JP5820757B2 - Endoscope - Google Patents

Description

  The present invention relates to an endoscope including two treatment instrument insertion channels in an insertion portion to be inserted into a subject.

  In recent years, a treatment inserted through a treatment instrument insertion channel provided in an insertion portion in a state where an insertion portion of an endoscope is inserted into a subject, for example, a body cavity, and a lesion site to be a test site in the body cavity is observed. A treatment technique has been used in which a mucous membrane of a lesion site is collectively incised over a wide area using a tool.

  Further, as a treatment tool for incising a mucous membrane at a lesion site inserted through a treatment tool insertion channel, that is, an incision tool, for example, a high frequency incision knife is well known.

  In a state where the high-frequency incision knife protrudes forward (hereinafter simply referred to as the front) in the insertion direction from the distal end surface of the insertion portion (hereinafter simply referred to as the distal end) through the treatment instrument insertion channel. For example, it is used for a procedure for incising the lower layer of the mucous membrane at the lesion site by swinging left and right by a bending operation of the bending portion provided in the insertion portion or a twisting operation of the insertion portion.

  In order to easily and reliably swing the high-frequency incision knife, a treatment instrument that causes the high-frequency incision knife to swing left and right and up and down by operating the operation section of the endoscope in the treatment instrument insertion channel in the distal end portion of the insertion section. A configuration provided with a swing table is also well known.

  Further, in Patent Document 1, two treatment instrument insertion channels are provided in the insertion portion, and the treatment instrument is inserted into the first treatment instrument insertion channel in the distal end portion of the insertion portion. A first treatment instrument swinging base for swinging the grasping forceps in the vertical direction of the endoscopic image (hereinafter simply referred to as the vertical direction) is provided, and the second treatment instrument insertion channel in the distal end portion of the insertion section is provided. In addition, a second treatment instrument swinging table for swinging a high-frequency incision knife, which is a treatment tool inserted through the second treatment tool insertion channel, in the left-right direction of the endoscopic image (hereinafter simply referred to as the left-right direction). The structure of the endoscope provided with is disclosed.

  If the configuration of the endoscope shown in this Patent Document 1 is used, the first treatment is performed after grasping the lesion site using the grasping forceps projecting from the distal end surface of the insertion portion through the first treatment instrument insertion channel. The mucous membrane of the lesion site is raised using a high-frequency incision knife that protrudes from the distal end surface of the insertion portion through the second treatment instrument insertion channel while raising the instrument swinging table upward and performing known counter traction. An incision can be made.

  Furthermore, in Patent Document 1, when each treatment instrument swinging table is in a non-oscillating state, the treatment instrument insertion channels are separated from each other in the radial direction of the insertion section, that is, from the distal end surface of the insertion section. Since the grasping forceps projecting straight along the insertion direction and the high-frequency incision knife projecting straight along the insertion direction are separated from the distal end surface of the insertion section, the vicinity of the lesion site to be incised by the high-frequency incision knife is separated. In addition to being difficult to grasp and raise, there is a problem in that in order to make a reliable incision of the mucous membrane of the lesion site at the time of incision, there is a problem that the lesion site must be frequently changed by grasping forceps. A technique is disclosed in which a high-frequency incision knife is brought close to a grasping forceps by swinging a tool swinging table to the left or right.

Japanese Patent No. 3927204

  However, in the endoscope disclosed in Patent Document 1, in order to bring the high-frequency incision knife and the grasping forceps close to each other, the second treatment instrument swinging table must be swung left or right, which is unnecessary. In addition to the increase in operation, the high-frequency incision knife is bent by being swung by the second treatment instrument rocking table. Compared with the state where the high-frequency incision knife is projected straight along, the high-frequency incision knife is difficult to move back and forth in the insertion direction (hereinafter simply referred to as front and back). It was.

  That is, in a case where a difficult procedure or a delicate operation is required in a known endoscopic submucosal dissection (ESD), the procedure is performed in the configuration of the endoscope disclosed in Patent Document 1. There was a problem that it was difficult.

  From the above, the operability of the high-frequency incision knife in the mucosal incision of the lesion site while ensuring a good observation field under endoscopic observation using the two treatment tools of the grasping forceps and the high-frequency incision knife The incision efficiency of the incision efficiency is high, and the incision work can be completed without frequently changing the gripping part at the lesion part while providing accurate and sufficient counter traction to the incision part from the beginning to the end of the incision. An endoscope having an excellent configuration has been desired.

  The present invention has been made in view of the above circumstances, and the incision of the mucosa of the lesion site performed while performing countertraction using the treatment tools inserted into the respective treatment tool insertion channels with high operability and efficiency. An object of the present invention is to provide an endoscope having a configuration that can be performed well.

  In order to achieve the above object, an endoscope according to one aspect of the present invention is a forward water supply that supplies fluid into the subject, which is opened at the distal end surface of the distal end in the insertion direction of an insertion portion that is inserted into the subject. A first opening of the channel, a second opening of the second treatment instrument insertion channel opened in the distal end surface, and a third opening of the bottomed hole opened in the distal end surface A fourth opening of the first treatment instrument insertion channel opened in the bottomed hole, and provided in the bottomed hole and protruded into the bottomed hole through the fourth opening. The treatment tool has a passage through which the treatment tool is inserted, and is swingable between a maximum raising position and an inverted position, so that the traveling direction of the treatment tool inserted through the passage can be changed. A treatment instrument swinging table guided to the third opening, and the treatment instrument swinging table The center of the passage of the treatment instrument swing base that overlaps the third opening in the inverted state is A, and the treatment instrument swing overlaps the third opening in the maximum raised state of the treatment instrument swing base. When the center of the passage of the moving base is A ′, the center of the second opening is B, and the center of the first opening is C, ∠ABC is 10 ° on the tip surface. The angle is set to an angle larger than 60 ° and ∠A′BC is 90 ° or more and 120 ° or less.

  According to the present invention, the treatment tool inserted through each treatment tool insertion channel can be used to perform incision of the mucous membrane at the lesion site while performing countertraction with good operability and efficiency. An endoscope can be provided.

The fragmentary perspective view which shows the endoscope of this Embodiment The front view which expands and shows the front end surface of the insertion part of the endoscope of FIG. 1 seeing from II direction Sectional drawing of the front-end | tip part of the insertion part in alignment with the III-III line in FIG. The figure which shows the movement of the grasping forceps accompanying rocking | fluctuation of a treatment tool rocking | fluctuation table in the state in which the high frequency incision knife, the grasping forceps, the water supply line, and the lesioned mucosa were projected on the endoscopic image Sectional drawing of the front-end | tip part of an insertion part which shows the state by which the treatment tool rocking | fluctuation stand of FIG. 3 was raised and the grasping forceps was raised to the maximum The front view which shows the treatment tool rocking | fluctuation stand of FIG. 2 with an operation wire and a terminal member The figure which shows the modification by which the notch was formed in the channel | path of the treatment instrument rocking | fluctuation stand of FIG. Side view of treatment instrument swing base, operation wire, and terminal member of FIG. The figure which shows the state by which the mucous membrane of the lesion site | part was hold | gripped and raised by the grasping forceps of FIG. 3 with the front end side of an insertion part roughly

Embodiments of the present invention will be described below with reference to the drawings.
FIG. 1 is a partial perspective view showing the endoscope of the present embodiment, FIG. 2 is a front view showing the distal end surface of the insertion portion of the endoscope of FIG. 1 as viewed from the II direction, and FIG. It is sectional drawing of the front-end | tip part of the insertion part in alignment with the III-III line in FIG.

  FIG. 4 is a view showing the movement of the grasping forceps accompanying the swing of the treatment instrument swinging table in a state where the high-frequency incision knife, the gripping forceps, the water supply line, and the lesioned mucosa are projected on the endoscopic image. FIG. 4 is a cross-sectional view of the distal end portion of the insertion portion, showing a state where the treatment instrument swinging table of FIG. 3 is raised and the grasping forceps are raised to the maximum.

  6 is a front view showing the treatment instrument swing base of FIG. 2 together with the operation wire and the terminal member, and FIG. 7 is a modified example in which a notch is formed in the passage of the treatment instrument swing base of FIG. FIG. 8 is a side view of the treatment instrument swing base, the operation wire, and the terminal member of FIG. 6, and FIG. 9 is a schematic view of the state where the mucous membrane of the lesion site is grasped and raised by the grasping forceps of FIG. It is a figure shown with the front end side of an insertion part.

  As shown in FIG. 1, the endoscope 1 includes an insertion portion 40 to be inserted into a subject and an operation connected to a proximal end (hereinafter simply referred to as a proximal end) of the insertion portion 40 in the insertion direction S. The main part is comprised including the part 50, the universal cord 60 extended from this operation part, and the connector not shown provided in the extension end of this universal cord 60. As shown in FIG. The endoscope 1 can be connected to an external device because the connector can be connected to a light source device, a video processor, etc. (not shown).

  The insertion portion 40 includes, in order from the distal end side in the insertion direction S (hereinafter simply referred to as the distal end side), the distal end portion 2, a bending portion 43, and an elongated flexible tube portion 44 having flexibility. Yes.

  The bending portion 43 is configured to be bendable in, for example, four directions, up, down, left, and right, by a left / right bending operation knob 51 and an up / down bending operation knob 52 provided in the operation unit 50.

  As shown in FIGS. 3 and 5, the distal end portion 2 includes a distal end hard member 21. The distal end hard member 21 is made of metal, for example, and various members are fixed therein. When the distal end hard member 21 is made of metal, the distal end of the distal end hard member 21 is used as shown in FIGS. 3 and 5 for the purpose of ensuring electrical safety in the case of a known high-frequency cauterization treatment. Part of the surface 21s and the outer peripheral surface 21g are preferably covered with a cover member 24 having electrical insulation.

  In the configuration in which the cover member 24 is covered, the distal end surface of the cover member 24 constitutes the distal end surface 2s of the distal end portion 2. Therefore, in the configuration in which the cover member 24 is not covered, the distal end surface 21 s of the distal end rigid member 21 constitutes the distal end surface 2 s of the distal end portion 2.

  Further, as shown in FIG. 2, the appearance of the distal end portion 2 as viewed in plan from the direction II in FIG. 1 is not circular but partially cut out, and in particular, an endoscopic image 150. A flat portion 16 is formed on the outer peripheral surface in the upward direction, that is, in the upward direction in FIG.

  A treatment instrument insertion channel (not shown) different from the channels 10 and 8 through which the gripping forceps 23 and the high-frequency incision knife 28 described later are inserted is detachably attached to the flat surface portion 16.

  Further, since the planar portion 16 is formed in a planar shape, after the treatment instrument insertion channel is externally attached to the planar portion 16, the insertion portion 40 is frequently twisted in the subject. However, the treatment instrument insertion channel attached to the flat surface portion 16 does not easily move with respect to the distal end portion 2.

  As shown in FIGS. 1 and 2, an observation window 4 of an imaging unit (not shown) fixed to the distal end hard member 21 in the distal end portion 2 extends from the cover member 24 at approximately the center of the distal end surface 2 s of the distal end portion 2. A light (not shown) which is exposed and is fixed to the distal end hard member 21 and inserted into the insertion portion 40 at a position sandwiching the observation window 4 in the radial direction of the distal end portion 2 on the distal end surface 2s. Two illumination windows 5 for supplying illumination light into the subject through the guide are located exposed from the cover member 24.

  Further, on the front end surface 2s, in the vicinity of the observation window 4, a gas or liquid is fixed toward the observation window 4 through an air / water supply conduit (not shown) fixed to the front end rigid member 21 and inserted into the insertion portion 40. The nozzle 6 for supplying is located exposed from the cover member 24.

  Further, the distal end surface 2 s is inserted into the subject via the forward water supply channel 7 inserted into the insertion portion 40 by, for example, a button operation of the forward water supply button 54 provided in the operation unit 3. The first opening 7k of the front water supply channel 7 that supplies the liquid further forward and penetrates the distal end hard member 21 along the insertion direction S is exposed from the cover member 24 and opened. As shown in FIG. 2, the first opening 7 k is provided at the position of the distal end surface 2 s on the opposite side of the observation window 4 across the line segment AB in the radial direction of the distal end 2. Further, when the liquid is supplied forward from the first opening 7k of the front water supply channel 7, it is not limited to the button operation of the front water supply button 54, and a foot switch operation may be performed.

  The distal end surface 2s is covered with the second opening 9 on the distal end side in the second treatment instrument insertion channel 8 that is inserted into the insertion portion 40 and penetrates the distal rigid member 21 along the insertion direction S. It is exposed from the member 24 and opened. As shown in FIG. 1, the proximal end of the second treatment instrument insertion channel 8 is opened as an insertion port 79 in the operation unit 50.

  As shown in FIG. 3, an axis 30 that passes through the opening center B of the second opening 9 in parallel with the insertion direction S and an axis that passes through the opening center C of the first opening 7k in parallel with the insertion direction S. 31 has a substantially 90 degree with respect to the front end face 2s.

  In addition, the second treatment instrument insertion channel 8 includes a treatment instrument, specifically, a mucous membrane 29 (see FIG. 3) of a lesion site that is a test site grasped by a grasping forceps 23 (see FIGS. 3 and 4) described later. 4 (see FIG. 9), a high-frequency cutting knife 28 (see FIGS. 5 and 9), which is an incision tool for incising, can be inserted through the insertion port 79, and the high-frequency cutting knife 28 is inserted through the second opening 9. The front end face 2s can protrude forward.

  Further, the third opening 13 of the bottomed hole 17 (see FIGS. 2 and 3) formed in the distal end hard member 21 is exposed and opened from the cover member 24 on the distal end surface 2s.

  Note that the third opening 13 can be smoothly advanced without being caught by the fold when the insertion portion 40 is inserted into a narrow and vagina-like lumen such as the lower digestive tract, for example. As described above, it is opened only at the distal end surface 2 s and is not opened at the outer peripheral surface 2 g of the distal end hard member 21.

  Further, as shown in FIG. 3, in the first treatment instrument insertion channel 10 that is inserted into the insertion portion 40 and penetrates the distal end rigid member 21 along the insertion direction S in the bottom surface 17 t of the bottomed hole 17. A fourth opening 11 on the distal end side is opened. As shown in FIG. 1, the proximal end of the first treatment instrument insertion channel 10 is opened as an insertion port 71 in the operation unit 50.

  In addition, the first treatment instrument insertion channel 10 includes a grasping forceps 23 (see FIG. 4 and FIG. 9) that grasps the treatment instrument, specifically, the mucosa 29 (see FIGS. 4 and 9) of the lesion site as the test site. 5) can be inserted through the insertion port 71, and the grasping forceps 23 can project forward from the third opening 13 via the fourth opening 11 beyond the front end surface 2s.

  The grasping forceps 23 can be changed in a traveling direction, that is, a protruding direction from the third opening 13 by a treatment instrument swinging table 12 described later.

  As shown in FIGS. 3 and 5, the bottomed hole 17 has a passage 14 through which the grasping forceps 23 projecting from the bottomed hole 17 through the fourth opening 11 is inserted. At the same time, it can swing between the inverted position shown in FIG. 3 and the maximum raised position shown in FIG. 5, that is, it can swing vertically in the endoscopic image 150 shown in FIG. A treatment instrument swinging table 12 is provided that guides the grasping forceps 23 to the third opening 13 so that the advancing direction of the grasping forceps 23 inserted through the passage 14 is variable.

  As shown in FIGS. 2, 3, and 5, the oscillating table operating wire 18 inserted into the wire insertion path 20 provided in the insertion portion 40 along the insertion direction S is inserted into the treatment instrument oscillating table 12. The distal end of the treatment tool is connected and fixed to the upper side of the passage 14 avoiding the passage 14 and the distal end side of the treatment instrument swinging table 12 via the wire terminal member 19.

  Specifically, as shown in FIG. 6, at the stepped portion 26 formed in the upper part of the passage 14 of the treatment instrument swing base 12, the wire terminal member 19 is placed above the passage 14 in the treatment instrument swing base 12 and After passing through the wire attachment hole 27 (see FIG. 8) formed on the distal end side, the distal end of the oscillating base operating wire 18 is connected and fixed to the treatment instrument oscillating base 12 by bending it to about 90 °. Yes.

  The wire mounting hole 27 to which the swing base operation wire 18 is connected is formed on the upper side of the treatment instrument swing base 12 from the lower side of the passage 14 so as to avoid the passage 14. This is because, as shown in FIG. 6, since the dimension W1 in the radial direction of the treatment instrument swing base 12 can be reduced, the distal end portion 2 can be reduced in diameter.

  Note that the base end of the swing base operation wire 18 is connected to a swingable swing base operation knob 53 (see FIG. 1) provided in the operation unit 50.

  Further, the treatment instrument swinging base 12 has a rotating shaft 22 (see FIG. 3) fitted in a shaft mounting hole 25 (see FIG. 8) provided on the base end side with respect to the distal end hard member 21 in the bottomed hole 17. , See FIG. 5).

  Therefore, when the swinging base operation knob 53 is turned, the swinging base operation wire 18 is pulled and relaxed, so that the treatment instrument swinging base 12 has a bottom 12t as shown in FIG. Between the inverted position contacting the lower side surface 17g of the bottom hole 17 and the maximum raised position shown in FIG.

  Note that the maximum raising angle of the treatment instrument swinging base 12 is set to an angle at which the grasping forceps 23 can advance and retreat the passage 14 even when the treatment tool swinging table 12 is raised to the maximum in order to improve the treatment by the grasping forceps 23.

  The passage 14 is formed when the grasping forceps 23 that protrudes from the fourth opening 11 of the first treatment instrument insertion channel 10 into the bottomed hole 17 is in the inverted position as shown in FIG. Is penetrating the treatment instrument rocking table 12 along an axial direction J, which will be described later, so as to pass through the passage 14 and project into the subject through the passage 14 while maintaining a substantially straight state, and the cross section is forward. It is formed in the shape which inclines below as it goes to.

  For example, as shown in FIG. 3, the center axis 15 of the passage 14 of the treatment instrument swinging base 12 in the inverted position and the opening center 11 c of the fourth opening 11 of the first treatment instrument insertion channel 10 are the first. The passage 14 is formed in a shape that coincides in the axial direction J of the treatment instrument insertion channel 10. That is, the passage 14 is formed in a shape in which the inclination angle of the passage 14 matches the inclination angle of the first treatment instrument insertion channel 10.

  The passage 14 does not necessarily have a shape in which the central axis 15 and the opening center 11c coincide with each other in the axial direction J as long as the cross section has a linear shape. That is, the inclination angle of the passage 14 and the inclination angle of the first treatment instrument insertion channel 10 may be different.

  From the above, when the swing base operation knob 53 is turned, the swing base operation wire 18 is pulled and relaxed, so that the treatment instrument swing base 12 has the bottom 12t as shown in FIG. Between the inverted position that contacts the lower side surface 17g of the bottomed hole 17 and the maximum raised position shown in FIG. 5, it is inserted into the passage 14 by being rotatable about the rotation shaft 22, As shown in FIG. 4, the grasping forceps 23 protruding forward from the third opening 13 are also placed in the inverted position shown in FIG. It can be swung between the maximum raised position shown.

  2, 3, 5, and 6, the passage 14 is an insertion hole that is entirely covered by the treatment instrument swinging base 12, that is, a penetration that penetrates along the axial direction J. Although it is a hole, as shown in FIG. 7, it may have a shape in which a slit 14s communicating with the outside of the treatment instrument swinging base 12 is formed on a part of the entire circumference, for example, on the right side when viewed from the front. .

  Here, as shown in FIG. 3, the center of the passage 14 that overlaps the third opening 13 in the state in which the treatment instrument swinging table 12 is inverted, that is, the intersection of the center axis 15 and the distal end surface 2s is A, and FIG. As shown in FIG. 4, the center of the passage 14 that overlaps the third opening 13 in the maximum raising state of the treatment instrument swinging base 12, that is, the intersection of the central axis 15 ′ of the passage 14 and the distal end surface 2s at the maximum raising position. Is A ′, the opening center of the second opening 9 is B, and the opening center of the first opening 7k is C, the first opening 7k and the second opening are formed on the tip surface 2s. 9. The outer shape region 14 a where the outer shape of the passage 14 of the treatment instrument swinging table 12 in the inverted state in the third opening 13 overlaps along the central axis 15, and the treatment tool swing in the maximum raised state in the third opening 13. An outer region 14 in which the outer shape of the passage 14 of the moving table 12 overlaps along the central axis 15 ′. 2, when the intersection points A and A ′ and the opening center C are connected to the opening center B by a straight line, and the intersection point A and the opening center C are connected by a straight line, ∠ABC = θ1 is 10 The angle is set to be larger than 60 ° and smaller than 60 °, and ∠A′BC = θ2 is arranged at the position of the front end surface 2s set to 90 ° or more and 120 ° or less.

  As a result, the maximum raising angle of the treatment instrument swinging table 12 can be set large, and the second opening 9 and the outer region 14a are close to each other in the radial direction of the distal end portion 2. The high-frequency incision knife 28 protruding from the opening 9 and the grasping forceps 23 protruding from the third opening 13 in the state in which the treatment instrument swinging table 12 is placed in the proximity of the distal end portion 2 in the radial direction. it can.

  In other words, when θ1 is 10 ° or less and is set to 60 ° or more, the second opening 9 and the outer region 14a of the third opening 13 are separated in the radial direction of the tip 2. Therefore, the high-frequency incision knife 28 protruding from the second opening 9 and the grasping forceps 23 protruding from the third opening 13 in the inverted state of the treatment instrument swinging table 12 are They are separated in the radial direction, causing the same problem as the conventional one as described above.

  Further, when θ2 is smaller than 90 °, the maximum raising angle of the treatment instrument swinging table 12 becomes small, so that it is difficult to perform sufficient countertraction on the mucous membrane 29 by the grasping forceps 23. .

  Furthermore, when θ2 is larger than 120 °, the maximum raising angle of the treatment instrument swinging base 12 is increased. In this case, the diameter of the distal end portion 2 is increased by the increase in the raising angle.

  Returning to FIG. 2, in the front end surface 2 s, the outer region 14 a in the first opening 7 k, the second opening 9, and the third opening 13 has ∠ACB = θ3 larger than 70 ° and larger than 100 °. It is placed at a small position.

  Also by this, the second opening 9 and the outer region 14a of the third opening 13 are close to each other in the radial direction of the tip 2 on the tip face 2s, and the first opening 7k is the tip face 2s. , The high-frequency incision knife 28 and the treatment projecting from the second opening 9 are positioned close to the outer region 14a of the second opening 9 and the third opening 13 in the radial direction of the distal end 2. The liquid can easily be supplied from the first opening 7k to the lower mucous membrane 29 of the grasping forceps 23 that passes through the passage 14 in the inverted state and the tool swinging base 12 protrudes from the third opening 13.

  Next, the operation of the present embodiment will be described. Specifically, the incision treatment of the mucous membrane 29 at the lesion site in the subject will be described using the grasping forceps 23 and the high-frequency incision knife 28.

  When the incision of the mucous membrane 29 at the lesion site is performed by performing the above-described countertraction using the grasping forceps 23 and the high-frequency incision knife 28 inserted into the treatment instrument insertion channels 8 and 10, respectively, Inserts the grasping forceps 23 into the first treatment instrument insertion channel 10 through the insertion port 71, the fourth opening 11, the passage 14 of the treatment instrument swinging base 12 in the inverted state, and the third opening 13. Then, the grasping forceps 23 is caused to protrude forward from the front end surface 2s.

  At this time, as shown by a two-dot chain line in FIG. 5, the grasping forceps 23 is substantially straight from the third opening 13 obliquely below the endoscopic image 150 when the treatment instrument swinging table 12 is in the inverted state. It protrudes into the subject in the state. Therefore, in this state, the grasping forceps 23 can be moved back and forth while maintaining the linear state.

  Next, the high frequency incision knife 28 is inserted into the second treatment instrument insertion channel 8 through the insertion port 79, and then the high frequency incision knife 28 protrudes forward of the distal end surface 2 s through the second opening 9. Let

  At this time, the high-frequency incision knife 28 protruding forward from the second opening 9 and the grasping forceps 23 protruding forward from the third opening 13 include the second opening 9 and the third The outer region 14a in the opening 13 is set at an angle where ∠ABC = θ1 is larger than 10 ° and smaller than 60 °, and ∠A'BC = θ2 is 90 ° or more and 120 ° or less. Furthermore, since ∠ACB = θ3 is arranged at the position of the tip surface 2s set to be larger than 70 ° and smaller than 100 °, it protrudes close to the radial direction of the tip portion 2. .

  Therefore, the grasping forceps 23 can be raised by grasping the vicinity of the mucosa 29 to be incised by the high-frequency incision knife 28, and by grasping the mucosa 29 by the grasping forceps 23, When lifting to the upper position, it is not necessary to frequently change the mucous membrane 29, so that the mucous membrane 29 can be efficiently raised.

  Thereafter, as shown in FIG. 9, the grasping forceps 23 is operated to grip the mucous membrane 29 at the lesion site, and the swing table operating knob 53 is rotated to raise the treatment instrument swing base 12. The mucous membrane 29 is incised using the high-frequency incision knife 28 while counter traction for lifting the mucosa 29 upward in the endoscopic image 150 by the grasping forceps 23 is applied to the mucosa 29.

  Specifically, when the mucous membrane 29 is slightly lifted upward by the grasping forceps 23, the procedure of cutting the mucosa 29 using the high-frequency incision knife 28 is performed as shown in FIG. Incision of the mucous membrane 29 is performed by repeating the process a plurality of times.

  When the treatment instrument swinging table 12 is in the maximum raised state, as shown by the solid line, the gripping forceps 23 are partially bent in the vicinity of the fourth opening 11 by the rising of the treatment tool swinging table 12. In this state, the image is projected from the third opening 13 into the subject in a substantially linear state obliquely above the endoscopic image 150.

  Thus, in the present embodiment, the first opening 7k, the second opening 9, the outer region 14a of the third opening 13, and the outer region of the third opening 13 on the front end surface 2s. 14b is arranged at the position of the tip surface 2s where ∠ABC = θ1 is set to an angle larger than 10 ° and smaller than 60 °, and ∠A'BC = θ2 is set to 90 ° or more and 120 ° or less. It has been shown.

  Further, in the front end surface 2s, the outer region 14a of the first opening 7k, the second opening 9, and the third opening 13 is set such that ∠ACB = θ3 is larger than 70 ° and smaller than 100 °. Shown to be placed in position.

  According to this, when the treatment instrument swinging base 12 is in the inverted state as shown in FIG. 3, the high-frequency incision knife 28 protruding into the body cavity and the distal end portion are sufficiently formed only by protruding the grasping forceps 23 into the body cavity. Since the two are close to each other in the radial direction, the incision of the mucous membrane 29 can be started from the vicinity of the mucosa 29 gripped by the grasping forceps 23 using the high frequency incision knife 28.

  Further, when the treatment instrument swinging table 12 is in the inverted state, the grasping forceps 23 also has a linear state along the axial direction J and protrudes into the body cavity. Fine adjustment of the position of the mucous membrane 29 is facilitated.

  Further, since θ2 is set to 90 ° or more and 120 ° or less, the diameter of the distal end portion 2 is changed from the state in which the mucous membrane 29 is grasped by the grasping forceps 23 in the inverted state of the treatment instrument swinging base 12 as described above. Since the treatment instrument swinging table 12 can be raised largely without making it thick, sufficient counter traction can be applied to the lower layer of the mucosa 29 as shown in FIGS. Collective excision of the mucosa 29 can be performed safely and in a short time while securing an endoscopic field.

  Further, since θ3 is set to be larger than 70 ° and smaller than 100 °, the first opening 7k is formed in the outer region 14a of the second opening 9 and the third opening 13 on the front end surface 2s. Since the distal end portion 2 is located close to the radial direction, the high-frequency incision knife 28 and the treatment instrument swinging table 12 protruding from the second opening 9 pass through the passage 14 in the inverted state and pass through the third opening. In addition to facilitating the supply of the liquid from the first opening 7k to the grasping forceps 23 protruding from 13, the liquid force fed from the first opening 7k is fed as shown in FIGS. Since the liquid line 32 is formed below the protruding grasping forceps 23 and the high-frequency incision knife 28, the lower layer of the mucous membrane 29 can be washed without obstructing the movement of the treatment tools 23 and 28.

  From the above, the incision of the mucosa 29 at the lesion site performed while performing countertraction using the grasping forceps 23 and the high-frequency incision knife 28 respectively inserted into the treatment instrument insertion channels 8 and 10 is easy and efficient. An endoscope 1 having a configuration that can be performed can be provided.

  In the present embodiment, the treatment instrument inserted into the second treatment instrument insertion channel 8 is shown by taking the grasping forceps 23 as an example. However, the treatment instrument is not limited to this and has a linear shape that can grasp the mucosa 29. Any treatment tool may be used as long as it has a holding tool.

  Further, the treatment instrument inserted into the first treatment instrument insertion channel 10 has been described by taking the high-frequency incision knife 28 as an example. However, the present invention is not limited to this, and any treatment instrument having a linear shape capable of incising the mucosa 29 can be used. Not limited to high frequency incision knives.

  Further, the distal end surface 2s may not be a single plane as shown in FIG. For example, the front end surface 2s is partially uneven, and the intersection point A, the intersection point A ', the opening center B, and the opening center C may not be on a single plane.

  Furthermore, the inner diameter of the second treatment instrument insertion channel 8, the inner diameter of the passage 14 of the treatment instrument rocking base 12, and the inner diameter of the first treatment instrument insertion channel 10 are not limited, but are each 3.7 mm, for example. When set to 2.8 mm and 2.8 mm, bleeding and the like can be quickly sucked from the second treatment instrument insertion channel 8 through which the high-frequency incision knife 28 is inserted, so that the treatment performance is further improved.

DESCRIPTION OF SYMBOLS 1 ... Endoscope 2s ... Front end surface 7 ... Forward water supply channel 7k ... 1st opening part 8 ... 2nd treatment tool penetration channel 9 ... 2nd opening part 10 ... 1st treatment tool penetration channel 11 ... 4th Opening part 12 ... Treatment instrument swinging table 13 ... Third opening 14 ... Passage of the treatment tool swinging base 23 ... Gripping forceps (treatment tool) (gripping tool)
28 ... high frequency incision knife (treatment tool) (incision tool)
29 ... mucosa (test site)
40: Insertion section J: Axial direction S: Insertion direction

Claims (5)

A first opening portion of a front water supply channel that supplies a fluid into the subject, which is opened at a distal end surface of a distal end in an insertion direction of an insertion portion that is inserted into the subject;
A second opening of the second treatment instrument insertion channel opened in the distal end surface;
A third opening of a bottomed hole opened in the tip surface;
A fourth opening of the first treatment instrument insertion channel opened in the bottomed hole;
The treatment tool that is provided in the bottomed hole and protrudes through the fourth opening through the bottomed hole has a passage through which the treatment tool is inserted, and swings between a maximum raised position and an inverted position. A treatment instrument oscillating base for guiding the treatment instrument to the third opening by making the traveling direction of the treatment instrument inserted into the passage freely variable from being movable;
Comprising
The center of the passage of the treatment instrument swinging table that overlaps the third opening in the inverted state of the treatment instrument swinging base is A, and the third opening in the maximum rising state of the treatment instrument swinging base. When the center of the passage of the treatment instrument swinging table that overlaps the part is A ′, the center of the second opening is B, and the center of the first opening is C, , ∠ABC is set to an angle larger than 10 ° and smaller than 60 °, and ∠A′BC is 90 ° or more and 120 ° or less.   2. The endoscope according to claim 1, wherein the heel ACB is set to be larger than 70 ° and smaller than 100 ° on the distal end surface.  The treatment instrument that is inserted into the first treatment instrument insertion channel and whose traveling direction can be varied by the treatment instrument swinging table is a grasping instrument that grasps a region to be examined in the subject. The endoscope according to claim 1 or 2.  The endoscope according to claim 3, wherein the treatment instrument inserted through the second treatment instrument insertion channel is an incision instrument for incising the test site grasped by the grasping instrument.   2. The center of the passage and the center of the fourth opening in the inverted state of the treatment instrument swinging base coincide with each other in the axial direction of the first treatment instrument insertion channel. The endoscope according to any one of 4.

Images