JP6807080B2 - Endoscope device - Google Patents

Description

The present invention relates to an endoscope device including an endoscope and an overtube into which the endoscope is inserted.

As a method for inspecting the biliary tract (gallbladder and bile duct) and pancreatic duct of the human body, a method of inserting an endoscope into the papilla of Vater, which is an outlet for bile and pancreatic juice, is known. In this method, an endoscope having a bendable portion at the tip is generally used, but since the position and shape of the papilla of Vater differ from individual to individual and the diameter is small, the endoscope is bent. It is not easy to insert.

In particular, in this method, the endoscope is inserted through the mouth or nose, and the endoscope is inserted into the papilla of Vater via the esophagus, stomach, and duodenal, so that the endoscope flexes in a wide stomach. It may be irritated. In this case, even if the base end side of the endoscope is pushed in an attempt to move the endoscope further forward, the endoscope further bends in the stomach, and the force pushing the base end side becomes difficult to be transmitted to the tip side, resulting in endoscopy. The operation itself of arranging the tip of the mirror in the vicinity for inserting it into the papilla of Vater becomes difficult.

On the other hand, conventionally, a tubular flexible main body through which the insertion part of the endoscope can be inserted is attached to the inside, and the main body is attached to the outer surface of the main body and is normally contracted. An endoscope insertion aid consisting of an expansion member whose tip part expands greatly to one side and curves the main body in a "" shape, and a flow tube that guides a pressure fluid to the expansion member. Are known.

According to this insertion aid, the flexible body into which the endoscope is inserted is curved in a "" shape, so that the tip of the endoscope is forcibly directed toward the duodenum in the stomach. , Prevents the endoscope from bending in the stomach.

Jikken Sho 54-175895

However, in the conventional insertion assisting tool, the tip of the flexible body is arranged near the entrance of the duodenum, and the tip of the endoscope protrudes from the tip and is inserted into the duodenum. Therefore, there is an inconvenience that strict alignment must be performed in advance so that the tip of the flexible body is arranged so as to face the entrance of the duodenum.

In view of the above points, it is an object of the present invention to provide an endoscope device capable of easily inserting an endoscope into the duodenum while preventing the endoscope from bending in the stomach. ..

In order to achieve such an object, the endoscope device of the present invention has a flexible endoscope bending portion at the tip end portion and a bending operation portion for bending the endoscope bending portion at the proximal end side. In an endoscope device including an endoscope and an overtube that inserts the endoscope and assists the insertion of the endoscope into the body, the tip of the overtube is attached to the tip of the overtube. An expandable cut formed in the axial direction from the endoscope, a balloon provided on the outer peripheral surface of the overtube adjacent to the direction intersecting the cut and expandable and contractible in the outer peripheral direction, and the balloon from the proximal end side. The balloon is provided with a fluid passage for guiding the fluid that inflates the balloon, and the cut is widened when the balloon is inflated, and the tip of the overtube is the base end of the cut. It is characterized by having an overtube bent portion that bends so as to approach the side.

In the endoscope device of the present invention, the endoscope is inserted from the base end of the overtube and inserted into the stomach through the mouth or nose of the patient to bring it closer to the lower body of the stomach directly below the esophagus.

Next, a fluid that inflates the balloon is fed into the balloon of the overtube through a fluid passage. Then, as the balloon expands in the outer peripheral direction, the outer peripheral surface of the tip end portion of the overtube is pulled in the outer peripheral direction, and as a result, the cut provided adjacent to the balloon is expanded.

Then, when a fluid is further sent into the balloon, the tip of the overtube bends around the bent portion of the overtube provided at the cut so that the tip of the overtube approaches the base end side of the cut. ..

As a result, when the endoscope is directed toward the duodenum and the balloon is placed in contact with the lower body of the stomach, the overtube extends straight down from the esophagus to the lower body of the stomach, and then its tip bends toward the duodenum. Will be done. Therefore, according to the endoscope device of the present invention, it is possible to prevent the endoscope from bending in the stomach.

Further, at this time, since the tip of the overtube is widened at the cut, the tip of the endoscope has a higher degree of freedom than simply protruding from the tip of the cylinder. Therefore, if the tip of the overtube is roughly oriented toward the duodenum, the tip of the endoscope is bent by the bending operation part and the bending part of the endoscope is bent even if the tip of the overtube is not exactly opposed to the entrance of the duodenum. The endoscope can be easily inserted into the duodenum by advancing the endoscope while adjusting it.

In the endoscope device of the present invention, it is preferable that the cut is provided as a planned break portion, and the planned break portion is broken and formed by the expansion of the balloon.

According to this, when the overtube is inserted into the stomach from the esophagus, the insertion resistance can be reduced and damage to the esophageal mucosa can be prevented.

In the endoscope device of the present invention, it is preferable that the endoscope has a suction portion for sucking a fluid at the tip portion.

In this endoscope device, the balloon is inflated and brought into contact with the inside of the stomach, and the tip of the endoscope is sucked while being advanced to the tip of the main body of the overtube. As a result, the stomach is contracted by sucking the air in the stomach, and the inner wall thereof contacts the overtube, and the movement of the overtube in the stomach is restricted.

As a result, the operation of the endoscope is also stable, so that the endoscope can be easily inserted into the duodenum.

Further, in an endoscope device including a suction portion, it is preferable that the side wall of the overtube is provided with a through hole having a size through which the endoscope can pass on the proximal end side in the extension direction of the cut. ..

According to this, by surely sucking the air in the stomach from the upper part of the stomach to the area around the fundus, the stomach is contracted and the operation of the endoscope is stabilized, so that the endoscope can be easily moved to the duodenum. Can be inserted.

It is a figure which shows the endoscope device of this embodiment, and is the perspective view of the state which the balloon is inflated. It is a figure which shows the endoscope device of this embodiment, and is the side view of the state before the balloon is inflated. It is a figure which shows the deformation process of the balloon and the cut of the endoscope device of this embodiment, FIG. 3A is the explanatory view of the state before balloon expansion, FIG. 3B is the explanatory view of the state during balloon expansion, and FIG. Explanatory drawing of a state where a cut is opened by expansion. It is a figure which shows the usage of the endoscope device of this embodiment, FIG. 3A is the explanatory view of the state which inserted the endoscope device into the stomach, and FIG. 3B is the state which the balloon of the endoscope device is inflated. Explanatory drawing, FIG. 3C is an explanatory view of a state in which an inflated balloon is placed at the bottom of the stomach and the endoscope is projected from the overtube. The explanatory view which shows the modification of the overtube of the endoscope apparatus of this embodiment. The explanatory view which shows the overtube of the endoscope apparatus which concerns on the modification of this Embodiment.

As shown in FIGS. 1 and 2, the endoscope device 1 of the present embodiment internally inserts the endoscope 10 and the endoscope 10 in order to assist the insertion into the body. It is provided with an overtube 20 to be inserted.

The endoscope 10 has a substantially columnar shape, and has an endoscope bending portion 11 that can be flexed at an end portion and the endoscope bending portion 11 that is bent at a base end portion so that the tip portion is directed in a predetermined direction. It is provided with a bending operation unit 12 for causing the bending.

The endoscope 10 has a built-in wire (not shown) along the axial direction from the tip end side of the endoscope bending portion 11 to the bending operation portion 12. When considering the cross section of the endoscope 10 along the radial direction, the wires are arranged at four points in the circumferential direction evenly over a distance on the circular edge portion, so that the bending operation portion 12 By towing the wire, the endoscope bending portion 11 is bent up, down, left and right.

The overtube 20 has a cylindrical main body 21 formed of a flexible synthetic resin such as polyvinyl chloride, silicone rubber, and a thermoplastic elastomer, a fluid passage 22 to which a fluid is supplied or discharged, and the fluid. It has a balloon operating unit 23 connected to the passage 22 to supply a fluid.

A cut 24 and a balloon 25 capable of expanding and contracting are provided at the tip of the main body 21. As shown in FIGS. 2 and 3A, the cut 24 is formed as a planned fracture portion by providing a plurality of linear discontinuous cutting portions 24a in a predetermined range along the axial direction from the tip.

The balloon 25 is a rectangular thin-film member, and is attached along the outer peripheral surface of the tip end portion of the main body portion 21. In particular, in the present embodiment, a pair of rectangular facing sides are arranged along the axial direction of the balloon 25. Each of the pair of sides has a predetermined distance from the cut 24 and is arranged so as to be adjacent to each other with the cut 24 in between.

The balloon 25 is formed of a synthetic resin such as polyvinyl chloride, silicone rubber, and a thermoplastic elastomer, and is designed to be more flexible than the main body 21 by adjusting the material, thinness, and the like. After being molded, the balloon 25 can be attached to the main body 21 by adhesion, welding, or the like, and can be integrally molded with the same material.

The outer surface of the balloon 25 is preferably anti-slip processed by rough surface processing or the like.

A fluid passage 22 is connected to the base end side of the balloon 25. The balloon 25 expands or is hemispherically expanded in the axial outer peripheral direction of the main body 21 by operating the balloon operating portion 23 to supply or discharge the fluid to the inside of the balloon 25 through the fluid passage 22. It is designed to contract.

When a fluid is supplied to the balloon 25, as shown in FIGS. 3A to 3C, the cut 24 is pulled by the expanding balloon 25 and splits between the axially adjacent cutting portions 24a to form the cutting portion 24a. It is opened by connecting. Then, as the balloon 25 tries to deform into a hemispherical shape, the opened cut 24 is also bent and expanded at a predetermined position (overtube bent portion 24b) between the tip end and the base end. As a result, the tip of the main body 21 is bent so as to approach the base end side of the cut 24.

Next, a method of using the endoscope device 1 according to the present embodiment will be described with reference to FIG. Specifically, a case where the endoscope is inserted into the duodenum D from the inside of the stomach S by using the endoscope device 1 will be described as an example.

First, the endoscope 10 is inserted into the main body 21 of the overtube 20 from the proximal end side. In that state, the endoscope device 1 is inserted into the stomach S via the patient's mouth or nose, as shown in FIG. 4A.

Next, the fluid is supplied to the balloon 25 through the fluid passage 22 by operating the balloon operating unit 23. As a result, as shown in FIG. 4B, the balloon 25 expands into a hemispherical shape, the cut 24 is opened as described above, and the tip portion of the main body portion 21 has a “dogleg” shape centered on the overtube bent portion 24b. It is bent into a "shape".

Next, when the endoscope device 1 is further inserted in that state, the tip of the main body 21 of the overtube 20 advances while being further bent along the lower body S1 of the gastric corpus, as shown in FIG. 4C. , Placed in the pyloric vestibular S2. At this time, since the balloon 25 of the endoscopic device 1 mainly contacts the inside of the stomach S, the burden on the stomach S is extremely small.

Next, the tip of the endoscope 10 is advanced to the tip of the main body 21 of the overtube 20, and the entrance of the duodenum D is visually recognized using the endoscope 10.

Next, by operating the bending operation portion 12, as shown in FIG. 4C, the endoscope 10 is bent by the endoscope bending portion 11 and the tip of the endoscope 10 is projected from the opened cut 24. And insert it into the entrance of duodenum D.

As described above, according to the endoscope device 1 of the present embodiment, when the main body 21 of the overtube 20 is inserted into the stomach S via the esophagus, the cut 24 is not opened, so that the insertion resistance Can be reduced and damage to the esophageal mucosa can be prevented. Since the main body 21 of the overtube 20 is arranged from the esophagus to the pyloric antrum S2, it is possible to prevent the endoscope 10 from bending toward the fundus S3 when the endoscope 10 is inserted. To. Further, since the tip of the main body 21 of the overtube 20 is bent in the duodenum D direction, it is possible to roughly align the tip of the endoscope 10 in the protruding direction. In the endoscope device 1 of the present embodiment, the tip of the overtube 20 is opened at the cut 24, and the tip of the endoscope 10 can be projected from anywhere in the opening, so that the endoscope There is a high degree of freedom in operating 10.

Therefore, the endoscope device 1 of the present embodiment is suitable for freely inserting the tip of the endoscope 10 into the duodenum D in a state where the overtube 20 is in contact with the pyloric antrum S2 by the balloon 25. Since it can be moved to a position, the endoscope 10 can be easily inserted into the duodenum D.

As a result, the endoscope device 1 of the present embodiment is suitable when the endoscope 10 is to be inserted into the papilla of Vater via the duodenum D. That is, when the endoscope 10 bends toward the fundus S3 side, even if the proximal end side of the endoscope 10 is pushed in an attempt to advance the endoscope 10, the endoscope 10 is further inside the stomach S. It bends. In this case, the force pushing the proximal end side of the endoscope 10 becomes difficult to be transmitted to the distal end side, which makes it difficult not only to advance the endoscope 10 in the vicinity in order to insert it into the papilla of Vater, but also to perform endoscopy. This is because the tip of the mirror 10 may not reach the papilla of Vater.

Next, with reference to FIG. 5, the cut 34 will be described as a modification of the cut 24 of the endoscope device 1 of the present embodiment.

As shown in FIG. 5, the cut 34 is formed as a planned fracture portion by passing the string member 34a in advance along the axial direction from the tip inside the wall portion of the overtube 20. The cut 34 is opened by pulling the grip portion 34b provided at the base end portion of the string member 34a in the base end direction, thereby sequentially tearing from the tip end direction.

In the endoscope device 1 provided with the cut 34 shown in this modification, it is not necessary to split the tip of the main body 21 by the balloon 25. Therefore, the main body portion 21 and the balloon 25 can be designed by considering only the bending amount of the overtube bending portion 24b in these designs. Therefore, in the endoscope device 1 provided with the cut 34 shown in the modified example, the tip of the cut 34 or the main body 21 can be adjusted more accurately so as to face the entrance of the duodenum D.

The cut is not limited to the one that is opened ex post facto in the stomach, such as the cut 24 of the present embodiment and the cut 34 of the modified example, and may be opened in advance.

Further, the balloon 25 of the endoscope device 1 of the present embodiment has been described as having a rectangular shape, but the present invention is not limited to this, and the balloon 25 may be an elliptical one, and the overtube bent portion 24b. It is preferable that the diagonal line is a diamond shape arranged along the longitudinal direction of the overtube 20 so as to be easily bent.

Next, a modified example of the overtube 20 of the endoscope device 1 of the present embodiment will be described with reference to FIG.

The endoscope 10 in this modified example has a suction function (suction portion) for degassing the air in the stomach from the tip. This suction function is used in a state where the balloon 25 is inflated and brought into contact with the inside of the stomach S, and the tip of the endoscope 10 is advanced to the tip of the main body 21 of the overtube 20. According to this, the movement of the overtube 20 in the stomach is restricted because the stomach is contracted by sucking the air in the stomach and the inner wall thereof contacts the overtube 20.

As a result, the operation of the endoscope 10 is also stable, so that the endoscope 10 can be easily inserted into the duodenum D.

However, when suction is performed with the tip of the endoscope 10 advanced to the tip of the main body 21 of the overtube 20, degassing near the pyloric antrum S2 is easy, but from the upper part of the stomach to the area around the fundus. Degassing may be inadequate.

Therefore, a through hole 40 is provided on the side wall of the overtube 20 in the modified example. The through hole 40 of this modification is formed on the base end side in the extension direction of the cut 24 so as to allow the endoscope 10 to pass through.

According to this, the endoscope 10 can be easily inserted into the duodenum D by surely contracting the stomach from the upper part of the stomach to the periphery of the fundus and stabilizing the operation of the endoscope 10.

1 ... Endoscope device, 10 ... Endoscope, 11 ... Endoscope bending part, 12 ... Bending operation part, 20 ... Overtube, 22 ... Fluid passage, 24 ... Cut, 24b ... Overtube bending part, 25 ... balloon.

Claims (4)

An endoscope having a flexible endoscope bending portion at the tip portion and a bending operation portion for bending the endoscope bending portion at the base end side.
In an endoscope device including an overtube that inserts the endoscope and assists the insertion of the endoscope into the body.
The tip of the overtube is provided on the outer peripheral surface of the overtube adjacent to the expandable cut formed axially from the tip of the overtube and the direction intersecting the cut, and is provided in the outer peripheral direction. Is provided with a balloon that can be expanded and contracted, and a fluid passage that guides the fluid that inflates the balloon from the proximal end side to the balloon.
The cut is characterized by having an overtube bent portion that expands when the balloon is inflated and bends so that the tip of the overtube approaches the proximal end side of the cut. Endoscopic device. In the endoscope device according to claim 1,
The endoscope device is characterized in that the cut is provided as a planned break portion, and the planned break portion is broken and formed by expanding the balloon. In the endoscopic apparatus according to claim 1 or 2.
The endoscope is an endoscope device having a suction portion for sucking a fluid at a tip portion thereof. In the endoscope device according to claim 3,
An endoscope device characterized in that a through hole having a size through which an endoscope can pass is provided on a side wall of the overtube on the proximal end side in the extension direction of the cut.