JP4590192B2 - Endoscope system - Google Patents

Description

  The present invention relates to an endoscope system including an endoscope overtube that is externally or transanally inserted into a body cavity and externally fitted to an endoscope that observes the inside of the body cavity.

  As a procedure for inserting a medical endoscope into a deep digestive tract cavity in a body cavity, for example, the small intestine, there are a case where it is inserted orally and a case where it is inserted transanally. In any case, since the intestinal tract is bent flexibly, even if the insertion part of the endoscope is pushed out of the body cavity, the force is not easily transmitted to the distal end part of the insertion part, and it is difficult to insert it deeply. is there.

  Therefore, an endoscope tube is provided at the distal end portion of the endoscope so that the insertion portion of the endoscope can be smoothly inserted into a complicatedly bent intestine, and an overtube (externally inserted into the endoscope insertion portion) A double-balloon endoscope system in which an overtube balloon is provided at the tip of a sliding tube is known (for example, see Patent Document 1).

  This is because after inserting the overtube that serves as a guide when inserting the endoscope insertion portion into the deep part to the deep part of the intestine, the overtube balloon is inflated to fix the overtube balloon to the intestinal tract. In this state, by retracting the overtube, the intestinal tract is bent to insert the endoscope insertion portion deeper.

Also, when the overtube balloon is inflated and the overtube is fixed to the intestinal tract, the balloon is made of a soft material such as latex so as not to place a burden on the intestinal tract and the internal pressure of the balloon is measured. Thus, there is also known one that can control the pressure (see, for example, Patent Documents 2 and 3).
JP 11-290263 A JP 2001-340462 A JP 2002-301019 A

  Patent Documents 1 to 3 are all endoscopes for intestinal tract observation in which an endoscope balloon is fixed to a distal end portion of an endoscope insertion portion. The overtube that guides the endoscope to the intestinal tract is formed of a flexible synthetic resin material so that the endoscope insertion portion and the overtube are pushed forward and deeper in the axial direction while relatively moving forward and backward in the axial direction. I have to. As a general endoscopic insertion procedure, air is supplied into the intestine via an air supply channel or the like built in the insertion part of the endoscope, the intestinal tract is expanded, and the overtube is confirmed while checking the lumen. And the insertion part of the endoscope is pushed forward.

  However, it is not easy to remove the air supplied into the body cavity except at the endoscope tip having the suction port. When the intestinal tract is over-aired, the burden on the patient increases and the overtube and There are problems that the insertion resistance of the insertion portion is increased, and that control of the intestinal tract, such as removing the bowel, becomes difficult.

  The present invention has been made paying attention to the above circumstances, and its purpose is to allow the patient to be degassed through the lumen of the overtube when the inside of the intestinal tract is overspiated. Another object of the present invention is to provide an endoscope system including an endoscope overtube that can reduce the burden on the endoscope and improve the insertability of the overtube and the insertion portion.

In order to achieve the above object, according to a first aspect of the present invention, an endoscope includes an endoscope overtube that is externally inserted into an insertion portion of an endoscope and guides the insertion portion into a body cavity. In the system, a plurality of communication holes configured so that a gap is formed between an inner surface of the body of the overtube and an outer surface of the insertion portion, and communicated with the inner cavity of the peripheral wall of the overtube body provided with a said elastically deformable hood and the balloon on the distal end of the body of the over-tube, when the outer diameter of the insertion portion of the endoscope to a, the inner diameter of the hood and B, a ≧ B And an elastically deformable cap is provided at the proximal end of the overtube main body, and when the outer diameter of the insertion portion of the endoscope is A and the inner diameter of the cap is C, A ≧ C, The proximal end of the overtube body Characterized in that a deaerating passage for degassing in communication with the lumen of the body of Bachubu.

A second aspect of the present invention is characterized in that the plurality of communication holes of the first aspect are arranged in a staggered manner in the axial direction of the overtube body .

According to a third aspect of the present invention, the overtube main body according to the first aspect is formed of a multi-lumen tube, and has an air supply conduit communicating with the balloon in a thick portion thereof, and the communication hole is disposed in the thick portion. It is characterized by.

  According to the present invention, when the inside of the intestinal tract is over-aired, it can be degassed through the lumen of the overtube, reducing the burden on the patient and improving the insertability of the overtube and the insertion portion. There is an effect that it can be improved.

  Embodiments of the present invention will be described below with reference to the drawings.

  1 to 3 show a first embodiment, FIG. 1 is a side view of the entire double balloon endoscope, FIGS. 2A and 2B are longitudinal side views of an overtube, and FIG. FIG.

  As shown in FIG. 1, for example, an endoscope 1 for a small intestine has an elongated flexible insertion portion 2, and a distal end configuration (distal end side) of the insertion portion 2 via a bending portion 3. Part 4 is provided. An operation unit 5 is provided at the proximal end (base end side) of the insertion unit 2, and an angle operation knob 6 is provided in the operation unit 5. Furthermore, the operation part 5 is connected to a universal cord 8 having a connector 7 at the distal end.

  The distal end configuration portion 4 of the insertion portion 2 is provided with an observation optical system (not shown) such as an illumination optical system and a solid-state imaging device, and an endoscope balloon 9 is provided at the distal end portion of the insertion portion 2. Yes. This endoscope balloon 9 communicates with an air supply line (not shown) built in the insertion portion 2, is inserted into the universal cord 8 through the operation portion 5, and is connected to an air supply connection port 10 provided in the connector 7. Since it is connected and the ventilation duct is not exposed to the outside, there is an effect that it does not interfere with the procedure. Further, the air supply connection port 10 provided in the connector 7 of the endoscope 1 is connected to an air supply source (not shown) via an air supply tube (not shown).

  The insertion portion 2 is provided with an endoscope overtube 11 that is extrapolated to the insertion portion 2. An overtube balloon 13 is held at the distal end of the overtube body 12, and a grip is held at the proximal end. A portion 14 is provided.

  As shown in FIG. 2, the overtube main body 12 is formed of a multi-lumen tube formed of a synthetic resin material, and supplies air to the lumen 15 that passes through the insertion portion 2 of the endoscope 1 and the overtube balloon 13. An air supply line 16 is provided over the axial direction. The overtube balloon 13 has a cylindrical shape with openings at both ends, and both ends of the overtube balloon are bound by a binding thread 17 and are airtightly fixed in a state of being fitted onto the overtube body 12. The air supply line 16 is connected to an air supply source (not shown) via an air supply tube 16a.

  Further, a metal ring 18 is fixed to the inner peripheral surface at the distal end of the overtube balloon 13 at the distal end of the overtube body 12, and a hood 19 made of rubber or a synthetic resin material is fixed to the metal ring 18. Has been. The outer peripheral surface of the hood 19 has a tapered surface that gradually becomes smaller in diameter toward the distal end, and the inner diameter of the distal end portion 19 a is in contact with the outer peripheral surface of the insertion portion 2 of the endoscope 1. That is, when the outer diameter of the insertion portion 2 of the endoscope 1 is A and the inner diameter of the hood 19 is B, the hood 19 and the insertion portion 2 having a relationship of A ≧ B are inserted with the diameter of the hood 19 enlarged. Part 2 is extrapolated. Therefore, when the endoscope overtube 11 is pushed along the insertion portion 2 of the endoscope 1, there is no resistance and there is no possibility of involving the mucous membrane.

  In addition, a plurality of communication holes 20 are formed in the peripheral wall of the overtube main body 12 at a desired interval in the axial direction, and the outside of the overtube main body 12 communicates with the lumen 15. Further, the gripping portion 14 provided at the proximal end of the overtube main body 12 is provided with an opening portion 21 communicating with the lumen 15, and the opening portion 21 is provided with a base 22. The base 22 is connected by, for example, a suction pump. A cap 23 made of rubber or the like is attached to the proximal end surface of the grip portion 14, and an opening 24 that is in close contact with the outer peripheral surface of the insertion portion 2 of the endoscope 1 is provided in the cap 23. That is, when the outer diameter of the insertion portion 2 of the endoscope 1 is A and the inner diameter of the opening 24 of the cap 23 is C, the cap 23 and the insertion portion 2 having a relationship of A ≧ C are expanded on the cap 23 side. Thus, it is extrapolated to the insertion portion 2.

  Therefore, in a state where the insertion portion 2 of the endoscope 1 is inserted through the overtube body 12, the distal end of the lumen 15 of the overtube body 12 is closed by the hood 19 and the proximal end is closed by the cap 23. In this state, the outer peripheral portion of the overtube body 12 is in communication with the lumen 15 through the plurality of communication holes 20.

  Next, the operation of the double balloon endoscope will be described.

  FIG. 3 shows a technique for orally inserting a double balloon endoscope into the small intestine and observing the inner wall of the intestinal tract, where a is the esophagus, b is the stomach, and c is the small intestine. First, the overtube main body 12 is inserted into the insertion portion 2 of the endoscope 1, and the air in the endoscope balloon 9 and the overtube balloon 13 is extracted to be in a contracted state.

  Next, as shown in FIG. 3A, the insertion portion 2 of the endoscope 1 is inserted into the body cavity from the patient's mouth, and the bending portion 3 is operated by operating the angle operation knob 6 of the operation portion 5. The insertion part 2 is inserted into the small intestine c through the esophagus a and the stomach b. And when the front-end | tip structure part 4 of the insertion part 2 of the endoscope 1 passes the duodenum, for example, a remote controller etc. are operated and an air supply source is driven.

  Then, as shown in FIG. 3B, when the endoscope balloon 9 is inflated by supplying air to the endoscope balloon 9 via the air supply connection port 10, the endoscope balloon 9 is The distal end component 4 of the endoscope 1 is fixed to the small intestine c while being pressed against the inner wall of the small intestine c. In this state, when the gripping portion 14 of the overtube main body 12 is gripped and the overtube main body 12 is advanced along the insertion portion 2, the distal end of the overtube main body 12 becomes the rear end portion of the endoscope balloon 9. Led up to.

  Next, as shown in FIG. 3C, the remote controller or the like is operated again to supply air from the air supply source to the overtube balloon 13 through the air supply conduit 16. Accordingly, the overtube balloon 13 is inflated and pressed against the inner wall of the small intestine c, and the distal end of the overtube body 12 is fixed. In this state, when the gripping portion 14 of the overtube main body 12 is gripped and the overtube main body 12 is retracted integrally with the insertion portion 2 of the endoscope 1, it is inserted together with the overtube main body 12 by the tensile force. Since the radius of curvature of the portion 2 is large and is in a substantially straight state, it is possible to shorten the small intestine c by removing excessive bending of the small intestine c.

  Next, as shown in FIG. 3D, when the endoscope balloon 9 is deflated by extracting air, when the insertion portion 2 of the endoscope 1 is pushed toward the deep portion of the small intestine c, the insertion portion 2 is inserted toward the deep part of the small intestine c while being guided by the overtube body 12.

  And when the front-end | tip structure part 4 of the insertion part 2 of the endoscope 1 advances to the desired position of the small intestine c, as shown in FIG.3 (E), it is for endoscopes through the air supply connection port 10 again. Air is supplied to the balloon 9 to inflate the endoscope balloon 9 and press the endoscope balloon 9 against the inner wall of the small intestine c to fix the distal end constituting portion 4.

  In this state, the overtube balloon 13 is deflated by removing the air, and the overtube body 12 is advanced along the insertion portion 2 by grasping the grasping portion 14 of the overtube body 12. When the distal end of the overtube main body 12 reaches the rear end of the endoscope balloon 9, the overtube balloon 13 is expanded again as shown in FIG.

  By repeating this operation, the distal end constituting portion 4 of the endoscope 1 can be inserted to the deep portion of the small intestine c. Further, in the case of the above-described procedure, an air supply gas is supplied to the small intestine c from an air supply port provided in the distal end configuration portion 4 of the endoscope 1, and the small intestine c is inflated so that the inner wall of the small intestine c A space is maintained between the outer wall of the overtube body 12 and the outer wall. Then, the overtube main body 12 is pushed forward toward the deep portion, or the overtube balloon 13 is inflated and fixed to the inner wall of the small intestine c, and is pulled toward the hand side to shorten and shorten the small intestine c.

  However, when the amount of the gas supplied from the endoscope 1 becomes excessive and the inside of the small intestine c is in an excessively supplied state, the air accumulated on the hand side from the distal end constituting portion 4 of the endoscope 1 having the suction port. It is not easy to remove, and the burden on the patient is large. When pushing the overtube body 12 deeper, or when pulling the overtube body 12 toward the hand and shortening the small intestine c, When the gas is full, this becomes resistance, and the small intestine c may become stiff due to the air supply gas and may not be free.

  Therefore, when suction is performed from the opening 21 provided in the grip portion 14 of the overtube main body 12, the air supply gas in the small intestine c is sucked into the opening 21 from the communication hole 20 via the lumen 15 of the overtube main body 12. The Therefore, the excessive air supply state in the small intestine c can be immediately eliminated, and the burden on the patient can be reduced. Furthermore, when pushing the over-tube main body 12 deeper, or pulling the over-tube main body 12 toward the proximal side to shorten the small intestine c, the resistance can be reduced, and the small intestine c is also free. Therefore, resistance of relative movement of the overtube main body 12 and the insertion portion 2 of the endoscope 1 is reduced, and operability can be improved.

  Furthermore, if the air supply gas is sucked from the opening 21 in the state where the overtube balloon 13 is inflated, the air supply gas only at the proximal end of the endoscope overtube 11 can be sucked, and the intestine to be controlled can be controlled. Only the air supply gas can be removed, which is more effective.

  Although FIG. 3 shows a procedure for orally inserting a double balloon endoscope into the small intestine, the same basically applies when the double balloon endoscope is inserted transanally into the small intestine through the large intestine. It is.

  FIG. 4 shows a second embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals, and description thereof is omitted. FIG. 4 is a longitudinal side view of the overtube body. In this embodiment, a plurality of communication holes 20 provided in the peripheral wall of the overtube body 12 are arranged in a staggered manner in the axial direction. If the plurality of communication holes 20 of the overtube body 12 are provided in an uneven manner, the strength of the overtube body 12 itself is unevenly reduced, but the strength reduction is prevented by arranging the communication holes 20 in a zigzag shape in the axial direction. In addition, it is possible to suck the air supply gas in the intestine with a good balance. Further, when the communication holes 20 are provided in a biased manner, the inner walls of the small intestine c may be blocked, but by arranging the communication holes 20 in a staggered manner in the axial direction, the communication holes 20 may be blocked and cannot be sucked. Can be prevented.

  FIG. 5 shows a third embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted. FIG. 5 is a cross-sectional view of the overtube body. In this embodiment, the overtube body 12 is a multi-lumen tube 25 made of thermoplastic resin, and the insertion portion 2 of the endoscope 1 is inserted into the multi-lumen tube 25. The air supply conduit 27 is used to supply air to the inner lumen 26 and the overtube balloon 13. In addition, a thick portion 25a is formed in a part of the multi-lumen tube 25 to be eccentric, and an air supply conduit 27 is provided in the thick portion 25a. Therefore, the air supply conduit 27 is not crushed and blocked, and a constant conduit can always be maintained.

  Further, a plurality of communication holes 28 communicating with the inner lumen 26 are provided in the thick portion 25 a in the vicinity of the air supply duct 27. If the communication hole 28 is provided in the overtube body 12, the strength of the overtube body 12 itself is reduced. However, by providing the communication hole 28 in the thick portion 25 a of the multi-lumen tube 25, the strength of the overtube body 12 is reduced. Can be prevented.

  FIG. 6 shows a fourth embodiment, and the same components as those in the first embodiment are denoted by the same reference numerals and description thereof is omitted. FIG. 6 is a longitudinal side view of the overtube body. In this embodiment, when the outer diameter of the insertion portion 2 of the endoscope 1 is A, the inner diameter of the hood 19 is B, and the inner diameter of the opening 24 of the cap 23 is C, A <B and C <B. A gap g is formed between the outer surface of the portion 2 and the inner surface of the overtube body 12. When the opening area of the gap g is D and the opening area E of all the communication holes 20 is set, D <E.

  However, since the gap g between the insertion portion 2 and the overtube main body 12 is smaller than that of the communication hole 20, air can be sucked from the communication hole 20 when sucked from the opening 21. As a result, air flows as shown by the arrow, and deaeration is possible. As a result, friction is reduced.

  According to each of the embodiments, the following configuration is obtained.

  (Appendix 1) In an endoscope system including an overtube for an endoscope that is extrapolated to an insertion portion of an endoscope and guides the insertion portion into a body cavity, the distal end of the overtube body can be elastically deformed An endoscope system, wherein a hood and a balloon are provided, and A ≧ B, where A is the outer diameter of the insertion portion of the endoscope and B is the inner diameter of the hood.

  (Supplementary note 2) The endoscope system according to supplementary note 1, wherein the hood is formed of an elastic material, and an outer peripheral surface has a tapered surface tapered toward a tip portion.

  (Supplementary note 3) The endoscope according to supplementary note 1, wherein the overtube main body has a plurality of communication holes communicating with the lumen on a peripheral wall thereof, and the lumen communicates with a vacuum suction source. system.

  Note that the present invention is not limited to the above-described embodiment as it is, and can be embodied by modifying the constituent elements without departing from the scope of the invention in the implementation stage. Moreover, various inventions can be formed by appropriately combining a plurality of constituent elements disclosed in the embodiment. For example, some components may be deleted from all the components shown in the embodiment. Furthermore, you may combine suitably the component covering different embodiment.

1 is an overall side view of a double balloon endoscope showing a first embodiment of the present invention. (A) (B) is a vertical side view of the overtube of the embodiment. The same embodiment is shown, (A)-(F) is an operation explanatory view of a double balloon type endoscope. The vertical side view of the overtube main body of 2nd Embodiment of this invention. The cross-sectional view of the overtube main body of 3rd Embodiment of this invention. The vertical side view of the overtube main body of 4th Embodiment of this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Endoscope, 2 ... Insertion part, 3 ... Bending part, 4 ... Tip structure part, 6 ... Operation part, 9 ... Endoscope balloon, 13 ... Overtube main body, 13 ... Overtube balloon, 15 ... Lumen, 16 ... Air supply line, 19 ... Hood, 20 ... Communication hole

Claims (3)

In an endoscope system provided with an endoscope overtube that is extrapolated to an insertion portion of an endoscope and guides the insertion portion into a body cavity.
A gap is formed between the inner side surface of the body of the overtube and the outer surface of the insertion portion, and a plurality of communication holes are provided in the peripheral wall of the overtube body to communicate with the lumen. ,
An elastically deformable hood and balloon are provided at the distal end of the body of the overtube ;
When the outer diameter of the insertion portion of the endoscope is A and the inner diameter of the hood is B, A ≧ B ,
And providing an elastically deformable cap at the proximal end of the overtube body,
When the outer diameter of the insertion portion of the endoscope is A and the inner diameter of the cap is C, A ≧ C,
The endoscope system according to claim 1, further comprising a deaeration passage for deaeration communicating with a lumen of the body of the overtube at a proximal end of the overtube body . The endoscope system according to claim 1, wherein the plurality of communication holes are arranged in a staggered manner in the axial direction of the overtube main body . The over-tube main body is made of a multi-lumen tube, according to claim which has a duct feeding said balloon and communicating with the thick portion, the communication hole, characterized in that disposed on the thick portion The endoscope system according to 1.

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