JP5887222B2 - Endoscope apparatus and endoscope system - Google Patents

Description

  The present invention relates to an ultrafine endoscope apparatus and an endoscope system having a limited outer diameter.

  In recent years, diagnosis using a three-dimensional image has been widely performed. For example, a tomographic image of a patient is picked up by an X-ray CT (Computed Tomography) apparatus or the like, and three-dimensional image data inside the body is obtained, and a target region is diagnosed using the three-dimensional image data.

  In the CT apparatus, while continuously feeding the patient in the body axis direction, X-ray irradiation and detection of X-rays that have passed through the body and partly absorbed and attenuated in the body, A three-dimensional region in the body is continuously scanned in a helical manner (helical scan). Then, a three-dimensional image is created from a large number of continuous two-dimensional tomographic images.

  One of the three-dimensional images used for diagnosis is a three-dimensional image of lung bronchi. The three-dimensional image of the bronchus is used to three-dimensionally grasp the position of an abnormal part suspected of lung cancer, for example. In order to confirm the abnormal part by biopsy, for example, a catheter is inserted to collect a tissue sample. In this case, under X-ray fluoroscopy, a catheter having an X-ray opaque metal marker is inserted at the tip, and the diseased part is reached in a half-explored state. However, it is difficult to reach the right place with a fluoroscopic black and white two-dimensional image. In some cases, the tissue of a different place must be collected and the catheter must be inserted again. The burden on the surgeon is also great.

  Further, in a duct in the body having a multi-stage branch such as a bronchi, when the location of the abnormal part is close to the end of the bronchus, it is difficult to correctly reach the target site in a short time in the endoscope. For this purpose, for example, as disclosed in Patent Document 1, a three-dimensional image of a pipeline is created based on image data of a three-dimensional region inside the body, and the target point is reached along the pipeline on the three-dimensional image. Insertion support apparatus that obtains the path of the image, creates a virtual endoscopic image of the duct along the path based on the image data, and displays the virtual endoscopic image, thereby navigating the bronchoscope to the target site Has been proposed.

  In Patent Document 2, the tip portion of an optical fiber sensor composed of an optical fiber and a coating having high bending flexibility for covering the optical fiber is bent in advance with a desired bending radius to give a bending wrinkle. A configuration has been proposed in which an optical fiber sensor is inserted into a straight pipe, and the optical fiber sensor is advanced and retracted in the straight pipe so that the bending angle of the optical fiber sensor coming out of the straight pipe can be arbitrarily set. . Such a configuration eliminates the need for a joint ring connection structure as compared to an endoscope having a tip portion structure in which a plurality of joint rings are swingably connected by pin coupling and the tip portion is bent by wire operation. It is possible to reduce the diameter. For this reason, using an ultra-fine endoscope as described in Patent Document 2 as a bronchoscope and performing navigation for insertion together with the insertion support device disclosed in Patent Document 1 has been studied.

JP 2009-279251 A JP-A 61-273517

  However, in an ultra-fine endoscope with a limited diameter of the insertion portion as disclosed in Patent Document 2, forming an optical fiber sensor and a coating constituting the insertion portion at a desired bending angle is a part molding. Difficult in terms of method and molding accuracy. In addition to the optical fiber sensor and the coating, there is a problem in that the number of parts and the cost increase when a part to which a bending wrinkle is previously provided is provided.

  The present invention has been made in view of the above problems, and provides an ultrafine endoscope apparatus and an endoscope system that can be changed from a straight tube shape to a bent state that is bent to a desired bending angle with a simple configuration. The purpose is to do.

  In order to achieve the above object, in the present invention, a distal end rigid portion disposed at the distal end, an observation unit attached to the distal end rigid portion, an insertion portion having a flexible tube connected to the proximal end side of the distal end rigid portion, an insertion portion An internal view provided with a sliding protrusion protruding from the outer peripheral surface, a pressing protrusion protruding from the outer peripheral surface and protruding from the outer peripheral surface, and an operation portion attached to the proximal end of the insertion portion A mirror and a guide sheath in which the insertion portion is housed, formed on the inner peripheral surface, to be pressed by the pressing projection, and bent together with the insertion portion when the pressed portion receives pressure from the insertion portion And a guide sheath having a bent portion. The configuration of the ultra-thin endoscope can be simplified and can be surely changed from a straight tube to a bent state bent at a desired bending angle.

  It is preferable that the guide sheath further includes a cam groove that is formed obliquely with respect to the cylindrical core and in which the sliding protrusion slides. The pressing protrusion is preferably disposed on the proximal end side of the sliding protrusion.

  The guide sheath is arranged in parallel with the cylindrical core, is arranged continuously with the distal end portion of the cam groove, and guides the sliding projection portion into the cam groove when the sliding projection portion enters from the proximal end side. It is preferable to have a groove. Further, the guide groove is provided on the base end side with respect to the tip end of the cam groove, and includes a stepped portion whose amount of protrusion increases from the base end side toward the tip end side. When entering from the base end side of the groove, it is preferable to allow the sliding projection to move toward the distal end side and to restrict the sliding projection from returning from the distal end side to the proximal end side of the guide groove. In the guide sheath, guide grooves and inclined grooves are alternately formed at predetermined intervals in the circumferential direction, and it is preferable that the base end portion of the inclined groove and the guide groove are continuously arranged. Thereby, an insertion part can be rotated with a predetermined pitch, and can be made into a bending state. Moreover, it is preferable that a to-be-pressed part is a taper surface distribute | arranged to the base end part of the guide groove, and was distribute | arranged according to the width | variety of a press protrusion part.

  The pressing protrusion is the same as the sliding protrusion, and the guide sheath preferably has a plurality of pressed parts that are pressed by the pressing protrusion in part of the cam groove. It is preferable that the pressed portion is a steeply inclined surface in which the inclination of the guide sheath with respect to the cylindrical core is abruptly formed from other portions of the cam groove. Or it is preferable that a to-be-pressed part is a click groove | channel engaged with a sliding protrusion part. Thereby, a guide sheath can be pressed by each steep slope or each click groove | channel, and an insertion part can be made into a bending state.

  The sliding protrusion is provided so as to be movable by a predetermined amount with respect to the insertion part, and the insertion part has a contact part that contacts the cam groove when the sliding protrusion moves by contacting the click groove. It is preferable.

  It is preferable that the guide sheath is formed with a retaining portion that locks the sliding protrusion on the distal end side of the guide groove, and restricts the insertion portion from being detached toward the distal end side of the guide sheath. Moreover, it is preferable that a bending part is distribute | arranged to the base end side of a to-be-pressed part, and when a to-be-pressed part receives a press, it bends and expand | extends.

  The guide sheath includes a straight tubular outer tube and an inner tube disposed on the inner peripheral surface distal end side of the outer tube and formed with a cam groove, and the inner tube is a metal formed of a metal that is opaque to X-rays. A marker is preferred. It is preferable to provide a treatment instrument that is inserted into the guide sheath and can be moved in and out from the distal end of the guide sheath.

  An endoscope system according to the present invention includes an endoscope device, virtual image generation means for generating a virtual endoscopic image of the observation target lumen based on three-dimensional image data of the observation target, and the observation target It is preferable to include an insertion support apparatus having image display means for displaying a plurality of virtual endoscopic images at a branching portion where the lumen branches.

  According to the present invention, since the pressed portion formed on the guide sheath is pressed from the pressing protrusion protruding from the outer peripheral surface of the insertion portion, the guide sheath and the insertion portion are bent from the straight tube with a simple configuration. It can be. And the structure which connects a some joint ring becomes unnecessary, and the outer diameter of an insertion part can be made small.

It is the schematic which shows an endoscope system. It is explanatory drawing which shows the usage condition of an endoscope system. It is explanatory drawing which shows another usage pattern of an endoscope system. It is a disassembled perspective view which shows the structure of an insertion part. It is principal part sectional drawing of an insertion part and a guide sheath. It is the perspective view which looked at the front-end | tip rigid part from the base end side. It is a perspective view which shows the structure of a flexible tube. It is a perspective view which shows the structure of the insertion pipe | tube of a guide sheath. It is a perspective view of the cam cylinder in which the cam groove was formed. It is an expanded view of the cam cylinder in which the cam groove was formed. It is principal part sectional drawing of the insertion part used as the bending state. It is explanatory drawing which shows the insertion path | route setting screen of an insertion assistance apparatus. It is explanatory drawing which shows the insertion assistance screen of an insertion assistance apparatus. It is explanatory drawing which shows an example of the change of the observation image of an endoscope, The state (B) before bending an insertion part, and the state (B) which adjusted the position of the observation image by bending and rotating an insertion part It is description which shows. It is sectional drawing which shows an example which inserted the insertion part accommodated in the guide sheath into the pipe line. It is a disassembled perspective view which shows the structure of the insertion part of 2nd Embodiment. It is a perspective view which shows the penetration tube of the guide sheath of 2nd Embodiment. It is principal part sectional drawing of the insertion part and guide sheath of 2nd Embodiment. It is an expanded view of the inner tube | pipe in which the cam groove of 2nd Embodiment was formed. It is principal part sectional drawing of the insertion part used as the bending state of 2nd Embodiment. It is a disassembled perspective view which shows the structure of the insertion part of 3rd Embodiment. It is a perspective view which shows the sliding protrusion part periphery structure of 3rd Embodiment. It is a perspective view which shows the penetration tube of the guide sheath of 3rd Embodiment. It is principal part sectional drawing of the insertion part and guide sheath of 3rd Embodiment. It is an expanded view of the inner tube | pipe in which the cam groove of 3rd Embodiment was formed. It is principal part sectional drawing of the insertion part used as the bending state of 3rd Embodiment.

[First embodiment]
As shown in FIG. 1, the endoscope system 2 of the present invention includes an endoscope main body 3, an endoscope apparatus 5 having a guide sheath 4, and an insertion support apparatus 6. The endoscope main body 3 has an insertion portion 7 and a hand operation portion 8. As shown in FIG. 2, the endoscope body 3 is inserted into the bronchus 10 which is a lumen in the body of a patient 9, for example, so that the inside of the bronchus 10 can be observed. In addition, the endoscope apparatus 5 includes a treatment instrument 11, and after inserting the insertion portion 7 and the guide sheath 4 to the vicinity of the target site 10 </ b> A in the bronchus 10, the insertion portion 7 is pulled out from the guide sheath 4. The treatment instrument 11 is inserted into the guide sheath 4. The treatment instrument 11 is, for example, a biopsy forceps having a cup 11 </ b> A capable of collecting a biological tissue at the distal end portion. The treatment instrument 11 is inserted into the guide sheath 4 and can be protruded and retracted from the distal end of the guide sheath 4.

  As shown in FIG. 3, the endoscope system 2 may be used in combination with an endoscope apparatus 12 other than the endoscope apparatus 5. The endoscope device 12 is connected to the distal end portion 13A containing an imaging means such as a CCD, the insertion portion 13 provided with a bending portion 13B having a structure in which a joint ring is connected, and the proximal end of the insertion portion 13. This is a conventional endoscope that includes a hand operation unit 14, an insertion unit 13, and a treatment instrument insertion channel (not shown) provided inside the hand operation unit 14. 14A, and the distal end portion 13A has a treatment instrument outlet 13C. The insertion portion 13 of the endoscope apparatus 12 cannot be inserted into the thin duct of the bronchus 10 and may not reach the target site 10A close to the end of the bronchus 10. In this case, the endoscope apparatus 5 of the present invention is inserted from the treatment instrument inlet 14A into the treatment instrument insertion channel of the endoscope apparatus 12, and the guide sheath 4 and the insertion portion 7 are projected from the treatment instrument outlet 13C. The guide sheath 4 and the insertion portion 7 have an outer diameter smaller than that of the insertion portion 13 of the endoscope apparatus 12 and can be inserted up to a conduit that is thinner than the insertion portion 13.

  As shown in FIGS. 4 and 5, the insertion portion 7 is divided into a distal end rigid portion 19 and a flexible tube 20. The distal end rigid portion 19 located at the distal end of the insertion portion 7 is formed from a rigid synthetic resin or metal cylindrical body, and the distal end outer peripheral surface is tapered. An observation optical system 22, a light guide 23, and an image guide 24 are accommodated in the distal end rigid portion 19. For this reason, the inner peripheral surface of the distal end rigid portion 19 is formed with a first inner peripheral surface 19a, a second inner peripheral surface 19b, and a third inner peripheral surface 19c having different inner diameters in order from the distal end.

  The observation optical system 22 includes a first lens 25, a diaphragm 26, a second lens 27, and a third lens 28 arranged in order from the tip. Among these, the diaphragm 26, the second lens 27, and the third lens 28 are housed in the lens barrel 29.

  The first inner peripheral surface 19a of the distal end rigid portion 19 functions as a first lens holding portion and is formed up to the vicinity of the outer peripheral surface. The first lens 25 of the observation optical system 22 is fixed to the first inner peripheral surface 19a. The second inner peripheral surface 19b has an inner diameter that is smaller than the inner diameter of the first inner peripheral surface 19a, and functions as a locking step for preventing the lens barrel 29 from falling off. The third inner peripheral surface 19c has an inner diameter that is smaller than the inner diameter of the first inner peripheral surface 19a and larger than the inner diameter of the second inner peripheral surface 19b.

  As shown in FIGS. 4 and 6, the second inner peripheral surface 19 b and the third inner peripheral surface 19 c are partially cut out, and the cut portions function as the light guide introduction groove 30. Four light guide introduction grooves 30 are formed at a 90 ° pitch in the circumferential direction. The light guide 23 is inserted into the light guide introduction groove 30. The light guide 23 is composed of an optical fiber bundle in which optical fibers are bundled, and the distal end portion 23a is divided into four and inserted into each light guide introduction groove 30. A light source 31 (see FIG. 1) is provided at the base end of the light guide 23. Illumination light from the light source 31 is emitted from the tip of the light guide 23 and illuminates the patient's body. As the light source 31, for example, a light source provided in an external light source device connected to the endoscope main body 3 via a connector is preferable, or a light source built in the endoscope main body 3 may be used.

  On the third inner peripheral surface 19 c of the distal end rigid portion 19, a lens barrel holding portion 32 is formed to protrude inward between the light guide introduction grooves 30. The lens barrel holding portion 32 holds the lens barrel 29 of the observation optical system 22. Reference numeral 33 denotes a front end cover of the image guide 24, reference numeral 34 denotes a protective tube for the image guide 24, and reference numeral 35 denotes a protective tube for the light guide 23. In FIG. 3, the protection tube 34 and the protection tube 35 are not shown in order to prevent the drawing from becoming complicated.

  The tip cover 33 is formed of, for example, a hard synthetic resin or metal cylinder, is fixed to the tip of the image guide 24, and is inserted into the lens barrel 29. The image guide 24 inserted into the lens barrel 29 together with the tip cover 33 is fixed at a position where the center axis is on the same axis as the optical axis of the observation optical system 22 and the tip surface is close to the third lens 28. ing. Thereby, the tip rigid part 19, the observation optical system 22, and the image guide 24 are integrated as an observation unit. The protective tube 34 is inserted into the lens barrel 29 located inside the lens barrel holding portion 32 to a position close to the base end portion, which covers the image guide 24. Further, the base end portion of the lens barrel 29 is adhered to the outer peripheral surface of the distal end cover 33 by, for example, an adhesive. As a result, the observation optical system 22 and the image guide 24 are sealed while being kept airtight.

  The outer peripheral surface of the distal end rigid portion 19 is divided from the distal end into a tapered surface 19d, an outer peripheral surface 19e, and a flexible tube attachment step portion 19f. Further, the lens barrel holding portion 32 protrudes from the rear end of the distal end rigid portion 19 in the tube core direction. A protective tube 35 of the light guide 23 is fixed to the lens barrel holding portion 32 extending from the rear end. Further, the distal end side tube 37 of the flexible tube 20 is covered from above the protective tube 35. The outer peripheral surface of the flexible tube mounting step portion 19f is the same as the outer diameter of the lens barrel holding portion 32 covered with the protective tube 35.

  The distal end rigid portion 19 is integrally provided with a pair of sliding protrusions 36 a and 36 b that protrude from the outer peripheral surface 19 e and are disposed at the same position in the cylindrical core direction of the distal end rigid portion 19. The sliding protrusions 36a and 36b are formed at positions that are rotationally symmetric at a 180 ° pitch, and slide with cam grooves 53a to 53d and guide grooves 54a to 54d of the guide sheath 4 described later.

  As shown in FIG. 7, the flexible tube 20 is formed by connecting a distal end side tube 37, a connecting sleeve 38, and a proximal end side tube 39 in order from the distal end. The distal end side tube 37 and the proximal end side tube 39 are made of, for example, elastomer and have a rubber-like elastic force.

  The connection sleeve 38 is formed in a cylindrical shape from a material having higher rigidity than the distal end side tube 37 and the proximal end side tube 39, for example, ABS resin. The connecting sleeve 38 includes a distal end side connection portion 38a, an intermediate portion 38b, and a proximal end side connection portion 38c in order from the distal end side. In the connection sleeve 38, the distal end side connection portion 38a is covered with the proximal end portion of the distal end side tube 37, and the proximal end side connection portion 38c is covered with the distal end portion of the proximal end side tube 39. As a result, the distal end side tube 37 and the proximal end side tube 39 are connected via the connecting sleeve 38. The distal end side of the distal tube 37 is covered with the flexible tube mounting step 19 f of the distal rigid portion 19, and the flexible tube 20 is fixed to the proximal end side of the distal rigid portion 19.

  The connecting sleeve 38 has one pressing protrusion 40. The pressing protrusion 40 protrudes from the outer peripheral surface of the intermediate portion 38b and is integrally formed. The intermediate portion 38b of the connecting sleeve 38 has a larger outer diameter than the distal end side connection portion 38a and the proximal end side connection portion 38c, and the distal end side tube 37 and the proximal end side tube are connected to the distal end side connection portion 38a and the proximal end side connection portion 38c. It is the same as the outer diameter when 39 is covered.

  The pressing protrusion 40 is disposed along the outer peripheral surface of the intermediate portion 38b and is formed in an arc shape with a central angle of 90 °. The pressing projection 40 is disposed on the proximal end side of the sliding projection 36a and presses tapered surfaces 55a and 55b of the guide sheath 4 described later.

  The guide sheath 4 is formed in a distal tube portion 48 arranged at the tip, a cam tube 49, a straight tube, the insertion tube 50 through which the insertion portion 7 of the endoscope body 3 is inserted, and the base of the insertion tube 50 And a grip 51 (see FIG. 1) connected in series to the end portion. The insertion tube 50 is made of a material having flexibility, such as polyurethane resin, and higher rigidity than the insertion portion 7. The distal end cylinder portion 48 is formed of the same resin or the like as the insertion tube 50.

  As shown in FIGS. 8 and 9, the cam cylinder 49 includes two semi-cylindrical cam members 49a and 49b divided into two in the circumferential direction. The cam members 49a and 49b are formed of a rigid X-ray opaque metal plate and can be used as a metal marker under X-ray transparency.

  The cam members 49a and 49b are formed with convex portions 52a and 52b that are one step convex from the periphery on the outer peripheral surface. The convex portions 52a and 52b are formed in an arc shape and are arranged at the same position in the cylinder core direction. When the cam members 49a and 49b are joined, the outer diameter is the same as that of the distal end cylindrical portion 48 and the insertion tube 50. It becomes two circles. The cam members 49 a, 49 b have outer peripheral surfaces 52 c, 52 d on the tip side of the convex portions 52 a, 52 b fitted into the inner peripheral surface of the tip tube portion 48, and the tips are arranged at the same position as the tip of the tip tube portion 48. The Furthermore, the cam members 49 a and 49 b are fitted on the distal end side of the inner peripheral surface of the insertion tube 50 with the outer peripheral surfaces 52 e and 52 f closer to the base end than the convex portions 52 a and 52 b.

  The inner peripheral surfaces of the cam members 49a and 49b are formed to have a slightly larger inner diameter than the outer peripheral surface excluding the sliding protrusions 36a and 36b of the insertion portion 7, and four cam grooves 53a to 53d and four guide grooves 54a to 54d are formed. Is formed.

  FIG. 10 is a developed view of the cam cylinder 49, and the cam grooves 53 a to 53 d and the guide grooves 54 a to 54 d are viewed from the inside of the cam cylinder 49. FIG. 10 shows a state where one joining surface A1 of the cam member 49a and one joining surface A2 of the cam member 49b are separated from each other, and the cam members 49a and 49b are joined. The joining surfaces A1 and A2 are continuous.

  The cam grooves 53 a to 53 d and the guide grooves 54 a to 54 d are alternately arranged in the circumferential direction of the cam cylinder 49. The cam grooves 53a to 53d are inclined grooves that are formed obliquely with respect to the cylinder core of the cam cylinder 49 and in which the sliding protrusions 36a and 36b slide, and are clockwise when the cam cylinder 49 is viewed from the front end side. The cam cylinder 49 is formed in a direction extending from the distal end side toward the proximal end side. The cam grooves 53 a to 53 d are arranged at a 90 ° pitch in the circumferential direction of the cam cylinder 49.

  The guide grooves 54 a to 54 d are arranged in parallel with the cylinder core of the cam cylinder 49 and are arranged at a 90 ° pitch in the circumferential direction of the cam cylinder 49. The guide grooves 54a to 54d are continuously arranged with the distal end portion and the proximal end portion of the adjacent cam grooves 53a to 53d. In addition, the front-end | tip and base end of cam groove 53a-53d are distribute | arranged at predetermined intervals from the front-end | tip and base end of guide groove 54a-54d. Of the guide grooves 54a to 54d, the guide grooves 54a and 54c are formed across the joint surfaces of the cam members 49a and 49b, and the guide grooves 54b and 54d are located at the circumferential center of the cam members 49a and 49b. Yes.

  As described above, since the pair of sliding protrusions 36a and 36b are formed at positions that are rotationally symmetric with each other at a pitch of 180 °, the cam grooves 53a to 53d and the guide grooves 54a to 54d are 180 °. Sliding projections 36a and 36b enter a combination that is rotationally symmetric with respect to each other, that is, cam grooves 53a and 53c, cam grooves 53b and 53d, guide grooves 54a and 54c, or guide grooves 54b and 54d. To do.

  When the sliding projections 36a, 36b slide along the cam grooves 53a, 53c or the cam grooves 53b, 53d, the insertion portion 7 has a hard end portion 19 integrated with the sliding projections 36a, 36b. Rotate around the core.

  At the base ends of the guide grooves 54a to 54d, tapered surfaces 55a and 55b whose width gradually decreases from the base end portion of the cam cylinder 49 toward the guide grooves 54a to 54d are formed. The tapered surfaces 55 a and 55 b are arranged at intervals according to the width of the pressing projection 40, the minimum interval is smaller than the width of the pressing projection 40, and the maximum interval is larger than the width of the pressing projection 40. The tapered surfaces 55a and 55b function as pressed parts that come into contact with the pressing protrusions 40 and receive pressure from the pressing protrusions 40 when the sliding protrusions 36a and 36b enter the guide grooves 54a to 54d (see FIG. 9). Further, the tapered surfaces 55a and 55b also function as guiding surfaces for guiding the sliding protrusions 36a and 36b that have passed through the inner peripheral surface of the insertion tube 50 to the distal ends of the guide grooves 54a to 54d.

  Further, at the tips of the guide grooves 54a to 54d, there are retaining portions 56 for retaining the sliding protrusions 36a and 36b. Since the sliding protrusions 40 a and 40 b are restricted from moving toward the distal end side of the cam cylinder 49 by the retaining portion 56, it is possible to restrict the insertion portion 7 from being detached toward the distal end side of the guide sheath 4.

  The guide grooves 54a to 54d are arranged on the proximal end side from the distal ends of the cam grooves 53a to 53d and on the distal end side from the proximal ends of the cam grooves 53a to 53d, and the protruding amount increases from the proximal end side toward the distal end side. A stepped portion 57 is provided. The stepped portion 57 allows the sliding projections 36a and 36b to move to the distal end side when the sliding projections 36a and 36b enter from the proximal end side of the guide grooves 54a to 54d, and also slides the projection. The movement of 36a, 36b from the distal end side to the proximal end side of the guide grooves 54a to 54d is restricted. As a result, when the sliding protrusions 36a and 36b are moved back from the positions where the sliding protrusions 36a and 36b enter the distal ends of the guide grooves 54a to 54d and the sliding protrusions 36a and 36b are moved to the proximal side, the stepped portion 57 is obtained. Therefore, the sliding protrusions 36a and 36b enter the cam grooves 53a to 53d, and further pass through the cam grooves 53a to 53d to be adjacent to the guide grooves 54a to 54d. It enters into the grooves 54a to 54d.

  The insertion tube 50 has a bent portion 58 formed at a position closer to the base end side than the cam tube 49. The bent portion 58 is thinner than the other portion of the insertion tube 50 and is formed in a bellows shape. The bent portion 58 is bent when an external force is applied, and is extended when pulled in the cylinder core direction. The bent portion 58 is bent and extended when the tapered surfaces 55a and 55b are pressed.

  The total length of the guide sheath 4 is longer than the total length of the insertion portion 7. Accordingly, when the insertion portion 7 is pushed into the guide sheath 4, the distal end of the insertion portion 7 does not protrude from the distal end of the distal end cylindrical portion 48.

  As shown in FIG. 4, the sliding protrusions 36a and 36b are in the guide grooves 54a and 54c (or the guide grooves 54b and 54d) in the state where the insertion part 7 is inserted into the guide sheath 4, and the pressing protrusions When 40 is located on the proximal end side of the tapered surfaces 55 a and 55 b, the guide sheath 4 is not pressed from the insertion portion 7, and thus has a straight tubular shape together with the insertion portion 7. When the hand operating part 8 is pressed from the state shown in FIG. 4 and the insertion part 7 is pushed into the distal end side of the guide sheath 4, the sliding protrusions 36a and 36b get over the step part 57 and the guide grooves 54a to 54d are formed. While entering the tip, the pressing protrusion 40 abuts against the tapered surfaces 55a and 55b to press the tapered surfaces 55a and 55b.

  As shown in FIG. 11, when the pressing projection 40 abuts the tapered surfaces 55a and 55b and presses the tapered surfaces 55a and 55b, the pressing force received by the tapered surfaces 55a and 55b is transmitted to the bent portion 58 as an external force. Thus, the bent portion 58 is bent and extended, and the insertion portion 7 housed in the guide sheath 4 is also bent. In this way, a bent state in which the cylindrical core of the distal end rigid portion 19 is inclined with respect to the cylindrical core of the guide sheath 4 is obtained. In this bent state, the inclination angle of the cylindrical core of the distal end rigid portion 19 with respect to the cylindrical core of the guide sheath 4 is preferably set to 5 ° to 30 °.

  When the hand operating portion 8 is pulled from the state shown in FIG. 11 and the insertion portion 7 is pulled back to the proximal end side of the guide sheath 4, the sliding protrusions 36a and 36b are restricted by the stepped portion 57, and the cam grooves 53a and 53c. (Or cam grooves 53b, 53d). When the sliding projections 36a and 36b enter the cam grooves 53a to 53d, as described above, the sliding projections 36a and 36b slide along the cam grooves 53a to 53d, and the insertion portion 7 is centered on the cylinder core. Rotate to. And if it moves to the base end side of cam groove 53a-53d, it will move to the base end part of the adjacent guide grooves 54a-54d. At this time, since the pressing protrusion 40 moves to the proximal end side of the tapered surfaces 55 a and 55 b, the tapered surfaces 55 a and 55 b are released from the pressing, and the guide sheath 4 returns to the straight tube together with the insertion portion 7.

  As described above, when the insertion portion 7 is pushed into the distal end side of the guide sheath 4, the pressing projection 40 presses the tapered surfaces 55 a and 55 b to make the insertion portion 7 bent together with the guide sheath 4. When the sliding projections 36a and 36b are slid along the cam grooves 53a to 53d by pulling back to the proximal end side of the guide sheath 4, the insertion portion 7 can be rotated at a 90 ° pitch. The direction of bending changes. Further, the insertion portion 7 can be pushed into the distal end side of the guide sheath 4 and pulled back to the proximal end side four times and rotated by 90 ° pitch for a total of 360 °. Therefore, the insertion part 7 can be rotated one or more times with respect to the cylindrical core.

  The outer diameter of the insertion portion 7 of the present embodiment, that is, the outer diameter excluding the distal end rigid portion 19 and the sliding projections 36a and 36b and the pressing projection 40 of the flexible tube 20 is 2.0 mm or less. preferable. The guide sheath 4 preferably has the same inner diameter as the outer diameter of the insertion portion 7 or has a slight gap, and the outer diameter is 2.4 mm or less.

  The hand operation unit 8 includes an eyepiece unit 46. In the eyepiece 46, the base end of the image guide 24 is fixed, and an eyepiece optical system (not shown) is accommodated. In the eyepiece optical system, the optical axis is arranged on the same axis as the central axis of the image guide 24. An image of the subject taken in by the observation optical system 22 is emitted from the proximal end of the image guide 24, and the image is enlarged through the eyepiece optical system. Further, the insertion portion 7 is fitted with a bend preventing member 47 formed of a soft member such as a rubber member at an end portion on the hand operating portion 8 side.

  The insertion support apparatus 6 includes a CT image data storage unit 61, a VBS image generation unit 62 that generates a virtual endoscopic image (hereinafter referred to as “VBS image”), and a VBS image storage unit 63. An insertion path setting unit 64, an image processing unit 65, and an image display unit 66. The CT image data storage unit 61 stores, for example, three-dimensional CT image data in a DICOM (Digital Imaging and Communication in Medicine) format generated by a known CT apparatus (not shown) that captures an X-ray tomogram of the patient 9. To do. The VBS image generation unit 62 generates a VBS image from three-dimensional CT image data based on a line-of-sight parameter described later. The insertion / insertion path setting unit 64 sets an insertion path for inserting the insertion unit 7 into the target site of the bronchus 10 from the three-dimensional CT image data. The image processing unit 65 generates an insertion path setting screen for setting an insertion path, and an insertion support screen described later including a VBS image and a plurality of thumbnail VBS images. The image display unit 66 displays the screen generated by the image processing unit 65 on the monitor 67.

  The endoscope system 2 having an insertion navigation function will be briefly described with reference to FIGS. FIG. 12 is a diagram illustrating an example of an insertion path setting screen, and FIG. 13 is a diagram illustrating an example of an insertion support screen. Note that the endoscope system of the present invention does not necessarily have an insertion navigation function. Further, when the insertion path setting screen is displayed to set the insertion path, or the screen or the image is switched, for example, it is performed by an input operation of an input device (not shown).

  As shown in FIG. 12, when performing the insertion navigation, first, for example, information 68A related to the patient 9, an image 68B displaying the insertion route R of the endoscope device 5 and details are not shown on the monitor 67. An insertion path setting screen 68 including the VBS image 68C and the like is displayed. In the image 68B, the insertion path R of the endoscope apparatus 5 up to the target site 70A set by the insertion path setting unit 64 is superimposed on the bronchial image 70 of the patient 9 generated from the three-dimensional CT image data. It is displayed.

  When the endoscope insertion operation is started, the input device switches to the insertion support screen 69. As shown in FIG. 13, the insertion support screen 69 reduces the VBS image display area 69A for displaying the VBS image and the VBS images at all branch portions of the insertion path to the target site and displays them as branch thumbnail VBS images. Branch thumbnail VBS image area 69B and the like.

  FIG. 12 shows an insertion support screen 69 when the target part is reached via four branch parts. That is, the VBS image display area 69A displays the VBS image 71 of the first branch portion of the insertion path, and the branch thumbnail VBS images include the branch thumbnail VBS images 72A to 72D at the four branch sections on the insertion path. Is displayed. In the VBS image 71, a mark 73 is superimposed and displayed on a path hole for proceeding along the insertion path 1.

  The surgeon looks into the eyepiece 46 of the endoscope device 5 and confirms an actual observation image of the bifurcation. FIG. 14 shows an example of an image observed by the endoscope apparatus 5. In FIG. 14, a range surrounded by a solid circle indicates the observation image 74, and a dotted line portion indicates a peripheral portion of the observation image 74. FIG. 14A shows an observation image 74 when the insertion portion 7 is inserted into the bronchus 10 of the patient 9 and the first branch portion is reached. Then, after comparing the VBS image 71 and the actual observation image 74, the distal end rigidity of the insertion portion 7 is adjusted so that the observation image is aligned with the actual path hole 75 corresponding to the path hole indicated by the mark 73 in the VBS image 71. The direction of the part 19 is changed. As described above, the insertion portion 7 can be bent by pushing the insertion portion 7 into the guide sheath 4, and the insertion portion 7 can be rotated by pulling the insertion portion 7 back to the guide sheath 4. The part 19 can be easily changed to a desired direction. As shown in FIG. 14B, by inserting the insertion portion 7 together with the guide sheath 4 in a state where the observation image 74 is aligned with the path hole 75 corresponding to the path hole indicated by the mark 73, the insertion path 7 is inserted. The insertion portion 7 and the distal end portion of the guide sheath 4 can be fed into the route hole 75 along the route.

  After the surgeon inserts the insertion part 7 and the guide sheath 4 into the path hole 75 along the insertion path indicated by the mark 73 at the first branch part, the VBS image 71 of the insertion support screen 69 is the second branch part. The VBS image is switched to. Then, the endoscope apparatus 5 is operated so that the observation image is aligned with the actual path hole corresponding to the path hole indicated by the mark 73 as in the case of the first branch portion. In this way, the operator inserts the insertion portion 7 and the guide sheath 4 up to the branch portion in the vicinity of the target site 70A without making a mistake in the path hole into which the insertion portion 7 and the guide sheath 4 are to be inserted in each branch portion. can do.

  As described above, since the pressing protrusion 40 presses the tapered surfaces 55a and 55b to bend the insertion portion 7 together with the guide sheath 4, the insertion portion 7 can be changed from a straight tube to a bent state with a simple configuration. In addition, since the endoscope device 5 having a very small outer diameter of the insertion portion 7 and the guide sheath 4 is used, the insertion portion reaches a branch portion where the inner diameter of the bronchus 10 is smaller than that of the prior art, that is, a portion near the extinction of the bronchi 10. 7 and the guide sheath 4 can be inserted, and the insertion portion 7 and the guide sheath 4 can reach the vicinity of the target portion 70A. Then, after inserting the insertion portion 7 and the guide sheath 4 to the vicinity of the target site 70A, the insertion portion 7 is pulled out from the guide sheath 4 and a treatment instrument such as a biopsy forceps is inserted into the guide sheath 4 instead. . Accordingly, it is possible to perform a treatment such as causing the treatment tool to reach the vicinity of the target site 70A and collecting a tissue sample.

  In addition, since the guide sheath 4 is provided with X-ray opaque cam members 49a and 49b at the distal end portion, the guide sheath 4 is inserted to the vicinity of the target site 70A of the bronchus 10 using the insertion navigation function. The distal ends of the guide sheath 4 and the insertion portion 7 can reach the target site by confirming the positions of the cam members 49a and 49b under fluoroscopy. After inserting the guide sheath 4 to the vicinity of the target site 70A of the bronchus 10 using the insertion navigation function, the position of the cam members 49a and 49b and the metal treatment tool is confirmed by performing treatment under X-ray fluoroscopy. Since the treatment tool can be inserted while the treatment is performed, the treatment can be performed more reliably.

  Furthermore, as described above, since the sliding protrusions 36a and 36a can be rotated one or more times in the circumferential direction of the cam cylinder 49, the tip rigid portion 19 can be easily changed to a desired direction. Thereby, when the position of the observation image is adjusted to the path hole 75 by changing the bending direction of the insertion portion 7, the position of the observation image can be adjusted only by repeatedly pushing and pulling the insertion portion 7 with respect to the guide sheath 4. Therefore, the change of the direction of the distal end rigid portion 19 can be further simplified.

  Further, since the flexible tube 20 includes a pair of sliding protrusions 36 a and 36 a and the guide sheath 4 includes cam grooves 53 a to 53 d corresponding to the sliding protrusions 36 a and 36 a, The insertion part 7 can be rotated stably. Alternatively, as shown in FIG. 15, when the insertion portion 7 is inserted into the guide sheath 4 and the conduit 76 close to the extremity of the bronchus 10 is inserted, the conduit 76 is in close contact with the outer peripheral surface of the guide sheath 4. However, since the distal end of the insertion portion 7 does not protrude from the distal end of the distal end cylindrical portion 48, the distal end of the insertion portion 7, that is, the first lens 25 is contaminated with tissue in the body. Can be prevented. In addition, guide grooves 54 a to 54 d are formed on the inner peripheral surface of the guide sheath 4, and the guide grooves 54 a to 54 d have a retaining portion 56 at the distal ends thereof. When the cleaning liquid is poured, the cleaning liquid that has passed through the guide grooves 54 a to 54 d can change the direction at the retaining portion 56 to clean the tip of the insertion portion 7.

[Second Embodiment]
In the first embodiment, the pressing protrusion 40 is provided separately from the sliding protrusions 36 a and 36 b, and the pressing protrusion 40 presses the guide sheath 4 to bend the insertion portion 7 together with the guide sheath 4. The present invention is not limited to this, and in the second embodiment described below, when the pressed portion is provided in a part of the cam groove and the pressed portion is pressed from the sliding protrusion, the insertion portion is inserted together with the guide sheath. Is configured to bend.

  As shown in FIG. 16, the insertion portion 80 of the second embodiment includes a distal end rigid portion 81 and a flexible tube 82. In addition, when using the same component as the said 1st Embodiment, the same code | symbol is attached | subjected and description is abbreviate | omitted. In addition, a proximal operation unit 8 is connected to the proximal end of the insertion unit 80 in the same manner as the insertion unit 7 of the first embodiment. The distal end rigid portion 81 has the same shape as the distal end rigid portion 19 of the first embodiment except that the distal end rigid portion 81 does not have the sliding projections 36a and 36b and has the fitting projections 83a and 83b for attaching the flexible tube 82. is there. In FIG. 16, the protection tube 34 and the protection tube 35 are not shown in order to prevent the drawing from being complicated.

  The flexible tube 82 is formed by connecting a distal end side tube 84, a connecting sleeve 85, and a proximal end side tube 39 in order from the distal end. The distal end side tube 84 is made of, for example, an elastomer and has a rubber-like elastic force, like the proximal end side tube 39. Fixing attachment holes 84a and 84b are formed in the distal end portion of the distal tube 84 at positions spaced from the distal end by a predetermined distance.

  The connection sleeve 85 has the same shape as the connection sleeve 38 of the first embodiment except that the connection protrusion 85 does not have the pressing protrusion 40 and has the sliding protrusion 86, and is more rigid than the distal end tube 84 and the proximal end tube 39. Is formed from a material having a high value, for example, ABS resin. The distal end side tube 84 and the proximal end side tube 39 are coupled via the coupling sleeve 85. When the distal tube 84 is covered with the flexible tube mounting step 19f of the distal rigid portion 81, the fitting projections 83a and 83b of the distal rigid portion 81 are fitted into the mounting holes 84a and 84b of the distal tube 84. The flexible tube 82 is fixed to the proximal end side of the distal end rigid portion 81.

  The connecting sleeve 85 has a sliding protrusion 86. The sliding protrusion 86 is integrally formed so as to protrude from the outer peripheral surface of the intermediate portion 38b. The sliding projection 86 slides with a cam groove 91 of a guide sheath 87 described later and is also used as a pressing projection.

  As shown in FIGS. 17 and 18, the guide sheath 87 combined with the insertion portion 80 includes an outer tube 88 formed in a straight tube shape, and an inner tube 89 disposed on the distal end side of the inner peripheral surface of the outer tube 88. An insertion tube 89 is provided. A grip 51 is connected to the proximal end portion of the insertion tube 89 in the same manner as the insertion tube 50 of the first embodiment. The outer tube 88 is made of a material having flexibility, such as polyurethane resin, and higher rigidity than the insertion portion 80.

  The inner tube 89 is formed of a rigid X-ray opaque metal plate and has the same outer diameter as the inner peripheral surface of the outer tube 88 and a slightly larger inner diameter than the outer peripheral surface excluding the sliding projection 86 of the insertion portion 80. Is formed. The inner tube 89 is formed with a pair of cam grooves 91 and a retaining portion 92 located on the distal end side of the cam groove 91, and the distal end surface is arranged at the same position as the distal end surface of the outer tube 88 and is fitted. Has been. The inner tube 89 can be used as a metal marker under fluoroscopy.

  FIG. 19 is a developed view of the inner tube 89, and the cam groove 91 is viewed from the outside of the inner tube 89. The cam groove 91 is an inclined groove formed obliquely with respect to the cylindrical core of the inner tube 89, viewed counterclockwise when the inner tube 89 is viewed from the distal end side, and from the proximal end side to the distal end side of the inner tube 89. It is formed in the extending direction. FIG. 19 illustrates a state in which the inner tube 89 is cut and unfolded at a position indicated by a two-dot chain line A1 and a position indicated by a two-dot chain line A2. Therefore, the cam groove 91 is continuous at the positions indicated by the two-dot chain lines A 1 and A 2, and is formed over one circumference of the inner tube 89 in the circumferential direction of the inner tube 89.

  The inner tube 89 is formed with a plurality of steeply inclined surfaces 93 in which a portion of the cam groove 91 is steeply inclined with respect to the cylindrical core of the inner tube 89 from other portions of the cam groove 91. In the present embodiment, the steeply inclined surfaces 93 are formed at 90 ° pitches in the circumferential direction of the inner tube 89 at every predetermined interval of the cam grooves 91. The cam groove 91 is formed in a Z shape that is bent at the distal end and the proximal end of the steeply inclined surface 93. The steeply inclined surface 93 is used as a pressed portion that is pressed in the cylinder core direction by a frictional force generated between the steeply protruding surface 86. The steeply inclined surface 93 preferably has an inclination angle with respect to the cylindrical core of the inner tube 89 of 5 ° to 30 °.

  Further, the base end of the cam groove 91 is formed with a tapered surface 94 (pressed portion) whose width gradually decreases from the base end portion of the inner tube 89 toward the distal end side. The tapered surface 94 functions as a guide surface that guides the sliding projection 86 that has passed through the inner peripheral surface of the outer tube 88 to the tip side of the cam groove 91.

  The outer tube 88 is formed with a bent portion 95 at a position closer to the proximal end than the inner tube 89. Like the bent portion 58 of the first embodiment, the bent portion 95 is thinner than the other portions of the outer tube 88 and is formed in a bellows shape, bent when receiving external force, Stretches when pulled in the core direction. The bent portion 95 bends and expands when the steeply inclined surface 93 is pressed.

  As shown in FIG. 18, when the sliding protrusion 86 is located on the proximal side of the tapered surface 94 in a state where the insertion portion 80 is inserted into the guide sheath 87, the guide sheath 87 is inserted into the insertion portion 80. Since it has not been pressed from, it has a straight tubular shape together with the insertion portion 80. When the hand operating portion 8 is pressed from the state shown in FIG. 18 and the insertion portion 80 is pushed toward the distal end side of the guide sheath 87, the sliding projection 86 is brought into either one of the cam grooves 91 by the leading of the tapered surface 94. The sliding protrusion 86 comes into contact with the steeply inclined surface 93 and presses the steeply inclined surface 93.

  As shown in FIG. 20, when the sliding protrusion 86 abuts on the steeply inclined surface 93 and presses the steeply inclined surface 93, the pressing force received on the steeply inclined surface 93 is transmitted to the bending portion 95 as an external force and bent. The portion 95 is bent and extended, and the insertion portion 80 housed in the guide sheath 87 is also bent. In this manner, a bent state in which the cylindrical core of the distal end rigid portion 19 is inclined with respect to the cylindrical core of the guide sheath 87 is obtained with a simple configuration. In this bent state, the inclination angle of the cylindrical core of the distal end rigid portion 19 with respect to the cylindrical core of the guide sheath 87 is preferably set to 5 ° to 30 °.

  When the hand operating portion 8 is further pressed from the state shown in FIG. 20 to push the insertion portion 80 toward the distal end side of the guide sheath 87, the sliding projection 86 passes through the steeply inclined surface 93 and slides on the cam groove 91. The insertion portion 80 rotates around the cylindrical core. At this time, the steeply inclined surface 93 is released from the pressure, and the guide sheath 87 returns to the straight tube together with the insertion portion 80. Then, when the sliding projection 86 moves to the tip side of the cam groove 91, it moves to the next steeply inclined surface 93.

  As described above, when the insertion portion 80 is pushed into the distal end side of the guide sheath 87, the sliding projection 86 presses the steeply inclined surface 93 to make the insertion portion 80 bend together with the guide sheath 87, and the insertion portion 80 is guided. If the sliding protrusion 86 is further slid along the cam groove 91 by further pushing into the distal end side of the sheath 87, the insertion portion 80 can be rotated at a 90 ° pitch, so that the direction in which the insertion portion 80 bends changes. . Further, the insertion portion 80 can be pushed four times to the distal end side of the guide sheath 87 and rotated by 90 ° pitch by a total of 360 °. Since the insertion portion 80 can be rotated one or more times with respect to the cylindrical core, the distal end rigid portion 19 can be easily changed to a desired orientation as in the first embodiment.

[Third embodiment]
In the second embodiment, a steeply inclined surface 93 used as a pressed portion is formed in a part of the cam groove 91, and is inserted together with the guide sheath 87 when the steeply inclined surface 93 is pressed from the sliding projection 86. However, the present invention is not limited to this, and in the third embodiment described below, a click groove that engages the sliding protrusion is provided as a pressed portion provided in a part of the cam groove. When the click groove is pressed from the sliding projection, the insertion portion is bent together with the guide sheath.

  As shown in FIG. 21, the insertion portion 100 of the third embodiment includes a distal end rigid portion 81 and a flexible tube 101. In addition, when using the same components as the said 1st and 2nd embodiment, the same code | symbol is attached | subjected and description is abbreviate | omitted. Further, a hand operating portion 8 is connected to the proximal end of the insertion portion 100 in the same manner as the insertion portions 7 and 80 of the first and second embodiments. In FIG. 21, the protection tube 34 and the protection tube 35 are not shown in order to prevent the drawing from being complicated.

  The flexible tube 101 is formed by connecting a distal end side tube 84, a connecting sleeve 102, and a proximal end side tube 39 in order from the distal end. The connecting sleeve 102 has the same shape as the connecting sleeve 85 of the second embodiment except that it does not have the sliding protrusion 86 and has the sliding protrusion 103, and is based on the distal end side tube 84 and the proximal end side tube 39. It is made of a material having high rigidity, such as ABS resin. The distal end side tube 84 and the proximal end side tube 39 are connected via the connecting sleeve 102. The flexible tube 101 is fixed to the proximal end side of the distal end rigid portion 81 in the same manner as the flexible tube 82 of the second embodiment.

  The connecting sleeve 102 has a sliding protrusion 103. The sliding protrusion 103 is integrally formed so as to protrude from the outer peripheral surface of the intermediate portion 38b. The sliding protrusion 103 slides with a cam groove 110 of the guide sheath 107 described later and is also used as a pressing protrusion.

  As shown in FIG. 22, the connecting sleeve 102 has contact portions 104 a and 104 b on both sides of the sliding protrusion 103. The sliding protrusion 103 is formed in a semicircular shape on the tip side, and is located inside a notch portion 105 in which the intermediate portion 38b is cut out along the cylinder core direction, and is a connecting piece 106 disposed on the tip side. It is connected with the connecting sleeve 102 via the. Thereby, the sliding protrusion 103 is provided so as to be movable by a predetermined amount with respect to the cylindrical core direction of the connecting sleeve 102.

  The contact portions 104 a and 104 b are arranged so as to protrude from the outer peripheral surface of the intermediate portion 38 b along the notch portion 105, and the distal end side is an inclined surface that matches the cam groove 110 of the guide sheath 107. The contact portions 104a and 104a are proximal to the sliding projection 103, and when the sliding projection 103 moves to the proximal side, the distal end of the sliding projection 103 is positioned on the extension of the distal end surface. It is arranged to do.

  As shown in FIGS. 23 and 24, the guide sheath 107 combined with the insertion portion 100 includes an insertion tube 109 having an outer tube 88 and an inner tube 108 disposed on the distal end side of the inner peripheral surface of the outer tube 88. The grip 51 is connected to the proximal end portion of the insertion tube 109 in the same manner as the insertion tubes 50 and 89 of the first and second embodiments.

  The inner tube 108 is formed of a rigid X-ray opaque metal plate, has the same outer diameter as the inner peripheral surface of the outer tube 88, and excludes the sliding protrusion 103 and the contact portions 104a and 104b of the insertion portion 100. The inner diameter is slightly larger than the outer peripheral surface. The inner tube 108 is formed with a pair of cam grooves 110 and a retaining portion 111 located on the distal end side of the cam groove 110, and the distal end surface is arranged at the same position as the distal end surface of the outer tube 88 and is fitted. Has been. The inner tube 108 can be used as a metal marker under X-ray fluoroscopy.

  FIG. 25 is a developed view in which the inner tube 108 is developed, and the cam groove 110 is viewed from the outside of the inner tube 108. The cam groove 110 is an inclined groove formed obliquely with respect to the cylindrical core of the inner tube 108, viewed counterclockwise when the inner tube 108 is viewed from the distal end side, and from the proximal end side to the distal end side of the inner tube 108. It is formed in the extending direction. FIG. 25 illustrates a state in which the inner tube 108 is cut and unfolded at a position indicated by a two-dot chain line A1 and a position indicated by a two-dot chain line A2. Therefore, the cam groove 110 is continuous at the positions indicated by two-dot chain lines A1 and A2, and is formed over one circumference of the inner tube 108 in the circumferential direction of the inner tube 108.

  In the inner tube 108, a plurality of click grooves 112 that engage with the sliding protrusion 103 are formed in a part of the cam groove 110. In this embodiment, the click grooves 112 are formed at a 90 ° pitch in the circumferential direction of the inner tube 108 at predetermined intervals of the cam grooves 110. The click groove 112 is used as a pressed part that is pressed in the cylinder core direction by a frictional force generated between the click groove 112.

  Further, the base end of the cam groove 110 is formed with a tapered surface 113 (pressed portion) whose width gradually decreases from the base end portion of the inner tube 108 toward the distal end side. The tapered surface 113 functions as a guide surface that guides the sliding protrusion 103 that has passed through the inner peripheral surface of the outer tube 88 to the distal end side of the cam groove 110. The bent portion 95 of the outer tube 88 is arranged on the proximal end side of the inner tube 108 as in the second embodiment, and bends and expands when the click groove 112 is pressed.

  As shown in FIG. 24, when the sliding protrusion 103 is positioned on the proximal side with respect to the tapered surface 113 in a state where the insertion portion 100 is inserted into the guide sheath 107, the guide sheath 107 is inserted into the insertion portion 100. Since it has not been pressed from, it has a straight tube shape together with the insertion portion 100. When the hand operating portion 8 is pressed from the state shown in FIG. 24 and the insertion portion 100 is pushed toward the distal end side of the guide sheath 107, the sliding projection 103 enters one of the cam grooves 110 due to the leading of the tapered surface 113. The sliding protrusion 103 engages with the click groove 112 and presses the click groove 112.

  As shown in FIG. 26, when the sliding protrusion 103 engages with the click groove 112 and presses the click groove 112, the pressing force received by the click groove 112 is transmitted to the bent portion 95 as an external force and is bent. Is bent and extended, and the insertion portion 100 housed in the guide sheath 107 is also bent. In this way, a bent state in which the cylindrical core of the distal end rigid portion 19 is inclined with respect to the cylindrical core of the guide sheath 107 is obtained. In this bent state, the inclination angle of the cylindrical core of the distal end rigid portion 19 with respect to the cylindrical core of the guide sheath 107 is preferably 5 ° to 30 °.

  26, when the hand operating portion 8 is further pressed to push the insertion portion 100 toward the distal end side of the guide sheath 107, the sliding protrusion 103 is located on the proximal end side in the cylinder core direction with respect to the insertion portion 100. The contact portions 103a and 103b contact the cam groove 110. Thereby, the engagement between the click groove 112 and the sliding protrusion 103 is released, and the pressing force is not transmitted from the sliding protrusion 103 to the click groove 111. The sliding projection 103 released from the engagement with the click groove 112 passes through the click groove 112 and slides with the cam groove 110 together with the contact portions 103a and 103b. When the sliding protrusion 103 slides with the cam groove 110 together with the contact portions 103a and 103b, the insertion portion 100 rotates around the cylindrical core. At this time, the click groove 112 is released from the pressing, and the guide sheath 107 returns to the straight tube together with the insertion portion 100. Then, when the sliding protrusion 103 moves to the tip side of the cam groove 110, it moves to the next click groove 112.

  As described above, the insertion portion 100 is pushed into the distal end side of the guide sheath 107, so that the sliding protrusion 103 presses the click groove 112 and bends the insertion portion 100 together with the guide sheath 107. Can be obtained. Further, when the insertion portion 100 is pushed into the distal end side of the guide sheath 107 and the sliding projection 103 is slid along the cam groove 110, the insertion portion 100 can be rotated at a 90 ° pitch. The direction of bending changes. Further, it is possible to rotate the insertion portion 100 by 90 ° pitch by a total of 360 ° by repeatedly pushing the insertion portion 100 toward the distal end side of the guide sheath 107 four times. Since the insertion portion 100 can be rotated one or more times with respect to the cylindrical core, the distal end rigid portion 19 can be easily changed to a desired direction as in the first and second embodiments.

  In the third embodiment, the sliding protrusion 103 and the connecting sleeve 102 are connected via the connecting piece 106 disposed on the distal end side of the sliding protrusion 103. However, the present invention is not limited to this. An urging member such as a coil spring may be disposed between the moving protrusion 103 and the connecting sleeve 102 so that the sliding protrusion 103 can move by a predetermined amount with respect to the cylindrical core direction of the connecting sleeve 102.

  Further, in each of the above embodiments, the pressed portions are arranged at a 90 ° pitch in the circumferential direction of the guide sheath, and the insertion portion is rotated by 90 ° pitch and bent at the position of each pressed portion. The invention is not limited to this, and a configuration may be adopted in which a pressed portion is arranged at every predetermined rotation angle other than 90 °, rotated at each rotation angle, and bent at the position of each pressed portion.

  In the above embodiment, the endoscope inserted into the trachea has been described as an example. However, for example, various medical endoscopes such as a colonoscope inserted into the large intestine, and other uses such as industrial applications The present invention can also be applied to an endoscope or the like used for the above.

DESCRIPTION OF SYMBOLS 10 Endoscope system 11 Endoscope main body 12 Guide sheath 13 Endoscope apparatus 15 Insertion part 19,81 Hard tip part 20,82,101 Flexible tube 22 Observation optical system 24 Image guide 36a, 36b, 86,103 Sliding Moving projection 40 Pressing projection 53a-53d, 91, 110 Cam groove 55a, 55b Tapered surface 84a, 84b Mounting hole 93 Steeply inclined surface 112 Click groove

Claims (16)

A distal end rigid portion disposed at the distal end, an observation unit attached to the distal end rigid portion, an insertion portion having a flexible tube connected to a proximal end side of the distal end rigid portion, an outer peripheral surface provided integrally with the insertion portion An endoscope provided with a sliding projection protruding from the insertion portion, a pressing projection protruding integrally from the outer peripheral surface, and an operation portion attached to the proximal end of the insertion portion;
A guide sheath in which the insertion portion is housed, and is formed on an inner peripheral surface and receives a pressure from the pressing protrusion, and when the pressed portion receives pressure from the insertion portion, together with the insertion portion An endoscope apparatus comprising a guide sheath having a bent portion that bends.   The endoscope apparatus according to claim 1, wherein the guide sheath further includes a cam groove that is formed obliquely with respect to the cylindrical core and in which the sliding protrusion slides. The pressing protrusions endoscope apparatus 請 Motomeko 2, wherein the disposed proximally of the sliding protrusion.   The guide sheath is arranged in parallel with the cylindrical core, is arranged continuously with the distal end portion of the cam groove, and when the sliding projection portion enters from the proximal end side, the sliding projection portion is inserted into the cam groove. 4. The endoscope apparatus according to claim 2, further comprising a guide groove for guiding. The guide groove is provided on the base end side with respect to the tip end of the cam groove, and includes a stepped portion in which a protruding amount increases from the base end side toward the tip end side,
The step portion allows the sliding projection portion to move to the distal end side when the sliding projection portion enters from the proximal end side of the guide groove, and the sliding projection portion is formed on the guide groove. The endoscope apparatus according to claim 4, wherein the return from the distal end side to the proximal end side is restricted. In the guide sheath, the guide groove and the cam groove are alternately formed at a predetermined interval in the circumferential direction, and the base end portion of the cam groove and the guide groove are continuously arranged. The endoscope apparatus according to claim 4 or 5.   The said pressed part is a taper surface distribute | arranged to the base end part of the said guide groove, and was arrange | positioned according to the width | variety of the said press protrusion part, The one of Claim 4 thru | or 6 characterized by the above-mentioned. The endoscope apparatus described.   The pressing protrusion is the same as the sliding protrusion, and the guide sheath has a plurality of pressed parts pressed by the pressing protrusion in a part of the cam groove. The endoscope apparatus according to claim 2.   9. The endoscope apparatus according to claim 8, wherein the pressed portion is a steeply inclined surface in which an inclination of the guide sheath with respect to the cylindrical core is abruptly formed from other portions of the cam groove.   The endoscope apparatus according to claim 8, wherein the pressed portion is a click groove that engages with the sliding protrusion. The sliding protrusion is provided to be movable by a predetermined amount with respect to the insertion portion,
The endoscope apparatus according to claim 10, wherein the insertion portion has a contact portion that contacts the cam groove when the sliding protrusion moves in contact with the click groove. The guide sheath is formed with a retaining portion for locking the sliding projection on the distal end side of the guide groove, and restricts the insertion portion from being detached to the distal end side of the guide sheath. The endoscope apparatus according to any one of claims 4 to 7 .   The said bending part is distribute | arranged to the base end side of the said to-be-pressed part, and when the said to-be-pressed part receives a press, it bends and expand | extends, The one of Claim 1 thru | or 12 characterized by the above-mentioned. Endoscopic device. The guide sheath includes a straight tubular outer tube, and an inner tube that is disposed on a distal end side of the inner peripheral surface of the outer tube and in which the cam groove is formed,
14. The endoscope according to claim 2 , wherein the inner tube is a metal marker formed of a metal that is opaque to X-rays. 15. Mirror device.   The endoscope apparatus according to any one of claims 1 to 14, further comprising a treatment instrument that is inserted into the guide sheath and is allowed to protrude and retract from a distal end of the guide sheath. The endoscope apparatus according to any one of claims 1 to 15,
Virtual image generating means for generating a virtual endoscopic image of the observation target lumen based on the three-dimensional image data of the observation target, and a plurality of virtual endoscopic images at a branching portion where the observation target lumen branches An endoscope system, comprising: an insertion support apparatus having an image display means for displaying the image.

Images