JPH0438413B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Field of Application] The present invention relates to an endoscopic device for biliary and pancreatic ducts for performing pessimistic endoscopic observation of biliary and pancreatic ducts.

[Conventional technology]

A parent-child scope system is known that uses a parent endoscope that has an insertion section that can be inserted up to the duodenum, and a child endoscope that has an insertion section that is inserted transpapillary through a forceps hole in the insertion section. In this method, the insertion section of the child endoscope is directly inserted into the nipple through the forceps hole of the parent endoscope to observe the inside of the biliary and pancreatic ducts. However, in order to observe the bile and pancreatic ducts, it is necessary to perform perfusion to clean the inside of the observation area. For this reason, the insertion section of the secondary endoscope requires a passage for sending saline for irrigation, and the diameter of the insertion section of the secondary endoscope has to be increased. The distal end of the insertion section of such a child endoscope cannot be properly inserted into the nipple unless it is curved to determine the direction, and therefore the distal end has a function of being curved in two directions, up and down.

[Problem to be solved]

The outer diameter of the insertion part of the child endoscope is approximately 3.5 mm in order to provide a passage for saline water supply and a curved tip, so if the nipple is inserted incorrectly, the nipple, bile,
Not only was there a risk of damaging the pancreatic duct, but the operation of inserting the nipple was also difficult.

Therefore, in this invention, instead of directly inserting the insertion section of the child endoscope into the nipple, several guide tubes with different diameters are prepared, the narrowest guide tube is selected first, and the selected guide tube is is inserted into the bile/pancreatic duct via the papilla, and the insertion part of the child endoscope is inserted into this guide tube, making the insertion operation easy and safe. Saline can be delivered using the gap between the insertion part and the small diameter guide tube, and after inserting the large diameter guide tube into the biliary and pancreatic ducts using the small diameter guide tube, the small diameter guide tube can be pulled out and the child can be viewed. It is an object of the present invention to provide an endoscope device for biliary and pancreatic ducts in which the insertion portion of a mirror is inserted into a guide tube having a large diameter, and various treatment tools can be inserted into this gap.

[Means to solve the problem]

In order to achieve the above-mentioned object, the present invention includes a master endoscope whose insertion section having a forceps hole can be inserted up to the duodenum, and a guide tube that is guided from the forceps hole of this parent endoscope to a flexible guide tube. -Equipped with a child endoscope having an insertion section that is inserted into the pancreatic duct, and two or more fixing tubes with different diameters are arranged concentrically on the proximal side of the insertion section of the child endoscope so as to cover the insertion section. established,
A fixing tube and a guide tube corresponding to the selected guide tube via an adapter according to the diameter of the selected one among two or more guide tubes with different diameters inserted into the bile/pancreatic duct from the forceps hole of the parent endoscope. The structure is such that the two can be connected communicatively.

[Effect]

When attempting to observe the biliary and pancreatic ducts using the device of this invention, after orally inserting the insertion end of the master endoscope into the duodenum and confirming the position of the papilla, select a diameter that is easy to insert into the papilla through the forceps hole. Insert the guide tube and
If you insert the guide tube further toward the nipple using the forceps stand provided at the tip of the insertion section of the parent endoscope, the guide tube is highly flexible and can be inserted without damaging the nipple. It is inserted papillary into the bile duct or pancreatic duct. In addition, the guide tube can be made thin enough to allow insertion of the insertion section (no passage or forceps hole) that has only the observation function of the child endoscope, and can be made thin enough to be inserted into the nipple where it is difficult to insert it. becomes. Once the guide tube has been inserted from the nipple into the bile duct or pancreatic duct, insert the insertion section of the child endoscope into the guide tube. Saline water can be supplied using the gap between the insertion section of the child endoscope and the guide tube. At this time, a corresponding small-diameter guide tube is selected from two or more fixing tubes, these tubes are communicatively connected via an adapter, and saline water is fed using the adapter. Further, when using a large diameter guide tube, the large diameter guide tube is inserted into the bile/pancreatic duct using a small diameter guide tube, and the small diameter guide tube is extracted. A fixing tube corresponding to the large diameter guide tube is selected, these tubes are connected through an adapter so that they can communicate with each other, and various treatment tools are inserted using the adapter.

〔Example〕

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

FIG. 1 is a schematic diagram showing the entire device, including a master endoscope 1 having an insertion section 2 that can be inserted into the duodenum, and an insertion section 5 that is inserted into the biliary and pancreatic ducts from an insertion port 4 of a forceps hole 3. It consists of a child endoscope 6 having a small diameter guide tube 7. As shown in FIG. 2, the tip of the insertion section 2 inserted into the duodenum includes an image guide window 8, a light guide window 9, an air and water supply port 10, and a forceps stand provided at the forceps hole 3. It is equipped with 11. When observing the biliary and pancreatic ducts using the master endoscope 1, guide tube 7, and slave endoscope 6, the guide tube 7 is inserted into the forceps hole 3 through the insertion port 4 of the master endoscope 1. A Luer lock 12 is attached to the proximal end of the guide tube 7, and a flexible core bar 13 is attached to the Luer lock 12. The tip of the core bar 13 is designed not to protrude from the tip of the guide tube 7. Duodenum 10 at the tip of insertion section 2 of parent endoscope 1
Observe the nipples 101 and 102 at position 0, and insert the forceps hole 3.
Then insert the guide tube 7 into the nipple 101.
The pancreatic duct 103 at the top of FIG. 4 is an accessory pancreatic duct,
The lower, thicker one is the main pancreatic duct. Also, code 104
indicates a bile duct, and 105 indicates a pancreas. Nipple 1
When inserting the guide tube 7 into the nipple 01, the forceps stand 11 is operated while observing with the parent endoscope 2, and the tip of the guide tube 7 is inserted into the nipple 101. Since the core bar 13 is inserted into the guide tube 7,
It becomes easier to insert the flexible guide tube 7 from the papilla 101 into the pancreatic duct 103. When the pancreatic duct 103 or the bile duct 104 is photographed, it can be seen to which part of the pancreatic duct 103 or the bile duct 104 the guide tube 7 has been inserted due to the presence of the core bar 13. In addition, the pancreatic duct 103 or the bile duct 10 is connected via the guide tube 7.
Image contrast agent can be injected into the 4. bile duct 10
4 and the guide tube 7 inserted into the pancreatic duct 103 had a diameter of 1.7 mm. The purpose of inserting the core bar 13 into such a guide tube 7 is to prevent meandering within the forceps hole 3 and to facilitate insertion of the guide tube 7 into the nipples 101, 102. The image of
This is to make it possible to confirm the position of the tip.
If the tip side of the guide tube 7 inserted into the pancreatic duct 103 or the bile duct 104 is coated with metal powder or the like so that the image is visible when viewing through the core, the core metal 13 There is no problem even if you do not insert . In this way, the parent endoscope 1
After inserting the guide tube 7 into the forceps hole 3 through the insertion port 4 and inserting the distal end of the guide tube 7 into, for example, the pancreatic duct 103, the Luer lock 12 is removed and the core bar 13 is pulled out from the guide tube 7. Next, the insertion section 5 of the secondary endoscope 6, which does not have a saline water supply passage or a forceps hole, is inserted into the guide tube 7. Insert the insertion section 5 into the guide tube 7 so that the distal end of the insertion section 5 of the child endoscope 6 and the distal end of the guide tube 7 are approximately aligned and so that the insertion section 5 does not protrude beyond the distal end of the guide tube 7. An adapter 14 is provided on the child endoscope 6 to prevent over-insertion of the insertion section 5 during the procedure. adapter 14
consists of a straight pipe section 14A and a crossed pipe 14B that is orthogonal to and communicates with the straight pipe section 14A. One end of the straight tube section 14A is connected to fixing tubes 15 and 16 provided in the slave endoscope 6.
The other end is connected to the proximal end of the guide tube 7 (see FIGS. 1 and 5). The crossover tube 14B of the adapter 14 is connected to the tube 17.
This is a conduit that supplies saline through the tube. Saline water is supplied from a syringe or the like connected by a Luer lock 18 provided at the other end of the tube 17.
Water is fed into the biliary and pancreatic ducts 103 and 104 through the gap between the insertion portion 5 and the guide tube 7 via A.
Among the fixing tubes 15 and 16 provided concentrically on the proximal end side of the insertion section 5 of the child endoscope 6, the fixing tube 16 with a larger diameter is used when using another guide tube 19 and an adapter 20. This will be discussed later. a small diameter fixing tube 15;
In order to seal the gap between the secondary endoscope 6 and the insertion section 5 on the proximal end side of the insertion section 5, a sealing ring 21 is provided, and a fixing ring 22 is provided on the outermost periphery (Fig. 5). reference).

Next, to explain the case where three endoscopes are used, as mentioned above, the master endoscope 1 and the guide tube 7 are used to connect the guide tube 7 to the bile/pancreatic duct 10.
3, 104, the guide tube 7 is connected to a connecting tube 24 of the same diameter using a joint 23 as shown in FIG. 7 (see FIG. 6).
The parent endoscope 1 is removed with both tubes 7 and 24 intact (with the tip of the guide tube 7 inserted into the biliary and pancreatic ducts 103 and 104). Next, as shown in FIG. 8, an endoscope 1' equipped with forceps 3' larger than the forceps hole 3 is orally inserted into the duodenum 100. At this time, both tubes 7 and 24 are inserted into the forceps hole 3', and the tube 24 is sequentially brought out through the insertion port 4'. Next, the guide tube 1 with a large diameter
9 to both tubes 7 and 24, and the bile/pancreatic duct 1.
03, 104 (see Figure 9). The tip of the guide tube 19 is already connected to the bile/pancreatic duct 10.
Once guided by the guide tube 7 inserted into the interior of 3,104, the tube 7,24 is pulled out. The tip of the insertion section 2' of the endoscope 1' is in the duodenum 1.
00 and the tip of the guide tube 19 is inserted into either the bile/pancreatic duct 103 or 104, guide the insertion section 5 of the child endoscope 6 via the adapter 20 as shown in FIG. tube 1
Insert into 9. One end of the direct portion 20A of the adapter 20 is connected to the fixing tube 16, and the other end is connected to the guide tube 19. Details of this condition can be found in Chapter 11.
As shown in the figure, the communication point of the crossover tube 20B is from the tip of the fixing tube 15 to the guide tube 1.
It's leaning towards 9. When this adapter 20 is attached to the child endoscope 6 and also attached to the guide tube 19, the tip of the insertion section 5 is attached to the guide tube 1.
Of course, it is designed so that it is almost aligned with the tip of 9 and does not protrude. Large diameter guide tube 1
Using the gap between the tube between the insertion part 9 and the insertion part 5,
Not only can saline be fed through the chiasm tube 20B, but also various treatment instruments such as forceps 25 can be inserted therein as shown in FIG. Although the endoscope 1', which can also be called the parent endoscope 1, was used, the guide tube 7 with a narrow diameter was inserted using the endoscope 1' as the parent from the beginning, and then the guide tube 19 with a large diameter was inserted. It is also possible to do so.

〔effect〕

As explained above, according to the present invention, two or more guide tubes are used, and after first inserting a small diameter guide tube into the bile/pancreatic duct, the insertion section of the child endoscope is inserted into this guide tube. The insertion section can be safely and easily inserted into the biliary and pancreatic ducts. Further, even when a large diameter guide tube is inserted, it is guided by a small diameter guide tube, so that it can be smoothly inserted into the bile/pancreatic duct. Furthermore, when inserting either guide tube, the fixing tube provided at the proximal end of the insertion section of the child endoscope can be connected to the guide tube via the adapter. Saline and various treatment tools can be inserted into the guide tube from the adapter without protruding from the tip.

[Brief explanation of drawings]

Fig. 1 is an overall view showing the outline of this device, Fig. 2 is an enlarged view of the tip of the main endoscope insertion section, and Fig. 3 is a perspective view of the guide tube inserted into the forceps hole of the main endoscope. Figure 4 is an explanatory diagram of the state in which the master endoscope is inserted into the duodenum and the guide tube is inserted toward the nipple, Figure 5 is a cross-sectional view showing details of the adapter, and Figure 6 is a diagram showing how the spliced tube is connected. A front view, FIG. 7 is a sectional view showing the joint, FIG. 8 is an explanatory diagram of inserting the endoscope after removing the parent endoscope, and FIG. 9 is an explanatory diagram of inserting a large diameter guide tube.
FIG. 10 is an explanatory diagram of inserting the insertion section of the child endoscope;
Figure 11 is a sectional view showing details of the adapter;
The figure shows the state in which forceps are inserted. 1... Parent endoscope, 1'... Endoscope, 2, 2'...
Insertion section, 3, 3'... Forceps hole, 4, 4'... Insertion port, 5... Insertion section, 6... Child endoscope, 7, 19...
...Guide tube, 11,11'...forceps stand,
14, 20...adapter, 15, 16...fixing tube.

Claims (1)

[Scope of Claims] 1. A master endoscope whose insertion part having a forceps hole can be inserted up to the duodenum and a flexible guide tube guided through the forceps hole of this master endoscope and inserted into the biliary and pancreatic ducts. A child endoscope having an insertion section, two or more fixing tubes with different diameters are concentrically provided at the proximal end of the insertion section of the child endoscope so as to cover the insertion side, and Inserted into the bile/pancreatic duct through the forceps hole 2
The fixing tube corresponding to the guide tube selected from among the guide tubes having different diameters is configured to be connected to the guide tube so as to be able to communicate with each other via an adapter according to the diameter of the guide tube selected from among the guide tubes having different diameters. Endoscope device for biliary and pancreatic ducts.