JP4614283B2 - Object internal treatment device - Google Patents

Description

The present invention relates to an object internal treatment apparatus that performs excision of a target site inside an object, and more particularly to an apparatus for treating a lesion in a patient.

In surgical treatment of a lesion in a patient, it may be necessary to simultaneously introduce a plurality of treatment tools into the incision. In such a case, the length of the incision portion into which a plurality of treatment tools are introduced at the same time can be prevented, and a visual field can be secured even if a plurality of treatment tools are introduced. A central hole formed in the center of the end surface of the flexible tubular main body for inserting an endoscope or a treatment tool, and a endoscope or a treatment tool are formed around the central hole on the end surface of the main body, respectively. There has been proposed an object treatment device including a plurality of peripheral hole portions (Patent Document 1).

However, in the above-described object treatment apparatus, the observation screen by the endoscope may be hidden by the treatment tool, so that the field of view becomes narrow and it may be difficult to see the lesion and its surroundings. For this reason, a flexible cylindrical main body introduced into the object is provided so as to penetrate the main body from the center of the bottom surface arranged on the object side among the bottom surfaces of the main body. A target provided with a central hole part for inserting an endoscope for observing a part, and a plurality of peripheral hole parts provided so as to penetrate the main body part from the side surface of the main body part and for inserting a treatment tool for treating the target part An internal treatment device has been proposed (Patent Document 2).
JP-A-2005-46361 JP-A-2005-204728

However, in the above-described object internal treatment apparatus, since the treatment tool extends from the side surface of the main body, it is necessary to perform a bending operation of the treatment tool in order to make the treatment tool face the extension line of the central axis of the main body. As a result, the operation may become complicated. Furthermore, since it is not easy to control the extension amount of the treatment tool, even if the treatment tool can be bent, it takes time to arrange the treatment tool in a desired position in a desired direction. There was a risk of burdening the patient.

In order to solve the above-described problem, an object internal treatment device of the present invention includes an endoscope for observing a target region on a flexible tubular main body introduced into the object, and an object. An object internal treatment device in which a flexible tubular member having a treatment tool for treating a region is inserted, and supports an endoscope or a treatment tool extending from a main body in a bendable state. with curved section, a bend section is provided on the present body portion, the portion located to the body outer, the endoscope or inner extending from the body portion supporting the treatment置具with bendable state It is characterized by doing.

The bending means includes a hollow guide member swingably supported on the main body , and an operation wire having one end connected to the guide member, and pulls the operation wire to swing the guide member. Accordingly, it is preferable to bend the endoscope or the treatment instrument inserted in the guide member.

Further the main body is provided with a guide portion body Ru tubular member der to be inserted into the said body portion, the endoscope or treatment instrument, may have been inserted into the guide member and the guide body.

The other end of the operation wire is fixed to the pulley shaft, and the operation wire is pulled by rotating the pulley shaft in a predetermined direction, thereby swinging the guide member and inserting the endoscope into the guide member or The treatment tool may be curved.

The object internal treatment device according to the present invention preferably includes an operation lever for rotating the pulley shaft. When the operation shaft is rotated by pulling the operation shaft by moving the operation lever, the guide member is operated. The lever can be swung so as to face a direction corresponding to the direction in which the lever has moved.

According to the present invention, since the endoscope or treatment instrument inserted in the main body is provided with the bending means for extending and supporting from the main body in a bendable state, the treatment tool can be easily bent, and The operation for arranging the treatment tool in an arbitrary direction and in an arbitrary position can be performed in a short time.

<First Embodiment>
Hereinafter, a first embodiment according to the present invention will be described in detail with reference to FIGS. An object internal treatment device 100 according to the first embodiment is for treating a lesion (target site) in a patient's body as an object, and a main body into which an endoscope and a treatment tool are inserted. And a guide member 50 and a first operation wire 60 as a bending means for extending and supporting the endoscope or the treatment tool from the main body in a freely bendable state. Although the first embodiment shows a case where there is one bending means, two or more bending means can be provided.

The main body 10 is a flexible tubular member that is introduced into the body of a patient (object). As shown in FIG. 1, the main body portion 10 includes a distal end portion 11, a bending portion 12, an insertion tube portion 13, and a branching portion 14 connected in order from the front (left side in FIG. 1). The distal end portion 11, the bending portion 12, and the insertion tube portion 13 have circular cross sections having substantially the same diameter, and are connected to each other to form a single cylindrical shape. A branch portion 14 is formed on the rear end surface of the insertion tube portion 13. The front end faces of are connected. The distal end portion 11, the insertion tube portion 13, and the branch portion 14 are made of a hard material, and the bending portion 12 is made of a flexible material. The main body 10 is introduced into the patient from the distal end 11 and can be introduced to a deep part in the body according to the position of the lesion.

A center hole 20 and a peripheral hole 30 are provided in the main body 10. The central hole portion 20 is connected to the distal end portion 11 so as to pass through substantially the center of the axially orthogonal cross section of the bending portion 12, the insertion tube portion 13, and the branching portion 14, and is a stereoscopic view for observing a lesioned portion (target site). An endoscope (endoscope) 21 is inserted. The peripheral hole 30 is provided so as to penetrate the periphery of the central hole 20 in the axial orthogonal cross section of the distal end portion 11, the bending portion 12, the insertion tube portion 13, and the branch portion 14, and treats a lesioned portion. 31 is inserted. The central hole portion 20 is connected to a first opening 14a formed at the rear end of the branch portion 14, and the peripheral hole portion 30 is a second hole formed separately from the first opening 14a at the rear end of the branch portion 14. It continues to the opening 14b. The bending portion 12 and the insertion tube portion 13 may be hollow, and the central hole portion 20 and the peripheral hole portion 30 may penetrate only the tip portion 11 and the branch portion 14. Further, a plurality of peripheral hole portions 30 can be provided around the central hole portion 20, and an endoscope can be inserted according to the content and situation of the treatment in addition to the treatment tool.

At the rear end portion of the branching portion 14, an endoscope operation portion 23 into which an endoscope inserted into the central hole portion 20 is inserted, and a treatment instrument or an endoscope inserted into the peripheral hole portion 30 are inserted. Are connected to each other.

The endoscope operation part 23 is provided with a hole 24 that communicates with the central hole 20 when the front end opening 24 a is connected to the first opening 14 a of the branch part 14. An endoscope insertion port 25 communicating with the rear end of the hole 24 is provided on the side surface of the endoscope operation unit 23. The stereoscopic endoscope 21 is inserted into the endoscope operation unit 23 from the endoscope insertion port 25 and is inserted into the hole 24 and the central hole 20, and the front end is the main body from the distal end surface of the distal end portion 11. It extends outside the part 10.

In addition, a dial operation unit 26 for adjusting the bending state of the bending unit 12 is provided at the rear part of the endoscope operation unit 23. The dial operation unit 26 bends the up / down direction operation knob 26a for bending the bending unit 12 in the up / down direction (up / down direction in FIG. 1), and the bending unit 12 in the left / right direction (perpendicular direction in FIG. 1). The left-right direction operation knob 26b is provided. Operation wires 27a and 27b (FIG. 3) inserted into the bending portion 12 from the endoscope operation portion 23 are bent on the vertical operation knob 26a, and bent from the endoscope operation portion 23 on the left and right operation knob 26b. Operation wires 27c and 27d (FIG. 3) inserted into the portion 12 are connected to each other, and by pulling the vertical operation knob 26a and the horizontal operation knob 26b, that is, by an operation from the outside of the object. The bending portion 12 can be bent in an arbitrary direction.

The bending operation unit 40 includes a flexible tube unit 41, an adjustment tube unit 44, an operation tube unit 45, a pulley unit 48, and an operation lever unit 49 arranged in this order from the branching unit 14 side.
The flexible tube portion 41 includes a hollow front tube portion 42 whose front end portion is connected to the second opening 14b, a front end portion connected to the rear end portion of the front tube portion 42, and an inner diameter larger than that of the front tube portion 42. A hollow rear pipe portion 43 having an outer diameter. When the front end opening 42 a of the front pipe part 42 is connected to the second opening 14 b of the branch part 14, a hole part 41 a that penetrates the front pipe part 42 and the rear pipe part 43 communicates with the peripheral hole part 30.

On the outer peripheral surface of the rear pipe part 43, an adjustment pipe part 44 is fitted. An elastic annular member 44a is slidably attached to the inner surface of the adjustment pipe portion 44 via grease. When the adjustment tube portion 44 is externally fitted onto the outer peripheral surface of the rear tube portion 43 via the annular member 44a, the rear tube portion 43 receives a force that reduces the inner diameter due to the elasticity of the annular member 44a.

In the rear tube portion 43 of the flexible tube portion 41, a large-diameter portion 46a of a hollow flexible tube portion (guide body) that extends concentrically from the front end of the operation tube portion 45 is fitted. . A small-diameter portion 46b having an outer diameter smaller than that of the large-diameter portion 46a and extending concentrically with the large-diameter portion 46a is coupled to the front end of the large-diameter portion 46a. The small diameter portion 46 b is inserted into the hole portion 41 a and the peripheral hole portion 30. A fitting projection 43 a is projected inwardly on the inner surface of the rear end portion of the rear tube portion 43, and a fitting protrusion 46 a 1 is projected outwardly on the outer peripheral surface of the front end portion of the flexible tube portion 46. When the flexible tube portion 46 is inserted into the rear tube portion 43 until the fitting projection portion 46a1 gets over the fitting projection 43a, the fitting projection portion 43a and the fitting projection portion 46a1 come into contact with each other, so that the large-diameter portion 46a is The flexible tube portion 46 is prevented from being detached from the rear tube portion 43 and is rotatable in the flexible tube portion 41 around its axis. Furthermore, when the front end surface of the fitting convex portion 46a1 contacts the front inner wall 43b of the rear tube portion 43, the forward movement of the flexible tube portion 46 is restricted.

An insertion port 47 a for inserting the treatment instrument 31 is formed in the outer peripheral surface of the operation tube base 47. In the flexible tube portion 46 and the operation tube base portion 47, there is provided a hole portion 45 a that is connected to the insertion port 47 a and penetrates to the distal end portion of the flexible tube portion 46. The treatment tool 31 is inserted into the hole 45a from the insertion port 47a, and extends from the distal end surface of the flexible tube portion 46 inserted into the distal hole 11 through the peripheral hole 30.

With the above configuration, the flexible tube portion 46 can be rotated relative to the main body portion 10 by rotating the operation tube portion 45 relative to the flexible tube portion 41 about its axis. . Further, since the inner surface of the rear tube portion 43 is pressed against the outer surface of the fitting convex portion 46a1 due to the elasticity of the annular member 44a, relative movement and relative rotation of the flexible tube portion 46 in the axial direction with respect to the rear tube portion 43 are restricted. The Accordingly, when the adjustment tube portion 44 is expanded in the radial direction against the elasticity of the annular member 44a and the flexible tube portion 46 is moved in the axial direction to release the fitting with the rear tube portion 43, the flexible tube The part 46 can be relatively moved and rotated relative to the rear pipe part 43. When the desired amount of relative movement and relative rotation is finished, if the adjustment tube portion 44 is fitted again to the rear tube portion 43, the relative movement and relative rotation of the flexible tube portion 46 with respect to the rear tube portion 43 is restricted. The directional position and the rotational position can be held.

A first bending wire 61 and a second bending wire 62 having one end (front end portion) coupled to the guide member 50 are inserted into the flexible tube portion 46. The bending wire 62 is inserted into the operation tube base 47, and the other end (rear side end) is fixed to a pulley 48 a disposed in a pulley portion 48 connected to the rear portion of the operation tube base 47. (FIG. 2). Here, the first bending wire 61 and the second bending wire 62 constitute the first operation wire 60. At both ends in the axial direction of the pulley shaft 48a1 of the pulley 48a, one end of each of the two substantially L-shaped connecting plates 49a is screwed in a state where the pulley shaft 48a1 is rotatable about the shaft. An operating lever 49b is fixed to the support plate 49c sandwiched between the other ends of the connecting plate 49a by screws.

As shown in FIG. 3, the guide member 50 disposed at the distal end of the flexible tube portion 46 includes a first guide piece (guide member) 51 and a second guide piece (guide member) through which the treatment instrument 31 can be inserted. 52. The rear end portion 51a of the first guide piece 51 is coupled to the front end of the flexible tube portion 46 by a rivet 55a so as to be swingable about the axis of the rivet 55a (the axis extending in the direction perpendicular to the plane of FIG. 3). Yes. The rear end portion 52a of the second guide piece is coupled to the front end portion 51b of the first guide piece 51 by a rivet 55b so as to be swingable about the axis of the rivet 55b (the axis extending in the direction perpendicular to the plane of FIG. 3). Yes. The guide member 50 may be coupled to the distal end portion 11 instead of the flexible tube portion 46.

As shown in FIGS. 3 and 4, the rear end portion 51 a is a wire that penetrates in the front-rear direction so that the first bending wire 61 and the second bending wire 62 that extend from the flexible tube portion 46 are inserted therethrough. Insertion holes 51a1 and 51a2 are formed. In addition, wire insertion holes 51b1 and 51b2 are provided through the tip 51b at positions corresponding to the wire insertion holes 51a1 and 51a2. Furthermore, wire insertion holes 52a1 and 52a2 are provided in the rear end portion 52a at positions corresponding to the wire insertion holes 51b1 and 51b2. The first bending wire 61 extending from the flexible tube portion 46 is inserted into the wire insertion holes 51a1, 51b2, and 52a2, and the portion extending from the wire insertion hole 52a2 is bonded and fixed to the outer wall surface of the rear end portion 52a. . On the other hand, the second bending wire 62 extending from the flexible tube portion 46 is inserted into the wire insertion holes 51a2, 51b1, and 52a1, and the portion extending from the wire insertion hole 52a1 is bonded and fixed to the outer wall surface of the rear end portion 52a. Is done.

As shown in FIG. 4, the first guide piece 51 is provided with an insertion hole 51 c so as to penetrate in the front-rear direction in order to insert the treatment tool 31 extending from the flexible tube portion 46. Similarly, the second guide piece extends from the flexible tube portion 46 and is inserted into the treatment tool 31 inserted into the insertion hole 51c of the first guide piece 51 so as to extend forward from the front end portion 52b. An insertion hole (not shown) is provided so as to penetrate in the front-rear direction.

According to the above configuration, the first bending wire 61 and the second bending wire 62 are not pulled and the guide member 50 is not bent (the treatment instrument 31 inserted in the guide member 50 is along the front-rear direction). In the extended state), the operation lever 49b extends along the front-rear direction (solid line state in FIG. 1). On the other hand, when the operation lever 49b is moved upward, the pulley 48a fixed to the end of the connecting plate 49a rotates clockwise around the shaft 48a1 (FIG. 1), thereby causing the pulley 48a to move. The fixed first bending wire 61 is pulled (the state of the dotted line in FIG. 1), and as shown in FIG. 5, the wire insertion hole 52a2 side where the front end of the first bending wire 61 is fixed is pulled in the rear end portion 52a. As a result, the first guide piece 51 takes a posture of facing upward. On the other hand, when the operation lever 49b is moved downward, the connecting plate 49a rotates the pulley 48a counterclockwise around the shaft 48a1, thereby pulling the second bending wire 62 fixed to the pulley 48a, Of the rear end portion 52a, the wire insertion hole 52a1 side to which the front end of the second bending wire 62 is fixed is pulled, and as a result, the first guide piece 51 is oriented downward. That is, the first guide piece 51 swings in a posture corresponding to the posture of the operation lever 49b (the movement direction of the operation lever 49b).

Further, by rotating the cylindrical operation lever 49b about the axis of the operation tube portion 45, the flexible tube portion 46 can be rotated about the axis, thereby rotating the guide member 50. Can be moved. Therefore, by operating the operation lever 49b, the pulley 48a and the operation tube portion 45 can be respectively rotated, so that the treatment instrument 31 extending from the guide member 50 can be arranged in an arbitrary direction. Further, even after the treatment instrument 31 is inserted into the operation tube portion 45, the flexible tube portion 46 is moved relative to the flexible tube portion 41 in the axial direction to guide from the distal end portion 11. The extending amount of the member 50 can be arbitrarily set. Due to the above actions and effects, when the lesion treatment in the patient body is treated using the object internal treatment device 100, the burden on the operator can be reduced and the time required for the operation can be shortened. The physical and mental burden received can be reduced.

Next, a modification of the first embodiment will be described with reference to FIGS. In this example, a pulley portion 148 is provided instead of the pulley portion 48, and a guide member 150 is provided instead of the guide member 50. Furthermore, an operation wire 160 including four bending wires 161, a second bending wire 162, a third bending wire 163, and a fourth bending wire 164 is fixed to the guide member 150. The first bending wire 161 and the second bending wire 162 constitute a first operation wire (bending means), and the third bending wire 163 and the fourth bending wire 164 constitute a second operation wire (bending means). . In addition, the same code | symbol is attached | subjected to the same member as the above-mentioned embodiment, and the detailed description is abbreviate | omitted.

As shown in FIGS. 6 and 7, the pulley portion 148 includes a first pulley 148 a and a second pulley 148 b. In the flexible tube portion 46 and the operation tube base portion 47, one end (front end portion) of the first bending wire 161, the second bending wire 162, the third bending wire 163, the first bending wire 162 coupled to the guide member 150, respectively. The four bending wires 164 are inserted, and the other end (rear side end portion) reaches the pulley portion 148. In the pulley portion 148, the rear end portions of the first bending wire 161 and the second bending wire 162 are fixed to the first pulley shaft 148a1 of the first pulley 148a, respectively, and the second pulley shaft 148b1 of the second pulley 148b is connected to the second pulley shaft 148b1. The rear ends of the third bending wire 163 and the fourth bending wire 164 are fixed. At both ends in the axial direction of the pulley shaft 148a1, one end of each of the two generally U-shaped connecting plates 148c is screwed with the pulley shaft 148a1 being rotatable about the shaft. A second pulley shaft 148b1 is clamped at another position of the two connecting plates 148c by screws so as to be rotatable about the shaft. Further, a support plate 149c to which an operation lever 149b is fixed with screws is sandwiched between the other ends of the two connecting plates 148c.

As shown in FIG. 8, the guide member 150 includes a first guide piece (guide member) 151 and a second guide piece (guide member) 152 into which the treatment instrument 31 can be inserted. The rear end portion 151a of the first guide piece 151 is coupled to the tip of the flexible tube portion 46 by a rivet 155a so as to be swingable about the axis of the rivet 155a (the axis extending in the direction perpendicular to the plane of FIG. 8). Yes. The rear end portion 152a of the second guide piece 152 is coupled to the front end portion 151b of the first guide piece 151 by a rivet 155b so as to be swingable about the axis of the rivet 155b (axis extending in the direction perpendicular to the paper surface of FIG. 8). ing. The guide member 150 may be coupled to the distal end portion 11 instead of the flexible tube portion 46.

As shown in FIG. 9, the first bending wire 161, the second bending wire 162, the third bending wire 163, and the fourth bending wire 164 extending from the flexible tube portion 46 are inserted into the rear end portion 151a. Thus, wire insertion holes 151a1, 151a2, 151a3, 151a4 penetrating in the front-rear direction are respectively drilled. In addition, wire insertion holes 151b1 and 151b2 are provided in the distal end portion 151b at positions corresponding to the wire insertion holes 151a3 and 151a4.

As shown in FIG. 10, wire insertion holes 152a1 and 152a2 are provided in the rear end portion 152a at positions corresponding to the wire insertion holes 151b1 and 151b2.

The first bending wire 161 extending from the flexible tube portion 46 is inserted into the wire insertion hole 151a1, and the portion extending from the wire insertion hole 151a1 is bonded and fixed to the outer wall surface of the rear end portion 151a. On the other hand, the second bending wire 162 extending from the flexible tube portion 46 is inserted into the wire insertion hole 151a2, and the portion extending from the wire insertion hole 151a2 is bonded and fixed to the outer wall surface of the rear end portion 151a.

In contrast, after the third bending wire 163 extends from the flexible tube portion 46, the third bending wire 163 is inserted into the wire insertion holes 151a3, 151b1, and 152a1, and the portion extending from the wire insertion hole 152a1 is the portion of the rear end portion 152a. Bonded and fixed to the outer wall. On the other hand, after the fourth bending wire 164 extends from the flexible tube portion 46, the fourth bending wire 164 is inserted into the wire insertion holes 151a4, 151b2, and 152a2, and a portion extending from the wire insertion hole 152a2 is formed on the outer wall surface of the rear end portion 152a. Bonded and fixed.

That is, the four bending wires 161 to 164 are inserted into the rear end portion 151a of the first guide piece 151, but the two bending wires 163 are inserted into the second guide piece 152 (rear end portion 152a). Only 164 is inserted. Therefore, when the operation lever 149b is moved so as to rotate only the second pulley 148b, the bending wires 161 and 162 are not pulled, but only the third bending wire 163 or the fourth bending wire 164 is pulled. The second guide piece 152 swings in a posture corresponding to the posture of the operation lever 149b. In other words, the second guide piece 152 can swing independently of the first guide piece 151 and has a posture facing the same direction as the movement direction of the operation lever 149b.

As shown in FIGS. 9 and 10, the first guide piece 151 and the second guide piece 152 are penetrated in the front-rear direction in order to insert the treatment instrument 31 extending from the flexible tube portion 46. Insertion holes 151c and 152c are provided, respectively.

According to the above configuration, none of the bending wires 161 to 164 are pulled and the guide member 150 is not bent (the treatment instrument 31 inserted in the guide member 50 extends along the front-rear direction). ) (The state of the dotted line in FIG. 11), when the operation lever 49b is moved rearward and obliquely upward in the state along the front-rear direction, the second pulley 148b rotates clockwise about the shaft 148b1 (FIG. 11). Thus, the fourth bending wire 164 fixed to the second pulley 148b is pulled. Further, the first pulley 148a rotates clockwise about the shaft 148a1 (FIG. 11), whereby the first bending wire 161 fixed to the first pulley 148a is pulled. As shown in the solid line of FIG. 1 and FIG. 12, by pulling the first bending wire 161, the wire insertion hole 151 a 1 side of the rear end portion 151 a is pulled toward the main body portion 10 side, and the fourth bending wire 164 is pulled. As a result, the wire insertion hole 152a2 side of the rear end portion 152a is pulled toward the front end portion 151b, and as a result of these operations, the second guide piece 152 moves slightly upward in a state along the front-rear direction. That is, when the operation lever 149b is lifted upward while maintaining the posture along the front-rear direction, the second guide piece 152 is also lifted upward while maintaining the posture along the front-rear direction, similarly to the operation lever 149b.

<Second Embodiment>
Next, a second embodiment of the present invention will be described. In the first embodiment, a guide member 50 or a guide member 150 is provided at the distal end of the flexible tube portion 46 to extend and support the inserted endoscope or treatment tool from the main body portion in a bendable state. However, in 2nd Embodiment, it replaces with the guide member 50 or the guide member 150, and the curve for extending and supporting the endoscope or treatment tool inserted in the main body part from the main body part in a bendable state. Means are provided. In the following description, the bending means which is a characteristic part and the tip portion provided with the bending means will be mainly described.

In the second embodiment shown in FIG. 13, instead of the guide member 50 or the guide member 150 of the first embodiment, link mechanisms 250 and 270 (bending means) are provided at the distal end portion 211 of the main body 210. In the main body part 210, a central hole part 220 is provided so as to penetrate substantially the center of the axially orthogonal cross section of the tip part 211 and the bending part 212. From the curved portion 212 connected to the rear end of the front end portion 211, a peripheral hole portion 230 is provided outside the central hole portion 220 in the axial orthogonal cross section. The treatment tool 231 is inserted into the peripheral hole portion 230, and the treatment tool 231 extending from the peripheral hole portion 230 is inserted into the hole portion 250 a of the link mechanism 250.

The link mechanism 250 is disposed on the outer peripheral surface of the main body cylinder portion 211 a of the distal end portion 211 and includes three long plate-like arm portions 251, 252 and 254. The rear end of the arm portion 251 is attached to the outer peripheral surface of the main body cylinder portion 211a by a pin 256 so as to be swingable. The rear end of the arm 252 is attached to the tip of the arm 251 by a pin 257 so as to be swingable. The arm portion 254 has a distal end attached to the front end of the arm portion 252 by a pin 258 so as to be swingable, and a rear end attached to the outer peripheral surface of the main body cylinder portion 211a by a pin 259 so as to be swingable. .

The distal ends of the first bending wire (bending means) 261 and the second bending wire (bending means) 262 are bonded and fixed to the upper side surface 251a and the lower side surface 251b of the arm portion 251, respectively. The first bending wire 261 and the second bending wire 262 are inserted from the bending portion 212 into the main body portion 210, and the rear end portion is connected to the pulley 48a, for example, so as to be operable by the operator. Further, the arm portion 251 and the arm portion 252 are provided with holes 250a and 250b penetrating parallel to each other along the longitudinal direction so that an endoscope or a treatment instrument can be inserted. In the example shown in FIG. 13, the treatment instrument 231 extending from the peripheral hole 230 is inserted into the hole 250a.

When the first bending wire 261 and the second bending wire 262 are not pulled (initial state) (solid line state in FIG. 13), the link mechanism 250 is folded to form the outer peripheral surface of the main body cylinder portion 211a. Yes. On the other hand, when the first bending wire 261 is pulled, the arm portion 251 swings around the pin 256 so as to be separated from the main body cylinder portion 211a (from the central axis of the main body portion 210). The front end of the is moved upward. Along with this, the arm portion 252 also moves upward so as to be separated from the main body cylindrical portion 211a, and the arm portion 254 swings with the pin 259 as a fulcrum, and its front end moves upward (indicated by the dotted line in FIG. 13). Status). Therefore, by pulling the first bending wire 261, the treatment instrument 231 inserted into the link mechanism 250 is bent and moved to a position away from the main body cylinder portion 211a.

When the second bending wire 262 is pulled in this state, the arm portion 251 swings with the pin 256 as a fulcrum so as to approach the main body cylinder portion 211a, and the front end of the arm portion 251 moves downward. Along with this, the arm portion 252 also moves downward so as to approach the main body cylinder portion 211a, and the arm portion 254 swings with the pin 259 as a fulcrum, and the front end thereof moves downward. When the second bending wire 262 is further pulled, the link mechanism 250 is folded back to the initial state.
The link mechanism 270 is the same in structure and function as the link mechanism 250, and a description thereof will be omitted. In the second embodiment, the two link mechanisms 250 and 270 are provided. However, the number of link mechanisms may be one, or three or more.

Since the treatment instrument 231 can be rotated and moved in the axial direction within the peripheral hole portion 230 and the hole portion 250a, the amount of extension from the distal end portion 211 can be arbitrarily set when combined with the action of the link mechanism 250. It can be set and can be arranged in any direction. Therefore, when treating a lesioned part in a patient body, the burden on the operator is reduced, the time required for the operation can be shortened, and the physical and mental burden received by the patient can be reduced.
Other operations and effects are the same as those in the first embodiment.

Next, a modification of the second embodiment will be described with reference to FIG. In this modification, instead of the link mechanism 250 described above, five link mechanisms (curving means) 350, 370, 380, 390, 400 are equiangularly arranged in the circumferential direction of the distal end portion 311 of the substantially cylindrical main body 310. Provided at intervals. In the main body portion 310 of this modification, a central hole portion 320 is provided so as to penetrate substantially the center of the axial orthogonal cross section of the tip portion 311 and the bending portion 312. From the curved portion 312 connected to the rear end of the distal end portion 311, a peripheral hole portion 330 is provided outside the central hole portion 320 in the axial orthogonal cross section. The treatment tool 331 is inserted into the peripheral hole 330, and the treatment tool 331 extending from the peripheral hole 330 is inserted into the hole 350 a of the link mechanism 350.

The link mechanism 350 constitutes the outer peripheral surface of the distal end portion 311 in a folded state, and includes three long plate-like arm portions 351, 352, and 354. The rear end of the arm portion 351 is swingably attached to the outer peripheral surface of the bending portion 312 by a pin 356. The rear end of the arm portion 352 is swingably attached to the tip end of the arm portion 351 by a pin 357. The arm portion 354 has a distal end attached to the front end of the arm portion 352 by a pin 358 so as to be swingable, and a rear end attached to the outer peripheral surface of the front end portion 311 by a pin 359 so as to be swingable.

A distal end portion 366 of a fluid pressure driving unit (bending unit) 361 is fixed to a side surface of the arm unit 351. As the fluid pressure, for example, water pressure or hydraulic pressure can be used. A rear end portion 365 of the fluid pressure driving unit 361 is connected to a fluid pressure tube 362 inserted in the bending portion 312. The fluid pressure tube 362 is inserted into the main body 310 from the bending portion 312. The fluid pressure tube 362 is connected to, for example, an external pump and an external syringe (both not shown). The fluid pressure tube 362 may be joined to an operation unit (not shown) via a pump or a syringe. Furthermore, the arm part 351 and the arm part 352 are provided with holes 350a penetrating in parallel with each other along the longitudinal direction so that an endoscope or a treatment tool can be inserted. In the example shown in FIG. 14, the treatment tool 331 extending from the peripheral hole 330 is inserted into the hole 350a.

The link mechanism 350 is folded when the fluid pressure tube 362 is filled with fluid (for example, water, oil) but not pressurized (initial state) (solid line state in FIG. 14) from the external pump. Thus, the outer peripheral surface of the tip 311 is formed. On the other hand, when the fluid pressure tube 362 is pressurized by an external pump, the fluid pressure drive unit 361 extends in the axial direction thereof, so that the arm unit 351 swings away from the central axis of the distal end portion 311. The front end of the arm portion 351 moves upward. Along with this, the arm portion 352 also moves upward so as to be separated from the central axis of the tip portion 311, and the arm portion 354 swings around the pin 359 as a fulcrum, and its front end moves upward (FIG. 14). (Dotted line state). Therefore, when the external pump is driven to apply fluid pressure to the fluid pressure drive unit 361, the treatment tool 331 inserted into the link mechanism 350 is curved and moves to a position away from the central axis of the distal end portion 311. .

In this state, when the fluid pressure applied to the fluid pressure drive unit 361 is reduced, the length of the extended distal end portion 366 decreases and the arm portion 351 approaches the central axis of the distal end portion 311. 356 is used as a fulcrum, and the front end of the arm 251 moves downward. Along with this, the arm portion 352 also moves downward so as to approach the central axis of the tip portion 311, the arm portion 354 swings around the pin 359, and its front end moves downward. When the fluid pressure to the fluid pressure drive unit 361 is further reduced, the link mechanism 350 is folded back to the initial state. The link mechanisms 370, 380, 390, and 400 are the same as the link mechanism 350 in terms of configuration and operation, and thus the description thereof is omitted. In this modification, five link mechanisms 350, 370, 380, 390, and 400 are provided. However, the number of link mechanisms may be one, or six or more.

Since the treatment instrument 331 can be rotated and moved in the axial direction within the peripheral hole 330 and the hole 350a, the amount of extension from the distal end 311 can be arbitrarily set when combined with the action of the link mechanism 350. It can be set and can be arranged in any direction. Therefore, when treating a lesioned part in a patient body, the burden on the operator is reduced, the time required for the operation can be shortened, and the physical and mental burden received by the patient can be reduced.

Next, a further modification of the second embodiment will be described with reference to FIG. In this modification, two link mechanisms (bending means) 450 and 470 are provided in place of the link mechanism 250 and the link mechanism 270 described above. In the main body portion 410 of this modification, a central hole portion 420 is provided so as to penetrate substantially the center of the axial orthogonal cross section of the distal end portion 411 and the bending portion 412. From the curved portion 412 connected to the rear end of the distal end portion 411, a peripheral hole portion 430 is provided outside the central hole portion 420 in the axial orthogonal cross section. The treatment tool 431 is inserted into the peripheral hole 430, and the treatment tool 431 extending from the peripheral hole 430 is inserted into the hole 450a of the link mechanism 450.

The link mechanism 450 is disposed on the outer peripheral surface of the main body cylinder portion 411a of the tip end portion 411 and includes three long plate-like arm portions 451, 452, and 454. The rear end of the arm portion 451 is pivotally attached to the outer peripheral surface of the main body cylinder portion 411a by a pin 456. The rear end of the arm portion 452 is pivotally attached to the tip end of the arm portion 451 by a pin 457. The arm portion 454 has a tip end pivotably attached to the tip end of the arm portion 452 by a pin 458 and a rear end portion pivotally attached to the outer peripheral surface of the main body cylinder portion 411a by a pin 459. .

A balloon (bending means) 461 is disposed between the lower surface 451a of the arm part 451 and the main body cylinder part 411a. The balloon 461 is connected to a supply pipe 462 whose opening is inserted into the bending portion 412. The supply pipe 462 is inserted into the main body 410 from the bending portion 412 and connected to, for example, an external pump and an external syringe (both not shown). Further, the arm portion 451 and the arm portion 452 are provided with holes 450a and 450b penetrating parallel to each other along the longitudinal direction so that an endoscope or a treatment instrument can be inserted.

The link mechanism 450 is not supplied with fluid (for example, water) from the supply pipe 462 to the balloon 461. When the balloon 461 is in a deflated state (initial state) (solid line state in FIG. 15), the link mechanism 450 is folded and the main body cylinder portion. The outer peripheral surface of 211a is formed. On the other hand, when an external pump is driven to supply fluid into the balloon 461 via the supply pipe 462 and the balloon 461 is inflated, the arm portion 451 is moved from the main body cylinder portion 411a (from the main body portion 410). The pin 456 is swung around the pin 456 so as to be separated from the center axis, and the front end of the arm 451 moves upward. Along with this, the arm portion 452 also moves upward so as to be separated from the main body cylinder portion 411a, and the arm portion 454 swings around the pin 459 as a fulcrum, and its front end moves upward (indicated by the dotted line in FIG. 15). Status). Therefore, when the balloon 461 is inflated, the treatment instrument 431 inserted into the link mechanism 450 is curved and moves to a position away from the main body cylinder portion 411a.

In this state, when the external pump is stopped and the supply of the fluid into the balloon 461 is stopped, the arm portion 451 swings around the pin 456 as a fulcrum so as to approach the main body cylinder portion 411a. The front end moves downward. Along with this, the arm part 452 also moves downward so as to approach the main body cylinder part 411a, the arm part 454 swings around the pin 459 as a fulcrum, and its front end moves downward. When the arm portion 451 swings downward, the fluid in the balloon 461 is gradually discharged by its own weight, and when all the fluid in the balloon 461 is discharged, the link mechanism 450 is folded back to the initial state.
The link mechanism 470 is the same in structure and function as the link mechanism 450, and therefore the description thereof is omitted. In this modification, two link mechanisms 450 and 470 are provided, but one link mechanism may be provided, or three or more link mechanisms may be provided.

Since the treatment instrument 431 can rotate and move in the axial direction within the peripheral hole 430 and the link mechanism 450a, the amount of extension from the distal end 411 can be arbitrarily set when combined with the action of the link mechanism 450. It can be set and can be arranged in any direction. Therefore, when treating a lesioned part in a patient body, the burden on the operator is reduced, the time required for the operation can be shortened, and the physical and mental burden received by the patient can be reduced.

Next, a further modification of the second embodiment will be described with reference to FIG. In this modification, two lifting mechanisms (bending means) 550 and 570 are provided in place of the link mechanisms 250 and 270 described above. In the main body 510 of this modified example, a central hole 520 is provided so as to penetrate substantially the center of the cross section perpendicular to the axis of the tip 511 and the curved portion 512. From the curved part 512 connected to the rear end of the front end part 511, a peripheral hole part 530 is provided outside the central hole part 520 in the axial orthogonal cross section. The treatment tool 531 is inserted into the peripheral hole 530, and the treatment tool 531 extending from the peripheral hole 530 is inserted into the hole 550a of the lifting mechanism 550.

The elevating mechanism 550 includes a bellows type elevating part 561 that is disposed in the main body cylinder part 511 a of the front end part 511 and can expand and contract in the radial direction of the front end part 511, and a long plate-like support fixed to the upper part of the elevating part 561. A portion 551 and a gear 562 for expanding and contracting the elevating unit 561. The gear 562 is connected to an external drive device (not shown) via the transmission system 563.

In the lifting mechanism 550, the upper surface of the support portion 551 coincides with the outer peripheral surface of the main body cylinder portion 511a when the lifting portion 561 is in the most contracted state (initial state) (solid line state in FIG. 16). On the other hand, when the external drive device is driven and the elevating part 561 is extended radially outward of the tip part 511 via the transmission system 563, the support part 551 is separated from the central axis of the main body part 510. And move upwards.

In this state, when the elevating part 561 is contracted in the radial direction of the tip part 511 by operating an external driving device, the support part 551 moves downward so as to approach the central axis of the main body part 510, When the elevating part 561 contracts most, the elevating mechanism 550 returns to the initial state. Since the lifting mechanism 570 has the same configuration and function as the lifting mechanism 550, the description thereof is omitted. In this modification, two lifting mechanisms, that is, the lifting mechanism 550 and the lifting mechanism 570 are provided. However, the number of lifting mechanisms may be one, or three or more.

Since the treatment instrument 531 can rotate and move in the axial direction within the peripheral hole 530 and the hole 550a, the amount of extension from the distal end 511 can be arbitrarily set when combined with the action of the lifting mechanism 550. It can be set and can be arranged in any direction. Therefore, when treating a lesioned part in a patient body, the burden on the operator is reduced, the time required for the operation can be shortened, and the physical and mental burden received by the patient can be reduced.

Although the present invention has been described with reference to the above embodiment, the present invention is not limited to the above embodiment, and can be improved or changed within the scope of the purpose of the improvement or the idea of the present invention.

It is a figure which shows the structure of the target object internal processing apparatus which concerns on 1st Embodiment of this invention. It is a front view which expands and shows the structure of the pulley part and operation lever part which concern on 1st Embodiment of this invention. It is a partial sectional view showing the composition of the guide member concerning a 1st embodiment of the present invention. FIG. 4 is a partial cross-sectional view taken along line IV-IV in FIG. 3. It is a partial cross section figure which shows the example of an operation state of the guide member which concerns on 1st Embodiment of this invention. It is a figure which shows the structure of the target object internal processing apparatus which concerns on the modification of 1st Embodiment of this invention. It is a front view which expands and shows the structure of the pulley part and operation lever part of the target object internal treatment apparatus of FIG. It is a partial cross section figure which shows the structure of the guide member of the target object inside treatment apparatus of FIG. FIG. 9 is a partial cross-sectional view taken along line IX-IX in FIG. 8. FIG. 9 is a partial cross-sectional view taken along line XX in FIG. 8. It is a figure which shows the example of an operation state of the target object internal treatment apparatus of FIG. It is a partial cross section figure which expands and shows the guide member of FIG. It is a figure which shows the structure of the target object internal processing apparatus which concerns on 2nd Embodiment of this invention, (a) is the front view seen from the front, (b) is a side view. It is a figure which shows the structure of the target object internal processing apparatus which concerns on the modification of 2nd Embodiment of this invention, (a) is the front view seen from the front, (b) is a side view. It is a figure which shows the structure of the target object internal processing apparatus which concerns on the further modification of 2nd Embodiment of this invention, (a) is the front view seen from the front, (b) is a side view. It is a figure which shows the structure of the target object internal processing apparatus which concerns on the further modification of 2nd Embodiment of this invention, (a) is the front view seen from the front, (b) is a side view.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Main-body part 11 Tip part 12 Bending part 21 Stereoscopic endoscope (endoscope)
31 treatment tool 46 flexible tube (guide body)
48 Pulley 50 Guide member 51 First guide piece (guide member)
52 Second guide piece (guide member)
60 1st operation wire 61 1st bending wire 62 2nd bending wire 100 Object internal treatment apparatus 148 Pulley part 150 Guide member 151 1st guide piece (guide member)
152 Second guide piece (guide member)
250 Link mechanism (bending means)
350 Link mechanism (bending means)
450 Link mechanism (bending means)
550 Lifting mechanism (bending means)

Claims (6)

An endoscope for observing a target site and a flexible tubular member including a treatment tool for treating the target site are inserted into a flexible tubular main body introduced into the target object. An object internal treatment device, comprising:
A bending means for extending and supporting the endoscope or the treatment tool from the main body in a bendable state;
The bending means is provided in the main body, and supports the endoscope or the treatment tool extending from the main body in a bendable state by a portion located outside the main body. The object internal treatment device. The bending means includes a hollow guide member swingably supported by the main body portion , and an operation wire having one end connected to the guide member, and pulling the operation wire from the main body portion. The target object internal treatment apparatus according to claim 1, wherein the extended guide member is swung, whereby the endoscope or the treatment instrument inserted in the guide member is bent. Further, the body portion includes a tubular member Der Ru guide body which is inserted into the said body portion, the endoscope or the treatment instrument, the claims are inserted into the said guide member and the guide body 2. The object internal treatment device according to 2.   The bending means is a link mechanism provided on the outer periphery of the distal end portion of the main body, and is inserted into the link mechanism by operating the link mechanism so as to be separated from the central axis of the main body. The object internal treatment apparatus according to claim 1, wherein the endoscope or the treatment tool is curved.   The other end of the operation wire is fixed to a pulley shaft, and the operation wire is pulled by rotating the pulley shaft in a predetermined direction, whereby the guide member is swung and inserted into the guide member. The object internal treatment apparatus according to claim 2 or 3, wherein the endoscope or the treatment tool is bent.   An operation lever that rotates the pulley shaft is provided, and when the operation shaft is rotated by pulling the operation wire by pulling the operation wire, the guide member has a direction corresponding to a direction in which the operation lever moves. 6. The object internal treatment device according to claim 5, wherein the object internal treatment device swings so as to face.

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