JPH0438415B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Field of Industrial 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. Therefore, 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, so the distal end has been designed to be curved in two directions, up and down.

[Problem to be solved]

In the conventional parent-child scope system, the tip of the child endoscope's insertion section is inserted directly into the nipple, so the tip must be curved to ensure reliable insertion, and saline solution for irrigation must be used. A passage for feeding and a hole for inserting the treatment tools were also required, so the outer diameter had to be large (3.5mm outer diameter). When inserting into the pancreatic duct, which is smaller than the bile duct, the outer diameter is 3.5.
The operation of inserting the distal end of the insertion tube, which has a length of mm, was extremely difficult and required skill. In addition, there was a risk that the tip of the insertion portion might damage the nipple.

SUMMARY OF THE INVENTION Therefore, an object of the present invention is to provide a bile/pancreatic duct endoscopic device that can be inserted reliably and easily, without the risk of damaging the papilla, and into which various treatment tools can be inserted.

[Means to solve the problem]

In order to achieve the above object, the present invention provides a first guide tube having flexibility to be inserted into the bile/pancreatic duct from the insertion port of the parent endoscope through the forceps hole;
a joint tube connected to the guide tube; a second guide tube that is thicker than the first guide tube and flexible enough to be guided by the joint tube and the first guide tube and inserted into the bile/pancreatic duct; 2. A fixing tube attached to the proximal end of the insertion part inserted into the guide tube, and a fixing tube attached to the proximal end of the insertion part of the secondary endoscope so as to seal the gap between the fixing tube and the insertion part of the secondary endoscope. and the second guide tube and the fixing tube after the first guide tube and the joint tube are removed from the second guide tube guided by the first guide tube and inserted into the bile/pancreatic duct. A treatment tool such as forceps, saline water, etc. is passed through the second guide tube from the straight tube part of the adapter, which has at least a three-pronged path inside and one or more crossed tubes, to which both ends are attached. It is constructed so that it can be inserted into or injected into the biliary and pancreatic ducts.

[Effect]

In this invention, the papilla of the duodenum is confirmed at the tip of the insertion section of the parent endoscope, and then the small-diameter first tube is inserted through the insertion port.
The guide tube is inserted through the forceps hole, and the tip of the first guide tube is inserted toward the nipple by operating the forceps stand or the like at the tip of the insertion portion. Once the first guide tube has been inserted into the bile duct or pancreatic duct via the papilla, a spliced tube is connected to this first guide tube, and the second guide tube is guided by these tubes.
Insert the guide tube into the biliary and pancreatic ducts. At this time, since the first guide tube has a diameter that allows it to easily enter the pancreatic duct, a master endoscope with a narrow forceps hole can be used to facilitate the insertion operation. In this case, the parent endoscope with a small diameter forceps hole is removed, and the tube and the first guide tube are inserted into the forceps hole of another parent endoscope which has a large diameter forceps hole into which the second guide tube can be inserted. It is also possible to replace the parent endoscope as it is inserted. Next, the insertion section of the child endoscope is inserted into the second guide tube. At this time, when the other end of the adapter is attached to the second guide tube, the tip of the insertion portion is configured so that it is substantially aligned with the tip of the second guide tube and does not protrude, so that the tip of the insertion portion crosses the bile/pancreatic duct. Safe without causing any damage. Furthermore, since the gap between the second guide tube and the insertion section is relatively wide, the treatment instrument and saline can be inserted through the crossover tube of the adapter using this gap.

〔Example〕

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

FIG. 1 is a schematic diagram of the entire apparatus of this invention,
A forceps hole 3 is provided in the insertion section 2 inserted into the duodenum 100.
a first guide tube 5 that is inserted into the forceps hole 3 from an insertion port 4 that communicates with the forceps hole 3 of the parent endoscope 1; The second guide tube 6 has a thickness that allows the first guide tube 5 to be inserted therein, and a child endoscope 8 has an insertion section 7 that is inserted into the bile duct 102 or the pancreatic duct 103. The insertion section 2 of the parent endoscope 1 is designed to be orally inserted into the duodenum 100, and the forceps hole 3 has an inner diameter of 3.7 mm. In the drawing showing the parent endoscope 1, 1A is an eyepiece, and 1B is a light transmission cable connected to an external light source device (not shown). Insertion section 2 of this parent endoscope 1
The distal end has an image guide window 9, a light guide window 10, a water/air supply port 11, and a forceps stand 12 provided at the forceps hole 3, as shown in FIG. A Luer lock 13 is detachably attached to one end of the flexible first guide tube 5, and a flexible core bar 14 to be inserted into the first guide tube 5 is attached to the Luer lock 13. The tip of this core metal 14 has a length that does not protrude from the tip of the first guide tube 5. The child endoscope 8 is provided with an eyepiece 8A and a light transmission cable 8B connected to an external light source device (not shown), and a fixing tube 15 is provided on the proximal side, and one end of an adapter 16 is connected to the fixing tube 15. Ready to be installed. This adapter 16 consists of a straight pipe section 16A and a crossed pipe 16B that crosses this straight pipe section 16A.
7 and attach lure lock 1 to this tube 17.
8 is installed. The forceps hole 3 of this parent endoscope 1 is formed to have an inner diameter of 3.7 mm as described above.
The first guide tube 5 had an outer diameter of 1.7 mm.
The insertion section 2 of such a master endoscope 1 is inserted into the duodenum 10.
0, and insert the tip of the insertion section 2 into the nipple 101.
After confirming the position of the first guide tube 5
from the insertion port 4 to the forceps hole 3 and insert the forceps stand 12 into the forceps stand 12.
The tip is inserted into the nipple 101 by the operation. To determine whether the first guide tube 5 inserted from the papilla 101 has been inserted into either the bile duct 102 or the pancreatic duct 103, fluoroscopy will show the core bar 14 and reveal the insertion position. . Furthermore, a contrast medium can also be injected into the first guide tube 5 to perform contrast imaging. In this way, the first guide tube 5 is connected to the bile duct 102 or the pancreatic duct 103.
When the luer lock 13 is inserted to the desired position, the luer lock 13 is removed and the core bar 14 is pulled out, leaving only the first guide tube 5, as shown in FIG. A joint tube 21 of the same diameter is connected to the first guide tube 5 via a joint 20 (see FIG. 5),
As shown in FIG. 6, the first guide tube 5 guides the flexible second guide tube 6, and the second guide tube 6 is inserted into the bile duct 102 or pancreatic duct 103. Once the second guide tube 6 is inserted into the bile duct or pancreatic duct 103 in this way, the first guide tube 5 is inserted into the bile duct or pancreatic duct 103 as shown in FIG.
and pull out the joint tube 21. Thereafter, the insertion section 7 of the secondary endoscope 8 is inserted into the second guide tube 6. Insertion of the insertion portion 7 is stopped with the other end of the straight pipe portion 16A of the adapter 16 attached to the second guide tube 6. In this state, that is, the state shown in FIG. 9, the distal end of the insertion portion 7 is substantially aligned with the distal end of the second guide tube 6 and is configured not to protrude. The gap between the fixing tube 15 provided on the proximal side of the secondary endoscope 8 and the insertion section 7 is sealed by a sealing member 19. Therefore, even when a fluid, a treatment instrument, etc. is inserted into the gap between the second guide tube 6 and the insertion portion 7 through the intersecting tube 16B, the fluid flows toward the proximal side due to the presence of the sealing member 19. It never comes.

In the above embodiment, the inner diameter of the forceps hole 3 of the parent endoscope 1 was 3.7 mm, but the first guide tube 5 having a diameter of 1.7 mm was inserted into the 3.7 mm forceps hole 3 to remove the bile duct 102 or the pancreatic duct. The operation of inserting into 103 is the first
Since there is too much play between the guide tube 5 and the forceps hole 3, it becomes a little difficult to insert the first master endoscope 1' whose inner diameter of the forceps hole 3 is 2.8 mm as shown in Fig. 10. First guide tube 5 from mouth 4'
the bile duct 102 or pancreatic duct 1 according to the procedure described above.
03 and protrudes from this insertion opening 4'.
A joint tube 21 is connected to the guide tube 5 via a joint 20. After connecting the joint tube 21, the first master endoscope 1' is taken out from the first guide tube 5 and the auxiliary tube 21. Then, insert the tip of the insertion section 2 of the parent endoscope (which will become the second parent endoscope) 1 described earlier through the forceps hole 3 having an inner diameter of 3.7 mm, and insert the insertion section 2 into the duodenum 100. (See Figure 11). After replacing the first master endoscope 1' with the second master endoscope 1 in this way, the second guide tube 6
is inserted into the bile duct 102 or the pancreatic duct 103 while being guided by the joint tube 21 and first guide tube 5. The subsequent steps are as described above. Master endoscope 1 with forceps hole 3 with an inner diameter of 3.7 mm
The adapter 1 is inserted into the duodenum 100.
FIG. 12 shows a state in which the forceps 22 are inserted from the chiasm tube 16B of No. 6 and into the pancreatic duct 103 through the gap between the second guide tube 6 and the fiberscope 7.

The adapter 16, which is attached at both ends to the fixing tube 15 and the second guide tube 6, is not limited to the Y-shaped one having a three-way intersection inside, and can be used to directly connect the intersection tube 16B as shown in FIGS. 13 and 14. Pipe section 16
It may be provided for A, or two or more crossing tubes 16
B can also be provided. 2 or more crossing tubes 16B
In the adapter 16 provided with
It is also possible to insert a treatment instrument such as the forceps 22 through the opening and inject saline or the like through the other chiasm tube 16B.

〔effect〕

As explained above, according to the present invention, the first guide tube with a small diameter is first inserted into the biliary and pancreatic ducts through the papilla, and the connecting tube is connected to the first guide tube with a small diameter. The second guide tube, which has a larger diameter, is inserted into the biliary and pancreatic ducts while being guided by the tube.
Due to the flexibility of the guide tube, there is no risk of damaging the nipple or biliary/pancreatic duct. In addition, when it is desired to not only observe the bile/pancreatic duct but also to perform treatment, the second guide tube can be inserted into the bile/pancreatic duct while being guided by the first guide tube and the connecting tube. has already been inserted into the biliary/pancreatic duct, so even if the second guide tube has a large diameter, it can be smoothly inserted into the biliary/pancreatic duct. After inserting the second guide tube, pull out the first guide tube and the joint tube, and attach the other end of the adapter of the child endoscope to this second guide tube. Treatment instruments such as forceps can be inserted, and the biliary and pancreatic ducts can be treated and observed, and furthermore, clear observation can be made by injecting saline or the like through the chiasm of the adapter.

[Brief explanation of drawings]

Fig. 1 is a schematic diagram of the entire device, Fig. 2 is an enlarged view of the tip of the insertion section of the main endoscope, and Fig. 3 shows the insertion section of the main endoscope inserted into the duodenum and the first guide tube inserted into the nipple. Figure 4 is an explanatory diagram of the state facing the
A front view showing the state in which the Luer lock and core bar are pulled out after inserting the guide tube into the bile duct or pancreatic duct, Fig. 5 is a sectional view of the part where the connecting tube is connected, and Fig. 6 is a sectional view of the part where the connecting tube is connected. Figure 7 is a front view of the state in which the second guide tube is about to be inserted into the bile/pancreatic duct.
FIG. 8 is a front view of the state in which the guide tube and joint tube are pulled out, FIG. 8 is a front view of the state in which the insertion section of the secondary endoscope is inserted into the second guide tube, and FIG. A cross-sectional view of the state in which it is attached to the guide tube, Figure 10 is a front view of the state in which the first master endoscope is removed, and Figure 11 is a front view of the state in which the first master endoscope is removed and the insertion section of the master endoscope is inserted after the first master endoscope is removed. Figure 12 is a cross-sectional view of the child endoscope connected to the parent endoscope and the forceps inserted into the pancreatic duct from the adapter. Figures 13 and 14 show modified examples of the adapter. FIG. 1, 1'... Parent endoscope, 2... Insertion section, 3...
Forceps hole, 4, 4'... Insertion port, 5... First guide tube, 6... Second guide tube, 7... Fiber scope, 8... Child endoscope, 16... Adapter, 16A... Straight pipe section, 16B...Cross pipe,
21...Tie tube.

Claims (1)

[Scope of Claims] 1. A flexible first guide tube that is inserted into the bile/pancreatic duct from the insertion port of the parent endoscope through the forceps hole, a connecting tube connected to the first guide tube, and a first guide. A second guide tube that is thicker than the tube and has flexibility to be inserted into the bile/pancreatic duct while being guided by the spliced tube and the first guide tube, and a proximal end of the insertion portion to be inserted into the second guide tube of the child endoscope. a fixing tube attached to the side; a sealing member provided on the proximal side of the insertion section of the secondary endoscope so as to seal the gap between the fixation tube and the insertion section of the secondary endoscope; and a first guide tube. It consists of an adapter whose both ends are attached to the second guide tube and the fixing tube after the first guide tube and the connecting tube are removed from the second guide tube guided and inserted into the biliary/pancreatic duct, and at least inside the second guide tube. The adapter has a three-pronged path and is composed of a straight tube section and one or more crossed tubes, and is configured so that treatment instruments such as forceps, saline, etc. can be inserted or injected into the biliary and pancreatic ducts through the second guide tube. A bile/pancreatic duct endoscopic device characterized by: