JP5647780B2 - Treatment overtube and treatment system - Google Patents

Description

  The present invention relates to a treatment overtube and a treatment system that have a plurality of balloons and can be used in combination with a plurality of endoscopes.

  2. Description of the Related Art Conventionally, a treatment overtube including a plurality of balloons is known as a system for treating a lesion in a lumen of a subject using an endoscope (Patent Documents 1 and 2). In this treatment overtube, the distal end portion of the endoscope is pushed out from the endoscope insertion channel opened in the distal end surface.

JP 2008-253780 A JP 2002-186579 A

  In the conventional treatment overtube, the endoscope insertion channel is disposed only at the distal end. Therefore, even if a plurality of channels are provided, the advancing direction of the endoscope is the same, the interval between the channels is narrow, and both the inner and outer surfaces of the intestinal tract are accessed by the plurality of endoscopes. It was not suitable for performing surgical procedures. Furthermore, it is difficult to inflate the intestinal tract by insufflation with the technique in which a hole is made in the intestinal tract.

  The present invention has been made in view of the problem of the conventional treatment overtube, and enables the use of a plurality of endoscopes and allows the intestinal tract to be inflated during an insufflation. And to provide a treatment system.

The present invention that achieves such an object is equipped with a flexible portion having a plurality of endoscope insertion channels through which an endoscope is inserted, and an outer peripheral surface of a distal end portion of the flexible portion at a position spaced apart in the longitudinal direction, A pair of balloons that are independently inflated and deflated, and wherein the endoscope insertion channel includes a first endoscope insertion channel that opens at a distal end surface of the distal end of the flexible portion, and the pair of balloons. A second endoscope insertion channel between the balloons and opened at an outer peripheral surface of the distal end portion of the flexible portion, and the second endoscope insertion channel includes the second endoscope insertion channel . the distal portion of the endoscope Ru fed from the mirror insertion channel, characterized in that it is formed so as to guide the direction beyond the balloon is not in contact with the distal end of the balloon of the pair of balloon.

The second endoscope insertion channel, the portion located on the flexible portion is, the flexible portion of the guided within the endoscope front end portion of the tip side without contacting the free end portion of the balloon It is practical to use a rigid guide pipe having a direction control portion that guides in a direction beyond the balloon .
Preferably, the guide pipe is formed integrally with an annular portion fixed to the flexible portion.

  In a preferred embodiment, the first endoscope insertion channel includes a guide pipe protruding from the distal end surface of the flexible portion, and the guide pipe is fed out from the second endoscope insertion channel. Furthermore, it opens widely to the endoscope distal end side. The flexible part has a hard part at a tip part, and the guide pipe is formed integrally with the hard part.

  More practically, the flexible part is provided with a fluid path for sending a fluid for expanding and contracting the pair of balloons, and the fluid path is communicated with a connection pipe connected to the rear end of the flexible part. It is practical to provide a forceps channel on the distal end surface of the flexible part.

The present invention relating to a treatment system according to another aspect includes the treatment overtube, a first endoscope inserted through a first endoscope insertion channel of the treatment overtube, and the treatment overtube. The second endoscope inserted through the second endoscope insertion channel and the outer peripheral surface of the distal end portion of the flexible portion of the treatment overtube are mounted at positions spaced apart in the longitudinal direction and are independent of each other. And operating means for independently inflating and deflating the pair of balloons controlled to be inflated and deflated.
The treatment overtube includes a balloon catheter having a balloon at a distal end portion that is delivered from the forceps channel.

  According to the treatment overtube of the present invention, the second endoscope is inserted between the first and second balloons while being fixed in the intestinal tract or the like by the first and second balloons. Therefore, even in the procedure of making a hole in the intestinal tract, gas does not escape when inhaled, and a space around the endoscope can be secured.

It is a figure which shows embodiment of the treatment system whole structure using the overtube for treatment of this invention. It is a perspective view which shows the treatment overtube of the embodiment in the state which penetrated the main scope, the subscope, and the balloon catheter. It is a perspective view which shows the overtube for treatment of the embodiment. (A) is a front view which shows a front end surface, (B) is a rear view which shows a rear-end surface of the treatment overtube of the embodiment. It is a side view which shows the use condition of the overtube for treatment of the embodiment. It is a side view which shows the use condition of the overtube for treatment of the embodiment.

  Embodiments of the present invention will be described below in detail with reference to the accompanying drawings. An embodiment of a treatment overtube and a treatment system using the treatment overtube according to the present invention includes a treatment overtube 100, a main scope (first endoscope) 200, and a subscope (second endoscope) 300. The balloon catheter 400 and three syringes 125, 126, and 430 are provided. The main scope 200 and the sub-scope 300 are electronic endoscopes, and include flexible in-vivo insertion portions 210 and 310, operation portions 220 and 320, and universal cables 230 and 330, respectively.

  The main and sub scopes 200 and 300 are electronic endoscopes having video cameras built in the distal end portions 211 and 311 of the body insertion portions 210 and 310, and each of the universal cables 230 and 330 is a known endoscope processor (see FIG. The video captured by the video camera is displayed on a monitor (not shown). The operation units 220 and 320 include operation knobs 221 and 321 for bending the bending mechanisms of the distal end portions 211 and 311 of the body insertion portions 210 and 310 up and down, and left and right, and air supply and water supply valves 222 and 322 that control air supply and water supply. , Suction valves 223 and 323 for controlling suction, control switches 224 and 324 for controlling an image system such as image recording and enlargement, forceps ports (forceps plugs) 225 and 325 for inserting and removing forceps, and the like.

  The treatment overtube 100 is made of a resin such as polyurethane, thermoplastic elastomer, fluorine-based resin, or silicon, and has a long flexible portion 110 formed in a cylindrical shape as a whole, and a distal end portion of the flexible portion 110. A cylindrical tip portion 111 and a cylindrical connector portion 116 formed at the rear end portion are provided. The distal end portion 111 and the connector portion 116 are formed of a thick or hard resin, and a main scope channel 112 a and a forceps channel 113 a are provided on the distal end surface of the distal end portion 111.

The flexible portion 110 is provided with a sub-scope channel 114 a on the outer peripheral surface in the vicinity of the distal end portion 111. Thus, the first balloon 121 and the second balloon 122 are mounted at positions spaced apart in the longitudinal direction across the subscope channel 114a. The first balloon 121 and the second balloon 122 are made of a soft resin, for example, a thermoplastic resin such as silicon, latex, polyurethane, or nylon, and are fixed to the outer peripheral surface of the flexible portion 110.

  An independent fluid channel (air / water channel) communicates with the first and second balloons 121 and 122 through the flexible portion 110. Each fluid path is formed in or along the wall of the flexible portion 110, and is connected to fluid tubes (connection pipes) 123 and 124 drawn from the outer peripheral portion of the connector portion 116. Syringes 125 and 126 are connected to fluid tubes 123 and 124 via tubes 125a and 126a, respectively, and fluid delivery and suction are controlled by syringes 125 and 126. Normally, physiological saline is used as the fluid.

  A main scope channel 112b, a forceps channel 113b, and a subscope channel 114b are provided on the rear end surface of the connector 116. The main scope channels 112a and 112b, the forceps channels 113a and 113b, and the sub scope channels 114a and 114b are connected to each other by a guide tube, but the guide tube 131 that connects the sub scope channels 114a and 114b is shown in FIG. It was shown to. Reference numeral 150 denotes a mouthpiece that guides the flexible portion 110 so as to be freely inserted.

  The main scope channel 112a is constituted by a main scope guide pipe 112 formed so as to protrude from the distal end surface of the distal end portion 111. The main scope guide pipe 112 is formed integrally with the distal end portion 111, and is a sub scope channel. The distal end portion 211 of the main scope 200 that is wide open to the 114a side is guided to be easily bent in the direction of the distal end portion 311 of the sub scope 300 that is sent out from the sub scope channel 114a.

The forceps channel 113 a is formed at a position adjacent to the main scope guide pipe 112 of the distal end portion 111. From the forceps channel 113a, the distal end portion 410 of the balloon catheter 400 is sent out. A syringe 430 for expanding and contracting the balloon 420 at the distal end portion 410 is connected to the balloon catheter 400 via a tube 431. FIG. 1 shows a state in which the balloon 420 at the distal end portion 410 delivered from the forceps channel 113a is inflated by the syringe 431 . With this balloon 420 and the first balloon 121, the lumen is closed and air is supplied, and the lumen of the closed portion can be inflated.

The subscope channel 114a is constituted by a subscope guide pipe 114 formed of a hard material. The sub-scope guide pipe 114 is formed integrally with the annular portion 115. The annular portion 115 is formed in a cylindrical shape having the same outer diameter as the inner diameter of the flexible portion 110, and is fitted and fixed to the flexible portion 110. In the annular portion 115, a subscope channel 114 a is opened at a connection portion with the subscope guide pipe 114 .

The sub-scope guide pipe 114 extends obliquely rearward in the annular portion 115 and extends substantially parallel to the longitudinal direction of the flexible portion 110 via a curved portion serving as a direction control portion . A guide tube 131 inserted through the flexible portion 110 is connected to a parallel portion of the sub-scope guide pipe 114. The other end of the guide tube 131 is connected to the other subscope channel 114b.

The subscope 300 inserted into the subscope channel 114b from the distal end portion 311 is guided by the guide tube 131 and proceeds along the flexible portion 110. When the subscope 300 reaches the subscope guide pipe 114, the subscope guide pipe 114 is bent. The traveling direction is gradually changed along the portion to a direction protruding from the outer peripheral surface of the flexible portion 110, and is sent out from the opening of the sub-scope guide pipe 114. The direction of the distal end portion 311 when it is sent out from the opening of the sub-scope guide pipe 114 is a direction in which the first balloon 121 can be crossed without contacting the first balloon 121 as it proceeds. That is, the sub-scope guide pipe 114 is positioned between the first balloon 121 and the second balloon 122, and is inclined so that the sub-scope 300 to be sent out can be sent in a direction in which the tip does not contact the inflated balloon 121. Is set.

  As for the coupling means between the annular portion 115 and the flexible portion 110, the annular portion is also formed integrally with the flexible portion, and the sub-scope guide pipe is formed in the portion that becomes the annular portion, and then the portion that becomes the annular portion is thermally cured. You may process so that it may become difficult to bend.

  Since the subscope guide pipe 114 and the portion that supports the subscope guide pipe 114 control and support the direction of the subscope 300, it is preferable that the subscope guide pipe 114 is less bent than the flexible portion 110. Therefore, the sub-scope guide pipe 114 is made hard and supported by the flexible portion 110 via the hard annular portion 115, but is not limited to this embodiment.

  In another embodiment, a flange portion along the outer peripheral surface shape of the flexible portion 110 is formed around the outlet of the sub-scope guide pipe, and the guide pipe is inserted from a hole formed in the flexible portion 110 to The peripheral area of the hole may be fixed by adhesion or the like.

  The usage state of the treatment system of this embodiment is shown in FIG. Here, the treatment overtube 100 was inserted from the mouthpiece 150 that the patient lying on his / her back on the treatment table fried. At the time of insertion, the first and second balloons 121 and 122 of the treatment overtube 100 are contracted, and the distal end portion 211 of the main scope 200 is protruded from the main scope channel 112a. While observing the video taken by the 200 video cameras, the overtube 100 is inserted to a predetermined position.

  When the overtube 100 is inserted to a predetermined position, the balloon catheter 400 provided with the balloon 420 at the distal end is inserted from the forceps channel 113b and protruded from the forceps channel 113a with the balloon 420 contracted. When the balloon 420 reaches the desired position, the balloon 420 is inflated to contact the inner surface of the intestinal tract and fixed. The first and second balloons 121 and 122 are appropriately inflated and fixed.

The subscope 300 inserts the in- body insertion portion 310 from the subscope channel 114b and protrudes from the subscope channel 114a. Then, a hole is made in the intestinal tract using an incision tool passed through the forceps channel of the subscope 300, and the distal end portion 311 is advanced into the abdominal cavity from there, and the abdominal cavity is utilized using the air supply channel of the subscope 300. Inflate inside. Then, diagnosis, treatment, etc. of the outer surface of the intestinal tract are performed.

  Since the overtube 100 is fixed to the intestinal tract by the first and second balloons 121 and 122, the subscope 300 is stabilized and a reliable operation is possible. As for the gas in the abdominal cavity, since the intestinal tract is closed by the first and second balloons 121 and 122, the gas does not escape and the pneumoperitoneum state is maintained.

  On the other hand, the intestinal space where the main scope 200 is sent out is inflated by the balloon 420 and the first balloon 121. Using this swelled space, the needle scalpel 240 can be sent out from the forceps channel of the main scope 200 to perform an operation on the inner surface of the intestinal tract. Since the inside of the intestine is sealed by the balloon 420 and the first balloon 121, the intestinal wall between the balloon 420 and the first balloon 121 can be inflated by sending air from the air supply channel.

As described above, according to the embodiment, the following effects can be obtained by expanding and contracting the first and second balloons 121 and 122 while the balloon 420 is inflated.
By inflating the first balloon 121, when the hole D is opened in the intestinal tract, air is prevented from escaping from the path B, and the atmospheric pressure in the body cavity is maintained. By inflating the second balloon 122, when the hole C is opened, air is prevented from escaping from the path A, and the atmospheric pressure in the body cavity is maintained.
By inflating both the first and second balloons 121 and 122, even if the holes C and D are opened in the intestine, air does not escape from the routes A and B, and the space E in the intestine is maintained.
Even if both the first balloon 121 and the balloon 420 are inflated, the hole D is opened and the intestinal tract is tensioned by the first balloon 121 and the balloon 420 even when the air pressure in the intestinal tract and the body cavity is in an equilibrium state. Therefore, the space E can be maintained without the intestinal tract falling due to gravity .

  Although the present invention has been described based on the illustrated embodiment, the present invention is not limited to this embodiment. For example, two or more subscope channels may be provided between the first and second balloons with different positions in the circumferential direction or the axial direction. Alternatively, three or more balloons may be provided in the flexible part, and a subscope channel may be provided between the balloons.

100 treatment overtube 110 flexible portion 111 distal end portion 112 main scope guide pipe 112a 112b main scope channel (first endoscope insertion channel)
113a 113b Forceps channel 114 Subscope guide pipe 114a 114b Subscope channel (second endoscope insertion channel)
115 annular part 116 connector part 121 first balloon 122 second balloon 125 126 syringe (operation means)
131 Guide tube 150 Mouthpiece 200 Main scope 210 310 Insertion section 211 311 Tip section 220 320 Operation section 221 321 Operation knob 222 322 Air / water supply valve 223 323 Suction valve 224 324 Control switch 225 325 Forceps port (forceps plug)
230 330 Universal cable 300 Subscope 310 Tip 400 Balloon catheter 420 Balloon 430 Syringe

Claims (9)

A flexible portion having a plurality of endoscope insertion channels through which an endoscope is inserted, and an outer peripheral surface of the distal end portion of the flexible portion are attached at positions spaced apart in the longitudinal direction, and are independently controlled to expand and contract. A pair of balloons,
The endoscope insertion channel is between the first endoscope insertion channel opened at the distal end surface of the distal end portion of the flexible portion and the pair of balloons, and is an outer periphery of the distal end portion of the flexible portion. A second endoscope insertion channel open to the surface,
The second endoscope insertion channel is configured such that the distal end portion of the endoscope sent out from the second endoscope insertion channel is directed toward the balloon on the distal end side of the pair of balloons, and the distal end side A treatment overtube characterized in that the direction is determined so as to guide the balloon beyond the balloon on the distal end side without contacting the balloon. 2. The treatment overtube according to claim 1, wherein the second endoscope insertion channel is configured such that a portion of the second endoscope insertion channel that is positioned in the flexible portion guides the distal end portion of the endoscope guided in the flexible portion to the distal end side. An overtube for treatment formed by a rigid guide pipe having a direction control part that guides the balloon in a direction beyond the balloon on the distal end side without contacting the balloon.   The treatment overtube according to claim 2, wherein the guide pipe is formed integrally with an annular portion fixed to the flexible portion.   The treatment overtube according to any one of claims 1 to 3, wherein the first endoscope insertion channel includes a guide pipe protruding from a distal end surface of the flexible portion, and the guide pipe is The treatment overtube widely opened on the distal end side of the endoscope sent out from the second endoscope insertion channel.   The treatment overtube according to claim 4, wherein the flexible portion includes a hard portion at a distal end portion, and the guide pipe is formed integrally with the hard portion. The treatment overtube according to any one of claims 1 to 5, wherein the flexible portion is provided with a fluid path for sending a fluid for expanding and contracting the pair of balloons. An overtube for treatment that communicates with a connecting pipe connected to the rear end of the flexible portion.   The treatment overtube according to any one of claims 1 to 6, wherein a forceps channel is provided on a distal end surface of the flexible portion. The treatment overtube according to any one of claims 1 to 7,
A first endoscope that is inserted into a first endoscope insertion channel of the treatment overtube;
A second endoscope that is inserted into the second endoscope insertion channel of the treatment overtube;
An operation for independently inflating and deflating the pair of balloons that are attached to the outer peripheral surface of the distal end portion of the flexible portion of the treatment overtube in the longitudinal direction and are individually inflated and deflated. A treatment system comprising: means. The treatment system according to claim 8, wherein the overtube for treatment includes a balloon catheter having a balloon at a distal end portion that is delivered from the forceps channel.

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