JP6023636B2 - Biliary endoscope system - Google Patents

Description

  The present invention relates to a biliary endoscopic system for inserting a second insertion portion of a second endoscope inserted into a channel of a first insertion portion in the first endoscope into a papilla of a duodenum. .

  An optical system for observing a diseased site in the pancreaticobiliary system on the side surface of the distal end portion having the first insertion portion and positioned on the distal end side in the insertion direction of the first insertion portion (hereinafter simply referred to as the distal end side). And a second endoscope having a side endoscope that is a first endoscope provided with a channel opening, and a second insertion part that can be inserted into and removed from the channel of the side endoscope. Observation and treatment are performed using a biliary endoscope system including a biliary endoscope.

  In the observation and treatment of the pancreatic duct and bile duct, a second insertion portion having a small diameter of the cholangioscope, for example, 3 mm to 4 mm, is inserted into the pancreatic duct and bile duct. This is because the pancreatic duct and bile duct are very thin tubes of 5 mm to 10 mm. Therefore, it is difficult to directly insert the first insertion portion of the side-view type endoscope having an outer diameter of, for example, 15 mm into these tubes. This is because of this.

  In this way, the configuration of the biliary endoscope system that performs observation and treatment in the pancreaticobiliary duct using the side-viewing endoscope and the biliary mirror that can be inserted into and removed from the channel of the side-viewing endoscope, For example, it is disclosed in Patent Document 1.

  Here, for example, when observing the bile duct using the biliary endoscope system disclosed in Patent Document 1, first, the operator places the first insertion portion on the subject with the first insertion portion. Orally inserted until the distal end of the insertion part is located near the duodenal papilla, and the nipple is captured by the observation optical system of the side-view endoscope, and then provided in the operation section of the side-view endoscope The second insertion portion is inserted into the channel from the channel opening on the operation portion side.

  Next, the operator sets the distal end side in the insertion direction of the second insertion portion (hereinafter simply referred to as the distal end side) from the channel opening of the distal end portion of the first insertion portion to the channel provided in the distal end portion. Protruding into the duodenum using a tool stand.

  Thereafter, the operator curves the second bending portion provided on the distal end side of the second insertion portion, changes the rising angle of the treatment instrument raising base, or moves the second insertion portion toward the distal end side of the first insertion portion. Insert the distal end of the second insertion section into the bile duct via the nipple by bending the provided first bending section or increasing the amount of protrusion from the channel opening of the second insertion section. To do.

  Finally, the operator performs observation in the bile duct using an observation optical system provided at the distal end portion located on the distal end side of the second insertion portion inserted into the bile duct. The above insertion operation is the same even when the second insertion portion is inserted into the pancreatic duct via the nipple.

JP 2012-95719 A

  Here, the second bending portion can be freely bent in a plurality of directions in accordance with the bending operation of the bending operation member provided in the operation portion of the biliary scope, and only an external force is applied. There may be a configuration that can bend passively just by contacting the wall surface of the duodenum.

  In this case, when inserting the distal end side of the second insertion portion from the channel opening at the distal end portion of the first insertion portion into the duodenum until the second curved portion is exposed, and inserting it into the nipple. Since the diameter of the duodenum is as small as about 30 mm on average, the second curved portion tends to come into contact with the wall surface of the duodenum after protruding, and thus is easily passively curved.

  Therefore, when the maximum bending angle at which the second bending portion is passively bent is small, the distal end of the second insertion portion and the distal end of the first insertion portion press against the duodenal wall, and the side-view type endoscope In order to avoid such a current situation when the distal end side of the second insertion portion is inserted into the nipple using the first bending portion and the treatment instrument raising base of the first bending portion, Therefore, it is necessary to perform the bending operation with high accuracy or to accurately perform the operation of raising the treatment instrument raising base, and these operations require a skill and are complicated.

  In addition, if the maximum bending angle at which the second bending portion is actively bent is too large, the second bending portion is greatly bent even if the bending operation member that performs the bending operation on the second bending portion is slightly operated. Resulting in.

  Therefore, for example, when the second bending portion is bent in order to change the observation direction in the bile duct after the distal end side of the second insertion portion is inserted into the bile duct, the second bending portion is set in the bile duct having a small diameter. If the curve is greatly curved, there is a problem that the viewing direction changes greatly and it is difficult to find a diseased part.

  The present invention has been made in view of the above problems, and is configured to facilitate the insertion of the second insertion portion of the biliaryscope into the nipple and facilitate observation of the pancreaticobiliary duct by the second insertion portion after the insertion. An object of the present invention is to provide a biliary endoscope system having

  To achieve the above object, a biliary endoscope system according to an aspect of the present invention includes a first insertion portion that is orally inserted to the duodenum, and a channel provided in the first insertion portion. The endoscope can be freely inserted into and removed from the outside of the subject, and after insertion into the channel, the first insertion portion protrudes from the opening of the channel formed in the insertion direction and is inserted into the channel. A second endoscope having a second insertion portion to be inserted into the nipple, and a plurality of bending pieces extend along the insertion direction on the distal end side in the insertion direction of the second insertion portion. A bending portion configured to be bent in a plurality of directions by being connected to each other, and an active bending angle associated with a bending operation in the bending portion is set to 0 ° to 90 °, Along with the application of external force at the curved part The maximum bending angle for passive bending is set to 180 ° to 210 °.

  ADVANTAGE OF THE INVENTION According to this invention, the biliary endoscope system which has the structure which is easy to insert the 2nd insertion part of a bile duct into a teat, and can easily observe in a pancreaticobiliary duct by the 2nd insertion part after insertion is provided. can do.

The figure which shows the structure of the biliary tract endoscope system of this Embodiment. The perspective view which expands and shows the bile duct mirror of FIG. The figure which shows the fragmentary sectional view of the biliary endoscope system which follows the III-III line in FIG. 1 in the state inserted in the duodenum. The figure which extracts and shows the bending piece which comprises the 2nd bending part of FIG. The figure which shows the state which bent the 2nd bending part of FIG. 3 actively in a bile duct Partial sectional view of a biliary endoscope system including a side-viewing endoscope having a treatment instrument raising base having a conventional groove shape in a first insertion portion and a second insertion portion of a biliary scope Partial sectional view of a biliary endoscope system including a side-view type endoscope having a treatment instrument raising base having a groove shape in the first configuration in a first insertion portion and a second insertion portion of the biliary scope The figure which shows schematically the structure which provided the balloon in the outer periphery of the front end side of the 2nd insertion part of a bile duct in a bile duct The figure which shows schematically the structure which provided the roller in the front end surface of the 2nd insertion part of a bile duct in a bile duct

  Embodiments of the present invention will be described below with reference to the drawings.

  1 is a diagram showing the configuration of the biliary endoscope system of the present embodiment, FIG. 2 is an enlarged perspective view showing the biliary scope of FIG. 1, and FIG. 3 is taken along the line III-III in FIG. It is a figure which shows the fragmentary sectional view of the along biliary tract endoscope system inserted in the duodenum. In FIG. 3, the second bending portion of the second insertion portion of the biliary scope is shown to be exposed so that a plurality of bending pieces are exposed to the outside, and the distal end portion is also omitted. . Also, built-in items such as channel tubes and angle wires are omitted.

  As shown in FIG. 1, a biliary endoscope system 100 includes a main part of a side-view type endoscope 101 that is a first endoscope and a biliary endoscope 1 that is a second endoscope. ing.

  The side-view type endoscope 101 is inserted orally up to the duodenum 50 (see FIG. 3) having a diameter t1 of about 30 mm on average, and is elongated along the insertion direction S in which the outer diameter M is formed to be 15 mm, for example. A first insertion portion 102; an operation portion 103 connected to a proximal end in the insertion direction S of the first insertion portion 102 (hereinafter simply referred to as a proximal end); and a universal extending from the operation portion 103 A cord 105 and a connector (not shown) provided at the extending end of the universal cord 105 are provided. Further, the side-view type endoscope 101 can be connected to an external device of the side-view type endoscope 101 because the connector can be connected to an image processing device, a light source device, and the like (not shown).

  The first insertion portion 102 includes, in order from the distal end side, a hard distal end portion 111, a first bending portion 112 that is connected to the proximal end of the distal end portion 111, and a proximal end of the first bending portion 112. The main part is comprised including the flexible tube part 113 provided continuously.

  A notch 111c is formed in a part of the outer peripheral side surface 111g of the distal end portion 111, and an observation optical system (not shown) for observing the inside of the subject is provided in the notch 111c. Further, an imaging unit (not shown) including the above-described observation optical system is provided in the distal end portion 111. As a result, the side-view type endoscope 101 can be observed laterally with respect to the insertion direction S.

  In addition, the notch 111c is formed with an opening 110k at the distal end (hereinafter simply referred to as the distal end) of the channel 110 having an inner diameter H provided in the first insertion portion 102 in the insertion direction S. The base end of the channel 110 is opened at a treatment instrument insertion port 118 provided in the operation unit 103.

  Further, as shown in FIG. 3, in the channel 110 located in the distal end portion 111, the second insertion portion 2, which will be described later, advances in the channel 110 toward the front in the insertion direction S at a position facing the opening 110 k. A known treatment instrument elevator 120 that changes the traveling direction to the opening 110k side is provided.

  The treatment instrument elevator 120 is supported by a distal end rigid member that constitutes the distal end 111 so that the end 120i can be raised and lowered at a predetermined rotation angle. Specifically, the distal end of a wire 121 inserted into the first insertion portion 102 is fixed to the treatment instrument raising base 120, and the treatment instrument raising base operation in which the wire 121 is provided in the operation section 103 is fixed. By being pulled and relaxed by the lever 108, the end portion 120i can be moved up and down about the rotation axis.

  As shown in FIG. 3, the first bending portion 112 is provided in the operation portion 103 in a plurality of directions, for example, four directions, up, down, left, and right, by connecting a plurality of bending pieces 131 along the insertion direction S. The bending operation knobs 106 and 107 can be freely bent.

  Specifically, among the plurality of bending pieces 131, the bending piece 131 located on the most distal side in the insertion direction S is displaced by approximately 90 ° in the circumferential direction of the insertion portion 102 in the first insertion portion 102. The tip ends of four wires 132 (only two wires are shown in FIG. 3) inserted are connected to each other.

  Of the four wires 132, two opposing wires 132 for bending left and right are pulled and relaxed by the bending operation knob 106, whereby the first bending portion 112 is bent in either the left or right direction, The first bending portion 112 is configured to bend in either of the up and down directions when the two opposing wires 132 for up and down bending are pulled and relaxed by the bending operation knob 107.

  The first bending portion 112 improves the insertability into the distal end portion 111 into the duodenum 50 along with the bending, and is further described below of the biliary scope 1 protruding from the opening 110k by being bent in the duodenum 50. This is used when the distal end portion 11 and the second bending portion 12 of the second insertion portion 2 to be inserted are inserted into the nipple 51 (see FIG. 3).

  In addition, as shown in FIG. 1, the second insertion portion 2 of the biliary endoscope 1 can be inserted into and removed from the channel via a treatment instrument insertion port 118.

  As shown in FIG. 2, the biliary scope 1 includes, for example, a second insertion portion 2 that is elongated along the insertion direction S formed with an outer diameter 2 r of 3 mm to 4 mm as shown in FIG. An operation portion 3 connected to a base end (hereinafter simply referred to as a base end) of the insertion portion 2 in the insertion direction, a universal cord 5 extending from the operation portion 3, and an extension end of the universal cord And a connector (not shown). Further, the biliary mirror 1 is connectable to an external device of the biliary mirror 1 because the connector can be connected to an image processing device, a light source device, etc. (not shown).

  The second insertion portion 2 includes, in order from the distal end side, a hard distal end portion 11, a second bending portion 12 provided continuously with the proximal end of the distal end portion 11, and a proximal end of the second bending portion 12. The main part is comprised including the flexible tube part 13 provided continuously.

  As described above, the second insertion portion 2 can be inserted into the channel 110 via the treatment instrument insertion port 118. After the insertion, the second insertion portion 2 is inserted into the duodenum 50 as shown in FIG. The two distal end portions 11 (not shown in FIG. 3) and the second curved portion 12 are protruded laterally in the insertion direction S from the opening 110k of the notch 111c on the outer peripheral side surface 111g of the distal end portion 111, and the duodenum 50 It is inserted into the nipple 51.

  An imaging unit (not shown) or the like for observing the inside of the subject, specifically, the bile duct 55 (see FIG. 5) having a diameter t2 of 5 mm to 10 mm is provided in the distal end portion 11. Note that the observation optical system constituting the imaging unit is provided on the distal end surface of the distal end portion 11.

  As shown in FIG. 2, the second bending portion 12 is provided in the operation portion 3 with a bending operation lever 6 that is a bending operation member, in a plurality of directions, for example, an upper and lower two directions in an observation image obtained by a biliary scope. It can be bent freely.

  Note that the second bending portion 12 may be freely bent in two directions on the left and right in an observation image obtained by a biliary mirror. Further, the second bending portion 12 may be freely bendable in one upward direction in an observation image obtained by a biliary mirror.

  Further, the operation unit 3 is provided with stoppers 8d and 8u, which will be described later, for defining the operation amount of the bending operation lever 6.

  Next, the structure of the 2nd bending part 12 is demonstrated using FIGS. 4 is a diagram showing the bending pieces constituting the second bending portion of FIG. 3, and FIG. 5 is a diagram showing a state in which the second bending portion of FIG. 3 is actively bent in the bile duct. . In FIGS. 3 and 5, the tip is not shown.

  As shown in FIG. 3, the second bending portion 12 can be bent in, for example, two upper and lower directions by connecting a plurality of bending pieces 31 along the insertion direction S.

  Specifically, the bending pieces 31 adjacent in the insertion direction S are connected to the most distal side in the insertion direction S by connecting the end faces in the insertion direction S by two opposing pins 35. The proximal end surface of the first bending piece 31 positioned and the distal end surface of the second bending piece 31 positioned behind the insertion direction S of the first bending piece 31 (hereinafter simply referred to as the rear) are coupled, The base end surface of the second bending piece 31 and the distal end surface of the third bending piece 31 located behind the second bending piece 31 are connected to each other so that they can be bent in two directions. It has become.

  The outer periphery of the plurality of bending pieces 31 is covered with a bending cover (not shown), but is omitted in FIG.

  Also, the bending piece 31 located on the most distal side among the plurality of bending pieces 31 is inserted in the second insertion portion 2 so as to be different by 180 ° in the circumferential direction of the second insertion portion 2. The distal ends of the two wires that are not inserted (hereinafter simply referred to as the distal ends) are fixed, and each wire is pulled and loosened by turning the bending operation lever 6 provided in the operation section 3. Thus, the second bending portion 12 can be freely bent in two upper and lower directions.

Further, the angle at which the second bending portion 12 can be freely bent is set to 0 ° to 90 °. The active bending angle of the second bending portion 12 is the center of the second bending portion 12 parallel to the insertion direction S when the second bending portion 12 is in the non-curving state, as shown in FIG. For example, θ1 and θ2 are defined by the inclination angle of the central axis J of the second bending portion 12 when the second bending portion 12 is bent with respect to the axis J.
It is prescribed.

  Further, as shown in FIG. 3, the second bending portion 12 is passive when external force is applied by being brought into contact with the intestinal wall or the like of the duodenum 50 when protruding into the duodenum 50 from the opening 110 k. It can be freely bent.

  The maximum bending angle at which the second bending portion 12 can bend passively is set to 180 ° to 210 °. As shown in FIG. 3, the passive bending angle of the second bending portion 12 is such that the distal end surface of the bending piece 31 positioned closest to the distal end among the plurality of bending pieces 31 is inserted in the insertion direction S in the channel. Is defined as 0 °, the angle at which the distal end surface is directed to the side perpendicular to the insertion direction S by the treatment instrument raising base 120 is defined as 90 °, and the distal end surface is the second curved portion 12. The angle of directing backward with the curvature of 180 ° is defined as 180 °, and the angle at which the front end surface is directed to a predetermined angle from the rear with the curvature of the second bending portion 12, for example, 30 ° toward the first bending portion 112 side. It is defined as 210 °.

  Furthermore, as shown in FIG. 3, a value 2R2 that is twice the circumscribed radius R2 of the second bending portion 12 when the second bending portion 12 is passively bent to a maximum between 180 ° and 210 °. Is set to 20 mm to 30 mm. That is, the value of the circumscribed circle radius R2 is set to 10 mm to 15 m.

  Hereinafter, a configuration for setting the maximum bending angle at which the second bending portion 12 can bend passively to 180 ° to 210 ° will be described.

  As shown in FIGS. 3 and 4, first, when the diameter of the channel 110 of the first insertion portion 102 is H and the radius of the second insertion portion 2 is r, the outer diameter of the second insertion portion 2 is set. 2r needs to be smaller than the diameter of the channel 110 (2r <H, that is, r <H / 2).

  Further, in order to set the passive maximum bending angle of the second bending portion 12 to 180 ° to 210 °, the height of the inclined surface 31k formed in each end surface of the insertion direction S of each bending piece 31 in the insertion direction S. Is defined as k = r × tan (180 ° to 210 ° / n) where n is the total number of the inclined surfaces 31k in the plurality of bending pieces 31 (n is an integer of 3 or more).

This is from FIG.
tan θ = k / r,
θ = tan ⁻¹ (k / r)
Since n · θ = 180 ° to 210 °,
n · tan ⁻¹ (k / r) = 180 ° to 210 °,
tan ⁻¹ (k / r) = (180 ° to 210 °) / n
k / r = tan ((180 ° to 210 °) / n).

  Furthermore, when the interval in the insertion direction S of the pins 35 connecting the adjacent bending pieces 31 in the insertion direction S among the plurality of bending pieces 31 is P, as shown in FIG. 4, k = P × r / (2 (10-15) -r).

This is because the curvature R0 of the circle in contact with the straight line connecting the pins 35 in the insertion direction does not change in length before and after the curve, and can be defined as R0 = (P / 2) / tan θ = P / 2 tan θ, and the circumscribed circle radius R2 Can be defined by R2 = r + R0 = (P / 2 tan θ) + r. Further, from FIG. 4, since the value twice the circumscribed circle radius R2 is set to 2R2 = 20 mm to 30 mm, that is, the circumscribed circle radius Since R2 is set to 10 mm to 15 mm,
(P / 2 tan θ) + r = 10-15
P / 2 tan θ = ((10-15) −r)
2 tan θ ((10-15) −r) = P
tan θ = P / 2 ((10-15) −r)
k / r = P / 2 ((10-15) -r).

  That is, by satisfying the above three conditions of r <H / 2, k = r × tan (180 ° to 210 ° / n), and k = P × r / (2 (10-15) −r). The maximum bending angle at which the second bending portion 12 can bend passively can be set to 180 ° to 210 °.

  In other words, the second bending portion 12 is configured such that the plurality of bending pieces 31 constituting the second bending portion 12 are formed in a shape that satisfies the three conditions described above. Is set to 180 ° to 210 °.

  In the present embodiment, although the second bending portion 12 can passively bend from 180 ° to 210 °, the second bending portion 12 can only be actively from 0 ° to 90 °. Cannot bend.

  As described above, the second bending portion 12 is active when the bending operation lever 6 provided in the operation portion 3 is rotated and the wire inserted into the insertion portion 2 is pulled and relaxed. Therefore, the second bending portion 12 should be bendable between 0 ° and 210 ° in terms of structure, because the second bending portion 12 can be bent in two directions, ie, up and down.

  However, as shown in FIG. 2, in the operation unit 3, since the stoppers 8 u and 8 d are provided in the rotation operation area of the bending operation lever 6, the rotation of the bending operation lever 6 is performed by the stopper 8 u, It can only be done between 8d.

  That is, since the maximum operation amount of the bending operation lever 6 is defined by the stoppers 8u and 8d, the bending operation lever 6 cannot be rotated to a position where the second bending portion 12 is bent by 90 ° or more. In other words, since the bending operation lever 6 can only be rotated to a position where the second bending portion 12 can be bent only between 0 ° and 90 °, the wire is naturally pulled by the bending operation lever 6. Thus, the second bending portion 12 that is bent is also configured to bend only between 0 ° and 90 ° actively. Although the stoppers 8u and 8d are provided outside the operation unit 3 in the present embodiment, it is needless to say that these stoppers 8u and 8d may be disposed inside the operation unit 3.

  In order to insert the distal end side of the insertion portion 2 into the nipple 51 after the second bending portion 12 is passively bent, for example, 210 °, as shown by the solid line in FIG. The passive bending of the second bending portion 12 by moving the distal end side of the first insertion portion 102 in the duodenum 50 or reducing the amount of protrusion of the second bending portion 12 from the opening 110k. After the angle is reduced to about 90 ° to 180 °, the bending operation of the first bending portion 112 and the raising operation of the treatment instrument raising base 120 are performed, so that in the observation visual field of the side-view type endoscope 101. The distal end side of the second insertion portion is inserted into the nipple 51 while performing a pushing operation on the second insertion portion 2 from outside the subject.

  Thus, in this Embodiment, it showed that the maximum bending angle which the 2nd bending part 12 can bend passively was set to 180 degrees-210 degrees.

  According to this, as shown in FIG. 3, in the duodenum 50 having an average diameter t1 of approximately 30 mm, the second bending portion 12 protrudes from the opening 110k when the first bending portion 112 is in a non-curved state, When the second bending portion 12 is passively bent, the second bending portion 12 can passively bend at a large angle of 180 ° or more as shown by a solid line in FIG. 3, so that the second bending portion 12 is formed on the intestinal wall of the duodenum 50. It won't get caught.

  Here, as shown by a two-dot chain line in FIG. 3, when the maximum bending angle at which the second bending portion 12 can bend passively is less than 180 ° (in FIG. 3, less than 180 °), the circumscribed circle radius R2 When the second bending portion 12 has '(R2'> r2), when the second bending portion 12 protrudes from the opening 110k and is passively bent in the non-curving state of the first bending portion 112, the second bending portion 12 The distal end of the curved portion 12 is caught on the intestinal wall of the duodenum 50.

  Therefore, in this case, when the distal end side of the second insertion portion 2 is inserted into the papilla 51 using the first bending portion 112 and the treatment instrument raising base 120, the second bending portion 12 to the intestinal wall is inserted. In order to release the catch or prevent the catch itself, the bending operation must be accurately performed on the first bending portion 112 or the treatment tool raising base 120 must be accurately raised. Was complicated and complicated.

  However, if the maximum bending angle at which the second bending portion 12 can passively bend is set to 180 ° to 210 ° as in the present embodiment, the second bending portion 12 is shown in FIG. Even if the bending portion 12 of the second insertion portion 2 is passively bent by receiving an external force from the intestinal wall of the duodenum 50, the distal end side of the second insertion portion 2 enters the duodenum 50 from the opening 110k. Even if the second bending portion 12 is passively bent by receiving an external force in the protruded state, by performing an operation of bending the first bending portion 112 or by raising the treatment instrument raising base 120, The distal end side of the insertion portion 2 can be easily inserted into the teat 51.

  In the present embodiment, a value 2R2 that is twice the circumscribed circle radius R2 of the second bending portion 12 when the second bending portion 12 is passively bent to a maximum between 180 ° and 210 °. Indicates that it is set to 20 mm to 30 m.

  According to this, in the duodenum 50 having an average diameter of about 30 mm, the second bending portion 12 protrudes from the opening 110k in the non-curving state of the first bending portion 112, and the second bending portion 12 Is, for example, 210 ° passively curved, as indicated by the solid line in FIG. 3, the circumscribed circle radius R2 = 10 mm to 15 mm, that is, from the opening 110k to the nipple 51 direction of the second curved portion 12. The pop-out amount is 10 to 15 mm.

  Further, since the outer diameter M of the first insertion portion 102 is 15 mm, the outer diameter M (15 mm) + the amount of protrusion (the circumscribed circle radius R2) (10 mm to 15 mm) <t1 (30 mm). The second curved portion 12 protruding from the opening 110k surely fits in the duodenum 50 having a diameter t1 of an average of approximately t1 = 30 mm. Therefore, it is prevented that it becomes difficult to insert the front end side of the second insertion portion 2 into the teat 51 due to the curved shape of the second bending portion 12 after passive bending.

  Furthermore, in the present embodiment, it has been shown that the angle at which the second bending portion 12 can be freely bent is set to 0 ° to 90 °.

  According to this, as shown in FIG. 5, when the distal end side of the insertion portion 2 is inserted into the bile duct 55 through the nipple 51, for example, as shown by a two-dot chain line in FIG. When the bending portion 12 can be bent so that the bending angle θ2 is actively 90 ° or more, as shown by the solid line in FIG. 5 as in the present application, the bending angle θ1 is actively bent only from 0 ° to 90 °. Even if the bending operation lever 6 has the same operation amount, the second bending portion 12 is larger and sharply curved than the present application, so that the visual field direction of the biliary mirror 1 is greatly changed. Therefore, there is a possibility that the diseased part may be lost in the very small diameter bile duct 55 having a diameter t2 = 5 mm to 10 mm.

  However, as in the present application, if the second bending portion 12 can actively bend only from 0 ° to 90 °, the bending amount of the second bending portion 12 is relative to the operation amount of the bending operation lever 6. Therefore, even in the small-diameter bile duct 55, the visual field direction of the biliaryscope 1 does not change significantly with the bending of the second bending portion 12, so that it is easy to find the diseased part. The above is the same even when the distal end side of the insertion portion 2 is inserted into the pancreatic duct.

  From the above, the biliary endoscope system 100 having a configuration in which the second insertion portion 2 of the biliary endoscope 1 can be easily inserted into the nipple 51 and the pancreaticobiliary duct can be easily observed by the second insertion portion 2 after insertion. Can be provided.

  FIG. 6 is a partial cross-sectional view of a biliary endoscope system including a conventional endoscope having a treatment instrument raising base having a groove shape in a first insertion portion and a second insertion portion of the biliary scope. FIG. 7 shows a part of a biliary endoscope system including a side-view type endoscope having a treatment instrument raising base having a groove shape in the present configuration in a first insertion portion and a second insertion portion of the biliary scope. It is sectional drawing.

  In FIGS. 6 and 7, the second bending portion of the second insertion portion of the biliary scope is shown as being exposed so that a plurality of bending pieces are exposed to the outside, and the tip portion is omitted. Show.

  By the way, as described above, the insertion portion 2 of the biliary scope 1 is inserted from the treatment instrument insertion port 118 into the channel 110 in the first insertion portion 102 of the side-view type endoscope 101, and the distal end side of the insertion portion 2 is moved. When projecting from the opening 110k, the distal end side of the insertion portion 2 passes through the groove 120m on the guide surface of the treatment instrument elevator 120 as shown in FIG.

  The groove 120m is formed so that the biliary mirror 1 and other treatment tools can easily pass through the guide surface of the treatment tool raising base 120 that comes into contact with the biliary mirror 1 and other treatment tools. It is formed.

  However, as shown in FIG. 6, when the radius of curvature R1 of the groove 120m is smaller than the circumscribed radius R4 ′ when the second curved portion 12 is curved to the maximum (R1 <R4 ′), the second curved portion. 12 or the distal end portion 11 of the second insertion portion 2 is likely to be caught in the groove 120m at the portion V surrounded by the one-dot chain line in FIG. In addition to a decrease in the penetrability on the distal end side, there is a problem that the curved cover constituting the outer surface of the second curved portion 12 is damaged.

  In view of such a problem, in this configuration, as shown in FIG. 7, the groove 120 m is formed such that the curvature radius R 1 of the groove 120 m is larger than the circumscribed radius R 4 when the second bending portion 12 is bent to the maximum. (R1> R4).

  According to such a configuration, if the second bending portion 12 is bent, the second bending portion 12 and the distal end portion 11 are not easily caught in the groove 120m. In addition to improving the passability on the tip side of the portion 2, it is possible to prevent damage to the curved cover constituting the outer surface of the second curved portion 12.

  FIG. 8 is a diagram schematically showing a configuration in which a balloon is provided on the outer periphery on the distal end side of the second insertion portion of the biliary scope in the bile duct.

  By the way, normally, when the gallstone 45 in the bile duct 55 is taken out, a known balloon catheter is inserted into the bile duct 55 through the channel 110 of the first insertion portion 102 of the side-view type endoscope 101. This work has to be performed by the operator while viewing the X-ray observation image under X-ray fluoroscopy, and the workability is poor and the worker is exposed to an explosion.

  In view of such a problem, in this configuration, as shown in FIG. 8, a balloon 40 that can be inflated and contracted is provided on the distal end side of the second insertion portion 2 of the biliary scope 1, for example, on the outer periphery of the distal end portion 11. Yes. The balloon 40 is supplied with air from an intake / exhaust device connected to a connector (not shown) at the extended end of the operation unit 3 or the universal cord 5 via an intake / exhaust channel 41 provided in the insertion unit 2. By being exhausted, it can expand and contract.

  According to such a configuration, the balloon 40 is inflated to contact the wall surface of the bile duct 55 while observing the gallstone 45 with an observation optical system (not shown) provided on the distal end surface of the distal end portion 11 of the insertion portion 2 of the biliary mirror 1. The gallstone 45 can be easily scraped out of the bile duct 55 by the balloon 40 by moving the distal end side of the second insertion portion 2 in the direction of the nipple 51 in the contact state.

  Further, since it is not necessary to take out the gallstone 45 under X-ray observation, it is possible to prevent the operator from being exposed to radiation, and as described above, a treatment instrument such as a balloon catheter becomes unnecessary, and the second insertion The gallstone 45 can be taken out economically by simply replacing the balloon 40 with respect to the portion 2.

  Furthermore, normally, when the distal end side of the second insertion portion 2 is inserted into the nipple 51, there is a problem that the insertion operation is difficult due to the resistance force from the nipple 51. As shown in FIG. If the roller 43 is provided at the corner of the distal end surface of the distal end portion 11 of the second insertion portion 2, the resistance force that the roller 43 receives from the nipple 51 as the roller 43 rotates can be reduced. Insertability into the inside is improved.

1 ... Biliary scope (second endoscope)
2 ... 2nd insertion part 3 ... Operation part 6 ... Bending operation lever (bending operation member)
8d ... Stopper 8u ... Stopper 12 ... Second bending portion 31 ... Bending piece 31k ... Inclined surface 35 of the bending piece 35 ... Pin 50 ... Duodenum 51 ... Papilla 100 ... Biliary endoscope system 101 ... Side-view type endoscope ( First endoscope)
DESCRIPTION OF SYMBOLS 102 ... 1st insertion part 110 ... Channel 110k ... Channel opening 111g ... Side surface of front-end | tip part 112 ... 1st curved part 120 ... Treatment instrument raising base H ... Channel diameter k ... Height of inclined surface P ... Pin space | interval r ... Radius 2r of the second insertion portion ... Outer diameter of the second insertion portion R2 ... Radius of circumscribed circle S ... Insertion direction

Claims (10)

A first endoscope having a first insertion portion that is orally inserted to the duodenum, and a channel provided in the first insertion portion;
It can be inserted into and removed from the subject from outside the subject, and after being inserted into the channel, it protrudes from the opening of the channel formed at the distal end in the insertion direction of the first insertion portion and is inserted into the papilla of the duodenum. A second endoscope having a second insertion portion,
Comprising
A second bending portion configured to be bent in a plurality of directions is provided on the distal end side in the insertion direction of the second insertion portion by connecting a plurality of bending pieces along the insertion direction,
The active bending angle associated with the bending operation in the second bending portion is set to 0 ° to 90 °,
The maximum bending angle that passively bends with the application of external force in the second bending portion is set to 180 ° to 210 °.   A value twice the circumscribed circle radius of the second bending portion when the second bending portion is passively bent at the maximum bending angle is set to 20 mm to 30 mm. The biliary tract endoscope system according to claim 1. When the diameter of the channel of the first insertion portion is H and the radius of the second insertion portion is r,
r <H / 2,
When the height in the insertion direction of the inclined surface formed on the end surface in the insertion direction of each bending piece is k, and the total number of the inclined surfaces in the plurality of bending pieces is n,
k = r × tan (180 ° to 210 ° / n),
When the interval in the insertion direction of the pins connecting the bending pieces adjacent in the insertion direction among the plurality of bending pieces is P,
By k = P × r / (2 (10-15−r)),
3. The biliary tract endoscope system according to claim 1, wherein a maximum bending angle that passively bends with the application of an external force in the second bending portion is set to 180 ° to 210 °. .   The biliary endoscope system according to any one of claims 1 to 3, wherein an outer diameter of the second insertion portion is 3.0 mm to 4.0 mm. An operation unit is continuously provided at a proximal end of the second insertion unit in the insertion direction, a bending operation member that causes the operation unit to bend the second bending unit, and an operation amount of the bending operation member. The specified stopper is provided,
Since the maximum operation amount of the bending operation member is defined by the stopper provided in the operation unit, the active bending angle of the second bending unit is set to 0 ° to 90 °. The biliary tract endoscope system according to any one of claims 1 to 4.   The biliary tract according to any one of claims 1 to 5, wherein the second bending portion is freely bendable in any one of vertical directions in an observation image obtained by the second endoscope. Endoscope system.   The biliary endoscope according to any one of claims 1 to 5, wherein the second bending portion is freely bendable upward in an observation image obtained by the second endoscope. system.   The first endoscope is located laterally with respect to the insertion direction in which the opening is provided on the side surface of the distal end of the first insertion portion and an observation optical system for observing the inside of the subject is provided. The biliary endoscope system according to any one of claims 1 to 7, wherein the endoscope is a side-viewing endoscope for observation. A first bending portion that can be bent in a plurality of directions is also provided on the distal end side in the insertion direction of the first insertion portion,
The biliary tract endoscope system according to claim 8, wherein the second insertion portion is inserted into the nipple by bending the first bending portion of the first insertion portion. .   9. The raising channel for changing the traveling direction of the second insertion portion in the channel to the opening side is provided in the channel at the tip of the first insertion portion. Or the biliary endoscope system according to 9;

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