JP4813082B2 - Endoscope system - Google Patents

Description

  The present invention relates to an endoscope system including an endoscope having an elongated and flexible insertion portion and an insertion tool having an insertion portion having a bending function.

  2. Description of the Related Art Endoscopic treatment apparatuses that perform treatment by introducing a treatment tool into a body cavity through a flexible introduction guide tube under observation by an endoscope are known. The introduction guide tube used in this endoscopic treatment apparatus is also called a channel tube.

For example, in the endoscope treatment apparatus disclosed in Japanese Patent Laid-Open No. 2000-33071, a bending portion is provided in the vicinity of the distal end of the introduction guide tube (corresponding to the insertion tool of the present invention), and the bending portion can be bent by the proximal side operation portion. An introduction guide tube with a bending function has been proposed. In this endoscopic treatment apparatus, a treatment tool is guided into a body cavity through a plurality of introduction guide tubes with a bending function, and the treatment tool is operated by bending the bending portion of the introduction guide tube under endoscopic observation. Various treatments can be performed.
JP 2000-33071 A

  However, in the endoscopic treatment device of Patent Document 1, an endoscopic image displayed on the screen of the display device is observed, and the bending tool is instantaneously operated to appropriately operate the treatment instrument. It was difficult. Specifically, an operator observing an endoscopic image of the display device attempts to perform a bending operation to bend the bending portion of the introduction guide tube, for example, downward and place the treatment tool near the treatment site. In this case, the treatment tool displayed on the screen of the display device may move in an unexpected direction.

  This is because there is no correspondence between the vertical direction of the endoscope capturing the endoscopic image displayed on the screen and the bending direction of the introduction guide tube guided into the body cavity. . Therefore, when performing a hand operation for bending the bending portion of the introduction guide tube, it is necessary to check the moving direction by once performing a hand operation for checking the bending direction of the bending portion, which is troublesome.

  The present invention has been made in view of the above circumstances, and is excellent in usability in that an optimum operation can be smoothly performed by observing the distal end portion of the insertion tool insertion portion inserted into the body cavity or the vicinity of the bending portion. The objective is to provide an endoscope system.

An endoscope system according to the present invention includes an observation unit for observing the inside of a body cavity, and includes an endoscope having an insertion part that can be inserted into a body cavity, and an insertion tool provided in parallel with at least a part of the insertion part. An insertion tool provided with an insertion portion, a first bending portion disposed on the distal end side in the insertion tool insertion portion, and a proximal end side of the first bending portion in the insertion tool insertion portion In the outer periphery of the boundary part of the 2nd bending part and the 1st bending part and the 2nd bending part in the insertion tool insertion part which can be visually recognized by the observation means , the 1st bending part and the 1st A curved boundary portion notification index formed so that the boundary between the curved portion and the second curved portion can be visually recognized, and the first curved portion provided in the first curved portion of the insertion tool insertion portion visible by the observation means. A first bending direction notification index indicating a bending direction of the bending portion of the And a second bending direction notification index indicating a bending direction of the second bending portion provided in the second bending portion of the insertion tool insertion portion visible by means. .

  According to this configuration, it is possible to instantaneously determine the bending function of the bending portion by checking the notification means provided in the insertion tool insertion portion by the observation means.

  ADVANTAGE OF THE INVENTION According to this invention, the endoscope system excellent in the usability which can perform optimal operation smoothly is implement | achieved by observing the front-end | tip part of the insertion tool insertion part inserted in the body cavity, or the curved part vicinity.

Embodiments of the present invention will be described below with reference to the drawings.
1 to 40 relate to one embodiment of the present invention, FIG. 1 is a perspective view for explaining the configuration of an insertion tool, FIG. 2 is a view for explaining a treatment tool channel provided in an insertion tool insertion portion of the insertion tool, FIG. 3 is a diagram illustrating an example of the configuration of an endoscopic treatment apparatus, FIG. 4 is a cross-sectional view illustrating a suture instrument in which a suture member is disposed at a distal end portion, and FIG. 5 is a diagram illustrating the relationship between the suture instrument and the suture member. FIG. 6 is a diagram for explaining a state where observation and treatment are performed by the endoscope treatment apparatus, FIG. 7 is a diagram showing an example of an endoscopic image displayed on the monitor screen, and FIG. The figure which shows the other example of the endoscopic image displayed on the screen of FIG. 9, FIG. 9 is the figure which shows the state as which the character which is a curve direction notification parameter | index is displayed, FIG. 10 is the character comprised by the convex part, etc. FIG. 11 is a diagram illustrating a suturing member, FIG. 12 is a diagram illustrating a lock member, and FIG. 3 is a view for explaining the action of the lock member, FIG. 14 is a view for explaining the state where the lock member is dropped into the stomach, FIG. 15 is a view for explaining the state where the puncture needle is opposed to the mucous membrane, and FIG. FIG. 17 is a diagram illustrating a state in which the needle is pierced into the mucosa, FIG. 17 is a diagram illustrating a state in which the back mucosa is gripped by the gripping portion, and FIG. FIG. 19 is a diagram for explaining a state in which the engaging member is dropped to the side, FIG. 19 is a diagram for explaining a state in which the suturing device is removed from the endoscope, and FIG. 20 is a diagram for explaining a state in which the suture is gripped by the fastening tool. FIG. 21, FIG. 21 is a diagram for explaining a state in which the thread gripping portion of the fastener and the sheath of the fastener are moved, FIG. 22 is a diagram showing a state in which two mucous membranes are closely attached and an ulcer is covered, and FIG. FIG. 24 is a diagram for explaining another configuration example of the endoscope treatment apparatus, and FIG. FIG. 25 is a diagram for explaining another configuration example and its operation example of the endoscope treatment apparatus, and FIG. 26 is another configuration example and another action example for the endoscope treatment apparatus. FIG. 27 is a diagram for explaining another example of the configuration of the endoscope treatment apparatus, and FIG. 28 is a diagram showing the arrangement state of the horizontal swing table and the vertical swing table in the treatment instrument insertion channel. FIG. 29 is a view for explaining the operating state of the treatment instrument when each swing base is swung, FIG. 30 is a view for explaining the configuration of the distal end side of the insertion portion of the suturing device, and FIG. 31 is a suturing device. FIG. 32 is a diagram for explaining a state in which the lock member disposed in the inner hole of the puncture needle is dropped into the stomach, and FIG. 33 is a diagram for explaining the structure of the hand operating unit. FIG. 34 is a view for explaining a state in which the arranged engaging member is dropped into the stomach, and FIG. 34 is sutured by a fastening tool. FIG. 35 is a diagram for explaining another configuration example of the suturing member, FIG. 36 is a diagram for explaining a state in which the suturing member having another configuration is accommodated in the suturing device, and FIG. 37 is another configuration. FIG. 38 is a diagram for explaining another configuration example of the insertion tool, FIG. 39 is a diagram for explaining another configuration example of the insertion tool, and FIG. 40 is a diagram for explaining the procedure for performing ulcer occlusion using the suture member of FIG. It is sectional drawing in the Q surface of 39.

  As shown in FIG. 1, the insertion tool 1 includes an elongated insertion tool insertion portion 11 and an operation portion 12 that also serves as a grip portion. The insertion tool insertion portion 11 of the insertion tool 1 is introduced into the body cavity together with an endoscope insertion portion of an endoscope described later.

  The insertion tool insertion portion 11 is configured by connecting a distal end portion 13, a bending portion 14, and a long and flexible flexible tube portion 15 in order from the distal end side. The distal end surface of the distal end portion 13 is provided with a treatment instrument opening 13a through which a treatment instrument such as a grasping forceps 30 is led out.

  The bending portion 14 according to the present embodiment includes a plurality of bending portions, specifically, a first bending portion 16 and a second bending portion 17. The first bending portion 16 is provided on the distal end side of the insertion tool insertion portion 11, and connects a plurality of bending pieces (see reference numeral 24 in FIG. 2), for example, in the up-down direction indicated by the arrow a and in the left-right direction indicated by the arrow b. On the other hand, it is configured to be bendable.

  On the other hand, the second bending portion 17 is connected to the base end portion of the first bending portion 16 via a jumper member (not shown), and a plurality of bending pieces are connected to each other, for example, as shown by the arrows a. It is configured to be bendable with respect to the direction. In addition, the bending part 14 provided in the insertion tool insertion part 11 of the insertion tool 1 is not limited to multiple, One may be sufficient.

The operation unit 12 includes a main bending operation unit 18 and a sub bending operation unit 19 provided on the proximal side from the main bending operation unit 18.
The main bending operation section 18 includes a first bending section up / down operation knob (hereinafter abbreviated as a first bending up / down knob) 18a, and a first bending section left / right operation knob (hereinafter abbreviated as a first bending left / right knob). 18b, a first bending portion up / down direction fixing lever (hereinafter abbreviated as a fixing lever (not shown)), and a first bending portion left / right direction fixing knob (hereinafter abbreviated as a fixing knob) 18d; For example, operation buttons 20a and 20b for remotely operating, for example, an operation mode or an operation state of the cautery device described later are provided. The operation button 20a is an incision / coagulation operation switch, and the operation button 20b is a mode changeover switch for switching between an incision state and a coagulation state.

  The first bending up / down knob 18a is a knob for bending the first bending portion 16 in the up / down direction. The first bending left / right knob 18b is a knob for bending the first bending portion 16 in the left / right direction. The fixed lever is a lever that fixes the first bending up / down knob 18a, which is rotatable, at a desired rotation position, and holds the first bending portion 16 in a vertically bent state. The first fixing knob 18d is a knob that fixes the first bending left and right knob 18b, which is rotatable, at a desired rotation position, and maintains the left and right bending state of the first bending portion 16.

  Reference numeral 21 denotes a treatment instrument insertion port into which a treatment instrument such as a grasping forceps 30 is inserted. The treatment instrument insertion port 21 communicates with a treatment instrument opening 13a provided at the distal end portion 13 constituting the insertion instrument insertion section 11 via a treatment instrument insertion channel tube (see reference numeral 22 in FIG. 2 described later). Yes. The grasping forceps 30 includes a grasping portion 31 that can be freely opened and closed on the distal end side. The grasping forceps 30 is provided on the hand side so that the grasping portion 31 can be opened and closed by advancing and retracting a slider 32 that is a holding portion on which the operator's fingers are placed. It has become.

On the other hand, the auxiliary bending operation section 19 has a second bending section up / down operation lever (hereinafter abbreviated as a second bending up / down lever) 19a and a second bending section up / down fixing knob (hereinafter abbreviated as a second fixing knob). (Not shown). The second bending up / down lever 19a is a lever for operating the second bending portion 17 to bend in the up / down direction. The second fixed knob is a lever that fixes the second bending up / down lever 19a, which is turnable, at a desired turning position, and holds the second bending portion 17 in a vertically bent state.
Reference numerals 27U and 27L are bending direction notification indicators which are one of notification means described later, and reference numeral 28 is a curved boundary portion notification index (hereinafter abbreviated as a boundary notification indicator) which is one of notification means described later. ).

  As shown in FIG. 2, a treatment instrument channel 11a through which a grasping forceps 30 as a treatment instrument is inserted along the longitudinal axis direction is provided at a substantially central portion of the insertion instrument insertion portion 11 of the insertion instrument 1. The distal end portion 13 is formed with a through hole 13b constituting the treatment instrument channel 11a. That is, in this insertion tool 1, the treatment tool channel 11a for inserting the treatment tool is provided as the only built-in object.

  The treatment instrument channel 11 a includes a through hole 13 b provided in the distal end portion 13, and a treatment instrument insertion channel tube (hereinafter, abbreviated as a treatment instrument tube) 22 communicated with the through hole 13 b and the treatment instrument insertion port 21. And is mainly composed of. The distal end portion of the treatment instrument tube 22 is communicated with the through hole 13b via a metal distal end side connecting tube 23, and the proximal end portion is disposed on the treatment instrument insertion port 21 via a metal proximal end side connecting tube (not shown). It is communicated to. As a result, the treatment instrument inserted from the treatment instrument insertion port 21 is led out from the treatment instrument opening 13 a provided in the distal end portion 13 through the treatment instrument tube 22.

  The bending portion 14 including the first bending portion 16 and the second bending portion 17 provided in the insertion tool insertion portion 11 is covered with a net tube 25 and a bending rubber 26. The net tube 25 integrally covers, for example, the first curved portion 16 and the second curved portion 17, and the curved rubber 26 further covers the net tube 25.

  And in the insertion tool 1 of this embodiment as shown in FIG. 1, the curved part provided in the insertion tool insertion part 11 by displaying on the screen of the display apparatus which is an endoscope image display means. There are provided a bending direction notification indicator 27 and a boundary portion notification indicator 28 that enable easy determination of the 14 bending functions.

  The bending direction notification index 27 is provided on, for example, the distal end portion 13, the first bending portion 16, and the second bending portion 17 constituting the insertion tool insertion portion 11. In contrast, the boundary notification indicator 28 is provided at the boundary between the first bending portion 16 and the second bending portion 17.

  The distal end portion 13 and the first bending portion 16 are notified as a bending direction notification index 27, a bending upward direction notification index for notifying a bending upward direction, a bending downward direction notification index for notifying a bending downward direction, and a bending left direction. A curved left direction notification index and a curved right direction notification index for notifying the curved right direction are provided.

  Specifically, the curved upward direction notification index is, for example, a white white straight line 27U provided on the side circumferential upper surface along the longitudinal axis. The curved downward direction notification indicator is, for example, a red red straight line 27D provided along the longitudinal axis on the lower surface of the side periphery. The curved left direction notification indicator is, for example, a green green straight line 27L provided on the left side surface along the longitudinal axis. The curved right direction notification indicator is, for example, a blue blue straight line 27R provided on the right side surface along the longitudinal axis.

Further, the second bending portion 17 is provided with an upward bending direction notification indicator for notifying the upward bending direction and a downward bending direction notification indicator for notifying the downward bending direction as the bending direction notification indicator 27. The curved upward direction notification indicator is, for example, a white white straight line 27U provided on the side circumferential upper surface along the longitudinal axis in the same manner as the first bending portion 16, and the curved downward direction notification indicator is aligned with the longitudinal axis on the lateral circumferential lower surface. For example, the red line 27D is provided along the red line 27D.
On the other hand, the boundary part notification indicator 28 provided at the boundary part is, for example, a white outer peripheral line provided in white and circumferentially.
In addition, the line | wire used as a parameter | index is drawn on the outer surface of the front-end | tip part 13, the 1st bending part 16, the 2nd bending part 17, and the flexible tube part 15 with the paint containing the fluorescent paint which has biocompatibility, for example. Yes. Moreover, you may make it provide the clearance gap part which notifies a bending direction in a boundary part notification parameter | index.

As shown in FIG. 3, the insertion tool 1 configured as described above is configured as an endoscope treatment apparatus 3 that is one of the endoscope systems in combination with the endoscope 2.
The insertion tool insertion portion 11 of the insertion tool 1 is provided integrally with the endoscope insertion portion 4 via an external tube 5 provided in parallel along the endoscope insertion portion 4 of the endoscope 2. It is like that.

  The endoscope insertion portion 4 of the endoscope 2 is configured by connecting a distal end portion 4a, a bending portion 4b, and a flexible tube portion 4c in order from the distal end side. An observation window 4d, an illumination window 4e, a treatment instrument opening 4f, and the like are provided on the distal end surface. The bending portion 4b is bent in the vertical and horizontal directions, for example, by operating a bending knob (not shown) of the endoscope operation portion 6 provided on the proximal end side of the endoscope insertion portion 4. Yes. Reference numeral 6a denotes a treatment instrument insertion port of the treatment instrument insertion channel. The treatment instrument insertion port 7 and the treatment instrument opening 4f are communicated with each other through a treatment instrument insertion channel tube (not shown). Therefore, by inserting the treatment tool from the treatment tool insertion port 7, the treatment tool is led out from the treatment tool opening 4f.

  The external tube 5 includes a connection fixing portion 5a and a channel tube (hereinafter abbreviated as a tube body) 5b formed of a flexible tube body. The connection fixing part 5a is provided with a first insertion hole 5c through which the endoscope insertion part 4 is inserted, and a second insertion hole 5d through which the insertion tool insertion part 11 of the insertion tool 1 and other treatment tools are inserted. It has been. One end of the tube body 5b is fixed so as to communicate with the second insertion hole 5d. The connection fixing portion 5 a is disposed on the distal end side portion of the flexible tube portion 15. The tube body 5b and the flexible tube portion 4c of the endoscope insertion portion 4 are arranged in parallel with the endoscope insertion portion 4 by a tape member 8 provided at a predetermined interval, for example.

  The insertion tool insertion portion 11 is inserted through the proximal end opening 5e of the tube body 5b. By inserting the insertion tool insertion portion 11 up to a predetermined position of the tube body 5b, the insertion tool insertion portion 11 is inserted into the endoscope 2. An endoscope treatment apparatus 3 in a state where the insertion tool 1 is assembled to the endoscope insertion portion 4 is configured. And in this embodiment, the 2nd bending part 17 provided in the insertion tool insertion part 11 is made into the state protruded from the front end side of the 2nd insertion hole 5d.

  Accordingly, by operating a bending knob (not shown) of the endoscope operation unit 6, the bending portion 4b provided in the endoscope insertion unit 4 is bent to move the distal end portion 4a to a desired position. It is done. On the other hand, by operating the first bending up / down knob 18a and the first bending left / right knob 18b provided in the operation section 12 of the insertion tool 1, the first bending section 16 provided in the insertion tool insertion section 11 is bent. Be made. Further, the second bending portion 17 provided in the insertion tool insertion portion 11 can be bent by operating the second bending up / down lever 19a. That is, the distal end portion 13 of the insertion tool insertion portion 11 can be moved to a desired position by appropriately operating the first bending up / down knob 18a, the first bending left / right knob 18b, and the second bending up / down lever 19a. Yes.

  It should be noted that the endoscope 2 has an external device as a light source device 7a for supplying illumination light to the endoscope 2, control of the endoscope 2, and signal processing of image signals obtained by the endoscope 2. A video processor 7b that performs video recording, a monitor 7c that is a display device that receives a video signal output from the video processor 7b and displays an endoscopic image, a VTR deck 7d that records the endoscopic image, and a video disc 7e. And a video printer 7f that prints out the observation image.

  A universal cord 6c having an endoscope connector 6b at the end extends from the side of the operation unit 6 of the endoscope 2. The endoscope connector 6b is detachably connected to the light source device 7a. An electric cable 9 is detachably connected to the endoscope connector 6b via a first connector 9a. The other end of the electric cable 9 is provided with a second connector 9b that is detachably connected to the video processor 7c. A plurality of signal cables 10a, 10b, 10c, and 10d extend from the video processor 7c, and are connected to a monitor 7c, a VTR deck 7d, a video disk 7e, and a video printer 7f, respectively. The image of the observation region irradiated by the illumination light is imaged on a solid-state image pickup device (not shown) built in the distal end portion 4a, converted into an electric signal, and then transmitted to the video processor 7c. The video processor 7c It is converted into a video signal and displayed as an endoscopic image on the screen 7g of the monitor 7c.

With reference to FIGS. 3 to 37, the action of the endoscope treatment apparatus 3 including the insertion tool 1 assembled through the external tube 5 provided in the endoscope insertion portion 4 of the endoscope 2 will be described. explain.
As shown in FIG. 3, in an endoscope treatment apparatus 3 including an endoscope 2 in which an external tube 5 is arranged in parallel to the endoscope insertion portion 4 and an insertion tool 1, first, external attachment is performed for observation. The endoscope insertion portion 4 in which the tubes 5 are arranged side by side is introduced into the body cavity. At this time, the endoscope insertion unit 4 is introduced toward the target observation site while observing the endoscope image displayed on the screen 7g of the monitor 7c.

  When the endoscope insertion portion 4 reaches the target observation site, for example, the stomach, the bending knob provided in the endoscope operation portion 6 is appropriately operated to display the stomach wall on the screen 7g of the monitor 7c. An endoscopic image is displayed for observation. During this observation, for example, if an ulcer is found, the insertion tool insertion portion 11 of the insertion tool 1 is introduced into the stomach via the external tube 5 in order to close the ulcer. By displaying the insertion tool insertion portion 11 in the endoscopic image displayed on the screen 7g of the monitor 7c, it is confirmed that the insertion tool insertion portion 11 has been introduced into the stomach.

  Next, for example, the grasping portion 31 of the grasping forceps 30 is led out into the stomach via the treatment instrument channel 11a provided in the insertion instrument 1, and in the treatment instrument insertion channel provided in the endoscope 2. A suturing device provided with a suturing member to be described later is introduced.

  As shown in FIGS. 4 and 5, the suturing device 40 includes a soft sheath 41 that constitutes an insertion portion, a puncture needle 42 that is slidably disposed within the sheath 41, and a slide that is slidable within the puncture needle 42. The push-out member 43 is arranged. The distal end of the puncture needle 42 is configured as a sharp point that is formed to be inclined at an acute angle so as to facilitate penetration of the living tissue. A slit 42 a is formed at the tip of the puncture needle 42.

  A lock member 47 provided on one end side of the suture thread 46 constituting the suture member 45 is disposed at a predetermined position on the distal end side in the sheath 41 constituting the suture instrument 40. An engaging member 48 provided on the other end side of the suture thread 46 constituting the suture member 45 is arranged at a predetermined position on the distal end side in the puncture needle 42 constituting the suture instrument 40. On the rear side of the engaging member 48, the distal end portion of the pushing member 43 is disposed. Note that one end side of the suture thread 46 extends from the distal end surface of the sheath 41 to the outside.

Here, the operation of the endoscope treatment apparatus 3 will be described.
First, as shown in FIG. 6, the bending knob provided in the endoscope operation portion 6 is appropriately operated to cause the bending portion 4b to bend as shown by arrows d and e, so that the distal end portion 4a is formed in a desired manner. Move to position. Further, the grasping portion 31 of the grasping forceps 30 is led out from the treatment instrument opening 13 a provided at the distal end portion 13 of the insertion instrument insertion portion 11. Thereafter, the first bending up / down knob 18a, the first bending left / right knob 18b, or the second bending up / down lever 19a is appropriately bent, and the first bending portion 16 and the second bending portion 17 are indicated by arrows a, b, c. So that it bends. As a result, the grip portion 31 is moved and the living tissue near the ulcer is gripped, and a treatment for covering the ulcer portion with the biological tissue gripped by the grip portion 31 is performed.

  At this time, the surgeon observes the endoscopic image displayed on the screen 7g of the monitor 7c, and determines the direction in which the first bending portion 16 or the second bending portion 17 is bent. Specifically, as shown in FIG. 7, the orientation of the grip portion 31 displayed on the screen 7 g and the distal end portion 13, the first bending portion 16, and the second bending portion 17 of the insertion tool insertion portion 11 are provided. The bending direction notification indicator 27 is visually observed. Further, in addition to the grip portion 31 and the bending direction notification index 27 displayed on the screen 7g as shown in FIG. 8, the boundary portion notification for notifying the boundary portion between the first bending portion 16 and the second bending portion 17 is provided. The index 28 is visually confirmed. Then, the bending operation direction is determined, and the knobs 18a, 18b or the lever 19a are operated to cause the first bending portion 16 or the second bending portion 17 to bend in a desired direction. As a result, the grasping portion 31 led out from the treatment instrument opening 13a of the distal end portion 13 constituting the insertion instrument insertion section 11 is instantaneously and accurately moved to the target site as intended by the operator.

  As described above, the upper coloring portion extending along the longitudinal axis, the lower coloring portion indicating the bending direction of the distal end portion, the first bending portion, and the second bending portion constituting the insertion tool insertion portion of the insertion tool, By appropriately providing the direction coloring part, left direction coloring part and right direction coloring part, the endoscope image captured by the observation optical system of the endoscope introduced into the body cavity is displayed on the monitor screen and inserted. By confirming the bending direction index provided on the tool, the positional relationship between the observation site and the insertion tool insertion part, the twisted state of the insertion tool insertion part, etc. can be instantly and accurately determined, and the bending of the bending part can be determined. The operation can be performed reliably. Thereby, the operation of the treatment instrument led out into the body cavity via the insertion instrument can be performed smoothly.

  Further, in addition to the bending direction notification indicator, a boundary portion notification indicator indicating the boundary portion is provided at the boundary portion between the first bending portion and the second bending portion constituting the insertion tool insertion portion of the insertion tool. Then, by confirming the boundary portion notification index on the monitor screen, the positional relationship between the observation site and the insertion tool insertion portion can be determined more accurately, and the bending operation of the bending portion can be performed reliably. Specifically, for example, when a bending operation is performed on a target site in a body cavity to bring the distal end of the insertion tool closer to a desired direction, the operator visually recognizes the boundary portion notification index in addition to the bending direction notification index. By doing so, it is possible to easily grasp the positional relationship between the curved portions. Therefore, the surgeon can instantly grasp the positional relationship between the position of each bending portion and the target site. Therefore, the surgeon can easily determine which bending portion and how to perform the bending operation so that the target portion can be approached in a desired posture, and the operability can be improved. As a result, the first bending portion or the second bending portion provided in the insertion tool insertion portion of the insertion tool is appropriately bent so that the treatment tool guided through the insertion tool can be operated more smoothly. .

  In the present embodiment, as the bending direction notification index indicating the bending direction of the bending portions such as the first bending portion 16 and the second bending portion 17 in the insertion tool insertion portion 11, colored portions having different colors for each direction are provided. It shows the configuration to provide, but instead of changing the color of the colored part for each direction, the type of line, for example, solid line, dotted line, number of lines, etc. is changed for each direction to indicate the bending direction, or illumination light A reflecting plate that reflects the light may be provided to indicate the bending direction.

  Further, instead of providing a colored portion or a reflecting plate, letters such as alphabets “U”, “D”, “R”, “L” indicating the bending direction are printed, for example, by printing, the tip portion 13, the boundary portion 28, the first curve. You may make it provide in the middle part of the part 16, and the middle part of the 2nd bending part 17. FIG. A bending direction notification indicator for the second bending portion 17 may be provided on the flexible tube portion 15. As shown in FIG. 9, by confirming the characters displayed on the screen 7g by visual observation, the bending operation of the bending portion can be performed more quickly and reliably. Of course, in addition to the colored line etc., the structure which provides a character may be sufficient. Then, instead of the alphabet, the bending direction may be indicated by Arabic numerals or symbols such as “◯”, “×”, “Δ”, “□”.

  Further, instead of providing the bending direction notification indicator and the boundary portion notification indicator by coloring or printing, the concave portion or the convex portion is provided in the middle of the distal end portion 13, the boundary portion 28, the first bending portion 16, and the second bending portion 17. You may make it the structure provided in the surface of a part. For example, the convex portion is formed by applying an adhesive. The concave portion is provided by pre-processing when the endoscope is manufactured. As a result, not only the observation with normal light but also the observation with fluorescence and the observation with narrow band light can be performed by visually checking the bending direction notification index and the boundary portion notification index as shown in FIG. The bending operation of the part can be performed reliably.

Here, the suture member 45 used for ulcer occlusion will be described.
First, the suturing member 45 will be described with reference to FIGS. 11 to 13.
As shown in FIG. 11, the engaging member 48 is formed of a substantially cylindrical member, for example. One end of the suture thread 46 inserted into the living tissue is locked near the center of the engagement member 48 in the longitudinal direction. The engaging member 48 is engaged and disposed so as to come into contact with the living tissue over a wide area in the longitudinal direction during suturing. This prevents the suture thread 46 from falling out of the living tissue. Therefore, the engagement member 48 disposed at one end of the suture thread 46 is called a T-shaped anchor or T-bar because of its function and shape.

  On the other hand, the lock member 47 functions as a retainer for the suture thread 46 after the stitching. As shown in FIGS. 11 and 12, the lock member 47 includes a base portion 47a in which a hole 47d through which the suture thread 46 is inserted is formed at a substantially central portion, and two base portions 47a bent at a predetermined angle with respect to the base portion 47a. It is comprised by the bending pieces 47b and 47c. The flat portion of the base 47a having the hole 47d is configured as a contact surface that contacts the living tissue.

  The other end side of the suture thread 46 pulled out from the engagement member 48 and passed through the hole 47d provided in the base portion 47a is sandwiched between the end portions 47e and 47f of the bent pieces 47b and 47c as shown in FIG. Yes. That is, the gap between the end portion 47e of the bent piece 47b and the end portion 47f of the bent piece 47c is set to be equal to or smaller than the diameter of the suture thread 46. Accordingly, the end portions 47e and 47f come into contact with the suture thread 46 in a state where the suture thread 46 is disposed between the end portions 47e and 47f. Reference numeral 47g denotes a folding line that is folded in a mountain.

  When the suture thread 46 is disposed between the end portion 47e of the bent piece 47b and the end portion 47f of the bent piece 47c, the distance between the end portion 47e and the end portion 47f shown in FIG. 13 is separated. Thereafter, the suture thread 46 is passed from the base 47a side toward the end portions 47e and 47f. Then, the force which tries to adjoin each other generate | occur | produces in the bending pieces 47b and 47c. As a result, when the suture thread 46 is pulled as shown by the arrow f, the end portions 47e and 47f also move in the direction of the arrow f, the interval between the end portions 47e and 47f is reduced, and the suture thread 46 is tightened. The movement of the lever suture 46 is stopped. That is, the end portions 47e and 47f function as a lock mechanism.

  In this way, the lock member 47 reduces the distance between the end portion 47e and the end portion 47f when a force that separates the engagement member 48 and the lock member 47 from the suture thread 46 is applied. Acts to lock movement. Therefore, when a force is applied to move the lock member 47 from the suture target to the other end side of the suture thread 46 in the arrow g direction in a state where the suture target is sandwiched between the lock member 47 and the engagement member 48. The end portions 47e and 47f tighten the suture thread 46 to prevent the lock member 47 from moving in the arrow g direction.

  On the other hand, when the suture thread 46 is pulled in the direction of the arrow g, the end portions 47e and 47f move in a direction in which they are separated from each other. As a result, the tightening of the suture thread 46 is released. That is, it acts to allow the suture thread 46 to move in the direction in which the engagement member 48 and the lock member 47 are brought closer. In other words, when it is desired to press the lock member 47 against the suture target, that is, when the lock member 47 is to be moved in the direction of the arrow f, the end portion 47e and the end portion 47f are pulled by pulling the suture thread 46 in the direction of the arrow g. The lock member 47 can be moved in the direction of the arrow f by releasing the tightening of the suture thread 46 after the interval is released.

  In the present embodiment, the lock member 47 having an outer shape larger than that of the engagement member 48 can be used by disposing the lock member 47 on the distal end side of the puncture needle 42. Further, since the base portion 47a of the lock member 47 is arranged so as to be parallel to the longitudinal axis direction of the puncture needle 42, the base portion 47a that comes into contact with the living tissue even in the limited accommodation space of the suture instrument 40. Area, that is, the area of the contact surface can be secured to the maximum. Furthermore, one end of the suture thread 46 is fixed to the engaging member 48, and the end is connected to a ball shape with the end treatment. The end treatment plays a role of preventing the lock member 47 from falling off and a role of facilitating gripping by other forceps, and is applied after the lock member 47 is slidably inserted. As another example of the terminal processing, the ends of the suture thread 46 are tied in a ring shape, or the ends are melted to form a lump.

Next, an example of a technique for ulcer occlusion by the endoscope treatment apparatus 3 will be described.
First, the operator appropriately operates a bending knob provided in the endoscope operation unit 6 to display an endoscope image of the target observation site on the screen 7g of the monitor 7c. Then, the treatment instrument opening 4f of the endoscope insertion portion 4 is placed opposite to the target observation site. Here, the surgeon visually confirms the straight line 27U, 27D, 27L, 27R or the boundary portion notification index 28 which is the bending direction notification index 27 displayed on the screen 7g. Accordingly, the bending operation direction is appropriately determined, and the knobs 18a, 18b or the lever 19a of the insertion tool 1 are operated, and the first bending portion 16 or the second bending portion 17 is bent. Then, the grip part 31 led out from the treatment tool opening 13a of the distal end part 13 constituting the insertion tool insertion part 11 is arranged to face the target site.

  After that, as shown in FIG. 14, the surgeon performs a hand operation such as a bending operation and a twisting operation, and the grasping portion 31 led out from the distal end portion 13 of the insertion tool insertion portion 11, the front side in the vicinity of the ulcer portion 36. The mucous membrane 37 is gripped and lifted. In addition, the operator performs an operation of leading the sheath 41 of the suture instrument 40 inserted and disposed in the treatment instrument insertion channel provided in the endoscope insertion portion 4 from the distal end of the endoscope into the body cavity, An operation of moving the puncture needle 42 toward the distal end side in the sheath 41 is performed. As a result, the lock member 47 disposed in the sheath 41 is dropped into the stomach from the treatment instrument opening 4f.

  Next, as shown in FIG. 15, the puncture needle 42 is exposed from the distal end of the sheath 41 so that the distal end faces the mucous membrane 37. Then, the puncture needle 42 is further moved to the distal end side to puncture the mucous membrane 37. Then, as shown in FIG. 16, the puncture needle 42 penetrates the mucous membrane 37. Here, the sheath 41 is moved to the distal end side and the mucosa 37 punctured by the puncture needle 42 is held by the suturing device 40.

  Next, the surgeon performs a hand operation, and grips, for example, the mucous membrane 38 on the back side of the ulcer portion 36 by the grip portion 31 led out from the distal end portion 13 of the insertion tool insertion portion 11 as shown in FIG. Thereafter, as shown in FIG. 18, the mucous membrane 38 is pulled toward the hand side by the operator's hand operation. When the mucous membrane 38 is pulled to a desired position by the operator's hand operation, the operator performs an operation of moving the puncture needle 42 further to the distal end side. As a result, the puncture needle 42 penetrates the mucous membrane 38. Here, the operator performs an operation of moving the pushing member 43 to the distal end side, and drops the engaging member 48 arranged in the inner hole of the puncture needle 42 to the back side of the mucous membrane 38.

  Next, as shown in FIG. 19, the suturing device 40 is removed from the treatment instrument insertion channel. Thereafter, the grasping forceps 30 is removed from the insertion tool 1. As a result, the engagement member 48 and the lock member 47 of the suturing member 45 are left in the desired positions.

  Next, as shown in FIG. 20, the thread gripping portion 33 and the push-out sheath 34 of the fastening tool 30A, which is the treatment tool, are led out into the stomach via the treatment tool insertion channel of the endoscope 2. Then, the suture part 46 is bent by the operator's hand operation, and the suture thread 46 extending from the lock member 47 remaining in the stomach is held by the thread holding part 33.

  When the surgeon confirms that the suture thread 46 is gripped by the thread gripping portion 33 on the screen 7g, the operator pulls the thread gripping portion 33 of the fastening tool 30A toward the hand side as indicated by the arrow h as shown in FIG. On the other hand, the sheath 34 is moved to the distal end side as indicated by an arrow i. As a result, a force that presses the lock member 47 toward the suture target works. Then, a gap between the end portion 47e and the end portion 47f is opened, the tightening to the suture thread 46 is released, and the lock member 47 moves in the arrow f direction shown in FIG.

  At this time, the engaging member 48 connected to the suture thread 46 is pulled, and the relative distance between the mucous membrane 38 and the mucous membrane 37 with which the engaging member 48 abuts is reduced. Then, as shown in FIG. 22, the mucous membrane 38 and the mucous membrane 37 are sutured so as to cover the ulcer portion 36.

  At this time, the base 47 a of the lock member 47 comes into surface contact with the mucous membrane 37. Therefore, the locking member 47 exhibits a certain anchor effect without biting into the mucous membrane 37. Further, when a force to move the mucous membrane 38 and the mucous membrane 37 away from the locking member 47 is applied, the gap between the end portion 47e and the end portion 47f is closed and a tightening force is applied to the suture thread 46. This reliably prevents the suture thread 46 from moving and the two mucous membranes 38 and the mucosa 37 that have been sewn apart from each other from being separated.

  In the present embodiment, the mucous membrane 38 on the back side from the ulcer part 36 is drawn toward the hand side and the puncture needle 42 is pierced, but the mucous membrane that covers the ulcer part 36 together with the mucous membrane 37 is limited to the back side. Instead, it may be a mucous membrane located, for example, on the left side of the ulcer portion 36.

  Further, by appropriately operating the insertion tool, the mucous membrane 37 may be the left mucous membrane with respect to the endoscope insertion axis of the ulcer portion 36, the mucous membrane 38 may be the right mucosa, and the ulcer portion 36 may be closed by the left and right mucous membranes.

  Furthermore, in the endoscope treatment apparatus 3 of the present embodiment, the suturing device 40 and the fastening tool 30A are inserted into the treatment instrument insertion channel of the direct-view type endoscope 2, and the treatment instrument channel 11a of the insertion instrument 1 is inserted. Although the grasping forceps 30 are inserted, the endoscope treatment apparatus may be configured using an endoscope described later.

  In the endoscope 2A in the endoscope treatment apparatus 3A shown in FIG. 23, a forceps raising base (not shown) for swinging the treatment tool in the direction of the arrow k is disposed in the treatment tool insertion channel 4g. By this, for example, the grasping forceps 30 are inserted into the treatment instrument insertion channel 4g of the endoscope 2A, while the suture instrument 40 and the fastening tool 30A are sequentially inserted into the treatment instrument channel 11a of the insertion instrument 1, for example. Treatment can be performed while observing the ulcer portion 36 and the like from the side.

  Further, in the endoscope treatment apparatus 3B shown in FIG. 24, the endoscope 2B is a side view type. Thus, for example, the grasping forceps 30 are inserted into the treatment instrument insertion channel (not shown) of the endoscope 2B, and the suture instrument 40 and the fastening tool 30A are sequentially inserted into the treatment instrument channel 11a of the insertion instrument 1. Thus, the treatment can be performed while observing the ulcer portion 36 and the like from above.

  Furthermore, in the endoscope treatment apparatus 3C shown in FIGS. 25 and 26, the endoscope 2C is a direct-view type, and is provided with two treatment instrument insertion channels 4g. In the endoscope treatment apparatus 3C, for example, the first grasping forceps 35A is led out from the treatment instrument channel 11a of the insertion instrument 1, and the suture instrument 40 is introduced from one treatment instrument insertion channel 4g provided in the endoscope 2C. Is derived, and the second grasping forceps 35B is derived from the other treatment instrument insertion channel 4g.

  Thus, as shown in FIG. 25, one end side of the mucous membrane 38 is gripped by the gripping portion 31B of the gripping forceps 35B led out from the treatment tool insertion channel 4g, while the gripping led out from the treatment tool channel 11a of the insertion tool 1 is held. The other end side of the mucous membrane 38 is grasped by the grasping portion 31A of the forceps 35A. In this state, for example, the bending state of the insertion tool 1 is changed. Then, the mucous membrane 38 is pulled by the two grasping forceps 35A and 35B. Therefore, when the puncture needle 42 is punctured into the mucous membrane 38, the mucosa 38 is prevented from escaping from the puncture needle 42, and the puncture of the puncture needle 42 into the mucosa 38 can be performed reliably and smoothly.

  In addition, as shown in FIG. 26, the grasping portion 31A of one grasping forceps 35A is obtained by repeatedly performing a hand operation such as a twisting operation in addition to an operation of grasping the mucous membranes 37 and 38 using the two grasping forceps 35A and 35B. To hold the mucous membranes 37 and 38 in close contact with each other. Thereafter, the puncture needle 42 is punctured into the mucous membranes 37 and 38 at once. Thereby, the mucous membrane 37 and the mucous membrane 38 can be punctured by the puncture needle 42 at a time.

  Further, in the endoscope treatment apparatus 3D shown in FIG. 27, the endoscope 2D is a direct-view type and includes two treatment instrument insertion channels 4g. As shown in FIG. 28, a horizontal swing base 4h is provided in one treatment instrument insertion channel 4g, and a vertical swing base 4i is provided in the other treatment instrument insertion channel 4g. The horizontal swing base 4h is swingable in the direction of arrow m, and the vertical swing base 4i is swingable in the direction of arrow n.

  Therefore, by swinging the horizontal swing base 4h, for example, the suturing device 40 placed on the horizontal swing base 4h is moved in the left-right direction as shown by an arrow m1 in FIG. On the other hand, by swinging the vertical swing base 4i, for example, the grasping forceps 35B placed on the vertical swing base 4i is moved up and down as shown by an arrow n1 in FIG. .

  Thus, for example, as shown in FIG. 27, the grasping forceps 35A led out from the treatment instrument channel 11a of the insertion instrument 1 grips one end side of the mucous membrane 38, for example, while the vertical swing table 4i of the endoscope 2D The other end side of the mucous membrane 38 is grasped by grasping forceps 35B led out from the disposed treatment instrument insertion channel 4g. In this state, the mucous membrane 38 is pulled by performing an operation of pulling back the grasping forceps 35A to the proximal side.

  Thereafter, fine adjustment of the tension of the mucous membrane 38 is performed by swinging the vertical swing base 4i, and fine adjustment of the puncture position of the puncture needle 42 is performed by swinging the horizontal swing base 4h. . After fine adjustment is completed, the puncture needle 42 is punctured toward the target puncture position of the mucous membrane 38. Then, the puncture needle 42 is smoothly punctured into the mucous membrane 38.

That is, according to the endoscopic treatment device 3D of the present embodiment, after the mucous membrane 38 is gripped by the gripping portions 31A and 31B of the two gripping forceps 35A and 35B, the gripping forceps 35A is moved to move the mucosa 38 to a predetermined level. Can be stretched. Further, without changing the bending state of the bending portion 14 and the bending portion 4b provided in the insertion tool 1 and the endoscope 3D, in other words, the insertion tool 1 introduced into the body cavity and the endoscope Without changing the introduction state of the mirror 3D, the vertical oscillating table 4i is oscillated to finely adjust the tension or spread state of the mucous membrane 38 to a desired state, and the horizontal oscillating table 4h is oscillated. Thus, fine adjustment of the puncture position or the like with respect to the mucous membrane 38 can be performed.
As a result, the puncture needle can be reliably opposed to the target puncture position desired by the operator, and puncture can be performed reliably and smoothly.

  In the above-described ulcer occlusion technique example, the endoscope treatment apparatus 3 sequentially inserts the suturing device 40 and the fastening tool 30A into the treatment tool insertion channel of the direct-view type endoscope, while the treatment tool channel of the insertion tool 1 is inserted. The gripping forceps 30 was inserted into 11a. However, a suturing device 70 shown in FIGS. 30 and 31 may be used instead of the suturing device 40 used in the endoscope treatment apparatus 3.

  The suturing device 70 of the present embodiment includes a flexible insertion portion 71 inserted into the body cavity shown in FIG. 30 and a hand operation portion 72 operated by the operator outside the body cavity shown in FIG. Two push-out members 73 and 74 are provided.

  An insertion portion 71 shown in FIG. 30 includes a sheath 75 that is a flexible tube and a puncture needle 76 that is disposed in the sheath 75 so as to be able to advance and retract. The tip of the puncture needle 76 is a sharp point, and is easily configured to penetrate a living tissue. A lock member 47 attached to the suture thread 46 is accommodated and disposed on the distal end side of the inner hole of the puncture needle 76, and a pipe-shaped first pushing member 73 is inserted and disposed closer to the proximal end side than the lock member 47. . An engaging member 48 attached to the suture thread 46 is accommodated at the distal end side of the inner hole of the first push-out member 73, and a rod-like second push-out member 74 is disposed at the base end side of the engagement member 48, for example. It is inserted through.

  The first pushing member 73 is arranged to push the locking member 47 before the engaging member 48, and the second pushing member 74 is arranged to push the engaging member 48 after the locking member 47 is pushed. . That is, the second pushing member 74 and the engaging member 48 are slidably accommodated in the inner hole of the first pushing member 73.

  In addition, a slit 73 a through which the suture thread 46 attached to the engaging member 48 is pulled out is provided at the distal end portion of the first pushing member 73. In addition, it is desirable to provide clearance between the inner wall of the puncture needle 76 and the first pushing member 73 to such an extent that gas can flow.

  On the other hand, the hand operating section 72 shown in FIG. 31 mainly includes a tubular holding member 77, a tubular puncture needle operating section 78, a pushing member handle 79 having a central through hole, and a conical pushing member knob 80, for example. It is prepared for.

  A proximal end portion of the sheath 75 is fixed to the holding member 77. The proximal end portion of the puncture needle 76 is fixed to the puncture needle operation portion 78. The puncture needle 76 moves back and forth by moving the puncture needle operation unit 78 forward and backward. A proximal end portion of the first pushing member 73 is fixed to the pushing member handle 79. The push-out member handle 79 is provided with a central through hole 79a into which a second push-out member 74 described later is inserted. The first pushing member 73 moves forward and backward by moving the pushing member handle 79 forward and backward. A proximal end portion of the second pushing member 74 that has passed through the first pushing member 73 is fixed to the pushing member knob 80. The second pushing member 74 moves back and forth by moving the pushing member knob 80 forward and backward.

  On the proximal end side of the puncture needle operation unit 78, a circumferential groove-like finger hooking portion 78a for hooking a finger by the operator is provided. An air supply port 78b, which is a fluid introduction part used when introducing gas into a gap formed in the puncture needle operation part 78, is provided in the middle of the side peripheral surface of the puncture needle operation part 78. . A first push-out member 73 and a second push-out member 74 are inserted into the central through hole 78c of the puncture needle operation unit 78.

  Reference numeral 81 denotes a packing, which maintains airtightness between the central through hole 78c and the first push-out member 73. This prevents the gas from leaking from the gap in the puncture needle operation unit 78.

  The puncture needle 76 can be protruded with respect to the sheath 75 by advancing and retracting the puncture needle operation portion 78 relative to the holding member 77. The push member handle 79 is integrally attached to the outer peripheral surface of the first push member 73 extended from the end face side of the puncture needle operation portion 78. The lock member 47 can be pushed out of the puncture needle 76 by pushing the push member handle 79 toward the puncture needle operation portion 78 by a predetermined amount. The pushing member knob 80 is integrally attached to the end portion of the second pushing member 74 extended from the end face side of the first pushing member 73. The engaging member 48 can be pushed out of the first pushing member 73 by pushing the pushing member knob 80 toward the pushing member handle 79 by a predetermined amount.

Here, an ulcer blockage technique using the suturing member 45 by the endoscope treatment apparatus 3 including the suturing device 70 will be described.
First, in order to perform observation in the endoscope treatment apparatus 3 including the endoscope 2 and the insertion tool 1 in which the external tube 5 is arranged in parallel with the endoscope insertion portion 4, the external tube 5 is first arranged in parallel. The endoscope insertion portion 4 thus made is introduced into the body cavity. At this time, the endoscope insertion unit 4 is introduced toward the target observation site while observing the endoscope image displayed on the screen 7g of the monitor 7c.

  When the endoscope insertion portion 4 reaches the target observation site, for example, the stomach, the bending knob provided in the endoscope operation portion 6 is appropriately operated to display the stomach wall on the screen 7g of the monitor 7c. An endoscopic image is displayed for observation. During this observation, for example, if an ulcer is found, the insertion tool insertion portion 11 of the insertion tool 1 is introduced into the stomach via the external tube 5 in order to close the ulcer. By displaying the insertion tool insertion portion 11 in the endoscopic image displayed on the screen 7g of the monitor 7, it is confirmed that the insertion tool insertion portion 11 has been introduced into the stomach.

  Next, the surgeon guides the grasping portion 31 of the grasping forceps 30 into the stomach via the treatment instrument channel 11 a provided in the insertion instrument 1, and treats the treatment instrument insertion channel provided in the endoscope 2. A suturing device 70 having a suturing member 45 disposed therein is introduced.

  Then, the surgeon appropriately operates the bending knob provided in the endoscope operation unit 6 so that the treatment instrument opening 4f of the endoscope insertion unit 4 is disposed to face the target site. Here, the surgeon places the grip portion 31 led out from the treatment tool opening 13a of the distal end portion 13 constituting the insertion tool insertion portion 11 so as to face the target site. Thereafter, a hand operation is performed and the right mucous membrane 37 in the vicinity of the ulcer portion 36 is gripped and lifted by the grip portion 31 led out from the distal end portion 13 of the insertion tool insertion portion 11.

  Thereafter, as shown in FIG. 32, the operator places the tip of the puncture needle 76 against the mucosa 37 and pierces the mucosa 37 with the puncture needle 76. In this state, the push-out member handle 79 is pushed in by a predetermined amount as indicated by an arrow k in the direction of the puncture needle operation portion 78. Then, the lock member 47 disposed in the inner hole of the puncture needle 76 is pushed out and falls into the body cavity.

  Here, the puncture needle is withdrawn from the mucous membrane that has once been lifted, and the gripping of the lifted forceps is released. Next, the surgeon performs a hand operation, and grips, for example, the left mucous membrane 38 of the ulcer portion 36 by the grip portion 31 led out from the distal end portion 13 of the insertion tool insertion portion 11. Thereafter, as shown in FIG. 33, the mucous membrane 38 is lifted by the operator's hand operation, the tip of the puncture needle 76 is opposed to the mucosa 38, and the puncture needle 76 is pierced into the mucous membrane 37. In this state, the pushing member knob 80 is pushed by a predetermined amount toward the pushing member handle 79 as indicated by an arrow m. Then, the engaging member 48 arranged in the inner hole of the first pushing member 73 is pushed out and falls into the stomach.

  Next, the suture instrument 70 is removed from the treatment instrument insertion channel provided in the endoscope 2 and the grasping forceps 30 is extracted from the insertion instrument 1. Thereafter, the bending portion 4b is bent by the operator's hand operation to adjust the position of the suture thread 46 extending from the lock member 47 remaining in the stomach. Then, the thread gripping portion 33 and the push-out sheath 34 of the fastening tool 30A, which is a treatment tool, are led out into the stomach via the treatment tool insertion channel of the endoscope 2, and the suture thread 46 is gripped by the thread gripping portion 33.

  Here, if the operator confirms on the screen 7g that the suture 46 has been grasped by the thread grasping portion 33, the thread grasping portion 33 of the fastening tool 30A as shown by the arrow n as shown in FIG. While pulling to the side, the sheath 34 is moved to the distal end side as indicated by an arrow p. As a result, a force for pressing the lock member 47 toward the suture target works, and as shown in FIG. 13, the gap between the end portion 47e and the end portion 47f is opened and the tightening to the suture thread 46 is released. The lock member 47 moves in a predetermined direction.

  At this time, when the engaging member 48 connected to the suture thread 46 is pulled, the mucosa 38 in contact with the engaging member 48 is gradually drawn toward the mucosa 37 side. Then, the mucous membrane 38 and the mucous membrane 37 are sutured so as to cover the ulcer portion 36.

  In this stitched state, the base portion 47a of the lock member 47 comes into surface contact with the mucous membrane 37, so that the lock member 47 does not bite into the mucosa 37 and exhibits a certain anchor effect. Further, when a force to move the mucous membrane 38 and the mucous membrane 37 away from the mucous membrane 37 is applied to the lock member 47, the force between the end portion 47e and the end portion 47f is closed and the suture thread 46 is tightened. This reliably prevents the suture 46 from moving and separating the two mucous membranes 38 and the mucous membrane 37 that are sewn together.

In the above-described ulcer occlusion technique, instead of accommodating the suturing member 45 in the suturing device 40 or the suturing device 70 constituting the endoscopic treatment device 3, the suturing member 90 is accommodated and disposed, May be performed.
As shown in FIG. 35, the suturing member 90 of the present embodiment includes two suturing threads 46 and an engaging member 91 formed by a cylindrical member provided at the end of each suturing thread 46. It mainly comprises a stopper member 92 into which each suture thread 46 extending from the member 91 is inserted and arranged. The stopper member 92 is made of, for example, silicon rubber having a predetermined elastic force. The ends of the suture thread 46 inserted through the stopper member 92 and extended are, for example, tied into a ball shape as a terminal treatment in a bundled state.

  As shown in FIG. 36, the stopper member 92 of the suturing member 90 is disposed at a predetermined position on the distal end side in the sheath 41 constituting the suturing device 40, for example. Two engaging members 91 provided on the other end side of the suture thread 46 constituting the suture member 90 are accommodated and arranged at predetermined positions on the distal end side in the puncture needle 42 constituting the suture instrument 40. Note that the distal end side portion of the pushing member 43 is disposed on the proximal end side of the two engaging members 91 arranged side by side.

A procedure for performing ulcer occlusion in the present embodiment will be described with reference to FIG.
First, the surgeon guides the grasping portion 31 of the grasping forceps 30 into the stomach via the treatment instrument channel 11a provided in the insertion instrument 1, and in the treatment instrument insertion channel provided in the endoscope 2. The suturing device 40 having the suturing member 90 disposed therein is introduced.

  The surgeon performs a hand operation and grips and lifts, for example, the left mucous membrane 37 in the vicinity of the ulcer portion 36 with the grip portion 31 led out from the distal end portion 13 of the insertion tool insertion portion 11. Further, the surgeon performs an operation of moving the sheath 41 of the suture instrument 40 inserted and disposed in the treatment instrument insertion channel provided in the endoscope insertion portion 4 to the distal end side, and moves the puncture needle 42 to the distal end side. The operation to move is performed, and the stopper member 92 arranged in the sheath 41 is dropped into the stomach.

  Next, the tip of the puncture needle 42 in which the two engaging members 91 are accommodated in the hole is opposed to one mucous membrane 37, and the puncture needle 42 is punctured into the mucosa 37. Here, the pushing member 43 is moved to the distal end side to drop only one engaging member 91 accommodated in the puncture needle 42 to the back side of the mucosa 37, and then the puncture needle punctured to the mucosa 37 42 is withdrawn from the mucous membrane 37.

  Next, the surgeon performs a hand operation so that the tip of the puncture needle 42 in which only one engaging member 91 is accommodated is opposed to the other mucosa 38 and punctures the mucosa 38 with the puncture needle 42. Here, the pushing member 43 is moved to the distal end side, and the engaging member 91 is dropped to the back side of the mucous membrane 38. As a result, the stopper member 92 is located closest to the endoscope 2 side. Then, the puncture needle 42 punctured in the mucous membrane 38 is pulled out from the mucosa 38 and the suture device 40 is removed from the endoscope.

  Next, the thread gripping portion 33 and the push-out sheath 34 of the fastening tool 30A, which is a treatment tool, are led out into the stomach through the treatment tool insertion channel of the endoscope 2. Here, the bending portion 4b is bent by the operator's hand operation, and the end portion of the suture thread 46 extending from the stopper member 92 remaining in the stomach is held by the yarn holding portion 33.

If the operator confirms on the screen 7g that the suture grasping part 33 has grasped the distal end of the suture thread 46, the operator pulls the thread grasping part 33 of the fastening tool 30A toward the proximal side, while the stopper member 92 is moved to the tip side. As a result, the stopper member 92 is moved toward the suture target, the mucous membranes 37 and 38 with which the engagement member 91 is in contact are gradually joined together, and the ulcer portion 36 is sutured.
In addition, when the force which tries to move to the direction which the mucous membrane 38 and the mucous membrane 37 leave | separate is applied to the stopper member 92, a movement is prevented in the range of the elastic force of this stopper member 92.

  As described above, the engaging member 91 is provided at each end of the two sutures 46, and the stopper member 92 is provided in the middle of the suture 46 to constitute the suture member 90. Since it is dropped to the mirror 2 side, the thread gripper 33 easily grips the end side where the end treatment of the suture is performed without performing a cumbersome operation of greatly bending the curved part 4b of the endoscope 2 can do. As a result, ulcer blockage in which the mucosa and the mucous membrane are sutured so as to cover the ulcer portion can be performed in a short time.

Another configuration of the insertion tool will be described with reference to FIG.
As shown in the figure, in the insertion tool 1A of the present embodiment, a connector (not shown) provided on an electric cable 101 for signal transmission extended from the cautery device 100 to the main bending operation unit 18A constituting the operation unit 12 is provided. A connector connecting portion 102 that is detachably connected is attached. By this, the endoscope treatment apparatus 3E is comprised by connecting the connector of the electric cable 101 extended from the cauterization apparatus 100 to the connector connection part 102 of the insertion tool 1 previously.

  In the insertion tool 1A shown in the figure, instead of providing the second bending up / down lever 19a and the second fixing knob on the auxiliary bending operating portion 19, a second bending up / down knob 19d and a second fixing knob 19e are provided. Provided. Reference numeral 103 is a patient electrode, and reference numeral 104 is an electric knife.

  In the endoscope treatment apparatus 3E, the operator introduces the electric knife 104 into the body cavity through the treatment instrument channel 11a provided in the insertion instrument 1 as necessary. When the electrocautery 104 is introduced into the body cavity, the surgeon first appropriately operates the operation button 20b that is a mode switching switch to switch the operation mode of the ablation device 100 to the incision mode or the coagulation mode.

  Then, if necessary, the operation button 20a which is an incision / coagulation operation switch is pushed in. Then, while the operation button 20a is being pushed in, a predetermined current flows from the distal end portion 104a of the electric knife 104 to the patient electrode 103, and an incision treatment or a coagulation treatment is performed.

  Therefore, in the endoscope treatment apparatus 3E, the buttons 20a and 20b provided on the operation unit 12 of the insertion tool 1A held by the surgeon are used without using a foot switch for mode switching, incision treatment, or coagulation treatment. It can be done smoothly by operating.

Another configuration of the insertion tool will be described with reference to FIGS. 39 and 40.
In the insertion tool 1 shown in FIG. 1, the operation section 12 is provided with a pair of knobs 18a and 18b and one lever 19a for bending the first bending section 16 and the second bending section 17, respectively. In addition, in the insertion tool 1A shown in FIG. 38, the operation unit 12 is provided with a pair of knobs 18a and 18b for operating the first bending unit 16 and the second bending unit 17 and a knob 19d.

On the other hand, in the insertion tool 1B shown in FIGS. 39 and 40, the first bending portion 16 is bent on the bending operation portion back side 111 on which, for example, the thumb of the operator's hand holding the operation portion 110 is placed. A first bending portion up / down operation lever 112 and a first bending portion left / right operation lever 113 for operating, and a second bending portion up / down operation lever 114 for bending the second bending portion 17 are provided. ing.
As a result, the first bending portion 16 and the second bending portion 17 can be easily operated without greatly moving the finger that holds the bending operation portion of the surgeon, in other words, without significantly changing the holding state. can do.

Specifically, as shown in FIG. 39, the first bending portion up / down operation lever 112 and the first bending portion left / right operation lever 113 are provided so that the rotation center axes thereof are orthogonal to the longitudinal axis, (2) The turning center axis of the bending portion up / down direction operating lever 114 is above the turning center axis of the first bending portion up / down direction operating lever 112 and the first bending portion left / right direction operating lever 113 by a predetermined interval with respect to the longitudinal axis. It is provided.
A treatment instrument opening 116 is provided on the operation unit front side 115. Reference numeral 117 denotes a first bending section vertical fixing knob, reference numeral 118 denotes a first bending section horizontal fixing knob, and reference numeral 119 denotes a second bending section vertical fixing knob.

Here, with reference to FIG. 40, the positional relationship of the operation wires inserted through the operation unit 110 will be described.
As shown in the drawing, the end of the first bending upward operation wire 16a extended from the first bending portion 16 is rotated by the first bending portion up / down operation lever 112, and the first bending portion up / down pulley 121. It is fixed at a predetermined position. Further, the end portion of the first bending downward operation wire 16b extended from the first bending portion 16 is a predetermined position of the first bending portion up / down pulley 121 rotated by the first bending portion up / down operation lever 112. It is fixed to. On the other hand, an end portion of the first bending left direction operation wire 16c extended from the first bending portion 16 is a predetermined position of the first bending portion left and right pulley 122 rotated by the first bending portion left and right operation lever 113. It is fixed to. The end of the first bending downward operation wire 16d extended from the first bending portion 16 is a predetermined position of the first bending portion left-right pulley 122 rotated by the first bending portion left-right operation lever 113. It is fixed to.

  On the other hand, the second bending upward operation wire 17a extended from the second bending portion 17 is inserted through the wire insertion coil pipe 123a disposed at the substantially central portion of the operation portion, and the end portion thereof. Is fixed to a predetermined position of a second bending portion up-down direction pulley (not shown) that is rotated by the second bending portion up-down direction operation lever 114. Further, the second bending downward operation wire 17b extended from the second bending portion 17 is inserted through the wire insertion coil pipe 123b arranged on the front side of the operation portion from the substantially central portion of the operation portion, and the The end portion is fixed to a predetermined position of the second bending portion up-down direction pulley that is rotated by the second bending portion up-down direction operation lever 114.

  This reliably prevents the operation wires 16a, 16b, 16c, 16d, 17a, and 17b that are inserted and disposed in the operation unit 110 from contacting each other.

  In addition, the 1st bending part up-down direction operation lever 112 is comprised by the metal lever member 112a and the resin finger contact member 112b, for example. The first bending portion left-right direction operation lever 113 includes, for example, a metal lever member 113a and a resin finger contact member 113b.

  The lever member 112a of the first bending portion up / down operation lever 112 is screwed and fixed to the first bending portion up / down shaft 124 with a screw 125, and the lever member 113a of the first bending portion left / right operation lever 113 is the first. The curved portion left-right shaft portion 126 is screwed and fixed by a screw 125. The lever member 114 a of the second bending portion up / down operation lever 114 is screwed and fixed to a second bending portion up / down shaft portion (not shown) by a screw 125.

  Further, a first bending portion up / down pulley 121 is integrally fixed to the first bending portion up / down shaft portion 124 by a fastening member 127, and the first bending portion left / right shaft portion 126 is fixed to the first bending portion left / right pulley. 122 is integrally fixed by a fastening member 127, and a second bending portion left and right pulley (not shown) is integrally fixed to a second bending portion up-and-down shaft portion (not shown) by a fastening member (not shown). ing. Accordingly, by rotating each operation lever 112, 113, 114, the corresponding pulley 121, 122 is rotated, and the operation wires 16a, 16b, 16c, 16d, 17a, 17b are pulled / relaxed. .

  By the way, in embodiment mentioned above, the insertion tool insertion part 11 of the insertion tool 1 is inserted in the tube body 5b of the external tube 5 currently arranged in parallel by the endoscope insertion part 4 of the endoscope 2, and a body cavity The endoscope insertion portion 4 and the insertion tool insertion portion 11 are introduced into the inside. Since the external tube 5 includes the connection fixing portion 5a and the tube body 5b, the cross-sectional shape of the arrangement position is flat when the connection fixing portion 5a is arranged in the endoscope insertion portion 4. As a result, the insertion into the body cavity deteriorated. For this reason, there has been a demand for an endoscope system in which the insertion property of the endoscope insertion portion 4 in which the external tubes 5 are arranged in parallel is improved.

Hereinafter, a configuration example of the external tube will be described with reference to the drawings.
41 and 42 relate to one configuration example of the external tube, FIG. 41 is a cross-sectional view illustrating the external tube, and FIG. 42 is a diagram illustrating the operation of the external tube.

  An external tube 5A shown in FIG. 41 includes a connection fixing portion 50A and a tube body 5b connected to the connection fixing portion 50A. The connecting and fixing portion 50A is formed of an elastic member having a predetermined elastic force, the tip side portion is tapered in consideration of the insertability, and has a bullet shape having a curved surface portion 51 that continuously changes smoothly from the tip side. It is composed.

  The connection fixing portion 50A is a recess 52 in which the distal end portion 4a of the endoscope insertion portion 4 is inserted and disposed, and a through hole through which the insertion tool insertion portion 11 of the insertion tool 1 and other treatment tools are inserted. A treatment instrument insertion hole 53 is provided. An observation hole 54 that communicates with the recess 52 is formed on the distal end side of the connection fixing portion 50A.

  The tube body 5b is made of, for example, a fluororesin member that is soft and has a predetermined elastic force so as not to hinder the bending operation of the bending portion 4b. The distal end portion of the tube body 5b is integrally fixed to the fixing recess 55 by adhesion, for example, so as to communicate with the treatment instrument insertion hole 53.

In the external tube 5A, the concave portion 52 is disposed at the distal end portion 4a of the endoscope insertion portion 4, and is fixed integrally to the distal end portion of the endoscope insertion portion 4 by the elastic force of the connection fixing portion 50A. Retained. The distal end surface of the distal end portion 4 a comes into contact with the bottom surface of the recess 52.
The tube body 5b of the external tube 5A and the flexible tube portion 4c of the endoscope insertion portion 4 are juxtaposed by a tape member 8 (see FIG. 42).

The operation of the endoscope insertion portion 4 in which the external tube 5A is arranged in parallel will be described with reference to FIG.
An endoscope in which a connecting and fixing portion 50A is integrally fixed to the oral cavity when the endoscope insertion portion 4 of the endoscope 2 in which the external tube 5A is arranged in parallel is introduced into the body cavity via the oral cavity. The distal end portion 4a of the insertion portion 4, the bending portion 4b, and the flexible tube portion 4c are inserted in this order. That is, since the connecting and fixing portion 50A is integrally fixed, the connecting and fixing portion 50A is introduced from the distal end portion 4a that is substantially the largest diameter.

  At this time, as shown in FIG. 42, the connecting and fixing portion 50A is formed of an elastic member in a tapered shape, so that the connecting and fixing portion 50A comes into contact with the wall of the esophagus at the time of introduction, so The side part which has and the front-end | tip part of the tube body 5b deform | transform so that it may be crushed. That is, the connecting and fixing portion 50A is crushed so that the outer dimension of the tip portion 4a is smaller than that in the initial state. For this reason, the endoscope insertion portion 4 in a state where the external tubes 5 are arranged side by side is smoothly introduced toward a deep portion in the body cavity.

  Then, when the distal end portion 4a of the endoscope insertion portion 4 reaches the target observation site, for example, the stomach, the pressing force from the wall of the esophagus is released, so that the connecting and fixing provided at the distal end portion 4a. The part 50A is restored to its original shape. Therefore, the insertion tool 1 can be smoothly inserted through the external tube 5.

  As described above, the connecting and fixing portion constituting the external tube is formed into a tapered shape with an elastic member having a predetermined elastic force, and the curved surface portion that continuously changes smoothly from the distal end side is provided. When the endoscope insertion portion provided with the tube is introduced into the body cavity, the connection fixing portion having a flat cross-sectional shape is deformed so as to be crushed, whereby the introduction into the body cavity can be smoothly performed.

  Even when the connecting and fixing portion 50A and the tube body 5b are integrally connected and fixed through a metal base to constitute an external tube, the connecting and fixing portion has an elastic member having a predetermined elastic force. Thus, by providing the curved surface portion that is tapered and continuously and smoothly changes from the distal end side, introduction into the body cavity can be performed smoothly. Further, the configuration of the external tube may be the configuration shown in FIGS. 43 and 44 shown below or the configuration shown in FIGS. 45 and 46.

43 and 44 relate to another configuration example of the external tube, FIG. 43 is a perspective view illustrating the external tube, and FIG. 44 is a cross-sectional view illustrating the external tube.
The external tube 5B shown in FIGS. 43 and 44 includes a connection fixing part 50B, a tube body 5b connected to the connection fixing part 50B, and an endoscope fixing member 56 provided integrally with the connection fixing part 50B. It consists of

  The endoscope fixing member 56 is formed in a pipe shape with, for example, a hard resin member so that the distal end portion 4a of the endoscope insertion portion 4 is engaged and disposed. The endoscope fixing member 56 includes a connecting portion 56a having a large diameter and an endoscope tip portion fixing portion 56b having a small diameter and stably holding the tip portion 4a in a predetermined posture. A circumferential groove 56c serving as a fixed portion is formed on the inner peripheral surface of the connecting portion 56a.

  The connection fixing part 50B of this embodiment is formed of an elastic member having a predetermined elastic force like the connection fixing part 50, and curved surface parts 51a, 51b, 51c considering insertion properties are continuously provided on the side surface of the tip. ing.

  In addition, the connection fixing portion 50B is provided with a connection protrusion 57 in which the endoscope fixing member 56 is externally disposed. At a predetermined position on the outer peripheral surface of the connecting projection 57, a circumferential convex portion 57a that is engaged with and disposed in the circumferential groove 56c is provided. Therefore, the endoscope fixing member 56 is fitted to the connecting protrusion 57 by disposing the endoscope fixing member 56 on the connecting protrusion 57 of the connecting fixing portion 50B against the urging force of the circumferential protrusion 57a. It is fixed integrally.

  The connecting protrusion 57 is provided with an endoscope arrangement hole 57b in which the distal end portion 4a of the endoscope insertion portion 4 is disposed, and the distal end surface of the distal end portion 4a abuts on the bottom surface of the endoscope arrangement hole 57b. It is like that. The observation hole 54 and the endoscope arrangement hole 57b are communicated with each other through a communication hole 58.

In the external tube 5B of the present embodiment, the distal end portion 4a of the endoscope insertion portion 4 is inserted into an endoscope placement hole 57b via an endoscope distal end portion fixing portion 56b provided in the endoscope fixing member 56. Placed in. As a result, the distal end portion 4a is held in a predetermined insertion state by the endoscope distal end portion fixing portion 56b, and the distal end portion 4a is integrally fixed and held by the elastic force of the connection fixing portion 50B.
The other configuration is the same as the configuration of the external tube 5A shown in FIG. 41, and the same members are denoted by the same reference numerals and description thereof is omitted.

  As described above, the connecting and fixing portion constituting the external tube is formed of an elastic member having a predetermined elastic force, and the curved surface portion considering the insertability is continuously provided on the tip side surface, thereby arranging the external tube. When the provided endoscope insertion portion is introduced into the body cavity, the connection fixing portion having a flat cross-sectional shape is deformed so as to be crushed, so that the introduction into the body cavity can be smoothly performed.

  In addition, a connecting projection is provided on the connecting and fixing portion, and an endoscope fixing member formed of a hard member is integrally fixed to the connecting and protruding portion, so that the endoscope is interposed via the endoscope fixing member. By disposing the distal end portion of the insertion portion in the endoscope arrangement hole, the endoscope can be more firmly and integrally disposed on the connection fixing portion.

45 and 46 relate to another configuration example of the external tube, FIG. 45 is a cross-sectional view illustrating the configuration of the external tube, and FIG. 46 illustrates a state in which the external tube is provided integrally with the endoscope. It is a perspective view.
The external tube 5C shown in FIG. 45 includes a connection fixing portion 50C, a base member 59 disposed in the connection fixing portion 50C, a tube body 5b connected to the base member 59, and a distal end side of the connection fixing portion 50B. It is comprised with the front end side structural member 60 which has the treatment tool penetration hole 60a fixedly attached to.

  The connection fixing part 50C includes an arcuate endoscope installation part 61 arranged at the distal end part 4a or the bending part 4b of the endoscope insertion part 4, and an attachment part 62 for arranging the distal end side component member 60. A recess 63 in which the cap member 59 is disposed, and a treatment instrument insertion hole 53 communicating with the recess 63 are provided. The base member 59 is, for example, a metal pipe, and is fixed integrally to the inner peripheral surface of the concave portion 63 by, for example, bonding while being in contact with the bottom surface of the concave portion 63 of the connection fixing portion 50C. The distal end side structural member 60 is formed of an elastic member having a predetermined deterministic force, and is provided with an inclined surface 60b on the distal end side surface in consideration of improved insertability. The distal end side component member 60 is integrally fixed to the attachment portion 62 of the connection fixing portion 50C by, for example, adhesion.

  In the present embodiment, the tube body 5b is integrally disposed on the connection fixing portion 50C via the base member 59. Further, the connecting and fixing portion 50C of the external tube 5C is integrally disposed in the endoscope insertion portion 4 via a tape 39 as shown in FIG. 46, for example.

  As described above, the distal end side portion having the treatment instrument insertion hole in which the treatment instrument such as the insertion instrument of the connection fixing portion constituting the external tube is disposed is formed of an elastic member having a predetermined elastic force, By providing an inclined surface in consideration of the insertability, when the endoscope insertion portion provided with the external tube is introduced into the body cavity, the connecting and fixing portion having a flat cross-sectional shape can be smoothly introduced into the body cavity. it can.

  In addition, in the external tubes 5A, 5B, and 5C described above, the connection fixing portions 50A, 50B, and 50 are arranged on the distal end portion 4a or the bending portion 4b of the endoscope insertion portion 4. For this reason, when the distal end portion of the endoscope insertion portion is moved to a desired position by appropriately operating the bending knob provided in the endoscope operation portion, the distal end portion of the insertion tool insertion portion also becomes the endoscope. It moves following the bending operation of the bending portion of the insertion portion.

  As a result, as shown in the drawing for explaining an example of operation when the connecting and fixing portion of the external tube in FIG. 47 is arranged behind the bending portion of the endoscope insertion portion and the bending portion of the insertion tool insertion portion. In the state where the connecting and fixing portion 50D of the external tube 5D is arranged behind the bending portions 4b and 14, the bending knob provided in the endoscope operation portion is operated to move the distal end portion of the endoscope insertion portion. The position of the distal end portion 4a of the endoscope 2 and the distal end portion 13 of the insertion tool 1 that occur when moved to a desired position cross, for example, and the distal end portion of the insertion tool insertion portion moves outside the observation visual field range. It is possible to prevent problems that occur.

48 to FIG. 50 relate to another configuration example of the external tube, FIG. 48 is a cross-sectional view illustrating the external tube, FIG. 49 is a diagram illustrating a state in which the external tube is mounted on the endoscope, and FIG. These are figures explaining the effect | action of an external tube.
As shown in FIG. 48, the external tube 5E of the present embodiment is provided with a guide convex portion 64 that protrudes a predetermined amount from the treatment instrument insertion hole 53 provided in the connection fixing portion 50E and serves as a guide portion. Yes.

  The external tube 5E includes a connection fixing portion 50E, a first base member 59a and a second base member 59b fixed to the connection fixing portion 50E, for example, by adhesion, and a tube connected and fixed to the first base member 59a. The body 5b, a guide convex portion 64 that is connected and fixed to the second cap member 59b, and an endoscope fixing member 56 that is provided integrally with the connecting and fixing portion 50E.

  The first base member 59a and the second base member 59b are made of, for example, metal pipes. The guide convex portion 64 is a flexible tube body made of an elastic member having a predetermined elastic force. The connection fixing portion 50E is provided with a connection protrusion 57 having a circumferential convex portion 57a. The connecting projection 57 is provided with an endoscope arrangement hole 57c through which the endoscope insertion portion 4 is inserted.

In the external tube 5E of the present embodiment, the distal end portion 4a of the endoscope insertion portion 4 is interposed via an endoscope distal end portion fixing portion 56b provided on the endoscope fixing member 56 as shown in FIG. It arrange | positions in the endoscope arrangement | positioning hole 57c. Accordingly, the distal end portion 4a is held in a predetermined insertion state by the endoscope distal end portion fixing portion 56b, and the distal end portion 4a is integrally fixed and held by the elastic force of the connection fixing portion 50E.
Other configurations are the same as the configuration of the external tube 5B shown in FIG. 44, and the same members are denoted by the same reference numerals and description thereof is omitted.

The operation of the external tube 5E attached to the endoscope 2 will be described with reference to FIG.
As shown in the drawing, the connecting and fixing portion 50E of the external tube 5E is introduced into the oral cavity through a mouthpiece, for example, in a state where it is disposed at the distal end portion 4a of the endoscope insertion portion 4. Then, the distal end side of the guide convex portion 64 provided in the connection fixing portion 50E comes into contact with the wall at the bent portion of the esophagus and is bent and deformed to follow the bent shape of the esophagus. Thereafter, when the surgeon pushes in the endoscope insertion portion 4 of the endoscope 2, the endoscope insertion portion 4 is introduced toward the deep portion so as to follow the curved shape of the guide convex portion 64. .

  That is, an endoscope insertion portion in which the external tube 5E is arranged in parallel by bending and deforming the guide convex portion 64 provided so as to protrude to the forefront of the connection fixing portion 50E along the bent shape of the lumen. 4 is smoothly introduced toward the deep part in the body cavity.

Thus, an endoscope in which an external tube is arranged by providing a guide convex portion protruding by a predetermined amount with an elastic member having a predetermined elastic force on the distal end side of the connecting and fixing portion constituting the external tube. When the insertion portion is introduced into the body cavity, the protruding guide convex portion is curved and deformed along the shape of the lumen, so that the introduction into the body cavity can be performed smoothly.
For example, a tapered surface may be provided on the guide convex portion to form a tapered shape. This further improves the bending deformability.

  Incidentally, for example, as shown in FIG. 51, a state in which the connecting and fixing portion of the external tube in FIG. 51 is disposed at the distal end portion of the endoscope and the insertion instrument having a bending portion is led out from the treatment instrument insertion channel. In addition, an endoscope treatment apparatus 3F is configured by integrally arranging, for example, a connecting and fixing portion 50C of an external tube 5C via a tape 39 at the distal end portion 4a of the endoscope insertion portion 4 of the endoscope 2. In this case, the distal end portion 13 of the insertion tool 1 led out from the treatment instrument insertion hole 60a provided in the distal-end-side component member 60 of the connection fixing portion 50C is disposed far from the distal end distal end surface 4k of the endoscope insertion portion 4. As a result, there is a problem that it becomes difficult to confirm the treatment site and perform the treatment. This is because the bending portions 16 and 17 are moved in a state in which the distal end portion of the flexible tube portion 15 of the insertion tool 1 led out from the treatment instrument insertion hole 60a of the coupling fixing portion 50C is disposed on the distal end side of the coupling fixing portion 50C. This is because the bending radii R1 and R2 are set so that the treatment instrument introduced into the treatment instrument channel 11a smoothly moves forward and backward when bent.

  In order to solve the problem that the distal end portion 13 of the insertion tool 1 described above is disposed far from the distal end portion distal end surface 4k, it becomes difficult to perform treatment or the like. For example, the bending portions 16 and 17 are inserted with a reduced length. When the instrument 1 is configured, the bending radius becomes smaller than the bending radii R1 and R2, so that it becomes difficult to smoothly move the treatment instrument forward and backward.

  For this reason, it is possible to set the distance from the distal end tip surface 4k to the distal end portion 13 of the insertion tool 1 to an optimum distance for treatment, and the distance is introduced into the treatment tool channel 11a of the insertion tool 1. There is a demand for an endoscope treatment apparatus that can smoothly move the treatment tool forward and backward.

  In FIG. 52, the distance from the distal end surface to the distal end of the insertion tool can be set to an optimum distance for treatment, and the advancement / retraction movement of the treatment instrument introduced into the treatment instrument channel of the insertion tool can be smoothly performed. It is sectional drawing explaining the structure of the external tube which comprises the endoscopic treatment apparatus which can be performed easily.

  As shown in the drawing, the external tube 5F of this embodiment includes a connection fixing portion 50F, a base member 59a connected to the connection fixing portion 50, a tube body 5b connected and fixed to the base member 59a, It is comprised with the endoscope front-end | tip part arrangement | positioning member 65 connected with the fixing | fixed part 50. As shown in FIG.

  The connection fixing part 50F is formed of an elastic member having a predetermined elastic force. A treatment that is a through-hole 66 through which the distal end portion 4a of the endoscope insertion portion 4 is inserted and a through-hole through which the insertion tool insertion portion 11 of the insertion tool 1, other treatment tools, and the like are inserted in the connection fixing portion 50E. A tool insertion hole 53 is provided. A protrusion 67 having a circumferential recess 67a is provided on the outer peripheral portion on the tip end side of the coupling fixing portion 50F on the through hole 66 side.

  The endoscope distal end portion arranging member 65 is formed in a pipe shape with, for example, a hard resin member, and has a convex portion 65a that is engaged and arranged in the circumferential concave portion 67a of the connection fixing portion 50F. The length dimension of the endoscope distal end portion arranging member 65 is set so that the distal end surface 65b of the endoscope distal end portion arranging member 65 and the distal end surface 53a of the treatment instrument inserting hole 53 are displaced from each other. The derived distal end portion 13 of the insertion tool 1 is set to have an optimum distance for treatment.

  Thus, according to the external tube of the present embodiment, the distal end portion of the endoscope is disposed in the endoscope distal end portion arranging member via the through hole of the coupling fixing portion, By aligning the distal end surface of the endoscope distal end arrangement member with the distal end surface, the position of the distal end side of the flexible tube portion of the insertion instrument disposed in the treatment instrument insertion hole is a predetermined amount from the distal end end surface of the endoscope. The distance from the distal end surface to the distal end portion of the insertion tool can be set to an optimum distance for the treatment without retreating and making the bending radius of the curved portion small.

  In addition, as shown in FIG. 53, the fixing position fixed by the tape 39 of the connection fixing portion 50G of the external tube 5G through which the insertion tool is inserted is displaced from the distal end tip surface 4k to the proximal end side, and curved. You may make it set the distance from the front-end | tip front-end | tip surface to the front-end | tip part of an insertion tool in the optimal distance for treatment, without making the curvature radius of a part small.

  FIG. 54 shows that the distance from the distal end surface to the distal end of the insertion tool can be set to an optimum distance for treatment, and the advancement / retraction movement of the treatment tool introduced into the treatment instrument channel of the insertion tool can be smoothly performed. It is a perspective view explaining the structure of the external tube which comprises the endoscopic treatment apparatus which can be performed easily.

  In the external tube 5H shown in the drawing, a notch portion 68a is provided in a predetermined side surface portion of the connection fixing portion 50H, and the front end side predetermined side surface of the tube body 5b connected and fixed to the connection fixing portion 50H is provided from the front end side. A notch 68b having a predetermined dimension is provided. The width dimension of the notches 68a and 68b is appropriately set depending on the material of the connecting and fixing portion 50H and the members constituting the tube body 5b. For example, the width dimension is set to be narrow when formed with a relatively thin member having elastic force, and the width when formed with a member having less elastic force or a relatively thick member. The dimensions are set wide.

  In this way, a notch portion having a predetermined length dimension from the distal end surface is provided on the connecting fixing portion and the distal end side predetermined side surface of the tube body, and insertion is performed by deriving the flexible tube portion of the insertion tool from the notch portion. The position of the distal end of the flexible tube portion of the instrument insertion portion is retracted by a predetermined amount from the distal end surface of the distal end of the endoscope, and the distal end of the insertion tool is inserted from the distal end surface without reducing the bending radius of the bending portion. The distance to the part can be set to the optimum distance for the treatment.

  Note that the distance from the distal end surface of the distal end portion of FIG. 55 to the distal end portion of the insertion instrument can be set to an optimum distance for treatment, and the treatment instrument introduced into the treatment instrument channel of the insertion instrument is moved forward and backward. As shown in the external tube 5I shown in the perspective view illustrating another configuration of the external tube constituting the endoscope treatment apparatus that can smoothly perform the side portion of the tube body 5b that is fixedly connected to the connection fixing portion 50I An insertion tool outlet 69 constituted by a side hole may be provided. Accordingly, by appropriately deriving the insertion tool from the insertion tool outlet port 69, the position of the distal end portion of the flexible tube portion of the insertion tool insertion portion is retracted by a predetermined amount from the distal end surface of the distal end portion of the endoscope. The distance from the distal end surface of the distal end portion to the distal end portion of the insertion tool can be set to an optimum distance for the treatment without reducing the bending radius of the curved portion.

Moreover, in the external tube 5 thru | or external tube 5I mentioned above, the detachable airtight stopper is provided in the base end part of the tube body 5b. Here, the airtight stopper and its operation will be described with reference to FIG.
FIG. 56 is a view for explaining the base end portion constituting member disposed at the base end portion of the tube body constituting the external tube.

  As shown in the drawing, a base end portion constituting member 130 is provided at the base end portion of the tube body 5b that is connected and fixed to the treatment instrument insertion hole 53 provided in the connection fixing portion. The insertion tool 1 and an airtight plug 132 having a substantially T-shaped cross section are inserted and disposed in the treatment tool introduction hole 131 of the base end component 130.

  The proximal end component member 130 includes a proximal end main body 133 and a treatment instrument introducing portion 134 that is screwed and fixed to the proximal end main body 133. The base end main body 133 is a resin-made tubular member, for example, and includes a recess 136 provided with an internal thread 135 on the inner peripheral surface and a through-hole 137 communicating with the recess 136. The inner surface of the through hole 137 is formed as a tapered surface on which the tube body is disposed.

On the other hand, the treatment instrument introducing portion 134 is, for example, a resin tubular member, and is screwed into a distal end pressing portion 138 having a tapered outer peripheral surface for closely arranging the tube body 5b on the inner surface of the through-hole 137 and the female screw 135 of the concave portion 136. A concave portion 142 is provided in the base end large diameter portion 141, which is composed of an intermediate portion 140 provided with a male screw 139 and a base end large diameter portion 141 serving as an insertion port. A female screw 143 is formed. For example, a plurality of annular rubber valves 144 and an annular valve restraining member 145 are arranged in the recess 142. A male screw 146 that engages with the female screw 143 is formed on the outer peripheral surface of the valve pressing member 144e disposed on the opening end side.

The rubber valve 144 is disposed in close contact with the side surface of the shaft portion 147 of the airtight stopper 132 by inserting and arranging the airtight stopper 132 in the treatment instrument introduction hole 131 of the proximal end component member 130 of the present embodiment.
Thus, by attaching the airtight plug 132 to the proximal end component member 130, the body cavity and the outside are in communication with each other in a state where the treatment tool such as the insertion tool 1 is not inserted into the tube body 5b. This can be surely prevented. Therefore, the air in the body is prevented from leaking outside.

  It should be noted that the present invention is not limited to the embodiments described above, and various modifications can be made without departing from the spirit of the invention.

1 to 40 relate to one embodiment of the present invention, and FIG. 1 is a perspective view for explaining the configuration of an insertion tool. The figure explaining the treatment tool channel provided in the insertion tool insertion part of an insertion tool The figure explaining the structural example of an endoscopic treatment apparatus Sectional drawing explaining the suturing device by which the sewing member was arrange | positioned at the front-end | tip part The figure explaining the relationship between a suture device and a suture member The figure explaining the state which is observing and treating with an endoscopic treatment apparatus The figure which shows an example of the endoscopic image displayed on the screen of a monitor The figure which shows the other example of the endoscopic image displayed on the screen of a monitor The figure which shows the state where the character which is the bending direction announcement index is displayed The figure which shows the state where the character etc. which consisted of the convex part are displayed The figure explaining a suture member The figure explaining a locking member The figure explaining the effect | action of a locking member The figure explaining the state which dropped the locking member in the stomach The figure explaining the state which made the puncture needle confront the mucous membrane The figure explaining the state which pierced the mucous membrane with the puncture needle The figure explaining the state which is grasping the mucous membrane of the back side with a grasping part The figure explaining the state which stabbed the puncture needle in the mucosa of the back side, and the engagement member was dropped to the back side of the mucous membrane The figure explaining the state which removed the suture instrument from the endoscope The figure explaining the state which is holding the suture with a clamp The figure explaining the state which is moving the thread holding part of a clamp, and the sheath of a clamp The figure which shows the state which adhered two mucous membranes and covered the ulcer The figure explaining the other structural example of an endoscope treatment apparatus The figure explaining another structural example of an endoscopic treatment apparatus The figure explaining the other structural example of an endoscopic treatment apparatus, and its operation example The figure explaining the other structural example and other effect example of an endoscope treatment apparatus. The figure explaining another example of composition of an endoscopic treatment device The figure explaining the arrangement | positioning state in the treatment tool penetration channel of a horizontal direction swing stand and a vertical direction swing stand. The figure explaining the operation state of a treatment tool when each rocking base is rocked The figure explaining the structure of the insertion part front end side of a suture instrument The figure explaining the structure of the hand operation part of a suture instrument The figure explaining the state which dropped the lock member arrange | positioned in the inner hole of the puncture needle into the stomach The figure explaining the state which drops the engaging member arrange | positioned in the inner hole of the 1st extrusion member in the stomach The figure explaining the state currently sewn by the fastening tool The figure explaining the other structural example of a sewing member The figure explaining the state which accommodated and arrange | positioned the sewing member of another structure in the suturing device. The figure explaining the procedure which performs ulcer obstruction | occlusion using the suture member of another structure The figure explaining the other structural example of an insertion tool The figure explaining another structural example of an insertion tool Sectional view in the Q plane of FIG. 41 and 42 are related to one configuration example of the external tube, and FIG. 41 is a cross-sectional view illustrating the external tube. Diagram explaining the action of the external tube 43 and 44 relate to another configuration example of the external tube, and FIG. 43 is a perspective view illustrating the external tube. Sectional view explaining external tube 45 and 46 relate to another configuration example of the external tube, and FIG. 45 is a cross-sectional view illustrating the configuration of the external tube. The perspective view which shows the state which provided the external tube integrally in the endoscope The figure explaining one operation example at the time of arrange | positioning the connection fixing | fixed part of an external tube behind the bending part of an endoscope insertion part, and the bending part of an insertion tool insertion part. 48 to 50 relate to another configuration example of the external tube, and FIG. 48 is a cross-sectional view illustrating the external tube. The figure which shows the state which attached the external tube to the endoscope Diagram explaining the action of the external tube The figure explaining the state which arrange | positions the connection fixing | fixed part of an external tube in the front-end | tip part of an endoscope, and has led out the insertion tool which has a curved part from a treatment tool penetration channel. The distance from the distal end surface to the distal end of the insertion tool can be set to the optimum distance for treatment, and the treatment tool introduced into the treatment instrument channel of the insertion tool can be smoothly moved forward and backward. Sectional drawing explaining the structure of the external tube which comprises an endoscopic treatment apparatus The distance from the distal end surface to the distal end of the insertion tool can be set to the optimum distance for treatment, and the treatment tool introduced into the treatment instrument channel of the insertion tool can be smoothly moved forward and backward. The figure explaining the example of arrangement position of the external tube which constitutes the endoscope treatment apparatus The distance from the distal end surface to the distal end of the insertion tool can be set to the optimum distance for treatment, and the treatment tool introduced into the treatment instrument channel of the insertion tool can be smoothly moved forward and backward. The perspective view explaining the structure of the external tube which comprises an endoscopic treatment apparatus The distance from the distal end surface to the distal end of the insertion tool can be set to the optimum distance for treatment, and the treatment tool introduced into the treatment instrument channel of the insertion tool can be smoothly moved forward and backward. The perspective view explaining the other structure of the external tube which comprises an endoscopic treatment apparatus The figure explaining the base end part structural member arrange | positioned by the base end part of the tube body which comprises an external tube.

Explanation of symbols

1 ... Insertion tool 1
2. Endoscope
3. Endoscopic treatment device
4. Endoscope insertion part
4a ... tip part 4b ... curved part 4d ... observation window 4f ... treatment instrument opening 5 ... external tube 5a ... connection fixing part
7c ... Monitor 11 ... Inserting tool insertion part 13 ... Tip part 14 ... Bending part 16 ... First bending part 17 ... Second bending part 27 ... Bending direction notification index 27U ... White straight line 27D ... Red straight line 27L ... Green straight line 27R ... Blue Straight line 28 ... Boundary part notification index 30 ... Gripping forceps 31 ... Gripping part

Claims (2)

An endoscope having an observation means for observing the inside of a body cavity, and having an insertion portion that can be inserted into the body cavity;
An insertion tool including an insertion tool insertion portion arranged in parallel with at least a part of the insertion portion;
A first bending portion disposed on a distal end side of the insertion tool insertion portion;
A second bending portion disposed on a proximal end side of the first bending portion in the insertion tool insertion portion;
In the outer circumference of the boundary portion between the first curved portion and the second bending portion of the insertion instrument insertion portion viewable by the observation means, a boundary between the first curved portion and the second curved portion A curved boundary portion notification indicator formed to be visible by coloring ,
A first bending direction notification index indicating a bending direction of the first bending portion provided in the first bending portion of the insertion tool insertion portion visible by the observation means;
A second bending direction notification index indicating a bending direction of the second bending portion provided in the second bending portion of the insertion tool insertion portion visible by the observation means;
An endoscope system comprising:   The endoscope system according to claim 1, wherein the first bending portion is formed so as to be able to bend in the vertical and horizontal directions, and the second bending portion is formed so as to be freely bent in the vertical direction.

Images