JPH06217933A - Endoscope - Google Patents

Abstract

PURPOSE:To provide an endoscope that can be quickly made to function as a tube for insertion into the tracheas, which reduces the possibility of causing complications, with safety ensured. CONSTITUTION:In an endoscope 1 having a channel tube which is open at the end of an insertion portion 3 and at an at-hand portion, a base 6 at the opening of the at-hand portion is so formed that the connector of a tube 39 for feeding air into the tracheas is removably connected thereto. The endoscope is used as a tube for insertion into the tracheas.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscope which can be used for endotracheal intubation for securing an airway.

[0002]

[Prior art]

(1) Conventionally, in the case of orally intubating the endotracheal tube to deliver air into the trachea, the laryngoscope was used for larynx deployment, and then the endotracheal tube was inserted. (2) As an improvement of the laryngoscope, the observation optical system is attached to the laryngoscope to make it easier to deploy the larynx.
No. 4,306,547. (3) Further, in order to clearly confirm the intubation position of the endotracheal tube, a light guide added to the endotracheal tube is proposed in USP 4,567,882. (4) In addition, if intubation is very difficult, a method of inserting an endotracheal tube into a flexible bronchoscope (bronchial fiberscope) and inserting the flexible bronchoscope as a guide is considered.

[0003]

By the way, although an urgent situation is required when performing endotracheal intubation, complications are likely to occur at this time. The main complications are as follows. (a) Upper airway injury: The larynx and endotracheal tube damage the pharynx and larynx. (b) Intrabronchial injury: It is caused by pushing the endotracheal tube too far. (c) Displacement of the endotracheal tube ... One lung ventilation occurs due to the displacement.

In the case of (1), (a), (b),
The situation of (c) is likely to occur. In the case of (2), (b),
The situation of (c) is likely to occur. In the case of (4), the situation of (c) is likely to occur. When (4) is performed in addition to (3), the above problems (a) to (c) can be almost solved,
Pass the endotracheal tube through the insertion part of the endoscope, insert the endoscope into the patient in that state, and insert the endotracheal tube using the endoscope as a guide, so emergency endotracheal intubation is possible in the event of an accident. If it is necessary and difficult to intubate, there remains a drawback that rapid intubation is difficult to perform.

The present invention has been made in view of the above-mentioned problems, and its purpose is to enable rapid use, achieve the function of endotracheal intubation with few complications, and secure safety. It is to provide an endoscope that can.

[0006]

SUMMARY OF THE INVENTION The present invention is an endoscope having a channel tube that opens at the distal end of the insertion portion and the proximal portion, and the mouth portion of the proximal opening is provided as a separate body. The connector of the tracheal insufflator is configured to be detachably connected. For example, use the JI
A female type with a 15 mm conical joint specified in ST72013 151 is used, and the connector of the tracheal air feeding tube is connected to use the endoscope as the tracheal air feeding tube.

[0007]

1 and 2 show a first embodiment of the present invention. FIG. 1 schematically shows the endoscope system. In the figure, 1 is an endoscope, the upper one is a plan view thereof, and the lower one is a side view thereof.

This endoscope 1 constitutes an endoscope main body from an operation section 2 and an insertion section 3, and the operation section 2 communicates with an eyepiece section 4, an operation lever 5, and a channel tube described later. A base 6 for forming a hand side opening is provided. The operation section 2 of the endoscope 1 is provided with a light guide mouthpiece 9 to which a tip connector 8 of an external light guide cable 7 is detachably connected. The external light guide cable 7 is configured such that the proximal end connector 10 is inserted into the connection port 12 of the light source device 11 to be connected, and the illumination light is transmitted to a light guide fiber of the endoscope 1 described later.

The insertion portion 3 of the endoscope 1 is constructed as shown in FIG. The tip frame 15 is made of metal or resin,
This is provided with a tip opening 17 communicating with the channel tube 16, an illumination lens 19 that spreads the illumination light from the light guide fiber 18, and an objective lens 21 that forms an observation visual field on the tip surface of the image guide fiber 20. The channel tube 16 is usually used as a passage for a treatment tool such as forceps and as a suction passage. When a gas supply tube 39 described later is connected to the channel tube 16, it is also used as a gas supply pipeline. It Therefore, it is desirable that the inner diameter is at least 2 mm or more, preferably 5 mm or more. That is, the endoscope 1 can be used as a tracheal air supply tube.

The bending portion 22 of the insertion portion 3 is constructed as shown in FIG. 2 (b). That is, in the bending portion 22, the bending pieces 24 ... Are inserted inside the rubber-like outer tube 23.
Are arranged side by side in the longitudinal axis direction. Further, each of the bending pieces 24 ... Can be bent by its adjacent end portions being rotatably connected by a rivet 25. In addition, a pair of bending operation wires 26 are provided in the insertion portion 3.
Is inserted and disposed.

The bending operation wire 26 is fixed to the most distal bending piece 24, and is held and guided between the peripheral wall of the bending piece 24 ... And the narrowed portion 27. And the bending operation wire 2
The base end of 6 is connected to a wire operating mechanism operated by the operating lever 5. Therefore, by operating the operation lever 5 and pulling one of the bending operation wires 26, the bending portion 22 can be bent in that direction. The tip end of the channel tube 16 is connected so as to communicate with the tip opening 17, and the base end is connected to the mouthpiece 6 of the operation portion 2. The length of the insertion portion 3 of the endoscope 1 is preferably 300 mm to 380 mm.

On the other hand, the base 6 has the outer periphery of its mouth portion 37,
It has a male shape of 15 mm conical joint specified in ISO3040 and JIST72013 151. This mouthpiece 6 has a suction plug 38
Alternatively, the connector 40 of the gas supply tube 39 is selectively and detachably attached. The gas supply tube 39 is connected to a ventilation device (not shown) used to manage the breathing of the patient. The connector 40 of the gas supply tube 39 is provided in the mouth portion 37 of the mouthpiece 6.
It consists of a 15 mm conical joint female connector that fits the outer circumference of the connector and can be detachably attached to the base 6.

On the other hand, the inner surface 38a of the mounting portion of the suction plug 38
Is adapted to the outer peripheral shape of the mouth body portion 37 of the base 15.
It is a female connector shape of mm conical joint. The suction plug 38 has a suction mouthpiece 41, and one end of a suction tube 42 is attached to the suction mouthpiece 41. The other end of the suction tube 42 is connected to the suction port portion 44 of the suction device 43. The operator has an opening 45 formed at the upper end of the suction plug 38, and by closing the opening 45 with a finger, suction can be performed by the suction port formed by the distal end opening 17 of the insertion portion of the channel tube of the endoscope 1. Is.

Therefore, for patients who need tracheal intubation,
The suction plug 38 is attached to the mouthpiece 6 of the operation unit 2 of the endoscope 1, and the suction device 43 is connected via the suction tube 42. Further, it is connected to the light source device 11 via the external light guide cable 7. Then, while performing appropriate suction, the bending portion 22 of the insertion portion 3 is bent, and the distal end of the insertion portion 3 is inserted up to the front of the tracheal branch portion.

After that, the suction plug 38 and the external light guide cable 7 are removed from the endoscope 1, and the connector 40 of the gas supply tube 39 is connected to the base 6 of the operating portion 2 of the endoscope 1 to The endoscope 1 is used as a tracheal tube. If necessary, the endoscope 1 is connected to the light source device 17 via the external light guide cable 7,
It is confirmed whether or not the endoscope 1 is displaced. If necessary, a suction plug 38 is attached to suck the sputum of the patient.

However, according to the configuration of the endoscope 1,
Since it is inserted while observing with the endoscope 1, it is possible to avoid the risk of damaging the upper airway and to introduce the upper airway at the correct position. Since there is no need to insert an endotracheal tube, rapid intubation can be performed. Further, even after the endoscope 1 is changed to the endotracheal tube, suction and position confirmation are easy.

FIG. 3 is an endoscope showing a second embodiment of the present invention. This endoscope 50 is of a type in which the flexible insertion portion 3 has no curved portion, and the other configurations are the same as those of the first embodiment described above. When using this, the base 6 of the operating unit 2
In addition, the stylet 51 is inserted into the channel tube 16 so that the insertion portion 3 of the endoscope 50 can be bent into a shape that can be easily inserted into the trachea.

Then, after inserting the stylet 51 into the channel tube 16 and bending the insertion portion 3 into a shape that can be easily inserted into the trachea, the tip of the insertion portion 3 of the endoscope 50 is extended to the tracheal branch while observing. insert. Then, as in the first embodiment described above, the stylet 51 and the external light guide cable 7 are removed, the gas supply tube 39 is connected, and the endoscope 50 is used as an endotracheal tube. If necessary, an external light guide is attached to correct the positional deviation, and a suction plug 38 is attached to suck the sputum of the patient. According to this embodiment, by using the stylet 51, the insertion portion 3 of the endoscope 50 has a shape that allows easy insertion into the trachea.
The bending mechanism is no longer needed.

FIG. 4 shows an endoscope 53 showing a third embodiment of the present invention. As shown in FIG. 4A, the endoscope 53 is provided with a cuff 55 on the outer circumference of the distal end portion of the insertion portion 54. Further, air can be injected into the operation portion 2 from an injection tube 56 communicating with the cuff 55 through a passage (not shown) formed in the endoscope body to inflate the cuff 55. In the middle of the injection tube 56, a pilot balloon 57 for confirming the degree of swelling of the cuff 55 is provided. Then, the mouth portion 58 of the injection tube 56
Is provided with a cap 59 for sealing the opening. Other configurations are the same as those of the second embodiment described above. Then, when the pressure fluid is supplied through the injection tube 56 after the insertion of the endoscope, the cuff 55 is inflated as shown in FIG. 4B. Then, it is possible to prevent air leakage during suction.

FIG. 4 shows the vicinity of the distal end portion 62 of the insertion portion 61 in the endoscope according to the fourth embodiment of the present invention. That is, a tip opening (suction port) 17 communicating with the channel tube 16 is opened in the tip frame 63 of the tip portion 62, and an end face 64 of the tip opening 17 is inclined with respect to the longitudinal axis direction of the insertion portion 62. is doing. Then, the tip frame 63
Since the end surface 64 of the distal end opening 17 is inclined, it is easy to pass the glottis and easily inserted into the trachea. Others are the same as the other embodiments described above.

FIG. 6 shows an endoscope system according to a fifth embodiment of the present invention. Reference numeral 71 in the figure is a first endoscope of a type that is used by inserting it into the trachea or bronchus. The first endoscope 71 includes an eyepiece section 72, an operation section 73 with a grip section, and an insertion section 74. The operation portion 73 is connected to the bending lever 75 for bending a not-shown bending portion provided at the tip of the insertion portion 74, and the above-mentioned channel tube provided in the insertion portion 74 and opened at the tip thereof. A base 76 having an opening and a suction opening 77 are provided.

A separate suction plug 78 is detachably attached to the suction opening 77. The suction plug 78 has a suction mouthpiece 79 to which a suction tube (not shown) connected to a separate suction device (not shown) is connected, and the operator operates the upper elastic member. By operating the portion 80, the valve portion 81 interposed between the suction tube and the channel tube is opened and closed. The channel base 76 is provided on the operation unit 73.
Has a flange 83 for connecting and fixing a separate forceps plug 82.

Further, there is provided a gas supply tube 84 connected to a ventilation device used for respiratory management of a patient during surgery, that is, a tracheal air supply device. At one end of the gas supply tube 84, a female connector 85 having a 15 mm conical joint, which is normally defined in JIST 72013 151, is attached.

Further, a portable first oxygen cylinder 86 is provided, and a regulator 87 for adjusting the flow rate is provided at the mouth of this oxygen cylinder 86. The base 88 of the oxygen cylinder 86 has the same connector shape as the connector 85 described above.

In the figure, reference numeral 89 is the above-mentioned first endoscope 71.
Similarly to the above, the second endoscope is used by being inserted into the trachea or bronchus. The second endoscope 89 is the first endoscope 7
Similar to the first embodiment, the eyepiece portion 72, the operation portion 73, and the insertion portion 74 are provided, but a dedicated oxygen administration base 91 communicating with the inside of the channel tube is provided on the side surface of the forceps opening portion 90. A cap 92 for closing the opening of the mouthpiece 91 when oxygen is not administered is connected to the mouthpiece 91 via a connecting means 93.

Further, a second oxygen cylinder 94 is provided,
This equips the mouth with the regulator 87 like the 1st oxygen cylinder 86 mentioned above. However, the base 95
Has a dedicated shape that can be airtightly connected and fixed to the shape of the oxygen administration base 91 of the second endoscope 89.

On the other hand, 96 and 97 are adapters for connecting the 15 mm standard connector to the forceps opening 90 of the first endoscope 71. The first adapter 96 has a cylindrical main body 98, which has an opening 99 at one end and an opening 100 at the other end. One opening 99 has a shape that can be connected and fixed airtightly and liquidtightly to the flange 83 of the channel mouthpiece 76, like the mouth portion of the forceps plug 82. The other opening 100 is formed in the same shape as the channel mouthpiece 76, while the forceps plug 8
2 can be connected airtightly and liquidtightly. First adapter 96
A cylindrical male type 15 mm standard connector 101, which is hermetically connected and fixed to the inner wall of the female type 15 mm standard connector, is provided on the side surface of the main body 98 of the standard type connector 1.
The inner cavity of 01 is the main body 9 that opens at the opening 99, 100.
It communicates with 8 lumens.

The cylindrical body 102 of the second adapter 97
Has an opening 103 at one end and an opening 104 at the other end.
The opening 103 has the same shape as the mouth portion of the forceps plug 82 and can be connected and fixed to the flange 83 in an airtight or liquid-tight manner, and the other opening 104 is airtightly connected to the inner wall of the female type 15 mm standard connector. The standard connector 101 fixed
It has the same cylindrical male connector as.

Further, a third adapter 105 is provided, which is the female type 15 mm standard connector 85.
This is an extension connector in which the connector 85 of the same type as the above and the connector 101 of the same type as the male type 15 mm standard connector 101 are connected by a flexible tube 106.

A further fourth adapter 107 is provided, which is a male 15 mm standard connector 101.
A specially shaped base 108 that can be airtightly connected and fixed to the same type of connector 101 and the oxygen administration base 91 of the second endoscope 89.
Is an extension connector in which a flexible tube 109 is connected.

Further provided fifth adapter 110
Has a connector 85 of the same type as the female type 15 mm standard connector 85 at one end and a base 111 having the same shape as the oxygen administration base 91 of the second endoscope 89 at the other end. The final sixth adapter 112 is provided with a base 114 having the same shape as the oxygen delivery base 91 of the second endoscope 89 at one end of a flexible tube 113.

In the figure, reference numeral 115 is a third endoscope. Like the other endoscopes 71 and 89, the third endoscope 115 includes an eyepiece portion 72, an operation portion 73, and an insertion portion 74, but the operation portion 73 is provided with a suction mouthpiece 116. . The pipe line in the suction mouthpiece 116 communicates with the channel pipe in the insertion portion 74, but is normally opened to the leak hole 118, and the leak hole 118 is opened by operating the valve operating lever 119 of the suction plug 117. It has a structure in which the side pipeline is closed and the channel side pipeline is opened.

When the endoscope system is used, however, it is necessary to administer oxygen to the patient by performing tracheal intubation in a place where there is no dedicated respiratory control device, such as outdoors during an emergency. Is performed as follows.

A suction plug 78 is attached to the suction opening 77 of the endoscope 71.
And connect the adapter 97 to the forceps opening 76.
Connect. The opening 103 of the adapter 97 is hermetically connected and fixed to the flange 83 of the forceps opening 90. Next, the base 88 of the portable oxygen cylinder 86 is connected to the opening 104. After inserting a tracheal tube (not shown) into the insertion portion 74 of the endoscope 71, the regulator 87 of the portable oxygen cylinder 86 is inserted while inserting the insertion portion 74 into the airway of the patient.
Is operated to supply oxygen in the portable oxygen cylinder 86 into the channel tube of the endoscope 71 at an appropriate flow rate.

Until the operator slides the tracheal tube around the insertion portion 74 of the endoscope 71 and places the endotracheal tube at an appropriate position in the airway of the patient, oxygen passes through the channel tube and the oxygen of the insertion portion 74 is transferred. Administered from the tip into the patient's respiratory tract. And
After leaving the tracheal tube in place, the endoscope 71 is removed, the portable oxygen cylinder 86 is removed from the adapter 97, and the mouthpiece 88 is attached to the mouthpiece of the tracheal tube (usually the male type 15
mm standard connector) and then administer oxygen into the patient's respiratory tract.

Next, a case where oxygen is administered to a patient during treatment under endoscopic observation will be described. When performing a tissue biopsy or the like on a patient whose lung function has deteriorated, a suction plug 78 is connected to the suction opening 77 of the endoscope 71, and an adapter 96 is connected to the forceps opening 76. This adapter 9
The opening 99 of 6 is airtightly connected and fixed to the flange 83 of the forceps opening 90. A forceps plug 8 is provided in the other opening 100.
Connect two. The male type 15mm standard connector 101 has
A female type 15 mm standard connector 85 at the tip of an oxygen gas supply tube 84 connected to a respiratory management device prepared in advance is connected to the examination room.

The operator inserts various kinds of processing tools into the channel through the opening of the forceps plug 82 and performs treatment under endoscopic observation such as tissue biopsy. During that time, it is supplied from the respiratory management device. Oxygen is injected from the adapter 96 into the patient's airway through the forceps and the gap in the channel and from the tip of the insertion portion 74. At this time, the portable oxygen cylinder 86 may be connected to the connector 101 when the respiratory management device is not ready due to sudden lung function deterioration or the like. If the portable oxygen cylinder 86 is directly connected to the adapters 96 and 97 due to the patient's body position, if the adapter 105 interferes with the operation of the endoscope, the adapter 105 is installed at a position away from the endoscope 71. It is used to connect the oxygen cylinder 86 and the adapter 96 or another adapter 97.

Next, the case of using the endoscope 89 having the dedicated oxygen administration base 91 will be described. A suction plug 78 is connected to the suction opening 77 of the endoscope 89, and
The cap 92 connected to the oxygen administration base 91 is removed, and the base 95 of the portable oxygen cylinder 94 is hermetically connected to the oxygen administration base 91. And regulator 87
Is operated appropriately to supply oxygen at an appropriate flow rate into the channel tube of the endoscope 89.

The adapter 107 is an oxygen administration base 9
Endoscope 89 with 1 and female 15mm standard connector 8
Oxygen cylinder 8 as an oxygen supply medium having 5,101
It is a compatible adapter used when combining 6,94. The adapter 110 is a compatible adapter used when the portable oxygen cylinder 94 having the oxygen administration base 95 and the male type 15 mm standard connector adapters 96 and 97 are combined.

Next, the endoscope 11 having the suction mouthpiece 116.
The case of using 5 will be described. The tube 113 of the adapter 112 is connected to the suction mouthpiece 116 of the endoscope 115, and the portable oxygen cylinder 94 is connected to the mouthpiece 114. Oxygen sent into the tube 113 by operating the regulator 87 is released to the outside air through the leak hole 118 of the suction plug 117 through the suction mouthpiece 116. Therefore, the operator operates the valve operating lever 119 to close the valve on the leak conduit side so that the inside of the suction mouthpiece 116 and the inside of the channel tube of the endoscope 115 communicate with each other, and oxygen is introduced from the distal end of the insertion portion into the airway of the patient. Can be administered.

According to this system, however, oxygen can be easily administered into the respiratory tract of a patient from a portable oxygen cylinder even in a place without a dedicated respiratory management device. In an emergency, if you want to secure the airway and administer oxygen as soon as possible, even if it is difficult to intubate and it takes time to insert the tracheal tube,
The various endoscopes 71, 89, 115 that can be easily inserted can continue to administer oxygen, and the hypoxic state of the patient can be stopped for the shortest time. Not only a portable oxygen cylinder but also a standard 15mm adapter can be connected, so it can be connected to an existing respiratory management device. Further, oxygen can be administered while using the endoscopic treatment tool. Furthermore, by providing a dedicated mouthpiece, a portable oxygen cylinder can be connected without using a means such as an adapter. Moreover, even if the endoscope and the mouthpiece of the oxygen administration medium are different, the connection can be made by the compatible adapter.

[0042]

As described above, according to the present invention, the endoscope can be immediately used as a tracheal tube. The endoscope as a tracheal air supply tube can be quickly inserted, and the insertion site can be easily confirmed and used safely. Moreover, since the endoscope used as a tracheal air supply tube is inserted while observing, it can be used safely with less damage to the upper airway.

[Brief description of drawings]

FIG. 1 is an explanatory diagram schematically showing an endoscope system according to a first embodiment of the present invention.

FIG. 2A is a front view of the tip of the insertion portion of the endoscope,
(B) is a horizontal cross-sectional view of the distal end portion, and (c) is a vertical cross-sectional view of the curved portion of the insertion portion of the endoscope.

FIG. 3 is a side view showing an endoscope according to a second embodiment of the present invention.

4A and 4B are plan views showing an endoscope according to a third embodiment of the present invention.

FIG. 5 is a perspective view showing a distal end portion of an insertion portion of an endoscope according to a fourth embodiment of the present invention.

FIG. 6 is an explanatory diagram schematically showing an endoscope system according to a fifth embodiment of the present invention.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Endoscope, 2 ... Operation part, 3 ... Insertion part, 6 ... Base, 16
... Channel tube, 39 ... Gas supply tube.

Claims (1)

[Claims] 1. An endoscope having a channel tube opened at a distal end of an insertion portion and a proximal portion, wherein a separate tracheal air feeding device is detachably attached to a mouth portion of an opening portion on the proximal portion side of the channel tube. An endoscope provided with connecting means for connecting.