記筒部先端または該鍔部から筒部に至る環状接合部又はそれより前方の筒部に装着可能であって、円周方向に所定間隔で複数のＬＥＤを埋設した環状カートリッジを用い、少なくとも上記筒部及びカートリッジを透明樹脂で形成して上記ＬＥＤからの発光を導光し、肛門内を照明可能とすることもできる（図９ＡおよびＢ参照）。
【００１３】
【発明の実施の形態】
本発明は巾着縫合に適する肛門鏡と、診断等の肛門内視鏡として適する肛門鏡と、肛門拡張器と併用することができる肛門鏡との、３形態に分けることができるが、当業者であれば、本件明細書の記載を参酌して相互に兼用できるように変形することができる。
また、各肛門鏡を一体型と、本体部分とそれに装着可能な、LEDを埋設したカートリッジとからなる分離型の２種に分けることができる。
以上の各実施形態を実施例に基づき、詳細に説明する。
【００１４】
【実施例１】
（巾着縫合用肛門鏡）
図３は本発明の肛門鏡の基本形態を示し、１は肛門内に挿入可能な筒体部で、該筒体部１の後端には筒体部半径方向に延び、肛門内に挿入された筒体部１をその軸線周りに回転させるハンドル部２が設けられている。
上記筒体部１は、肛門内への挿入を容易にするため、先端に向けて胴体部の径部が縮小されている。この先端部１１に続く胴体部分１は先端部からその少なくとも４分の１周の領域が切り欠かれ、術者が肛門管より奥の直腸粘膜に巾着縫合可能に接近するための切り欠き部１２が形成されている。上記切り欠き部１２は上記筒体部１の先端から後端まで切り欠かれるのが製造上好ましい。また、切り欠き領域は必要な肛門部位に近接可能な大きさとすべきであるが、切り欠き領域が大きいと筒体部１の回転が困難となる。したがって、上記筒体部の切り欠き部１２はおよそ３分の１周程度とし、巾着縫合部位４に近接できる領域において、少なくとも筒体部の回転方向後方部位がさらに円周方向に切り欠かれ、およそ２分の１周程度とし、巾着縫合後の針抜き可能域１２ａを形成するのが好ましい。巾着縫合部位においては、該切り欠き部と対向する筒体部内面に１個または複数個のＬＥＤ３が上記切り欠き部１２から巾着縫合部位を照明可能に配置される。上記切り欠き部を通して肛門管からその奥の直腸部位を至って照明可能に、上記切り欠き部と対向する筒体内面に複数のＬＥＤが配置され、入口近傍の主ＬＥＤ光源３−１は前方斜め上方に鋭角で広がり、巾着縫合位置近傍に、照射領域１を形成する。前方の補助ＬＥＤ光源３−２は巾着縫合位置の直下に位置し、上方に広角度で広がり、巾着縫合位置周囲を全体に照明可能な照射領域２を形成するように配置されている。
ＬＥＤが配置される筒体部内面は鏡面処理され、湾曲した鏡面処理部で上記LEDからの光を上記切り欠き部前方の巾着縫合部位周辺に集光させるように構成している。しかも上記筒体部が酸化チタンコーテイングされていると、術後の洗浄が容易となる。
【００１５】
【実施例２】
図４は筒体部胴体部分１の径を変化させず、先端部１１を円錐形として肛門内への挿入を容易にしている。先端部は先端を開口し、円錐台形状としてもよい。他方、上記筒体部１の後端には外周方向にラッパ状に広がるフランジ部１０を設け、該フランジ部１０から筒体部半径方向３方向に延びる翼部２１が形成され、肛門内に挿入された筒体部１をその軸線周りに回転させるハンドル部２を形成している。また、上記胴体部分の切り欠き部に歯状線から前方に長さ３〜４ｃｍで、目盛１５が形成され、巾着縫合位置の目安としている。他は実施例１と同様であるので説明を省略する。図１１は実施例２の肛門鏡を使用して巾着縫合をしている状態を示す断面説明図で、主ＬＥＤ光源３−１で照射領域１を照射し、補助ＬＥＤ光源３−２で照射領域２を照射して全体として巾着縫合部位４は手術に好適な照明環境が形成されている。いままでは肛門外の無影灯光源に頼っていたが、その時と比べて格段に優れた照明環境となることがわかる。Ｈは縫合糸Ｆの先端縫合針であり、術者は縫合針Ｈをかん子Ｉで把持し、縫合部位粘膜を右から左に貫通した巾着縫合状態にあるが、縫合針Ｈは縫合後左側に切り欠き部拡大部１２ａがあるので、肛門鏡の筒体部に邪魔されず、容易に針抜きができるようになっている。
図示の肛門鏡は翼部２１で時計回りに徐徐に回転され、同様の縫合を繰り返すと、図２の巾着縫合状態となる。巾着縫合が終わると、肛門拡張器Ｎから巾着縫合用肛門鏡を抜去して、代わりに肛門拡張器Ｎに、アンビルを最大に開いた吻合器Ｍを挿入し、次に巾着縫合糸Ｆを締めて一度よりをかけた後、縫合糸通し器Ｇを用いて吻合器のポートから縫合糸Ｆの両端を引き出し、アンビルを閉じると、図１Ｂに示すように、所定の粘膜が環状に切除される。術後の状態を見るために、図１２の環状切除縫合部位を見る作業が必要となる。ここでも本件発明の他の形態の肛門鏡が使用され、観察部位の照明が行われるため、従来と比べて格段に優れた照明環境が形成される。縫合部位からの出血が認められるときは適宜止血が行われる。
【００１６】
【実施例３】
図５は、筒体部１をロケット形式とし、その先端部１１に開口を設けて円錐台形状１１ａとするとともに、その胴体部の一部を切り欠いて切り欠き部１２を形成し、巾着縫合部位に近いところでは筒体部１の回転方向に拡大部１２ａを形成するようにしている。ハンドル部２はフランジ部１０と一体に樹脂成形して半径方向４方向に広がる翼部２１で形成する。製造上筒体部１と、フランジ部１０と一体となった翼部２１とは別体で成形するのが好ましい。翼部２１の１つから配線が出ており、前方の主ＬＥＤ光源３−１および補助ＬＥＤ光源３−２と導通し、筒体部１の壁部に埋め込み形成され、図示のように引き出され、所定の直流電源に接続されるようになっている。他は、実施例１と同様であるので同一部分には同一番号を付して説明を省略する。
【００１７】
【実施例４】
本実施例は、肛門鏡にＬＥＤを樹脂製カートリッジに埋設する場合を示す。
図６では図４に示す肛門鏡に対して装着されるカートリッジ５０で、図４の肛門鏡の切り欠き部１２と対向する筒体内面に沿って装着できるように断面Ｕ字形状の筒体部５１と筒体部５１の後端にその半径方向に延びるフック付翼部５５を形成し、筒体部５１を肛門鏡の筒体部１に挿入後、翼部５５を回転させ、フックを肛門鏡の翼部２１に回し止めして装着することができ、カートリッジ５０の肛門鏡への脱着が可能となっている。カートリッジの筒体部に埋設されたＬＥＤ５３−１及び５３−２は図示の照明領域１および２を形成し、上記切り欠き部から巾着縫合部位、あるいは巾着縫合部位から肛門管に至って照明するようになっている。上記カートリッジ５０の筒体部内面は鏡面処理５１ａすることにより前方での集光を容易にすることができる。
【００１８】
【実施例５】
図７はカートリッジ本体を、肛門鏡の切り欠き部１２に対向しつつ延びるように筒体部１の内面に装着できる帯状体５２とした場合を示す。図７では、図４の肛門鏡の切り欠き部１２と対向する筒体内面に沿って装着できる帯状体５２として設計され、その後端にフック５６を形成し、肛門鏡の筒体部１に沿って挿入後、フック５６を肛門鏡のフランジ部１０に差込み、装着することができ、カートリッジ５０の肛門鏡への脱着が可能となっている。カートリッジの帯状体５２に埋設されたＬＥＤ５４−１、５４−２及び５４−３は図示の照明領域１および２を形成し、上記切り欠き部から巾着縫合部位、要すれば巾着縫合部位から肛門管に至って照明するようになっている。上記カートリッジ５０の帯状体上面５２ａは鏡面処理することにより前方への集光を容易にすることができる。ＰＰＨに用いられる肛門鏡は使い捨て形式であるので、このようなカートリッジ形式として取替え繰り返し使用可能とすることができる。
【００１９】
【実施例６】
図８Ａ，Ｂは、最も簡単な肛門鏡の正面図、およびその横断面図を示し、肛門内に内挿可能な筒体部１０１と筒体部後端外周から放射状に延びる鍔部１０２とを有してなる。この実施例では、該鍔部１０２から筒体部１０１に至る湾曲接合部１０３に円周方向に所定間隔で複数のＬＥＤ１０４を埋設し、少なくとも上記筒体部１０１を透明樹脂で形成して上記ＬＥＤ光源１０４、１０４からの前方発光を透明樹脂筒体部１０１を介して導光し、肛門内を照明可能となっている。ＬＥＤ光源１０４はボタン電池から直流電圧で作動可能である。図１２に示すように、遠位照射位置では術後の環状切除縫合位置を確認するために、好適な照明環境を形成でき、近位照射位置では肛門入口から歯状線近傍の状態を観察するに好適な照明環境を形成できる。なお、図１２ではボタン電池ではなく、埋め込み配線等により外部電源に接続する形態を採用している。また、上記ＬＥＤ１０４は肛門鏡への埋め込み形式を採用したが、図９Ａ、Ｂに示すように、環状カートリッジ５５にＬＥＤ５６を所定間隔で埋め込み形成し、所定の部位に嵌め込むようにすることができ、従来肛門拡張器として使用されていたものに装着することにより上記肛門鏡を容易に形成することができる。
【００２０】
【実施例６】
図９Ａ，Ｂは前記巾着縫合用肛門鏡を内挿可能な筒径とする肛門拡張器（図８Ａ、Ｂ）を変形したもので、筒体部１０１の先端を４ｃｍ程度延長して筒体延長部１０５を形成し、ここに開口部１０６を設けることにより、筒体内部より巾着縫合部に接近可能としたものである。該鍔部１０２から筒体部１０１に至る湾曲接合部１０３には円周方向に所定間隔で複数のＬＥＤ１０４を埋設する代わりに、環状カートリッジ５５にＬＥＤ５６を所定間隔で埋め込み形成し、所定の部位に嵌め込んでなる。筒体部１０１を肛門部に挿入するにあたっては、図１０に示すように、筒体部１０１に内挿される砲弾形状の肛門挿入器１１０を併用することにより、歯状線より奥の巾着縫合部位に挿入可能となる。なお、図面では各ＬＥＤ５６が上記開口部１０６に照射領域を形成できるように前方指向性の高いものを使用している。広角照射のＬＥＤを使用してもよい。また、開口部に代えて切り欠き部により、巾着縫合位置に接近できるようにしてもよい。
【００２１】
この場合、前記筒部先端または該鍔部から筒部に至る環状接合部又はそれより前方の筒部に装着可能であって、円周方向に所定間隔で複数のＬＥＤを埋設した環状カートリッジを用い、少なくとも上記筒部及びカートリッジを透明樹脂で形成して上記ＬＥＤからの発光を導光し、肛門内を照明可能とすることもできる（図９ＡおよびＢ参照）。
【００２２】
【発明の効果】
本発明によれば、肛門内に挿入可能な筒体部と該筒体部の後端から筒体部半径方向に延び、肛門内に挿入された筒体部をその軸線周りに回転させる１または複数のハンドル部からなる肛門鏡において、胴体部分がその少なくとも４分の１周の領域が切り欠かれ、術者が肛門管より奥の直腸粘膜に巾着縫合可能に接近するための切り欠き部を介して、該切り欠き部と対向する筒体部内面に設けた１個または複数個のＬＥＤを用いて巾着縫合部位を照明可能であるから、無影灯による照明よりも簡単にかつ格段に明るく肛門内縫合部を照明することができるので、肛門鏡を用いる痔疾患の手術が極めて簡単となる。また、無影灯の照明を必要としないので、簡易手術ベッドでも痔疾患の手術を行える。
ＰＰＨ手術における巾着縫合において、従来は肛門内部が明瞭に直視できない結果、誤って深く又は浅く縫合したりする結果、適性な環状切断が行えない場合があった。また、ほぼ手探りに近い状態での手術の結果、より長い手術時間を要する結果を招来している。これに対し、本発明の肛門鏡を使用することにより、ＰＰＨ手術熟練者でなくとも比較的容易に、熟練者であれば比較的短時間で手術を適切に完了することができる。例えば、特に照明効果により、肛門鏡に付設した目盛を読みながら手術することができ、各々の症例に対し、適切な粘膜切除の幅を決定することが容易となる。このように、従来の肛門鏡では考えられない画期的な手術を行えることになる。
【００２３】
本発明は、用途に応じて巾着縫合に適する肛門鏡と、肛門内視鏡として適する肛門鏡と、肛門拡張器と併用する肛門鏡との、３形態に分けることができるが、切り欠き又は開口部を介してＬＥＤ光源を利用して手術部位を照明しつつ、接近できるようにすることには変りがない。また、各肛門鏡を一体型と、本体部分とそれに装着可能な、LEDを埋設したカートリッジとからなる分離型の２種に分けることができるが、後者のカートリッジ形式では既存の肛門鏡を照明形式の肛門鏡の容易に変更できるので、使い捨て形式のＰＰＨ肛門鏡にとって特に便利である。
【図面の簡単な説明】
【図１】（Ａ）はＰＰＨ術前状態の痔疾患肛門内部を示す断面図、（Ｂ）は術後の状態を示す断面図である。
【図２】巾着縫合された環状切除部に吻合器のアンビルを挿入した状態を示す断面図である。
【図３】本発明の第１形態の一体型肛門鏡を示す斜視図である。
【図４】本発明の第１の形態の一体型肛門鏡の第１変形例を示す斜視図である。
【図５】本発明の第１の形態の一体型肛門鏡を第２変形例を示す斜視図である。
【図６】本発明の第２形態の分離型カートリッジの装着状態を示す斜視図である。
【図７】本発明の第２形態の分離型カートリッジの変形例の装着状態を示す斜視図である。
【図８】本発明の第３形態の肛門拡張器と併用できる肛門鏡の（Ａ）正面図、（Ｂ）横断面図である。
【図９】本発明の第３形態の肛門鏡の変形例を示す（Ａ）正面図、（Ｂ）横断面図である。
【図１０】図９の内挿法を説明するための斜視図である。
【図１１】図８の肛門鏡の使用方法を示す説明図である。
【図１２】図４の肛門鏡の使用方法を示す説明図である。
【符号の説明】
１、１０１筒体部、２ハンドル部、２１翼部、１０２鍔部
３（５３、５４）ＬＥＤ光源、４巾着縫合部位、１０６開口部
５（５０、５２、５５）カートリッジ、１０フランジ部
１１先端部、１２切り欠き部、１２ａ切り欠き拡大部[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an anoscope, and more particularly to an anoscope suitable for use when a purse string suture having an illumination function is used.
[0002]
[Prior art]
Various methods have been proposed for hemorrhoid treatment, and a relaxed pre-operative anal cushion Ac (FIG. 1A) is sutured and suspended to restore the anatomical position (FIG. 2), and the lower rectal mucosa By reducing the blood flow to the hemorrhoidal tissue C by circular resection B (FIG. 1B, cross-sectional view of the anus after surgery), the wound is not formed on the anus side from the dentate line D due to the technique, and thus postoperative pain, As an operation method capable of early discharge and early rehabilitation with little bleeding, an anastomosis annuloplasty, that is, a PPH (Procedure For Prolapse And Hemorrhoids) method is recommended.
[0003]
[Problems to be solved by the invention]
In this surgical method, when circularly excising the lower rectal mucosa, as shown in FIG. FIG. 2 shows that after the purse string suture is finished, the purse string suture anoscope is removed, the anastomotic device M with the anvil opened to the maximum is inserted into the anal dilator N, and then the purse string suture F is tightened. A state in which both ends of the suture thread F are pulled out from the anastomotic device port using the suture threader G after being applied is shown. At present, the purse sewn portion inside the anus is illuminated by the surgical light from the operator's head, and this is sutured. However, since the illumination on the anus is inevitably blocked by the operator's head, it is difficult to quickly and accurately become dark. Then, an object of this invention is to provide the anoscope provided with the illumination function which can illuminate the suture part in an anus via the anoscope itself.
It is another object of the present invention to provide an anoscope capable of operating a hemorrhoid disease even in a simple operation bed without a surgical light.
[0004]
[Means for Solving the Problems]
There are various types of anoscopes. The anoscope has at least a cylindrical cylindrical part that can be inserted into the anus and at least one handle that extends in the cylindrical radial direction from the outer periphery of the rear end of the cylindrical part. A part. When the cylindrical part is long, it has at least a part where the trunk diameter increases from the tip toward the rear in order to facilitate insertion into the anus. At least four minutes of the trunk part of the cylindrical part If the region of 1 to 1/2 rounds, preferably about 1/3 rounds is cut out, the cutouts can be removed without hindering the rotation of the anoscope due to drooping of the suspended tissue. Via the rectal mucosa behind the anal canal, the purse can be sutured. In addition, by arranging at least one LED on the inner surface of the cylindrical body facing the notch so as to face the purse string suture site, the purse string suture part can be neatly illuminated, and the LED is embedded in the anoscope wall. And found that it does not hinder the purse string suture, the present invention has been completed,
An anoscope according to a first aspect of the present invention includes a cylindrical body portion 1 that can be inserted into the anus, and a cylindrical body portion that extends in the radial direction of the cylindrical body portion from the rear end of the cylindrical body portion and is inserted into the anus. The cylindrical body portion 1 includes a distal end portion 11 whose diameter portion is reduced toward the distal end of the barrel portion 1 that facilitates insertion into the anus. The body portion following the tip is cut out at least a quarter of the region, and the notch 12 for allowing the operator to approach the rectal mucosa deeper than the anal canal in a purse string suture, and the cut One or a plurality of LEDs 3 are arranged on the inner surface of the cylindrical body portion facing the notch portion so as to illuminate the purse string suture portion 4 from the notch portion 12 (see FIG. 3). Preferably, the distal end portion 11 has a conical shape or a truncated cone shape, and a flange portion 10 that is curved in a trumpet shape is provided at the rear end portion to reduce the contact resistance with the buttocks of the anal dilator N used together. (See FIG. 4). Further, as shown in FIG. 5, the cylindrical body portion 1 is formed into a rocket type, and a part of the body portion is notched to form the notched portion 12, and the handle portion 2 is formed in four radial directions. The design may be changed.
[0005]
In the region where the cutout portion 12 of the cylindrical body portion can be close to the purse string stitched portion, at least the rear portion in the rotational direction of the cylindrical body portion is further cut away, and the cutout portion starts from one third of the circumference in the circumferential direction. It is preferable to form an enlarged portion 12a that is enlarged to a half circumference area because it facilitates the removal of the needle after the purse string suture. When the cylindrical body portion is resin-molded, the enlarged portion 12a is preferably provided with a tear line that can be removed at the time of molding, and can be removed as necessary after molding. This is because, in the case of senile illness, there is a case where the drooping of the rectum is large, and it may be preferable that there is no enlarged portion.
Since the purse string stitching position is located at a front length of 2 to 4 cm from the tooth line, it is preferable to provide a scale 15 indicating the stitching position (see FIGS. 4 and 6).
[0006]
By arranging the plurality of LEDs 3 in a stepwise manner on the inner surface of the cylindrical body facing the notch 12, it is possible to illuminate from the anal canal to the deep rectum via the notch. For the purse string suture, as shown in FIG. 11, it is preferable to illuminate the front from a position closer to the entrance side of the anoscope than the purse string suture position 4 (this is called irradiation region 1). This is the main LED light source 3-1, and the auxiliary LED light source 3-2 is preferably irradiated at a wide angle from the position immediately below the purse string stitching position (this is referred to as irradiation region 2). As the LED light source, a white LED is preferably used, and it is preferable to operate at 3.6 V to 4.5 V because strong light emission can be obtained for a long time. The color temperature is preferably 6000 to 3000 degrees so that arterial blood and venous blood can be easily distinguished. A plurality of auxiliary light sources can be used, and one of them can have an antibacterial effect during surgery by using a near-ultraviolet LED having a peak wavelength of 400 nm or less, preferably 360 to 380 nm.
[0007]
The irradiation light from the LED light source illuminates the purse string stitching portion through the notch, but when the inner surface of the cylindrical body facing the notch is mirror-finished, the curved mirror-surface treatment portion Can be reflected forward, and the LED illumination light can be condensed on the surgical site without waste.
[0008]
Further, the anoscope is manufactured at a low cost when resin molding is performed. Further, when a photocatalyst such as titanium dioxide is contained or coated at the time of resin molding, the anti-contamination and bactericidal effects can be enhanced by the synergistic effect with the near-ultraviolet LED. Further, it is possible to form the LED compactly by embedding the LED in a predetermined position at the time of resin molding and embedding the LED wiring in the cylindrical body portion, and easily connect to an external power source.
[0009]
In the anoscope, the LED is embedded in the cylindrical body portion. However, in the second embodiment of the present invention, instead of this, for example, a resin cartridge in which at least one LED is embedded is opposed to the notch portion. It is possible to illuminate the LED embedded in the cartridge from the cutout portion to the purse string suture site or the purse string suture site to the anal canal so as to be mounted on the inner surface of the cylinder (FIGS. 6 and 7). 9A and 9B). The cartridge is mirror-finished to facilitate light collection in the front. The cartridge main body may be curved along the cylindrical body portion to have a U-shaped cross section (see FIG. 6), or may be a belt-like body extending along the notch portion (see FIG. 7). Moreover, it can also be set as an annular body (FIG. 9A, B). Since the anoscope used for PPH is a disposable type, it can be replaced and used repeatedly as such a cartridge type.
[0010]
In the anoscope, the entire cylindrical body portion is cut out from the front to the rear end, but an opening may be formed in a part of the cylindrical body portion (see FIGS. 5 and 10).
[0011]
Moreover, the whole shape can also be changed according to a use. The above-mentioned anoscope is suitable for purse string sutures. However, in the anoscope for expansion used at the same time as the purse string suture anoscope, it extends radially from the cylindrical body part that can be inserted into the anus and the outer periphery of the rear end of the cylindrical part. And a buttock. Therefore, in the third embodiment of the present invention, a plurality of LEDs are embedded at predetermined intervals in the circumferential direction in a curved joint portion extending from the flange portion to the cylindrical body portion or a cylindrical portion in front of the curved joint portion, and at least the cylindrical portion is provided. It is preferable that the light emission from the LED is guided through the transparent resin tube portion through the transparent resin so that the inside of the anus can be illuminated. Such an anoscope can be used as an anal dilator at the same time by making the purse-string suture anoscope into a cylindrical diameter that can be inserted. Moreover, it can be used as an anoscope for purse string suture by using a cannonball-shaped anal insertion device in combination (see FIG. 10). At that time, by providing an opening or a notch in the distal end extension portion of the cylindrical body portion, the purse string suture portion can be accessed.
[0012]
In this case, an annular cartridge that can be attached to the front end of the cylinder part or an annular joint part extending from the flange part to the cylinder part or a cylinder part ahead thereof, and in which a plurality of LEDs are embedded at predetermined intervals in the circumferential direction is used. In addition, at least the cylindrical portion and the cartridge can be formed of a transparent resin to guide the light emitted from the LED so that the inside of the anus can be illuminated (see FIGS. 9A and 9B).
[0013]
DETAILED DESCRIPTION OF THE INVENTION
The present invention can be divided into three forms: an anoscope suitable for purse string suture, an anoscope suitable as an anal endoscope for diagnosis and the like, and an anoscope that can be used in combination with an anal dilator. If there is, it can be modified so that it can be used in combination with the description of the present specification.
Each anoscope can be divided into two types: an integral type and a separate type consisting of a main body portion and a cartridge in which an LED is embedded.
Each of the above embodiments will be described in detail based on examples.
[0014]
[Example 1]
(Anascope for purse string suture)
FIG. 3 shows a basic form of the anoscope according to the present invention. Reference numeral 1 denotes a cylindrical part that can be inserted into the anus, and the rear end of the cylindrical part 1 extends in the radial direction of the cylindrical part and is inserted into the anus. A handle portion 2 is provided for rotating the cylindrical portion 1 around its axis.
In order to facilitate the insertion of the cylindrical body part 1 into the anus, the diameter part of the body part is reduced toward the tip. The body portion 1 following the distal end portion 11 is cut out at least a quarter of the region from the distal end portion, and the notch portion 12 for the operator to approach the rectal mucosa deeper than the anal canal in a purse string suture manner. Is formed. The notch 12 is preferably cut from the front end to the rear end of the cylindrical body 1 in terms of manufacturing. The cutout area should be sized so as to be close to the necessary anal site. However, if the cutout area is large, it is difficult to rotate the cylindrical portion 1. Therefore, the cutout portion 12 of the cylindrical body portion is about one third of the circumference, and at least the rear portion in the rotational direction of the cylindrical body portion is further cut away in the circumferential direction in the region that can be close to the purse string suture site 4. It is preferable to form about a half of the circumference and form the needle pullable area 12a after the purse string suture. In the purse string suture part, one or a plurality of LEDs 3 are arranged on the inner surface of the cylindrical part facing the notch part so as to illuminate the purse string stitch part from the notch part 12. A plurality of LEDs are arranged on the inner surface of the cylindrical body facing the notch so that the anal canal can be illuminated from the anal canal through the notch, and the main LED light source 3-1 in the vicinity of the entrance is diagonally forward The irradiation region 1 is formed in the vicinity of the purse string sewing position. The front auxiliary LED light source 3-2 is positioned immediately below the purse string stitching position, and is disposed so as to form an irradiation region 2 that can illuminate the entire periphery of the purse string stitching position.
The inner surface of the cylindrical part where the LED is arranged is mirror-finished, and the curved mirror-surface processing part is configured to collect light from the LED around the purse string suture site in front of the notch part. Moreover, if the cylindrical body portion is coated with titanium oxide, cleaning after surgery becomes easy.
[0015]
[Example 2]
FIG. 4 does not change the diameter of the cylindrical body portion 1 and facilitates insertion into the anus with the tip portion 11 having a conical shape. The tip portion may have a truncated cone shape by opening the tip. On the other hand, a flange portion 10 extending in a trumpet shape in the outer circumferential direction is provided at the rear end of the cylindrical portion 1, and a wing portion 21 extending from the flange portion 10 in the three radial directions of the cylindrical portion is formed and inserted into the anus. A handle portion 2 is formed for rotating the cylindrical portion 1 around its axis. Further, a scale 15 is formed in the notch portion of the body portion from the tooth-like line to the front with a length of 3 to 4 cm, which serves as a guideline for the purse string stitching position. Since others are the same as those of the first embodiment, the description thereof is omitted. FIG. 11 is a cross-sectional explanatory view showing a state in which the purse string is sutured using the anoscope of Example 2, and the irradiation region 1 is irradiated with the main LED light source 3-1, and the irradiation region with the auxiliary LED light source 3-2. As a whole, the purse string suture part 4 is irradiated with 2 and an illumination environment suitable for surgery is formed. Relying on the surgical light source outside the anus, it turns out that the lighting environment is much better than that. H is a distal suture needle of the suture F, and the operator holds the suture needle H with the lever I and is in a purse string suture state that penetrates the suture site mucosa from right to left, but the suture needle H is placed on the left side after the suture. Since there is the notch enlarged portion 12a, the needle can be easily removed without being obstructed by the cylindrical portion of the anoscope.
The illustrated anoscope is gradually rotated clockwise by the wing part 21, and when the same stitching is repeated, the purse string suture state of FIG. 2 is obtained. When the purse string suture is finished, the purse anoscope is removed from the anal dilator N, and instead, the anastomosis device M with the anvil fully opened is inserted into the anal dilator N, and then the purse string suture F is tightened. And then pulling out both ends of the suture thread F from the anastomotic instrument port using the suture threader G and closing the anvil, as shown in FIG. . In order to see the postoperative state, it is necessary to look at the annular resection suture site in FIG. Here again, an anoscope of another form of the present invention is used to illuminate the observation site, so that an illumination environment that is significantly superior to the conventional one is formed. When bleeding from the suture site is observed, hemostasis is appropriately performed.
[0016]
[Example 3]
In FIG. 5, the cylindrical body portion 1 is formed into a rocket type, and an opening is provided at the tip portion 11 to form a truncated cone shape 11a, and a cutout portion 12 is formed by cutting out a part of the trunk portion, and a purse string suture The enlarged portion 12a is formed in the rotation direction of the cylindrical portion 1 near the portion. The handle portion 2 is formed of a wing portion 21 that is integrally molded with the flange portion 10 and spreads in four radial directions. It is preferable that the cylindrical body part 1 and the wing part 21 integrated with the flange part 10 are formed separately from each other for manufacturing. A wiring is provided from one of the wing parts 21 and is electrically connected to the front main LED light source 3-1 and the auxiliary LED light source 3-2, embedded in the wall part of the cylindrical body part 1, and drawn out as shown. , Is connected to a predetermined DC power source. Others are the same as those in the first embodiment, so the same parts are denoted by the same reference numerals and the description thereof is omitted.
[0017]
[Example 4]
In this embodiment, an LED is embedded in a resin cartridge in an anoscope.
In FIG. 6, the cartridge 50 attached to the anoscope shown in FIG. 4 has a U-shaped cylindrical section so that the cartridge 50 can be mounted along the cylindrical inner surface facing the notch 12 of the anoscope in FIG. 4. 51 and a wing portion 55 with a hook extending in the radial direction are formed at the rear end of the cylindrical portion 51. After inserting the cylindrical portion 51 into the cylindrical portion 1 of the anoscope, the wing portion 55 is rotated and the hook is moved to the anus. The cartridge can be attached to the wing portion 21 of the mirror while being rotated, and the cartridge 50 can be attached to and detached from the anoscope. The LEDs 53-1 and 53-2 embedded in the cylindrical portion of the cartridge form the illumination areas 1 and 2 shown in the figure, and illuminate from the notch to the purse string suture site or from the purse string suture site to the anal canal. It has become. The inner surface of the cylindrical portion of the cartridge 50 can be easily focused in front by performing a mirror surface treatment 51a.
[0018]
[Example 5]
FIG. 7 shows a case where the cartridge main body is a belt-like body 52 that can be attached to the inner surface of the cylindrical portion 1 so as to extend while facing the notch portion 12 of the anoscope. In FIG. 7, it is designed as a belt-like body 52 that can be mounted along the inner surface of the cylinder facing the notch 12 of the anoscope of FIG. 4, and a hook 56 is formed at the rear end thereof, along the cylinder part 1 of the anoscope. After insertion, the hook 56 can be inserted into the flange portion 10 of the anoscope and attached, and the cartridge 50 can be attached to and detached from the anoscope. The LEDs 54-1, 54-2 and 54-3 embedded in the belt-like body 52 of the cartridge form the illumination areas 1 and 2 shown in the drawing, and the purse string suture site from the notch, and if necessary, from the purse string suture site to the anal canal It comes to illuminate. The belt-like body upper surface 52a of the cartridge 50 can be easily focused forward by performing a mirror finish. Since the anoscope used for PPH is a disposable type, it can be replaced and used repeatedly as such a cartridge type.
[0019]
[Example 6]
8A and 8B show a front view of the simplest anoscope and a cross-sectional view of the anoscope. The cylindrical body portion 101 that can be inserted into the anus and the flange portion 102 that extends radially from the outer periphery of the rear end of the cylindrical body portion are shown. Have. In this embodiment, a plurality of LEDs 104 are embedded at predetermined intervals in the circumferential direction in the curved joint portion 103 extending from the flange portion 102 to the cylindrical body portion 101, and at least the cylindrical body portion 101 is formed of a transparent resin. The front light emission from the light sources 104 and 104 can be guided through the transparent resin cylinder portion 101 so that the inside of the anus can be illuminated. The LED light source 104 can be operated with a DC voltage from a button battery. As shown in FIG. 12, a suitable illumination environment can be formed at the distal irradiation position to confirm the post-surgical annular excision suture position, and the state near the tooth line is observed from the anal entrance at the proximal irradiation position. A suitable lighting environment can be formed. In FIG. 12, a form in which the battery is connected to an external power source by an embedded wiring or the like instead of the button battery is adopted. Further, although the above-mentioned LED 104 employs an anoscope embedding type, as shown in FIGS. 9A and 9B, the LED 56 can be embedded in the annular cartridge 55 at a predetermined interval and can be fitted into a predetermined part. The anoscope can be easily formed by attaching to what has been conventionally used as an anal dilator.
[0020]
[Example 6]
FIGS. 9A and 9B show a modified anal dilator (FIGS. 8A and 8B) having a cylindrical diameter that allows insertion of the purse stringing anoscope. The distal end of the cylindrical body 101 is extended by about 4 cm to extend the cylindrical body. By forming the portion 105 and providing the opening 106 therein, the purse string suture portion can be accessed from the inside of the cylindrical body. Instead of embedding a plurality of LEDs 104 at a predetermined interval in the circumferential direction in the curved joint portion 103 extending from the flange portion 102 to the cylindrical body portion 101, LEDs 56 are embedded in the annular cartridge 55 at a predetermined interval. Fit. When inserting the cylindrical part 101 into the anus, as shown in FIG. 10, a purse string suture site behind the tooth-like line is obtained by using a cannonball-shaped anal insertion device 110 inserted into the cylindrical part 101. Can be inserted. In the drawing, each LED 56 has a high forward directivity so that an irradiation area can be formed in the opening 106. A wide-angle illuminated LED may be used. Moreover, it may replace with an opening part and you may enable it to approach a purse string sewing position by a notch part.
[0021]
In this case, an annular cartridge that can be attached to the front end of the cylinder part or an annular joint part extending from the flange part to the cylinder part or a cylinder part ahead thereof, and in which a plurality of LEDs are embedded at predetermined intervals in the circumferential direction is used. In addition, at least the cylindrical portion and the cartridge can be formed of a transparent resin to guide the light emitted from the LED so that the inside of the anus can be illuminated (see FIGS. 9A and 9B).
[0022]
【The invention's effect】
According to the present invention, the cylindrical part that can be inserted into the anus and the cylindrical part extending in the radial direction from the rear end of the cylindrical part and rotating the cylindrical part inserted into the anus around its axis 1 or In an anoscope comprising a plurality of handle portions, at least a quarter of the region of the trunk portion is cut out, and a notch portion for allowing the operator to approach the rectal mucosa deeper than the anal canal in a purse string suture is provided. Therefore, it is possible to illuminate the purse sewn region using one or a plurality of LEDs provided on the inner surface of the cylindrical portion facing the cutout portion, so that it is easier and much brighter than illumination with a surgical light. Since the intraanal suture can be illuminated, surgery for hemorrhoids using an anoscope becomes extremely simple. In addition, since no surgical light is required, surgery for hemorrhoids can be performed with a simple surgical bed.
In purse string sutures in PPH surgery, conventionally, the inside of the anus cannot be clearly seen directly, and as a result of stitching deeply or shallowly, there has been a case where appropriate circular cutting cannot be performed. In addition, as a result of the operation in a state close to groping, a result requiring a longer operation time is brought about. On the other hand, by using the anoscope of the present invention, it is relatively easy for a person who is not an expert in PPH surgery to complete the surgery appropriately in a relatively short time if he is an expert. For example, the operation can be performed while reading the scale attached to the anoscope, particularly by the illumination effect, and it becomes easy to determine an appropriate mucosal resection width for each case. In this way, an epoch-making operation that cannot be considered with a conventional anoscope can be performed.
[0023]
The present invention can be divided into three forms, an anoscope suitable for purse string sutures, an anoscope suitable as an anus endoscope, and an anoscope used in combination with an anal dilator, depending on the application. There is no change in making it accessible while illuminating the surgical site using the LED light source through the unit. In addition, each anoscope can be divided into two types: an integrated type and a separate type consisting of a body part and a cartridge with an embedded LED that can be attached to it. In the latter cartridge type, the existing anoscope is illuminated. This is particularly convenient for a disposable PPH anoscope because it can be easily modified.
[Brief description of the drawings]
FIG. 1A is a cross-sectional view showing the inside of a manic disease anus in a pre-PPH operation state, and FIG. 1B is a cross-sectional view showing a post-operation state.
FIG. 2 is a cross-sectional view showing a state in which the anvil of the anastomosis instrument is inserted into the annular excision part sutured with the purse string.
FIG. 3 is a perspective view showing an integrated anoscope according to the first embodiment of the present invention.
FIG. 4 is a perspective view showing a first modification of the integrated anoscope according to the first embodiment of the present invention.
FIG. 5 is a perspective view showing a second modification of the integrated anoscope according to the first embodiment of the present invention.
FIG. 6 is a perspective view showing a mounted state of the separation type cartridge according to the second embodiment of the present invention.
FIG. 7 is a perspective view showing a mounting state of a modified example of the separation type cartridge according to the second embodiment of the present invention.
8A is a front view and FIG. 8B is a cross-sectional view of an anoscope that can be used in combination with the anal dilator according to the third embodiment of the present invention.
9A is a front view and FIG. 9B is a cross-sectional view showing a modification of the anoscope according to the third embodiment of the present invention.
10 is a perspective view for explaining the interpolation method of FIG. 9; FIG.
FIG. 11 is an explanatory diagram showing how to use the anoscope of FIG.
12 is an explanatory view showing a method for using the anoscope of FIG. 4; FIG.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1,101 Cylindrical body part, 2 Handle part, 21 Wing part, 102 Ridge part 3 (53, 54) LED light source, 4 Drawstring suture part, 106 Opening part 5 (50, 52, 55) cartridge, 10 Flange part 11 Tip Part, 12 notch part, 12a notch enlarged part

Claims

A cylindrical part (1) that can be inserted into the anus, and one or more that extends in the radial direction of the cylindrical part from the rear end of the cylindrical part and rotates the cylindrical part inserted into the anus around its axis The cylindrical part (1) comprises a handle part (2), and the cylindrical part (1) includes a distal end part (11) having a diameter part reduced toward the distal end and a distal end part that facilitates insertion into the anus, and the distal end part And a notch (12) for allowing the operator to approach the rectal mucosa deeper than the anal canal in such a manner that the purse can be sutured is cut out. One or a plurality of LED light sources (3) are arranged on the inner surface of the cylindrical body facing the inner surface so as to be able to illuminate the purse sewn region from the notched portion (12), and the notched portion (12) of the cylindrical body portion is provided. In the region that can be close to the purse string suture site, at least the cylindrical body part is further cut away in the circumferential direction, Anoscope, wherein from one round of 3 minutes to 1 lap zone of 2 minutes was extended, that enlarged portion (12a) is formed on.

The LED light source ( 3 ) is disposed on the inner surface of the cylindrical portion facing the notch, and the main LED light source (31) capable of illuminating the irradiation region (1 ′) , which is a stitching position diagonally upward at the front, The anoscope according to claim 1, comprising an auxiliary LED light source (32) capable of illuminating the irradiation region (2 ') above the suturing position from above .

A scale indicating the stitching position in the notch of the body part ( 15 ) The anoscope according to claim 1.

The cylindrical body portion distal end portion of (1) (11) anoscope according to claim 1, wherein the conical or frustoconical.

While the cylindrical part ( 1 ) that can be inserted into the anus and the cylindrical part ( 1 ) has a conical or frustoconical part ( 11a ) that facilitates insertion into the anus at the tip part ( 11 ) , flange portion extending in a trumpet shape in the outer circumferential direction at the rear end has a (10), extends in the cylindrical portion radially from said flange portion (10), the cylindrical body portion that is inserted into the anus (1) about its axis 1 or a plurality of handle portions ( 2 ) to be rotated, and the cylindrical body portion ( 1 ) is cut away from the distal end portion to the one-third circumference of the trunk portion so that the operator can notches for purse can close the back of the rectal mucosa from the tube (12), the cutout portion facing the tubular body inner surface, disposed at the rear position from the purse position, forward and obliquely upper position and a suturing position and illuminable main LED light source an irradiation region (1 ') is (31), the notches of the body portion The anoscope, characterized in that it comprises a scale (15) indicating the suturing position.

The cylindrical inner surface opposed to the cutout portion, anoscope according to claim 5 Symbol mounting, characterized in that illuminable auxiliary LED light source above the purse string suture position around (32) is arranged.

3000 ° color temperature of the main LED light source is from 6000 degrees, according to claim 1 or 5 Symbol mounting anoscope superior red color developability.

One of the anoscope according to claim 2 or 6 Symbol mounting a near-ultraviolet LED having a peak wavelength in 400nm following auxiliary LED light source (32).

At least one part of the inner surface of the cylindrical part facing the notch is mirror-finished, and the light from the LED light source (3) is collected around the purse string suture site located in front of the notch by the curved mirror-finished part. The anoscope according to claim 1 or 5, wherein the anoscope is configured to emit light.

Claim 1 or 5 Symbol mounting anoscope the cylindrical body portion 1 is titanium oxide quotes Ing.

The cylindrical part (1) that can be inserted into the anus, and the cylindrical part extending in the radial direction from the outer periphery of the rear end of the cylindrical part, holding the cylindrical part inserted into the anus, and rotating around the cylindrical axis and at least one handle portion (2) for causing, a attachable to the tubular body inner surface, becomes from a cartridge in which at least one LED (53) is embedded (5), the cylindrical body portion ( 1) has a portion in which the barrel diameter increases at least from the tip toward the rear, and is formed by cutting out a region from a quarter turn to a half turn of the barrel portion of the cylindrical portion. It has a notch (12) , and can access the rectal mucosa at the back of the anal canal through the notch so that the purse can be sutured, and the cartridge is attached to the inner surface of the cylindrical body facing the notch, The LED embedded in Is an anoscope that can illuminate from the purse string suture site to the anal canal.

It has a cylindrical part (101) that can be inserted into the anus, and a collar part (102) that spreads in a trumpet shape from the outer periphery of the rear end of the cylindrical part. From the collar part (102) to the cylindrical part (101) A plurality of forward directional white LEDs (104) are embedded at predetermined intervals in the circumferential direction in the curved joint portion (103) leading to the front or a cylindrical body portion ahead thereof, and at least the cylindrical body portion (101) is made of a transparent resin. The light emission from the LED is formed and guided to the front and the outer periphery through the transparent resin cylinder part, the inside of the anus can be illuminated, and the cylinder part (101) is an extension extending forward of the anal canal line Part (105), and the extension part (105) is an opening that can be accessed by the operator so that the purse string can be sutured from the inner surface of the cylindrical body at the purse string stitching position, or a notch that extends from one quarter to one half of the circumference An anoscope characterized in that (106) is formed .

The cylindrical part (1) that can be inserted into the anus, and the cylindrical part extending in the radial direction from the outer periphery of the rear end of the cylindrical part, holding the cylindrical part inserted into the anus, and rotating around the cylindrical axis And at least one handle portion (2) for causing the cylindrical body portion (1) to have at least a portion whose diameter increases from the tip toward the rear, and to the body portion of the cylindrical portion. A cartridge (5) attached to an anoscope that has at least a quarter-round region cut out and is accessible through the notch (12) to the rectal mucosa at the back of the anal canal in a purse string suture At least one LED light source (53) is provided, and when the cartridge is mounted, the LED light source (53) is located on the inner surface of the cylindrical body facing the notch, and the purse-string suture site or the purse-string suture site from the notch To the anal canal and can be illuminated Cartridge anoscope, characterized in that.

The cartridge main body (50) supporting the LED has a U-shaped cross section (51) curved so as to be attachable to the inner surface of the cylindrical body facing the notch, and the inner surface is mirror-finished as necessary. the cross section U-shaped inner surface (51a) to at least one LED light source (53) is anoscope cartridge of claim 13 Symbol mounting is arranged.

The cartridge body (50) that supports the LED forms a band (52) that can be attached along the inner surface of the cylindrical body facing the notch, and the outer surface is mirror-finished as necessary. the outer surface portion (52a) to at least one LED light source (54) is anoscope cartridge of claim 13 Symbol mounting is arranged.

The front end of the cylindrical part of the anoscope formed of a transparent resin, comprising a cylindrical part (101) that can be inserted into the anus and a buttocks (102) extending radially from the outer periphery of the rear end of the cylindrical part An annular cartridge (55) that can be attached to the annular joint portion extending from the collar portion to the cylindrical body portion or a cylindrical portion in front of the annular joint portion, and embedded with a plurality of LEDs (56) at predetermined intervals in the circumferential direction, An anoscope cartridge that guides light emitted from the LED (56) through the cylindrical part and the cartridge (55) formed of the transparent resin, and enables illumination in the anus.