JP5932407B2 - Endoscope equipped with a treatment tool elevator - Google Patents

Description

  The present invention relates to an endoscope including a treatment instrument elevator.

2. Description of the Related Art Conventionally, ultrasonic endoscopes and side-view endoscopes are known that include a rotatable treatment tool elevator in the vicinity of the distal end of an insertion portion.
The endoscope of Patent Document 1 is an example of this, and a treatment tool insertion formed in the insertion portion so that the concave portion formed in the surface near the distal end of the insertion portion extending from the operation portion and the distal end opening communicates with the concave portion. A common conduit and an elevator that is housed in the recess and is rotatable about a rotation axis extending in the width direction of the insertion portion. The raising base rotates according to the operation of the operation means provided in the operation unit. Further, the raising base is formed with an insertion hole having a circular cross section (or C-shape) that is substantially coaxial with the distal end opening of the treatment instrument insertion conduit and passes through the raising base.
If a treatment instrument having flexibility is inserted into the treatment instrument insertion conduit of the endoscope, and the distal end portion of the treatment instrument is further inserted into the insertion hole of the elevator base, the distal end portion of the treatment instrument is connected to the elevator base. It can be projected forward. If the operating means is operated in this protruding state, the direction of the distal end of the treatment instrument can be adjusted by curving the vicinity of the distal end of the treatment instrument.
However, in the raising base of the endoscope of Patent Document 1, the upper portion of the insertion hole (the end portion on the side opposite to the bottom surface of the concave portion) is closed. Therefore, when the treatment instrument is to be inserted into the insertion hole of the elevator from the distal end opening of the treatment instrument insertion conduit, the distal end portion of the treatment instrument may come into contact with the upper portion of the inlet end portion of the insertion hole. Therefore, there is a possibility that the treatment tool cannot be smoothly inserted into the insertion hole, or the upper part of the entrance end of the raising base (the insertion hole) may be damaged.

On the other hand, the endoscope described in FIGS. 12 to 14 (the endoscope of Patent Document 2 has a similar structure) does not have such a defect.
On the upper surface (the side surface opposite to the bottom surface of the recess) of the raising base of the endoscope, a treatment instrument support groove having a V-shaped cross section perpendicular to the axis of the insertion portion and an open upper surface is formed. As shown in the drawing, the treatment instrument insertion conduit and the treatment instrument support groove are located on the same straight line in plan view. A side gap is formed between one side surface of the concave portion of the endoscope and one side surface of the raising base. Further, an operation wire whose rear end portion is linked to the operation means provided in the operation portion is disposed inside the insertion portion so as to be able to advance and retreat, and the front end portion of the operation wire passes through the side gap and serves as an elevator. Connected.
Therefore, when the treatment instrument is moved from the distal end opening of the treatment instrument insertion conduit to the treatment instrument support groove on the raising base, the distal end portion of the treatment instrument can be smoothly moved to the treatment instrument support groove side. Then, the orientation of the treatment instrument can be adjusted by operating the operating means with the vicinity of the distal end of the treatment instrument placed in the treatment instrument support groove to rotate the elevator.

Japanese Patent Application Laid-Open No. 9-122067 JP-A-8-191793

When the cross-sectional diameter of the treatment instrument is significantly smaller than the inner diameter of the treatment instrument insertion conduit, the axis of the treatment instrument inserted into the treatment instrument insertion conduit is inclined with respect to the axis of the treatment instrument insertion conduit Easy to do.
And in the endoscope of FIGS. 12-14, since the upper surface of the treatment tool support groove | channel formed in the raising base is open | released, when the axis line of a treatment tool inclines with respect to the axis line of a treatment tool penetration conduit There is a possibility that the treatment tool placed on the treatment tool support groove falls off to the side gap side (see FIG. 14).

  In the present invention, the axis of the treatment instrument is inclined with respect to the axis of the treatment instrument insertion conduit, while the structure includes the raising base having the treatment instrument support groove whose surface opposite to the bottom surface of the recess is open. Even in such a case, an object is to provide an endoscope including a treatment tool elevator that can suppress the treatment tool placed in the treatment tool support groove from dropping off to the side.

An endoscope including the treatment instrument elevator according to the present invention is formed in the insertion portion so that a concave portion provided on the surface of the vicinity of the distal end of the insertion portion extending from the operation portion and a distal end opening communicate with the concave portion. A treatment instrument insertion conduit through which a treatment instrument having flexibility can be inserted, an elevator housed in the recess and rotatable about a rotation axis extending in the width direction of the insertion section, and the recess of the elevator A treatment tool support groove formed on the side surface opposite to the bottom surface of the insertion portion and orthogonal to the axis of the insertion portion is V-shaped and the opposite side surface is open; A side gap formed between the side surface and the side surface facing the elevator, which is laterally offset with respect to the treatment instrument insertion conduit, and a tip connected to the elevator and a portion near the tip are For operating the operating means provided in the operating section, located in the side gap Flip provided with an operation wire for rotating the elevator by forward and backward on one side of the elevator, located on the opposite side of the bottom surface of the recess across the operating wire, and the recess The side support part in which the side part of the said treatment tool support groove | channel was formed in the surface located on the opposite side to the bottom face of this is provided.

  The said side support part may be located in the opposite side to the bottom face of the said recessed part compared with the other side part of the said raising stand.

  The treatment instrument support groove may be located in the recess when the raising base is located at any position.

  The gap dimension between the side surface of the other side portion of the raising base and the other side surface of the recess may be shorter than the width dimension of the treatment instrument.

In the endoscope of the present invention, a lateral gap that is offset laterally with respect to the treatment instrument insertion conduit is formed between one side surface of the recess that houses the elevator base and the side surface that faces the elevator base. The treatment instrument support groove formed on the raising base is open on the side opposite to the bottom surface of the recess.
However, a side support portion that is located on the opposite side of the bottom surface of the recess with the operation wire disposed in the side gap interposed between one side portion of the raising base and the side portion of the treatment instrument support groove is formed. Provided. Therefore, when the treatment instrument is placed in the treatment instrument support groove while being inclined with respect to the axis of the treatment instrument insertion conduit, the side support portion (treatment instrument support) The groove) effectively suppresses the treatment instrument from dropping out to the side gap side, and the side support part (treatment tool support groove) returns the treatment tool to the central part of the treatment tool support groove.

1 is an external view showing an embodiment of an ultrasonic endoscope to which the present invention is applied. It is an enlarged plan view of the tip (near) part of an insertion part when a raising stand is located in a non-standing position. It is the perspective view seen from the back of the raising stand. It is a figure showing the raising stand seen in the IV arrow line direction of FIG. It is a figure showing the raising stand seen in the arrow V direction of FIG. It is a figure showing the raising stand seen in the VI arrow line direction of FIG. It is a figure showing the raising stand seen in the VII arrow line direction of FIG. It is sectional drawing which follows the VIII-VIII arrow line of FIG. It is sectional drawing similar to FIG. 8 when a raising stand is located in the maximum standing position. FIG. 3 is an enlarged plan view similar to FIG. 2 when a treatment tool is supported by a raising table. It is an enlarged plan view similar to FIG. 2 of a modification. It is an enlarged plan view similar to FIG. 2 of a conventional example. It is a rear view of the raising stand of a prior art example. It is an enlarged top view similar to FIG. 2 when the treatment tool of a prior art example is supported by the raising stand.

Hereinafter, an embodiment of the present invention will be described with reference to FIGS. In the following description, the front-rear direction (the distal end side of the insertion portion 12 of the ultrasonic endoscope 10 is defined as “front” and the distal end side of the universal tube 13 is defined as “rearward”), the up-down direction, and the left-right direction Is based on the arrow direction in the figure.
An ultrasonic endoscope 10 shown in FIG. 1 includes an operation unit 11, an insertion unit 12 extending forward from the operation unit 11, a universal tube 13 extending from the operation unit 11 to the opposite side of the insertion unit 12, and ultrasonic image transmission. Tube 14. The ultrasonic image transmission tube 14 is connected to an ultrasonic diagnostic apparatus (not shown), and the universal tube 13 is connected to a processor (image processing apparatus / light source apparatus, not shown). The processor and the processor are both connected to a CRT monitor (not shown).
The insertion portion 12 is formed with a bending portion 17 that bends in the vertical and horizontal directions according to the rotation operation of the bending operation lever 15 provided in the operation portion 11. The flexible tube portion 18 is curved by a direct operation of the surgeon.
As shown in FIGS. 1 and 8, the distal end portion of the insertion portion 12 with respect to the bending portion 17 is a hard end portion 19 made of hard resin. An inclined surface 20 is formed in the rear half of the distal end hard portion 19, and an objective lens 21, an illumination lens 22, and the like are provided on the inclined surface 20. An ultrasonic probe 23 located immediately before the inclined surface 20 is formed in the front half of the distal end hard portion 19. Further, an annular groove 24 is formed over the entire circumference in a portion located between the inclined surface 20 of the distal end hard portion 19 and the ultrasonic probe 23.
The ultrasonic endoscope 10 is used by placing a balloon (not shown) made of an elastic material (for example, silicon rubber) on the front half of the hard tip portion 19 (the portion where the ultrasonic probe 23 is formed). Specifically, the mouth-wound part formed on the peripheral part of the balloon opening (the annular part thicker than the other part formed by rolling up the peripheral part) is elastically fitted into the annular groove 24 (adherence). And a space formed between the front half of the distal end hard portion 19 and the balloon is filled with water.

As shown in FIG. 1, a treatment instrument insertion port projection 11 a for inserting a flexible puncture needle A (treatment instrument) protrudes from the front end of the operation section 11. Is provided with a treatment instrument insertion tube 26 (treatment instrument insertion conduit) extending from the treatment instrument insertion port protrusion 11a toward the distal end rigid portion 19 side. The distal end of the treatment instrument insertion tube 26 is connected to a recess 28 that is recessed (downward) on the upper surface of the distal end hard portion 19, and the puncture needle A inserted from the treatment instrument insertion port projection 11a is inserted into the treatment instrument insertion tube. It is possible to project into the recess 28 from the opening of the tip 26.
The planar shape of the recess 28 is a rectangle that is long in the front-rear direction (see FIGS. 2 and 10), and the front portion of the recess 28 is formed on the inclined surface 20.

A metal elevator 30 is accommodated in the recess 28.
The rear end portion of the raising base 30 is a supported portion 31 that is narrower in the left-right width than the other portions, and a shaft support hole 32 is formed in the supported portion 31 as a through hole extending in the left-right direction. . A rotation shaft 25 extending in the left-right direction is inserted into the shaft support hole 32 so as to be relatively rotatable, and left and right end portions of the rotation shaft 25 are fixed to left and right inner surfaces of the recess 28, respectively. Therefore, the raising base 30 can rotate between the non-standing position shown in FIG. 8 and the maximum standing position shown in FIG. 9 with respect to the distal end hard portion 19 (concave portion 28).
The upper surface (the surface positioned on the opposite side of the bottom surface (lower surface) of the recess 28 when positioned in the non-standing position) constitutes the mounting surface 33 in a portion positioned in front of the supported portion 31 of the elevator 30. The mounting surface 33 is provided with a treatment instrument support groove 34 having a substantially V-shaped cross section perpendicular to the axis of the insertion portion 12 (hard tip 19). As shown in the drawing, the upper surface of the treatment instrument support groove 34 is open. Further, the bottom portion 34a of the treatment instrument support groove 34 has a linear shape extending in the front-rear direction, and the central axis of the bottom portion 34a and the front end portion of the treatment instrument insertion tube 26 are located on substantially the same straight line in plan view. .
As shown in the figure, the elevator base 30 has a left-right asymmetric shape. In other words, the front portion of the raising base 30 located in front of the supported portion 31 is a right side plane 35 whose right side is entirely perpendicular to the left-right direction. On the other hand, the lower half portion of the left side surface of the front portion is a left side plane 36 orthogonal to the left-right direction, and the left side upper half portion of the front portion is a side support portion that protrudes to the left side from the left side plane 36. 37. As shown in the figure, the side support portion 37 of the elevator base 30 protrudes upward from the right side portion of the elevator base 30 (see FIGS. 5 and 7), and the treatment instrument support groove 34 is formed on the upper surface of the side support portion 37. (The left part of) is formed.
Further, a wire fixing hole 38 penetrating the lower half portion in the left-right direction is formed in the lower half portion of the front portion of the elevator 30 as a through hole.

As shown in FIGS. 2 and 10, the gap dimension between the right side surface of the recess 28 and the right side plane 35 of the raising base 30 is very small, and the dimension is compared with the lateral width dimension (cross-sectional diameter) of the puncture needle A. Pretty small. On the other hand, the space between the left side surface of the recess 28 and the left side plane 36 of the raising base 30 is offset to the left side with respect to the front end portion of the treatment instrument insertion tube 26 and is larger than the left and right width of the puncture needle A. Side gaps 29 are formed.
Inside the operation unit 11 and the insertion unit 12, a metal operation wire 40 extending in the front-rear direction is disposed so as to be able to advance and retreat in the front-rear direction. The rear end portion of the operation wire 40 is connected to an elevator operation lever (operation means, not shown) provided in the operation unit 11. On the other hand, the vicinity of the front end of the operation wire 40 is located in the side gap 29 of the recess 28, and the front end of the operation wire 40 is fitted to the wire fixing hole 38 of the elevator 30 in a state of being bent toward the right side. It is fixed. 2, 8, 10, etc., the side support portion 37 of the raising base 30 is located immediately above the operation wire 40 (on the opposite side of the bottom surface of the recess 28 across the operation wire 40). To position).
When the elevator base operating lever is positioned at the non-operating position, the elevator base 30 is positioned at the non-standing position. When the operating wire 40 is pulled backward by rotating the elevator base operating lever to the operating position side, the elevator base 30 is Gradually rotates toward the maximum standing position, and when the raising base operation lever is rotated to the operating position, the raising base 30 moves to the maximum standing position. Further, when the elevator base operating lever is returned to the non-operation position side after the elevator base 30 has moved to the maximum standing position side, the operation wire 40 slides forward, whereby the elevator base 30 moves to the non-standup position side.
As shown in FIGS. 8 and 9, the treatment instrument support groove 34 (and the entire raising base 30) is located in the recess 28 when the raising base 30 is located at any position between the non-standing position and the standing position. .

Then, the usage point of the puncture needle A using the ultrasonic endoscope 10 is demonstrated.
After removing the cap 11b from the treatment instrument insertion port projection 11a of the ultrasonic endoscope 10 where the elevator base operation lever is located at the non-operation position (the elevation base 30 is located at the non-standup position), the treatment instrument insertion port projection 11a. The distal end portion of the puncture needle A is inserted into the treatment instrument insertion tube 26 from the opening portion, and the distal end portion of the puncture needle A is projected forward from the distal end opening of the treatment instrument insertion tube 26. Then, as shown in FIGS. 8 to 10, the vicinity of the distal end of the puncture needle A is supported by the treatment instrument support groove 34 of the elevator 30, and the distal end of the puncture needle A protrudes forward of the elevator 30. When an ultrasonic wave is transmitted from the ultrasonic probe 23 in this state, the ultrasonic wave reflected by the puncture needle A is received by the ultrasonic probe 23 and the tip of the puncture needle A is displayed as an ultrasonic image on the CRT monitor. .
When the surgeon rotates the raising base operation lever from the non-operating position to the operating position while looking at the CRT monitor, the raising base 30 located at the non-standing position rotates to the maximum standing position side. Then, as shown in FIG. 9, the vicinity of the distal end of the puncture needle A is bent by the treatment instrument support groove 34 (raising base 30), and the orientation of the distal end portion of the puncture needle A changes.

As shown in the figure, since the cross-sectional diameter of the puncture needle A is considerably smaller than the inner diameter of the treatment instrument insertion tube 26, the axis of the puncture needle A is inserted into the treatment instrument insertion tube 26 when the puncture needle A is inserted into the treatment instrument insertion tube 26. It may be inclined with respect to the axis of the common tube 26. When the puncture needle A is projected forward from the distal end opening of the treatment instrument insertion tube 26 in this state, the vicinity of the distal end of the puncture needle A is inclined with respect to the elevator 30 as shown in FIG. 10 reference A1).
However, as shown in FIG. 10, at this time, the vicinity of the front end of the puncture needle A is supported by the side support portion 37 (the left side portion of the treatment instrument support groove 34) located immediately above the side gap 29 (operation wire 40). Therefore, there is little possibility that the puncture needle A will drop off from the raising base 30 (the treatment instrument support groove 34) to the left side (side gap 29). In particular, in this embodiment, since the side support portion 37 of the raising base 30 protrudes upward from the right side portion of the raising base 30 (see FIGS. 5 and 7), the raising base 30 of the puncture needle A (treatment tool support) The dropout from the groove 34) to the left side (side gap 29) can be effectively suppressed. Furthermore, since the treatment instrument support groove 34 is located in the recess 28 as described above, the puncture needle A temporarily moves from the left side (side support part 37) of the raising base 30 (treatment instrument support groove 34) to the left side. Also, since the puncture needle A collides with the left side surface of the recess 28, it is pushed back again toward the treatment instrument support groove 34 (side support portion 37). Further, the puncture needle A that is in contact with the side support portion 37 (the treatment instrument support groove 34) is pushed back toward the bottom 34a along the inclined surface of the treatment instrument support groove 34 (see reference numeral A2 in FIG. 10). Therefore, even if the puncture needle A is inclined with respect to the raising base 30, it is possible to support the puncture needle A in a stable state by the raising base 30 and to point the tip of the puncture needle A in an arbitrary direction. .

  On the other hand, when the vicinity of the distal end of the puncture needle A is inclined to the opposite side (right side) of A1 in FIG. 10, the vicinity of the distal end of the puncture needle A gets over the right side of the treatment instrument support groove 34 and moves to the right. There are things to do. However, in this case, the puncture needle A collides with the right side surface of the recess 28 and is pushed back to the treatment instrument support groove 34 side, and is moved to the bottom 34 a side along the inclined surface on the right side portion of the treatment instrument support groove 34.

As mentioned above, although this invention was demonstrated using the said embodiment, this invention can be implemented, giving various deformation | transformation.
For example, like the ultrasonic endoscope 45 shown in FIG. 11, the left and right dimensions of the recess 46 are made larger than those of the recess 28, and the left and right symmetrical elevators 50 having the side support portions 37 on the left and right sides are provided. You may attach to (recess 46). In this case, as shown in FIG. 11, there are side gaps 29 between the right side surface of the recess 46 and the right side plane 35 of the elevator base 50 and between the left side surface of the recess 46 and the left side plane 36 of the elevator base 50. It is formed. However, since the side support portions 37 are formed on both the left and right sides of the raising base 50, the puncture is performed even when the axis of the puncture needle A is inclined to the left or right with respect to the axis of the treatment instrument insertion tube 26. It is possible to effectively suppress the needle A from dropping from the treatment instrument support groove 34 of the elevator 50.

Moreover, although the said embodiment and modification are what applied this invention to the ultrasonic endoscopes 10 and 45, you may apply this invention to a side-view type endoscope.
Further, as a treatment instrument that is inserted into the treatment instrument insertion tube 26 and supported by the raising bases 30 and 50 (has flexibility), a treatment instrument other than the puncture needle A (for example, a contrast tube or a baby scope) can be used. It is.

10 Ultrasound endoscope (endoscope)
DESCRIPTION OF SYMBOLS 11 Operation part 11a Treatment tool insertion port protrusion 11b Cap 12 Insertion part 13 Universal tube 14 Ultrasound image transmission tube 15 Bending operation lever 17 Bending part 18 Flexible tube part 19 Hard tip part 20 Inclined surface 21 Objective lens 22 Illumination lens 23 Ultrasonic probe 24 Annular groove 25 Rotating shaft 26 Treatment instrument insertion tube (treatment instrument insertion conduit)
28 Recess 29 Side gap 30 Raised base 31 Supported portion 32 Shaft support hole 33 Placement surface 34 Treatment instrument support groove 34a Bottom 35 Right side plane 36 Left side plane 37 Side support portion 38 Wire fixing hole 40 Operation wire 45 In ultrasonic wave Endoscope (endoscope)
46 Recess 50 Raising stand A Puncture needle (treatment instrument)

Claims (4)

A recess recessed in the surface of the vicinity of the distal end of the insertion portion extending from the operation portion;
A treatment instrument insertion conduit that is formed in the insertion portion so that the distal end opening communicates with the recess, and is capable of inserting a flexible treatment instrument;
An elevator that is housed in the recess and is rotatable about a rotation axis extending in the width direction of the insertion portion;
A treatment instrument support groove formed on a side surface opposite to the bottom surface of the recess of the raising base and having a V-shaped cross section perpendicular to the axis of the insertion portion and open on the opposite side surface; ,
A side gap formed between one side surface of the recess and the side surface facing the raising base, which is laterally offset with respect to the treatment instrument insertion conduit,
An operation wire that rotates the elevator by moving forward and backward according to the operation of the operating means provided in the operation unit, the tip of which is connected to the elevator and the vicinity of the tip is located in the lateral gap,
With
A side portion of the treatment instrument support groove is located on one side of the raising base on the side opposite to the bottom surface of the recess with the operation wire interposed therebetween. An endoscope provided with a raising stand for a treatment instrument, characterized in that a formed side support portion is provided. In an endoscope provided with the raising base for treatment tools of Claim 1,
An endoscope provided with a treatment instrument raising base in which the side support portion is located on the opposite side of the bottom surface of the recess compared to the other side of the raising base. In an endoscope provided with the raising stand for treatment tools of Claim 1 or 2,
An endoscope including a treatment instrument raising base in which the treatment tool support groove is located in the concave portion when the raising stand is located at any position. In an endoscope provided with the raising base for treatment tools of Claim 2 ,
An endoscope comprising a treatment instrument raising base in which a gap between the side surface of the other side of the raising base and the other side surface of the recess is shorter than a width dimension of the treatment tool.

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