JP5415746B2 - Endoscope system - Google Patents

Description

  The present invention relates to an endoscope system using an auxiliary tool in combination with a transnasal endoscope.

  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 opened to the distal end surface, and to the forceps inlet provided at the other end opened to the proximal end. Guide the insertion.
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.

  As a solution, an auxiliary tool provided with a forceps conduit having a diameter larger than the forceps conduit of the nasal endoscope at the insertion portion of the nasal endoscope that is the same as or slightly thinner than the nasal endoscope is used. It can be considered to be used in combination with an endoscope. For example, the insertion part of an auxiliary tool is inserted from the other nostril and used in combination with a transnasal endoscope. Thereby, the function of a transnasal endoscope can be assisted.

  When the nasal endoscope and the auxiliary tool are used in combination, if the distal end portion of each insertion portion is separated, each must be operated individually, resulting in poor operability. For this reason, when both treatments are performed in combination, after inserting each insertion portion through a separate nostril, the distal end portions of each insertion portion are placed in the body cavity of the patient (from the inner nostril to the vicinity of the esophagus). It is preferable to fix.

  However, if the auxiliary tool is fixed at an inappropriate position with respect to the transnasal endoscope, for example, the treatment tool derived from the forceps conduit of the auxiliary tool may cause a shadow on the object to be observed. In other words, the reflected light of the illumination light hitting the treatment tool may cause the image to be overexposed.

  An object of the present invention is to provide an endoscope system devised so as to fix an auxiliary tool provided with a forceps conduit at an appropriate position with respect to a transnasal endoscope.

In order to achieve the above object, in the endoscope system of the present invention, an insertion portion to be inserted into one outer nostril, an observation window and an illumination window provided on the distal end surface of the distal end portion of the insertion portion, and an insertion portion A forceps conduit built in the internal space from the distal end portion toward the proximal end portion, an operation portion main body connected to the proximal end portion and having a bending operation portion, and provided at the distal end portion. An endoscope having a bending portion that bends the distal end portion in at least two directions of up and down according to a bending operation, an insertion portion that is inserted into the other nostril, and a distal end surface to a rear end portion of the insertion portion A forceps conduit having a diameter larger than the forceps conduit of the endoscope, an auxiliary tool used in combination with the endoscope, the center of the observation window, and the distal end surface It is perpendicular to the straight line passing through the center and touches the outer periphery of the illumination window on the center side of the tip. The distal end surface of the endoscope insertion portion and the auxiliary tool insertion portion at the outer peripheral position of the second region in which the distal end surface is divided into the first region where the observation window is arranged and the other second region. And fixing means for detachably fixing them in the same direction and in substantially the same position in the axial direction.

The fixing means includes a first magnetic attachment that is axially spaced from the insertion portion of the endoscope and extends in the outer peripheral direction on the outer peripheral surface of the second region, and a first magnetic attachment in the axial direction of the insertion portion of the auxiliary tool. It is preferable to have an annular second magnetized body that is provided at a position corresponding to the body and is spaced apart and extends in the outer circumferential direction .

The fixing means includes a pipe outlet that opens to the outer peripheral surface of the second region of the insertion portion of the endoscope, a pipe for capturing that has a pipe inlet that opens to the operation section main body, and the pipe is accommodated in the pipe for capturing. It is preferable that a trapping loop that can be opened and closed by elasticity is provided at the tip and a catching tool having a handle at the rear end .

The endoscope receives an image sensor that captures an image of the subject through the observation window, and displays the image of the subject in a state where the vertical direction in which the bending portion is curved is aligned with the vertical direction in the screen. And means .

According to the present invention, the first region in which the observation window is arranged by a straight line that intersects perpendicularly to a straight line that passes through the center of the observation window and the center of the tip surface and that is in contact with the outer periphery of the illumination window on the center side of the tip surface. The outer peripheral position of the second region in which the distal end surface is divided into other second regions, and the distal end surfaces of the insertion portion of the endoscope and the insertion portion of the auxiliary tool are substantially the same in the axial direction in the same direction. Since it is detachably fixed by the fixing means , a shadow is formed on the observation object by the treatment tool derived from the forceps conduit of the auxiliary tool, or on the contrary, the reflected light of the illumination light hitting the treatment tool causes whiteout in the image. It is possible to reliably prevent inconveniences that can occur.

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 includes an insertion portion 16 to be inserted into one 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 magnetic bodies 40 and 41 are provided on the bending portion 38 of the auxiliary tool 12 before and after the insertion direction. When the pair of magnetic bodies 40 and 41 are inserted in the range from the posterior nasal passage to the esophagus in the insertion path, the pair of magnetic bodies 40 and 41 are magnetized to the pair of magnet bodies 23 and 24 provided on the bending portion 21 of the endoscope 11. To wear. 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 is bent inside the prism 62, thereby forming an erect image on the imaging surface of the image sensor 63. The imaging element 63 is attached in a direction in which the upward direction in which the bending portion 21 is bent coincides with the top of the image displayed on the screen of the monitor 15. 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 provided at the distal end portion of the insertion portion of the endoscope has a substantially C-shaped cross-section with a part of the ring shape cut out. The center O of the observation window 55 is on a line L1 connecting the center P of the distal end surface 20a when the distal end surface 20a of the endoscope is viewed at a rotational position where the upward direction in which the bending portion 21 is curved is directed to the sky. And it is located above the center P of the front end surface 20a. The magnetized range of the magnet bodies 23 and 24 is a horizontal line that passes through the center O of the observation window 55 when the distal end surface 20a of the endoscope 11 is viewed at a rotational position in which the bending portion 21 is bent upward. It is the range which fixes the front-end | tip part of the insertion part 35 of the auxiliary tool 12 to the outer peripheral surface below L2. As shown in FIG. 8, the magnetic bodies 40 and 41 provided in the auxiliary tool 12 have a cross-sectional ring shape.

  A pair of magnetic bodies 40 and 41 provided before and after the curved portion 38 of the assisting tool 12 are respectively fitted in recesses 77 and 78 provided by being recessed one step on the skin 74 so that the surface does not have unevenness. 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 magnetic 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 tip surfaces 20a and 37a aligned.

  As shown in FIG. 9, the distal end portion 37a of the auxiliary tool 12 is in contact with the outer peripheral surface below the horizontal line L2 passing through the center O of the observation window 55 at the distal end portion of the insertion portion 16 of the endoscope 11. The distal end portion of the insertion portion 35 of the auxiliary tool 12 is fixed. As a particularly preferable range of the range in which the distal end portion of the auxiliary tool 12 is fixed, as shown in FIG. 10, a pair of illumination windows that intersect perpendicularly with a straight line L1 that connects the center of the observation window and the center P of the distal end surface. The magnet bodies 23 and 24 are arranged in a range in contact with the outer periphery of a region other than the region where the illumination windows 56 and 57 are arranged (the region where light ink is applied), which is partitioned by the straight line L3 that is in contact with the outer periphery of the 56 and 57. Is preferred.

  As shown in FIG. 11, the image of the subject is displayed on the screen of the monitor 15 with the upward direction of the bending portion 21 facing upward. When the insertion portions 16 and 35 are fixed at the positions described with reference to FIGS. 9 and 10, an image 15b of a treatment instrument such as forceps is displayed from below the center of the screen 15a.

  The magnet bodies 23 and 24 and the magnetic bodies 40 and 41 constitute the fixing means of the present invention. As a fixing means, magnet bodies may be magnetized. A plurality of magnet bodies may be attached to a ring-shaped band and attached to the insertion portion 16 of the endoscope 11. In this case, positioning means is provided in the mounting portion so that the magnet body is in the magnetization range of FIG.

  The endoscope 11 includes the image pickup device 63 shown in FIG. 12 in the distal end hard portion 20, and further 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. In detail, as shown in FIG. 13, the air / water supply 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. 14, when an operation for pushing the air / water feed button 30 is performed, the air supply port 109 is blocked 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. 12, 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. ing. 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. 15, 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.

  As shown in FIG. 12, the engaging portion 36 of the auxiliary tool 12 is engaged with the forceps inlet 19 of the endoscope 11. The engaging portion 36 includes a locking claw (not shown) that can be freely engaged with and disengaged from the forceps inlet 19 of the endoscope 11 and a short-circuit tube 122 that connects the forceps conduit 72 and the forceps inlet 19 of the endoscope 11. Yes. 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. 17, 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 displaced so that the distal end surfaces 20a and 37a of both the insertion parts 16 and 35 are substantially at the same position, and the magnet body 23 and the auxiliary tool 12 of the endoscope 11 are thereby displaced. The magnetic body 40 of the endoscope 11 and the magnetic body 24 of the endoscope 11 and the magnetic body 41 of the auxiliary tool 12 are magnetized. Due to this magnetic attachment, the distal end portion of the insertion portion 16 of the endoscope 11 is placed on the insertion portion 35 of the auxiliary tool 12 so that the distal end surface 37a of the auxiliary tool 12 is in contact with the magnetic attachment range described with reference to FIGS. The tip is fixed. When fixed, the two curved portions 21 and 38 are in close contact in parallel, and the front end surfaces 20a and 37a face 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 magnetic 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 tool, for example, a pair of forceps cups or a strut loop 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 strangulation loop formed by bending an elastic wire enters and exits from 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 part of the polyp is properly tightened with a strut loop, and then a high-frequency current is applied to the strut loop to make contact with the strut 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.

  The illumination windows 56 and 57 disposed on the distal end surface 20a of the endoscope 11 are disposed on both sides of the observation window 55 as described with reference to FIG. The distal end surface 37a of the auxiliary tool 12 is a region below the observation window 55 as described in FIG. 7, or a region opposite to the region where the illumination windows 56 and 57 are disposed as described in FIG. It is fixed to the outer periphery corresponding to (the area where light ink is applied). For this reason, the image 15b of the treatment tool (forceps) inserted through the forceps conduit 72 of the auxiliary tool 12 is displayed from below the center of the screen 15a of the monitor 15. For this reason, the treatment tool does not obstruct the illumination light to cast a shadow on the observation target, and conversely, the reflected light of the illumination light that strikes the treatment tool does not cause the image to be overexposed.

  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, quick suction can be performed, and suction from both forceps outlets 59 and 76 can be performed simultaneously, so that the amount of suction can be increased.

  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 displacing 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 magnetic 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. 18, 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 and 24 and the magnetic bodies 40 and 41 are provided on both sides as fixing means, and both tip portions are fixed by the magnetic attachment of the magnet bodies 23 and 24. However, the structure is not limited to this, and 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 the fixing means using magnetic force, and as shown in FIG. 19, for capturing for inserting a snare-type capturing tool 151 into the internal space of the insertion portion 16 of the endoscope 150. A pipe line 152 is provided, and the distal end portion of the insertion portion 35 of the auxiliary tool 12 is captured by a capturing loop 153 provided at the distal end of the capturing tool 151, and the distal end portions are fixed so that the distal end faces are in the same direction. It is good also as a structure. One end of the capture conduit 152 is connected to a conduit outlet 154 provided at the distal end of the endoscope 150, and the other end is connected to a conduit inlet 155 provided in the operation unit main body. 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. When the distal ends are fixed, it is inflated in a loop. After the distal end of the insertion portion 35 of the auxiliary tool 12 is captured, the handle 156 is pulled to The loop 153 can be recessed to fix the distal end portion of the auxiliary tool 12 to the distal end portion of the endoscope 150.

  In this case, if the duct outlet 154 for projecting the capturing loop 153 is formed in the magnetic adhesion range described with reference to FIGS. 7 and 10 in the peripheral surface of the distal end portion 37 of the endoscope 150, the observation window 55 Is fixed to the outer periphery corresponding to the lower region or the region opposite to the region where the illumination windows 56 and 57 are arranged (the region where light ink is applied in FIG. 10). In addition, in FIG. 10, in order to expose and describe the conduit outlet 154, the upward direction in which the bending portion 21 is curved is illustrated as being downward.

  Further, the illumination functions incorporated in the endoscopes 11 and 150 may be one, or may be three or more. Further, instead of the light guides 48 and 49 and the illumination lens, an illumination function using an LED and a driver for driving the LED may be used.

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 description which shows the front end surface of the front-end | tip part of an endoscope, and has shown the magnetic attachment range. It is sectional drawing which shows the magnetic body 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 state which fixed the front-end | tip part of both an endoscope and an auxiliary tool, and has shown the especially preferable magnetic attachment range. It is explanatory drawing which shows the screen of the monitor which displays the image imaged with the endoscope, and has shown the state in which the image of a treatment tool is displayed. 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 of the endoscope system of the form 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 | mold capture | acquisition tool which capture | acquires the front-end | tip part of the insertion part of an auxiliary tool in the endoscope as a fixing means which fixes front-end | tip parts.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Endoscope system 11,150 Endoscope 12,140 Auxiliary tool 16 Endoscope side insertion part 35 Auxiliary tool side insertion part 23,24 Magnet body 40,41 Magnetic body 51 Endoscope side forceps conduit 55 Observation window 56, 57 Illumination window 59 Forceps outlet on endoscope side 72 Forceps conduit on auxiliary tool side 76 Forceps outlet on auxiliary tool side

Claims (4)

Built in an insertion portion inserted into one outer nostril, an observation window and an illumination window provided on a distal end surface of the distal end portion of the insertion portion, and an internal space from the distal end portion to the proximal end portion of the insertion portion A forceps conduit , an operation unit main body connected to the base end part and having a bending operation part, and provided at the distal end part. The distal end part is at least vertically moved according to the bending operation of the bending operation part. An endoscope having a bending portion that bends in two directions;
An insertion portion to be inserted into the other outer nostril, an internal space provided from the distal end surface to the rear end portion of the insertion portion, and a forceps conduit having a diameter larger than the forceps conduit of the endoscope; An auxiliary tool used in combination with the endoscope,
A first region in which the observation window is arranged by a straight line that intersects perpendicularly to a straight line passing through the center of the observation window and the center of the tip surface and is in contact with the outer periphery of the illumination window on the center side of the tip surface; The distal end surface is divided into the second region other than the outer peripheral position of the second region, and the distal end surfaces of the insertion portion of the endoscope and the insertion portion of the auxiliary tool are axially aligned in the same direction. Fixing means for removably fixing at substantially the same position in the direction ;
An endoscope system comprising: The fixing means includes a first magnetized body that is axially spaced from the insertion portion of the endoscope and extends in an outer peripheral direction on the outer peripheral surface of the second region, and an axial direction of the insertion portion of the auxiliary tool. The endoscope system according to claim 1 , further comprising: an annular second magnetized body that is provided at a position corresponding to the first magnetized body and is spaced apart from the first magnetized body and extending in an outer peripheral direction . The securing means includes a capture conduit having a conduit outlet opening on the outer peripheral surface of the second region of the insertion portion of the endoscope, and a conduit inlet opening on the operation portion main body, and the capturing conduit. The endoscope system according to claim 1 , further comprising: a capturing loop that is housed in the pipe and is elastically openable and closable at a distal end, and a capturing tool having a handle at a rear end . The endoscope includes an image sensor that images a subject through the observation window;
Claim 1, characterized in that it comprises a display means for displaying an image of the subject in a state matching the vertical direction of the receiving data captured, screen the vertical direction in which the bending portion is bent by the image pickup element The endoscope system according to any one of 3 to 3 .

Images