JP5390146B2 - Auxiliary tool and endoscope system using the same - Google Patents

Description

The present invention aids are used in combination with a nasal endoscopy, and it relates to an endoscope system using the same.

  In recent years, transnasal endoscopes are known in which an insertion portion to be inserted into the body has a diameter smaller than that of an oral endoscope (Patent Documents 1 and 2). Nasal endoscopy using this endoscope does not pass through the base of the tongue and does not touch the throat, so nausea and discomfort at the time of the examination are significantly higher than oral endoscopy The pain and burden on the subject can be reduced, and a smaller amount of anesthetic can be used compared to the oral endoscopy, and the subject may have a conversation with the operator during the examination. Demand is increasing due to the advantages of being able to breathe through the mouth.

  A transnasal endoscope, like an oral endoscope, has an observation optical system and an illumination optical system built into the distal end of an insertion part that is inserted into the body. The illumination optical system illuminates a subject, Image information of the illuminated subject is extracted as a video signal by the observation optical system, and the image is displayed on a monitor or the like. The insertion portion accommodates a forceps conduit (also serving as a suction conduit), an air / water supply conduit, a light guide, and the like in an internal space penetrating from the distal end portion to the proximal end portion.

The light guide has an incident end where light enters and an output end where light is emitted, and guides the light from the light source device to the distal end. The light emitted from the emission end is irradiated toward the subject from the illumination window provided on the distal end surface of the distal end portion through the illumination lens. The forceps conduit is connected to a forceps outlet provided at one end exposed at the distal end surface, and to the forceps inlet provided at the other end exposed at the proximal end. Guide the insertion. The air supply / water supply conduit is connected to the air supply / water supply nozzle that is exposed on the distal end surface, and the distal end surface (observation window) of the observation optical system is operated by a button operation on the proximal operation portion provided at the proximal end. Send air and water into the body cavity.
JP 2006-68030 A JP 2007-61377 A

  The transnasal endoscope has a feature that the insertion part is made more flexible than an oral endoscope because it passes through a narrow and winding insertion path from the outer nostril to the middle nasal passage (lower nasal passage). However, it has a very thin diameter (about 5 to 6 mm) with respect to the diameter (about 9 mm) of the insertion portion of the oral endoscope. When the insertion portion is thin as described above, the diameter (about 2 mm) of the forceps conduit provided in the internal space is also thin, and therefore the types and number of forceps that can be inserted into the forceps conduit are limited. For this reason, procedures such as cutting out polyps in the stomach or esophagus (polypectomy, polypectomy, mucosal resection), or pinching bleeding parts (such as gastric ulcers) with clips to stop blood (hemostasis) And sometimes difficult to treat.

  In addition, as the diameter of the insertion section is reduced, the air / water supply conduit is also reduced in diameter, so the power of air / water supply is weak, and the suction force when using the forceps conduit for suction is also low. Because it is weak, air and water are sent compared to the oral endoscope, the stomach is expanded to remove the clouding of the observation window, a clean field of view is secured, and extra residues and body fluids that disturb the observation are sucked There was a limit. Therefore, when a lesion is found by transnasal endoscopy, it may be necessary to perform treatment / treatment by other methods such as inserting an oral endoscope. In addition, since the diameter of the light guide is small, the number of fibers constituting the light guide fiber bundle is approximately half that of the oral endoscope. For this reason, there existed a fault that an illuminance and a light distribution characteristic fell and a distant view became darker than an oral endoscope.

  The present invention has been made in view of such circumstances, and an assisting device devised so as to be able to perform treatments and treatments that have been difficult with a nasal endoscope due to the configuration and function limitations associated with a small diameter, Another object of the present invention is to provide an endoscope system using the same, and a method for using the endoscope system.

In order to achieve the above object, the auxiliary device of the present invention penetrates from one outer nostril to an endoscope insertion portion inserted into a body cavity and from the distal end portion to the proximal end portion of the endoscope insertion portion. An endoscopic forceps conduit, an endoscopic forceps inlet connected to the endoscopic forceps conduit, which is exposed to the operation portion main body connected to the proximal end portion of the endoscopic insertion portion, and in combination with an endoscope is used to have, obtain Bei the aid for insertion section for assisting the function of the endoscope by inserting the nostril or et body lumen other hand. In addition, the auxiliary tool includes an auxiliary tool forceps conduit penetrating from the distal end portion to the rear end portion of the auxiliary tool insertion portion, an auxiliary device having one end connected to the assist device forceps conduit and the other end exposed to the outside. A tool forceps inlet, an engaging portion provided at the rear end of the auxiliary tool insertion portion and detachably engaged with the operation portion main body, and provided in the engaging portion. A short-circuit tube for connecting to the forceps inlet for the mirror is also provided.

Further, the endoscope system of the present invention includes an endoscope having an endoscope insertion portion to be inserted into a body cavity from one nostril, is used in combination with the endoscope, from the other nostril obtain Bei and aid with aid for insertion section for assisting the function of the endoscope by being inserted into a body cavity. The endoscope is exposed to the forceps conduit for endoscope that penetrates from the distal end portion to the proximal end portion of the endoscope insertion portion, and the operation portion main body connected to the proximal end portion of the endoscope insertion portion. And an endoscopic forceps inlet connected to the endoscopic forceps conduit. Further, the auxiliary tool has an auxiliary tool forceps conduit that penetrates from the front end portion to the rear end portion of the auxiliary tool insertion portion, one end connected to the auxiliary tool forceps conduit, and the other end exposed to the outside. An assisting tool forceps inlet, an engaging part provided at the rear end of the assisting tool insertion part and detachably engaged with the operation part main body, and provided in the engaging part. A short-circuit tube for connecting the endoscope forceps inlet.

  In addition to the observation means, the endoscope may have at least one function of a forceps conduit, an illumination device, an air supply conduit, and a water supply conduit. The auxiliary tool includes a function for assisting any one of the functions in the insertion portion.

  The insertion part of the auxiliary tool may be provided with at least a forceps conduit that penetrates from the front end to the rear end. In addition to the forceps conduit, a light guide and an illumination lens may be incorporated in the insertion portion of the auxiliary tool in order to assist the illumination of the endoscope. Further, an air / water supply conduit may be provided in order to assist the air / water supply of the endoscope. Further, a water jet line may be provided to assist the water jet mechanism of the endoscope.

  It is preferable that an engaging portion is provided at the rear end portion of the assisting tool and is detachably engaged with the proximal end portion of the insertion portion of the endoscope. The engagement destination of the engagement portion may be a hand operation portion of the endoscope, or a proximal end portion between the insertion portion and the hand operation portion or near the hand operation portion of the insertion portion. If the rear end portion of the auxiliary tool is engaged with the endoscope, it is not necessary to have the rear end portion of the auxiliary tool, so that insertion, treatment, or treatment of both insertion portions can be easily performed. In addition, a forceps conduit that penetrates from the distal end portion to the proximal end portion and a forceps inlet that is exposed to the proximal end portion or the proximal operation portion and is connected to the forceps conduit are provided in the insertion portion of the endoscope. In this case, a forceps inlet having one end connected to the forceps conduit of the auxiliary tool and the other end exposed to the outside, and the forceps inlet and the forceps inlet of the endoscope are connected to the engaging portion. It is desirable to provide a short tube because the forceps inlet can be used in common.

  When performing treatment / treatment using an auxiliary tool together, it is necessary to fix the distal end of each insertion portion after insertion into both nostrils. Therefore, a fixing means for detachably fixing the distal end portions of the insertion portions of the auxiliary tool and the endoscope so that the distal end faces in the same direction is attached to either or both distal ends. Provide. As a fixing means, a method of fixing by magnetizing magnet bodies, a method of capturing and fixing the tip of the other insertion portion with a snare type elastic wire, or the like can be employed.

  In the insertion part of a transnasal endoscope, generally, a small-sized imaging device is built in the distal end portion, and at least a small forceps conduit is provided in an internal space penetrating from the distal end portion to the proximal end portion. ing. The insertion portion of this endoscope is inserted into the body cavity from one outer nostril. The auxiliary tool has a forceps conduit having a larger diameter than the forceps conduit of the endoscope and penetrating from the front end portion to the rear end portion. The insertion part of this auxiliary tool is inserted into the body cavity from the other nostril. Fixing means is provided at either one or both of the insertion portions of the auxiliary tool and the endoscope. Both tip portions are inserted into the range from the nostril to the esophagus, and both tip portions are detachably fixed by fixing means so that the tip surfaces face the same direction.

  Then, before or after inserting the insertion part of the auxiliary tool into the other outer nostril, or after fixing the distal end part of both insertion parts, the engagement part provided at the rear end part of the insertion part of the auxiliary tool is viewed The forceps conduits are connected to each other by detachably engaging with the proximal end portion of the insertion portion of the mirror.

  According to the present invention, it is used in combination with an endoscope having an insertion portion that is inserted into a body cavity from one outer nostril, and the function of the endoscope is inserted into the body cavity from the other outer nostril. Since an assisting device having an insertion part for assisting is provided, it is possible to reliably perform a treatment / treatment that could not be performed using a conventional transnasal endoscope.

  As shown in FIG. 1, the endoscope system 10 includes a nasal endoscope (hereinafter “endoscope”) 11, an auxiliary tool 12, a light source device 13, a processor device 14, a monitor 15, and the like. . The endoscope 11 has an insertion portion 16 to be inserted into one outer nostril. A hand operating part 17 is attached to the grip part 22a connected to the proximal end of the insertion part 16, and a universal connector 18 connected to the light source device 13 and the processor device 14 is universally connected to the hand operating part 17, respectively. It is provided at the tip of the cable 18a. The insertion portion 16 of the endoscope 11 is provided with a forceps conduit in an internal space penetrating from the distal end portion to the grasping portion 22a. One end of the forceps conduit is connected to a forceps outlet provided at the distal end, and the other end is connected to a forceps inlet 19 provided at the grip portion 22a. The forceps inlet 19 may be provided in the hand operation unit 17. The gripping portion 22a and the hand operation portion 17 constitute an operation portion main body.

  The insertion portion 16 of the endoscope 11 includes a distal end hard portion 20, a bending portion 21, and a soft portion 22, as is well known. A pair of cylindrical magnet bodies 23 and 24 for using the auxiliary tool 12 in combination are provided before and after the bending portion 21. Note that the distal end hard portion 20 and the curved portion 21 constitute the distal end portion of the insertion portion 16 of the endoscope 11 of the present invention.

  The hard distal end portion 20 of the endoscope incorporates an observation optical system, an image pickup device, an illumination optical system, and the like inside a distal end main body formed of a hard metal material or the like. The universal connector 18 includes a light guide connector (LG connector) 25 and a video connector (electrical connector) 27 provided at the tip of a cord 26 extending therefrom. The electrical connector 27 is connected to the processor device 14 and the LG connector 25 is connected to the light source device 13.

  The processor device 14 is provided with a power supply circuit, an image processing circuit for performing image processing on an image pickup signal obtained from the image pickup device and encoding it into a composite signal or an RGB component signal. The light source device 13 incorporates a light source lamp, and the light is guided from the grip portion 22a to the tip portion by a light guide (fiber bundle) accommodated in the internal space of the insertion portion 16 through the hand operation portion 17. It is incident on the illumination optical system.

  The flexible portion 22 is a portion that connects the hand operating portion 17 and the bending portion 21 in a long diameter with a small diameter, and has flexibility. The bending portion 21 bends when the angle wire accommodated in the internal space of the insertion portion 16 is pushed and pulled in conjunction with the operation of the bending operation knob 28 provided in the hand operation portion 17. Thereby, the observation region is observed with the distal end surface of the distal rigid portion 20 directed in a desired direction within the body cavity. The observation site is illuminated with light emitted from the illumination optical system, the reflected light is imaged by the imaging device via the observation optical system, and displayed on the monitor 15 via the image processing circuit.

  In addition to the two bending operation knobs 28 and the forceps inlet 19, the hand operation unit 17 is provided with an air / water supply button 30, a suction button 31, a water jet port (WJ port) 32, and the like. The WJ port 32 is detachably connected to a syringe, a water supply device, and the like that contain a fluid such as cleaning water or a chemical solution that is jetted toward the site to be observed. Note that the WJ port 32 and the forceps inlet 19 are usually closed by a detachable stopper.

  The auxiliary tool 12 is used in combination with an endoscope, and has an insertion part 35 and an engagement part 36. The insertion part 35 is inserted into the other outer nostril where the insertion part 16 of the endoscope 11 is not inserted. The engaging portion 36 is provided at the rear end portion of the insertion portion 35, and is detachably engaged with the operation portion main body (the grip portion 22a or the hand operation portion 17) of the endoscope 11. The insertion portion 35 of the assisting tool 12 includes a distal end portion 37, a bending portion 38, and a flexible tube portion 39 in order from the distal end.

  A pair of cylindrical magnet bodies 40 and 41 are provided on the bending portion 38 of the auxiliary tool 12 before and after the insertion direction. The pair of magnet bodies 40 and 41 are magnetically attached to the pair of magnet bodies 23 and 24 of the endoscope 11 when inserted in a range from the posterior nasal passage to the esophagus in the insertion path. As a result, the bending portion 38 of the auxiliary tool 12 is bent following the bending of the bending portion 21 of the endoscope 11, and the distal end surface of the distal end portion 37 of the auxiliary tool 12 is bent at the distal end hard portion 20 of the endoscope 11. It will be in the same direction as the tip surface of.

  The distal end portion 37 of the auxiliary tool 12 is formed of a hard material. The bending portion 38 is a flexible portion that bends together with the bending portion 21 of the endoscope 11. The flexible tube portion 39 is a portion that connects the engaging portion 36 and the bending portion 38 in a long shape with a small diameter, and has flexibility. In addition, the front-end | tip part 37 and the curved part 38 comprise the front-end | tip part of the insertion part 35 of the auxiliary tool 12 of this invention.

  The insertion portion 35 of the auxiliary tool 12 is provided with a forceps conduit that penetrates from the distal end portion to the engagement portion 36. One end of the forceps conduit is connected to a forceps outlet provided on the distal end surface, and the other end is connected to a forceps inlet 42 provided on the engaging portion 36. A forceps plug 42 a is attached to the forceps inlet 42. The forceps plug 42a has an elastic plug portion formed with a slit or a small hole that is pushed open by the treatment instrument, and the forceps inlet 42 is prevented from being ejected from the forceps inlet 42 to the outside through the forceps conduit 72. Partially seal. The engagement portion 36 is detachably engaged with a forceps inlet 19 provided in the hand operation portion 17, and a short-circuit path that connects the forceps conduit of the auxiliary tool 12 to the forceps inlet 19 of the hand operation portion 17 by being engaged. Have. As a result, a treatment tool such as forceps is inserted from the forceps inlet 42 of the auxiliary tool 12 and the direction of the distal end in the insertion direction is changed after the insertion, so that the endoscope 11 and the auxiliary tool 12 can be connected to the forceps conduit to be used. You can choose.

  The insertion portions 16 and 35 are both formed into a thin flexible tube so as to be inserted into the stomach, duodenum, etc. via the outer nostril, the posterior nostril, the esophagus, and have substantially the same diameter and length. ing. Note that the timing at which the engaging portion 36 of the auxiliary tool 12 is engaged with the hand operating portion 17 at the time of treatment or treatment using the endoscope is before and after both insertion portions 16 and 35 are inserted into the body cavity. You could think so. In the latter case, it is desirable that the length of the insertion portion 35 of the auxiliary tool 12 is longer than that of the insertion portion 16 of the endoscope 11 because the operation is easy. Moreover, since it may be judged that it is impossible to insert the insertion part 16 of the endoscope 11 into one of the nostrils in the insertion test into the nostril, the insertion part 35 of the auxiliary tool 12 is used for the endoscope 11. It is preferable to make the diameter smaller than the insertion portion 16.

  As shown in FIG. 2, the flexible portion 22 of the endoscope 11 has a screw tube 44 called a flex that protects the inside while maintaining flexibility in order from the inside, and the outer layer 46 that is covered on the screw tube 44. It is composed of a flexible tube 47 composed of three layers of a net 45 called a blade for holding a resin and an outer layer 46 on which the resin is deposited on the net 45.

  Inside the flexible portion 22 of the endoscope 11, light guides 48 and 49 for guiding illumination light to the illumination lens of the distal end hard portion 20, an angle wire 50, a forceps conduit 51, and an air / water supply conduit 52. A plurality of contents such as a multi-core cable 53 and a water jet pipe (WJ pipe) 54 are loosely inserted. The multi-core cable 53 is a cable for mainly sending a signal for driving the imaging sensor from the video signal processing unit and sending an imaging signal obtained from the imaging sensor to the video signal processing unit. The cross-sectional shape is covered with a protective coating. The angle wire 50 is flexible because two angle wires for up and down and left and right are respectively wound around two pulleys interlocked with the operation of the bending operation knob 28 and their tips are inserted toward the bending portion 21. There are four inside the portion 22, and each is inserted into the close coil pipe 50a.

  As shown in FIG. 3, an observation window 55, a pair of illumination windows 56 and 57, a water jet nozzle (WJ nozzle) 58, a forceps outlet 59, and an air supply are provided on the distal end surface 20 a of the distal end hard portion 20 of the endoscope 11. -The water supply nozzle 60 etc. are exposed and provided. In the observation window 55, a part of an objective optical system for taking in image light of a site to be observed in the body cavity is arranged. The illumination windows 56 and 57 are provided on both sides of the observation window 55, and irradiate light to be observed in the body cavity with light transmitted from the light source device 13 via the light guides 48 and 49.

  A forceps outlet 59 of the endoscope 11 communicates with a forceps inlet 19 provided in the hand operation unit 17 via a forceps conduit 51. The air / water supply nozzle 60 supplies air / water to the affected area by operating an air / water supply button 30 provided in the hand operation unit 17, or jets cleaning water or air toward the observation window 55. The WJ nozzle 58 ejects fluid such as cleaning water or chemical supplied from a syringe that is detachably attached to the WJ port 32 toward the site to be observed.

  As shown in FIG. 4, a part of the objective optical system 61 is exposed in the observation window 55. The illumination light emitted from the illumination windows 56 and 57 is incident on the objective optical system 61 after being reflected from the site to be observed. The incident subject light enters the prism 62 through the objective optical system 61 and bends inside the prism 62 to form an image on the imaging surface of the image sensor 63. The imaging element 63 is connected to a circuit board 64, and each signal line 53 a of the multicore cable 53 is connected to the circuit board 64.

  The outer layer from the distal end hard portion 20 to the curved portion 21 of the endoscope 11 is formed of a flexible angle rubber 65. On the inner side of the angle rubber 65, a distal end side connection ring 66 with which the distal end of the angle wire 50 is engaged is provided. A plurality of node rings (not shown) are alternately connected to the distal end side connection ring 66 by left and right and upper and lower pins serving as the center of curvature toward the proximal end portion. An angle wire 50 is slidably engaged inside each node ring, and the node ring row is bent vertically and horizontally by pushing and pulling the angle wire 50 for up and down and left and right.

  Inside the bending portion 21 of the endoscope 11, a forceps conduit 51 inserted from the flexible portion 22 is disposed. The forceps conduit 51 is a flexible tube made of synthetic resin. A hard tube 67 disposed inside the distal end hard portion 20 is connected to the distal end of the forceps conduit 51. The hard tube 67 has a tip connected to a forceps outlet 59.

  As shown in FIG. 5, the flexible tube portion 39 of the auxiliary tool 12 is a flexible tube composed of three layers of a screw tube 68, a net 69, and an outer layer 70, as with the flexible portion 22 of the endoscope 11. 71. The screw tube 68 is provided around the forceps conduit 72 and protects the forceps conduit 72 while maintaining flexibility. The net 69 is covered on the screw tube 68 and holds the resin of the outer layer 70. The outer layer 70 is obtained by depositing a resin on the net 69.

  The forceps conduit 72 of the auxiliary tool 12 is made of a flexible tube made of synthetic resin, and its inner diameter is approximately 70% or more of the outer diameter of the insertion portion 35 of the auxiliary tool 12. The diameter is approximately twice or more than the inner diameter of the forceps conduit 51. As a result, a large treatment instrument can be inserted into the forceps conduit 72 of the auxiliary instrument 12.

  As shown in FIG. 6, the distal end portion 37 of the assisting tool 12 is covered with a distal end portion main body 73. A forceps outlet 76 is exposed on the distal end surface 37 a of the distal end portion 37. A rigid tube 75 is connected to the forceps outlet 76, and a flexible forceps conduit 72 is connected to the rigid tube 75. The inner diameters of the forceps outlet 76, the hard tube 75, and the forceps conduit 72 are substantially the same.

  The bending portion 38 of the auxiliary tool 12 is covered with a flexible skin 74 so as to bend following the bending portion 21 of the endoscope 11. The skin 74 of the bending portion 21 has substantially the same configuration as that of the flexible tube portion 39. However, when the inner skin 74 follows the bending of the bending portion 38 of the endoscope 11, the skin 74 The distal end surface 37a of the portion 37 is slightly expanded and contracted with respect to the insertion direction so that the distal end surface 37a does not deviate from the distal end surface 20a of the endoscope 11.

  As shown in FIG. 7, the pair of magnet bodies 40 and 41 provided on the curved portion 38 of the auxiliary tool 12 are provided with a pair of recesses 77 and 78 that are recessed by one step on the skin 74 so that the surface does not have unevenness. Are respectively fitted in the recesses 77 and 78. On the other hand, the pair of magnet bodies 23 and 24 provided before and after the bending portion 21 of the endoscope 11 are also fitted in the recessed portions 79 and 80 that are recessed by one step so that the surface does not have unevenness. The pair of magnet bodies 23 and 24 and the magnet bodies 40 and 41 have the same interval, and are magnetized at two positions with a predetermined distance, so that the endoscope 11 and the auxiliary tool 12 can be connected to each other. The curved portions 21 and 38 can be fixed in parallel with the front end surfaces 20a and 37a being aligned.

  These magnet bodies 23, 24, 40, and 41 constitute the fixing means of the present invention. The fixing means is not limited to magnetizing magnet bodies, but may be a set of magnet bodies and magnetized bodies. Alternatively, a plurality of magnet bodies may be attached to a ring-shaped band and the band may be fitted into the recess.

  The endoscope 11 includes the imaging device 63 shown in FIG. 8 at the distal end hard portion 20, and also includes a CPU 83, a reference clock oscillator 84, a timing generator (TG) 85, and an analog signal processing circuit (AFE: Analog Front End processor). 86 or the like is provided inside the universal connector 18.

  The image sensor 63 is a CCD, a CMOS, or the like, and captures a subject image formed by the objective optical system 61. On this light receiving surface, a color filter composed of a plurality of color segments (for example, a primary color filter with a Bayer array) is arranged.

  The CPU 83 controls the operation of each part of the endoscope 11. The TG 85 generates a drive pulse (vertical / horizontal drive pulse) of the image sensor 63 based on the reference clock signal generated by the reference clock oscillator 84, and generates a synchronization pulse for the AFE 86, and the drive pulse and the synchronization pulse. Are input to the image sensor 63 and the AFE 86, respectively. The imaging element 63 performs an imaging operation according to the drive pulse input from the TG 85 and outputs an imaging signal to the AFE 86.

  The AFE 86 includes a correlated double sampling circuit (CDS) 88, an automatic gain control circuit (AGC) 89, and an analog / digital converter (A / D) 90. The CDS 88 performs correlated double sampling processing on the image signal output from the image sensor 63 and removes reset noise and amplifier noise generated in the image sensor 63. The AGC 89 adjusts the gain of the image signal from which noise has been removed by the CDS 88. The A / D 90 converts the imaging signal amplified by the AGC 89 into a digital signal having a predetermined number of bits, and sends the digital signal to the processor device 14 via the universal connector 18.

  Further, the TG 85 sends a horizontal synchronization signal, a vertical synchronization signal, and a clock signal corresponding to the imaging signal output from the AFE 86 to the processor device 14 via the universal connector 18.

  The processor device 14 includes a CPU 91, an isolation circuit (insulation circuit) 92, a digital signal processing circuit (DSP) 93, a synchronization signal generation circuit (SSG) 94, a digital / analog converter (D / A) 95, and the like. Yes.

  The CPU 91 controls the operation of the processor device 14 and the light source device 13. The isolation circuit 92 is for insulating and separating the endoscope 11 from the processor device 14. A digital signal processing circuit (DSP) 93 performs signal processing on the imaging signal to generate a video signal.

  A synchronization signal generation circuit (SSG) 94 generates a corrected horizontal synchronization signal, vertical synchronization signal, and clock signal. A digital / analog converter (D / A) 95 converts the video signal output from the DSP 93 into an analog video signal of the NTSC system or the like.

  A horizontal drive pulse, a vertical drive pulse, and a clock pulse output from the TG 85 of the endoscope 11 are input to the SSG 94 via the isolation circuit 92. The SSG 94 corrects a phase shift between the input horizontal drive pulse, vertical drive pulse, and clock pulse, and generates a horizontal drive pulse, a vertical drive pulse, and a clock pulse with corrected phase shift. A signal is input to the DSP 93.

  An imaging signal output from the AFE 86 of the endoscope 11 is input to the DSP 93 via the isolation circuit 92. The DSP 93 performs color separation, color interpolation, gain correction, white balance adjustment, gamma correction, image enhancement processing, and the like on the input imaging signal, and generates a Y / Y composed of a luminance (Y) signal and a color difference (C) signal. A C format video signal is generated, and the generated video signal is input to the D / A 95. The D / A 95 converts the input video signal into an NTSC analog video signal, and outputs it to the monitor 15 externally connected to the connector 96.

  The light source device 13 includes a light source lamp 97, a light source driver 98, a diaphragm mechanism 99, a condenser lens 100, and a CPU 101. The light source lamp 97 is a white light source emitted from a xenon lamp, a halogen lamp, or the like. The light source driver 98 drives the light source lamp 97. The diaphragm mechanism 99 is disposed between the light source lamp 97 and the incident ends of the light guides 48 and 49, and increases or decreases the amount of light incident on the light guides 48 and 49. The condenser lens 100 condenses the light that has passed through the aperture mechanism 99 and guides it to the incident ends of the light guides 48 and 49. The CPU 101 communicates with the CPU 91 of the processor device 14 and controls the light source driver 98 and the diaphragm mechanism 99. Light emitted from the light source lamp 97 enters the incident ends of the light guides 48 and 49 through the diaphragm mechanism 99 and the condenser lens 100, and is emitted from the emission ends of the light guides 48 and 49. The light is irradiated into the body cavity from the illumination windows 56 and 57 via 103.

  The rear end of the air / water feed conduit 52 connected to the air / water feed nozzle 60 of the endoscope 11 is divided into two branches, an air feed conduit 104 and a water feed conduit 105. The air supply conduit 104 and the water supply conduit 105 are respectively connected to the air / water supply button 30. Specifically, as shown in FIG. 9, the air / water button 30 has a pipeline switching function, and has an air supply port 106, a water supply port 107, a water supply port 108, and an air supply port 109. doing. A water supply pipe 105 is connected to the water supply port 107, and an air supply pipe 104 is connected to the air supply port 106. A water supply tank 111 is connected to the water supply port 108 via a water supply connector 110 provided in the universal connector 18. A valve 112 built in the light source device 13 and an air supply pump 113 are connected to the air supply port 109 via the universal connector 18.

  The light source device 13 is provided with an air supply button 114 for selecting the air pressure to be exposed to the outside. The air pressure information selected by the air feed button 114 is sent to the CPU 101, and the CPU 101 adjusts the valve 112 based on the air pressure information. The air / water supply button 30 has a hole 115 in a part of the button, and the air supply pump 113 is always driven to discharge air from the hole 115. By performing the operation of closing the hole 115 of the air / water feed button 30, the pipe line to the air / water feed nozzle 60 is connected, and air blows out from the air / water feed nozzle 60. Further, as shown in detail in FIG. 10, when an operation for pushing the air / water feed button 30 is performed, the air supply port 109 is closed and the air flows into the water supply tank 111. The air pushes out water in the water supply tank 111, and the water is blown out from the air supply / water supply nozzle 60 through the water supply port 108 through the air supply / water supply conduit 52 through the water supply port 108.

  As shown in FIG. 8, the WJ pipe 54 accommodated in the insertion portion 16 of the endoscope 11 has one end connected to the WJ nozzle 58 and the other end connected to the WJ port 32 provided in the hand operation unit 17. Yes. A syringe 121 or a tube attached to the syringe 121 is connected to the WJ port 32. The liquid injected into the syringe 121 is ejected from the WJ nozzle 58 toward the affected part through the WJ conduit 54 by moving the plunger in the axial direction.

  The rear end of the forceps conduit 51 of the endoscope 11 is branched and connected to a forceps inlet 19 and a suction button 31 provided on the hand operation unit 17. The suction button 31 has a port 116 connected to the forceps conduit 51 and a port 117 connected to the suction connector 118 provided in the universal connector 18. As shown in detail in FIG. 11, the suction connector 118 is connected to a tube 120 connected to the suction device 119. When the suction button 31 is pressed, the ports 116 and 117 are connected, and the suction device 119 sucks dirt and blood and other body fluids in the body cavity from the forceps outlet 59 via the forceps conduit 51 of the endoscope 11, and the suction tank It is stored in 123.

  The engaging portion 36 of the auxiliary tool 12 is engaged with the forceps inlet 19 of the endoscope 11. The engaging portion 36 has a short-circuit tube 122 that connects the forceps conduit 72 and the forceps inlet 19 of the endoscope 11. When the engaging portion 36 is connected to the forceps inlet 19, the forceps conduit 51 of the endoscope 11 and the forceps conduit 72 of the auxiliary tool 12 are connected. When the auxiliary tool 12 is used together and the suction button 31 of the hand operating section 17 is pressed, the suction device 119 is connected to both the forceps outlets 59 and 76 via the endoscope 11 and the forceps conduits 51 and 72 of the auxiliary tool 12. A large amount of dirt, blood and other body fluids in the body cavity can be sucked.

  Next, the operation of the above configuration will be described with reference to FIG. In the transnasal endoscopy, as a pretreatment, in order to insert the insertion part 16 of the endoscope 11, an anesthesia is performed from the nasal cavity of the nostril to the middle (lower) nasal passage and an insertion test is performed. The nasal cavity having an insertion path through which the unit 16 can be inserted is determined. If it is determined that the nasal cavity to be inserted is narrow and the insertion part 16 cannot be inserted, the other nostril is used, and the nasal cavity is anesthetized from both outer nostrils. The pretreatment is performed in the sitting position or the supine position, and thereafter, the insertion portion 16 is inserted into one outer nostril in the supine position or the left-side supine position. As shown in FIG. 13, the insertion path is a path that reaches from one outer nostril 130 through the middle nasal passage 131 or the lower nasal passage 132 to the posterior nostril (inner nostril) 133, the esophagus 134, and the stomach.

  If no treatment or treatment is required by observing the duodenum or stomach, the insertion portion 16 of the endoscope 11 is removed. In addition, when a lesion is found and treatment or treatment can be performed using the small-diameter forceps conduit 51 of the endoscope 11, a small snare or biological forceps can be treated using the forceps conduit 51. A device is inserted for treatment or therapy.

  When treatment or treatment cannot be performed in the forceps conduit 51 of the endoscope 11, the auxiliary tool 12 is used in combination. When the auxiliary tool 12 is used together with the endoscope 11, first, the insertion part 35 of the auxiliary tool 12 is inserted into the other nostril, so that the nasal cavity of the other nostril is anesthetized. Next, since it is necessary to fix and insert the distal ends of the insertion portions 16 and 35 of the endoscope 11 and the auxiliary tool 12 together, the insertion portion 16 of the endoscope 11 is once inserted from the rear nostril 133 to the esophagus 134. Pull back so that the tip is located in the range up to. Thereafter, the insertion part 35 of the auxiliary tool 12 is inserted from the other nostril, and is inserted into the range from the rear nostril 133 to the esophagus 134 through the middle nasal passage 131 or the lower nasal passage 132. At this time, the insertion parts 16 and 35 are relatively shifted so that the distal end surfaces 20a and 37a of both the insertion parts 16 and 35 are substantially at the same position, so that the magnet body 23 and the auxiliary tool 12 of the endoscope 12 The magnet body 40 and the magnet body 24 of the endoscope and the magnet body 41 of the auxiliary tool 12 are magnetized. Thereby, both the curved parts 21 and 38 are closely contacted in parallel, and both front end surfaces 20a and 37a are in the same direction.

  Thereafter, the engaging portion 36 of the auxiliary tool 12 is engaged with the forceps inlet 19 of the endoscope 11, and after the engagement is completed, both the insertion portions 16 and 35 are gradually inserted. At this time, insertion is performed while bending the bending portion 21 of the endoscope 11 by operating the bending operation knob 28 while viewing the screen of the monitor 15. Since the bending portion 38 of the auxiliary tool 12 is in close contact with the bending portion 21 of the endoscope 11 by the magnetic attachment of the magnet bodies 23 and 24 and the magnet bodies 40 and 41, the bending portion 38 of the auxiliary tool 12 is combined with the bending portion 21 of the endoscope 11. And is inserted following the insertion of the insertion portion 16 of the endoscope 11. For this reason, the insertion part 35 of the auxiliary tool 12 is also inserted together by only inserting with the insertion part 16 of the endoscope 11.

  Thereafter, when an affected part that needs to be treated or treated is displayed on the screen of the monitor 15, a treatment tool such as a snare or a biopsy forceps is inserted from a forceps inlet 42 provided in the engaging part 36 into a forceps tube of the auxiliary tool 12. The insertion is performed so as to enter the path 72, and the distal end treatment member of the treatment instrument, for example, a pair of forceps cups, a squeezing loop, or the like is exposed from the forceps outlet 76 of the auxiliary tool 12 to perform treatment or treatment.

  A biopsy forceps described as an example of a treatment tool generally has an operation wire having a pair of forceps cups attached to the tip of the biopsy forceps so as to be freely opened and closed, and the rear end of the operation wire is positioned outside the forceps inlet. By moving forward and backward in the direction, the pair of forceps cups are inserted into and removed from the distal end of the flexible sheath, thereby opening and closing the forceps cups in a hook shape. Biopsy forceps are mainly used for the purpose of tissue collection, and the outer diameter of a compatible forceps conduit often requires, for example, 2.8 mm or more.

  In addition, a snare is generally configured such that a squeezing loop formed by bending an elastic wire enters and exits the sheath tip by operation from the proximal side of the sheath. In the state of being pulled in, it is elastically deformed into a constricted state, and when it is pushed forward from within the sheath, it expands into a loop-like shape. When polypectomy is performed with a snare, the root portion of the polyp is properly tightened with the loop for squeezing, and then a high-frequency current is applied to the squeezing loop to make contact with the squeezing loop. A part of living tissue is cauterized and cut and coagulated simultaneously. Many of these snares require an outer diameter of a compatible forceps conduit of, for example, 2.8 mm or more.

  Such a treatment tool such as a snare or a biopsy forceps is used by using the forceps conduit 72 of the auxiliary tool 12, for example, tissue sampling (biopsy), removing a foreign object, stopping bleeding, removing a tumor, removing a gallstone Treatment and treatment such as crushing. Further, when it is desired to aspirate body waste, blood, or other body fluids, when the suction button 31 of the hand operation unit 17 is pressed, suction is performed not only from the forceps outlet 59 of the endoscope 11 but also from the forceps outlet 76 of the auxiliary tool 12. Therefore, rapid suction can be performed, and suction from both forceps outlets 59 and 76 can be performed simultaneously, so that a large amount of living tissue can be collected.

  After the treatment or treatment is completed, a treatment tool such as a biopsy forceps or a snare is pulled out from the forceps inlet 42 of the auxiliary tool 12, and then both the insertion portions 16 and 35 are slowly pulled out. In the middle of this, for example, before passing through the range from the posterior nostril to the esophagus, the fixation of the distal end portions of both insertion portions 16 and 35 is released. This operation is performed by shifting one of the insertion portion 16 of the endoscope 11 and the insertion portion 35 of the auxiliary tool 12 relative to the other in the insertion direction, and the magnet bodies 23 and 24 and the magnet bodies 40 and 41. Can be released. After releasing the fixation of both tip portions, the insertion portions 35 and 16 are withdrawn individually in the order of the auxiliary tool 12 and the endoscope 11. Finally, the engaging part 36 of the auxiliary tool 12 is removed from the forceps inlet 19 of the hand operating part 17.

  If it is known from the beginning that treatment or therapy cannot be performed using the forceps conduit 51 of the endoscope 11, the assisting tool 12 may be used from the beginning. The timing of connecting the engaging portion 36 of the auxiliary tool 12 to the hand operating portion 17 may be performed before the insertion portion 35 of the auxiliary tool 12 is inserted, or the distal end portions of both insertion portions 16 and 35 are fixed. You may go after.

  In the said embodiment, although it has set it as the structure which connects the engaging part 36 of the auxiliary tool 12 to the hand operation part 17 of the endoscope 11, it is not restricted to this in this invention, It is an engaging part from the rear-end part of the auxiliary tool 12. May be omitted, and the rear end portion of the endoscope 11 and the auxiliary tool 12 may not be connected. In this case, as shown in FIG. 14, a forceps inlet 141 and a suction connector 142 that branch from the rear end of the forceps conduit 72 and are connected to each other are provided at the rear end of the auxiliary tool 140. You may use it with the form which connects with the suction device 143. The suction device 143 is a suction device dedicated to the auxiliary tool 140 and includes a control unit 145 and a pump 146. In this case, when the foot switch 144 is connected to the control unit 145 and the foot switch 144 is pressed with the foot, the suction operation with the auxiliary tool 12 is performed. It is desirable because it can be done without increasing. In this embodiment, suction using the forceps conduit 51 of the endoscope 11 and the forceps conduit 72 of the auxiliary tool 12 can be performed individually. Thus, a large biological tissue can be collected separately using the forceps conduit 72 of the auxiliary tool 12 and a small one can be collected separately using the forceps conduit 51 of the endoscope 11.

  In each of the above embodiments, the magnet bodies 23, 24, 40, and 41 are provided on both sides as fixing means, and both tip portions are fixed by magnetic adhesion between the magnet bodies. However, the present invention is not limited to this. Alternatively, an electromagnet may be provided on one side, a magnetic body may be provided on the other side, and an operation unit for turning on and off the electromagnet may be provided on one side provided with the electromagnet. The electromagnet is magnetically attached to the magnetic body when a current flows through the electromagnet in response to the operation of the operation unit. When an electromagnet is provided in the endoscope 11, a current may be transmitted from the light source device 13 or the processor device 14 via the universal connector 18. Conversely, when the auxiliary tool 12 is provided with an electromagnet, a terminal for taking in an electric current may be provided at the rear end of the auxiliary tool 12, and the terminal and the light source device 13 or the processor device 14 may be connected. It is good also as a structure which prepares and connects the power supply device and the terminal of the auxiliary tool 12.

  Further, the fixing means is not limited to a fixing means using magnetic force, and as shown in FIG. 15, a snare-type capturing tool 151 is provided in the internal space of the insertion portion 35 of the auxiliary tool 150 separately from the forceps conduit 72. A capturing pipeline 152 for insertion is provided, and the distal end portion of the endoscope 11 is captured by a capturing loop 153 provided at the distal end of the capturing tool 151 so that the distal end surfaces of the distal end portions are in the same direction. It is good also as a structure fixed to. The capture pipe line 152 has a smaller diameter than the forceps pipe line 72, and one end is provided at the pipe line outlet 154 provided at the distal end portion of the assisting tool 12, and the other route is provided at the rear end portion. 155, respectively. The trap 151 has an elastic wire slidably accommodated in a sheath, and an openable / closable trap loop 153 formed by bending the elastic wire at the tip, and a pipe inlet 155 at the rear end. Each has an exposed handle 156.

  The capturing tool 151 is elastically deformed into a constricted state when the capturing loop 153 is pulled into the sheath by pushing and pulling the handle 156 with respect to the sheath, and is looped when pushed forward from within the sheath. Swell. When it is inserted into the nostril, it is kept in a squeezed state, and when the distal ends are fixed, it is inflated in a loop. After the distal end of the insertion portion 16 of the endoscope 11 is captured, the handle 156 is pulled to capture it. The loop 153 can be squeezed and the distal end portion on the endoscope 11 side can be fixed to the distal end portion on the auxiliary tool 150 side.

  In this case, if the conduit outlet 154 for projecting the capturing loop 153 is formed on the peripheral surface on the rear end side of the distal end portion 37 of the auxiliary tool 150, the distal end portions can be brought into close contact with each other at the time of capturing. In this embodiment, when the distal end portions are fixed to each other, if the distal end portion on the endoscope 11 side is positioned behind the auxiliary tool 12 in the insertion direction, the capturing loop 153 is reflected on the screen of the monitor 15. Therefore, it is only necessary to insert the insertion portion 16 of the endoscope 11 so that the distal end portion on the endoscope 11 side passes through the capturing loop 153 while viewing the image of the loop 153, so that the fixing can be surely performed. Note that the capture tool 151 may be provided on the endoscope 11 side.

  By the way, many transnasal endoscopes 11 do not include the WJ nozzle 58. Accordingly, as an auxiliary tool 161 for assisting such an endoscope 11, as shown in FIG. 16, a water jet pipe (WJ pipe) 160 for ejecting liquid toward an observation object is used as a forceps pipe. A structure provided in addition to 72 may be used in combination. In this case, a water jet port (WJ port) 163 for connecting the water supply device 162 is provided at the rear end portion of the auxiliary tool 161, and the rear end of the WJ pipe line 160 is connected to the WJ port 163. The distal end of the WJ pipe line 160 is connected to a water jet nozzle (WJ nozzle) 164 provided on the distal end surface 37 a of the distal end portion 37.

  The water supply device 162 includes a water supply pump 165, a control unit 166 that controls driving of the pump 165, a foot switch 167, and a water supply tank 168 connected to the water supply pump 165. In response to the pressing operation of the foot switch 167, the control unit 166 drives the water supply pump 165 to send the liquid in the water supply tank 168 to the auxiliary tool 161. The fed liquid is ejected from the WJ nozzle 164 through the WJ pipe line 160. Since the WJ nozzle 164 and the WJ conduit 160 may be smaller in diameter than the forceps conduit 72 and the forceps outlet 76, the forceps conduit 72 and the forceps outlet 76 can be maintained at a large diameter. Note that the number of WJ nozzles 164 provided in the auxiliary tool 161 may be plural. In this case, different liquids can be ejected simultaneously by arranging the WJ pipes in parallel and providing the WJ ports individually.

  In addition, the operator may feel that the screen displayed on the monitor 15 is dark at the time of transnasal endoscopy. Therefore, an auxiliary tool that accommodates the light guide in the insertion portion instead of the WJ pipe, and provides an illumination window on the distal end surface of the insertion portion to increase the illumination light in addition to the illumination of the endoscope may be used. As such an auxiliary tool, as shown in FIG. 17, a light guide connector (LG connector) 172 is provided at the tip of a cord 171 extending from the rear end portion of the auxiliary tool 170, and the LG connector 172 is connected to the light source device 13. It is preferable that the light of the light source device 13 made for the endoscope 11 is separated. The light source device 13 is provided with two scope sockets to which both LG connectors 25 and 172 are connected. An illumination lens is built in the distal end portion 37 of the auxiliary tool 170, and the illumination lens has an object-side surface exposed to an illumination window 174 provided on the distal end surface 37a of the distal end portion 37, and a pseudo light source. The side surface is disposed in the vicinity of the emission end of the light guide 175. The incident end of the light guide 175 is guided into the light source device 13 via the LG connector 172.

  In the case of this embodiment, since the illumination light of the auxiliary tool 170 is added to the illumination light of the endoscope 11, the illumination range of the amount of light necessary for the imaging device 63 of the endoscope 11 is expanded, and the light distribution characteristics are improved. In addition, the amount of light increases, so the distant view becomes brighter. Thereby, a good image quality can be provided. In addition, the number of the illumination windows 174 provided in the auxiliary tool 170 may be plural. Moreover, you may use the light source device only for auxiliary tools. In this case, it is desirable to connect two light source devices and control the light amount of the light source device for the auxiliary tool so that the light amount is the same in response to the light amount produced by the light source device for the endoscope. As an illumination function provided in the auxiliary tool, an LED, a driver for driving the LED, and the like may be used instead of the light guide and the illumination lens.

It is explanatory drawing which shows the use condition of the endoscope system which consists of a transnasal endoscope of this invention, and an auxiliary tool. It is sectional drawing which shows the insertion part of an endoscope. It is explanatory drawing which shows the front end surface of the insertion part of an endoscope. It is sectional drawing which shows the inside of the front-end | tip hard part of an endoscope. It is sectional drawing which shows the insertion part of an auxiliary tool. It is a cross section which shows the inside of the front-end | tip part of an auxiliary tool. It is a perspective view which shows the state which fixed the front-end | tip part of both an endoscope and an auxiliary tool. It is explanatory drawing which shows the outline of the electrical connection form of the endoscope system of this invention, and a physical connection form. It is explanation which shows the outline of the pipeline switching of an air supply / water supply button, and has shown the state which performs the operation which plugs up the hole of an air supply / water supply button, and sends air from the air supply / water supply nozzle of an endoscope. It is explanation which shows the outline of the pipe line switching of an air supply / water supply button, and shows the state which pushes down an air supply / water supply button and sends a liquid from the air supply / water supply nozzle of an endoscope. It is a perspective view which shows the state which connected the suction device to the suction connector provided in the hand operation part of the endoscope. It is a flowchart which shows the procedure which performs endoscopy or treatment and treatment using the endoscope system of the present invention. It is explanatory drawing which shows the state which inserts an endoscope and an auxiliary tool into a posterior nostril and an esophagus through a middle nasal passage from an outer nostril. It is explanatory drawing which shows another embodiment which does not connect the rear-end part of an auxiliary tool to the hand operation part of an endoscope. It is explanatory drawing which shows other embodiment which provided the snare type capture | acquisition tool which capture | acquires the front-end | tip part of the insertion part of an endoscope in the auxiliary tool as a fixing means which fixes front-end | tip parts. It is explanatory drawing which shows embodiment which accommodated the forceps pipe line and the water jet pipe line in the insertion part of an auxiliary tool. It is explanatory drawing which shows embodiment which accommodated the forceps duct and the light guide in the insertion part of the auxiliary tool.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Endoscope system 11 Endoscope 12 Auxiliary tool 16 Endoscope side insertion part 35 Auxiliary tool side insertion part 36 Engagement part 51 Endoscope side forceps channel 59 Endoscope side forceps exit 72 Instrument side forceps conduit 76 Auxiliary instrument forceps outlet 122 Short circuit tube

Claims (6)

An endoscope insertion portion that is inserted into a body cavity from one outer nostril , an endoscope forceps conduit that penetrates from the distal end portion to the proximal end portion of the endoscope insertion portion, and the endoscope Used in combination with an endoscope having a forceps inlet for an endoscope connected to the forceps conduit for the endoscope, which is provided exposed to the operation portion main body connected to the proximal end portion of the insertion portion for use, in obtaining Bei the aid for insertion section for assisting the function of the endoscope by inserting from the other nostril in the body cavity aid,
A forceps conduit for an auxiliary tool penetrating from a distal end portion to a rear end portion of the auxiliary instrument insertion portion;
One end of the auxiliary instrument forceps conduit connected to the other end, and the other end exposed to the outside, the auxiliary instrument forceps inlet;
An engagement portion provided at a rear end portion of the insertion portion for the auxiliary tool, and detachably engaged with the operation portion main body;
A short-circuit tube provided in the engaging portion, for connecting the forceps inlet for the auxiliary tool and the forceps inlet for the endoscope;
An auxiliary device comprising: Lighting means of the endoscope, air feed conduit, and aid of claim 1, wherein at least any one function of the water feed conduit also characterized by an auxiliary. An endoscope having an insertion portion for an endoscope inserted into a body cavity from one outer nostril;
Is used in combination with the endoscope, an endoscope system Ru and an aid with aid for insertion section for assisting the function of the endoscope by the other nostril is inserted into the body cavity In
The endoscope is
An endoscope forceps conduit penetrating from the distal end portion to the proximal end portion of the endoscope insertion portion;
An endoscope forceps inlet provided exposed to an operation unit body connected to a proximal end portion of the endoscope insertion portion and connected to the endoscope forceps conduit;
With
The aid is
A forceps conduit for an auxiliary tool penetrating from a distal end portion to a rear end portion of the auxiliary instrument insertion portion;
One end of the auxiliary instrument forceps conduit connected to the other end, and the other end exposed to the outside, the auxiliary instrument forceps inlet;
An engagement portion provided at a rear end portion of the insertion portion for the auxiliary tool, and detachably engaged with the operation portion main body;
A short-circuit tube provided in the engaging portion, for connecting the forceps inlet for the auxiliary tool and the forceps inlet for the endoscope;
An endoscope system comprising: The aid, lighting means of the endoscope, air feed conduit, and an endoscope system according to claim 3, characterized in that also assist least one of features of the water supply conduit. The endoscope system according to claim 3 or 4, wherein the forceps conduit for an auxiliary tool also serves as a suction conduit that branches off from a rear end portion and is connected to a suction source. Wherein the distal end of either one or both of the aid for inserting portion and the endoscope insertion portion, of the tip face each other of the distal ends is fixed detachably so as to face in the same direction The endoscope system according to any one of claims 3 to 5, further comprising a fixing unit.

Images