JPH0641535Y2 - Internal diagnosis / treatment device - Google Patents

Description

[Detailed Description of the Invention] [Industrial field of application] The present invention uses a trocar to insert an insertion member for diagnosis and treatment such as an endoscope and a surgical operation tool from the body skin of a patient into a body cavity. The present invention relates to an in-vivo diagnosis / treatment device for performing in-vivo diagnosis and treatment.

[Prior Art] A trocar is used as a guide for inserting an endoscope such as a laparoscope or an insertion member including a surgical operation tool into a body cavity. This trocar is composed of an inner needle having a sharp needle tip for inserting the body skin into the tip of the shaft, and an outer tube through which the inner needle is inserted. Then, the inner needle is inserted into the mantle tube, and the needle tip is assembled so as to project from the tip of the mantle tube. The needle tip is pierced from the body skin and introduced into the body together with the mantle tube, By guiding the distal end of the tube into the body cavity and then withdrawing the inner needle from the outer tube, an insertion path for inserting an insertion member, for example, an endoscope, into the body tube is formed inside the outer tube. An insertion portion such as an endoscope can be inserted along the insertion path to perform inspection, diagnosis, and predetermined treatment.

[Problems to be Solved by the Invention] By the way, the aforementioned insertion member is configured to include an angle portion in order to direct the distal end portion thereof in a desired direction. It is designed so that it can be bent when it is positioned at. When the insertion member is taken out after the diagnosis / treatment is completed, the angle portion is often straight when it is located inside the body. Have to be operated. However, there is a possibility that the endoscope may be pulled out while the angle portion is curved due to carelessness of the operator. Thus, if the trocar is to be pulled out from the outer tube with the angle portion being curved, it will engage with the distal end of the outer tube. Here, since the tip portion of the mantle tube is in a sharp state, there is a problem that the outer skin layer of the angle portion is scraped off and damaged, and the foreign matter scraped off in this way remains in the body. is there. In particular, since the angle ring is internally provided in the angle portion, the contour of the angle ring has an uneven shape, so that the damage to the outer skin layer is significantly increased. Further, in the case where not only the angle portion but also the flexible portion is continuously provided on the base end side of the angle portion and the flexible portion is also led out from the outer tube of the trocar into the body, the soft portion is Since it is not always in a straight state at the time of extraction, the same can be said with respect to the outer surface of the flexible portion.

The present invention has been made in order to solve the problems of the prior art, and its object is to protect the surface of the insertion member from being damaged when the insertion member is pulled out. It is to provide an in-vivo diagnostic / treatment device by enabling the above.

[Means for Solving the Problems] In order to achieve the above-mentioned object, the present invention provides a trocar having an outer tube and an inner needle inserted into the outer tube, and an inner tube inserted into the outer tube of the trocar. And a plurality of split members provided in the distal end portion of the outer tube in the axial direction to bend each split piece inward, and the outer tube has each split piece. A guide pipe for allowing the insertion member to be inserted and removed in a non-contact manner with each of the split pieces by inserting the insertion member into the body from the outer tube of the insertion portion of the insertion member. A unidirectional restricting portion that restricts the movement of the insertion portion when the insertion portion is moved in the direction of pulling out from the outer tube is formed at a position on the proximal end side of the drawn-out portion. It is characterized by being configured.

[Operation] With the configuration described above, when the insertion member is inserted into or removed from the body using the outer tube of the trocar inserted into the body as a guide, it is curved inwardly formed at the tip of the outer tube. Since it is possible to insert the split piece by pushing it apart with the guide pipe, the insertion member can be held in a non-contact state with the split piece. Also, even when the guide pipe does not spread out at the time of pulling out, the one-way regulating portion provided on the insertion member engages with the split piece and cannot move further relative to this, so that the insertion member and The mantle tube will also be pulled out. Therefore, no matter what the state of the insertion portion of the insertion member into the body is, the outer skin layer of the angle portion is not damaged when the insertion member is taken out from the body.

[Embodiment] An embodiment of the present invention will be described below in detail with reference to the drawings.

FIG. 1 shows the overall structure of the trocar 1, which is composed of an inner needle 2 and an outer tube 3. The inner needle 2 has a sharp needle tip 2b formed at the tip of the shaft portion 2a, and a large diameter portion 2c having a larger diameter than the shaft portion 2a and a finger contact portion 2d are continuously provided at the base end portion.

On the other hand, as is apparent from FIG. 2, the outer tube 3 is entirely made of a cylindrical member having elasticity such as a metal pipe, and has a cylindrical portion having an inner diameter through which the inner needle 2 can be inserted. A large diameter portion 3b that engages with the large diameter portion 2c of the inner needle 2 is formed at the base end portion of 3a, and the outer surface portion of the distal end portion of the tubular portion 3a is inclined inwardly toward the distal end portion. It is a thinned part 3c that has been cut into. Then, a plurality of split pieces 4 are formed in the axial direction from the tip portion of the thinned portion 3c to the middle of the tubular portion 3a. As shown by the phantom lines in FIG. 4 is deformed so as to be curved inward.

The trocar 1 configured as described above has the outer tube 3 thereof.
With the inner needle 2 inserted therein, insert the inner needle 2 into the body through the skin, and guide the tip of the mantle tube 3 to a position where it enters the body cavity to be diagnosed or treated. , Inner needle 2
When the tube is pulled out from the outer tube 3, an insertion path into the body cavity is formed in the outer tube 3. Therefore, as shown in FIG. 3, for example, the insertion portion 11 of the endoscope 10 is inserted into the insertion path formed by the outer tube 3 as an insertion member.

Here, the insertion portion 11 of the endoscope 10 has a distal end hard portion 11a provided with an illumination window, an observation window, a processing tool outlet, etc. at the distal end, and the distal end hard portion 11a is provided with an angle portion 11b. Then, by bending the angle portion 11b, the tip hard portion 11a
Can be directed in a desired direction.
A connecting portion 11c for connecting to the main body operating portion is connected to the base end portion of the angle portion 11b, and the connecting portion 11c has a soft structure or a hard structure.

As is well known, the angle portion 11b has an outer shell formed by connecting a large number of angle rings inside the angle portion 11b. Therefore, the outer surface has a gentle uneven shape.
Then, in the continuous portion between the angle portion 11b and the connecting portion 11c, a sloping slope portion 12a is formed from the angle portion 11b side toward the connecting portion 11c side, and a step portion 12b is formed on the connecting portion 11c side. A one-way restricting portion 12 is formed. When the insertion portion 11 is to be inserted into the outer jacket tube 3, the one-way restricting portion 12 can pass through the split piece 4 of the outer jacket tube 3 so as to spread along the inclined portion 12a. However, when the insertion portion 11 is to be pulled out, the split piece 4 engages with the step portion 12b of the one-way regulation portion 12 to regulate the withdrawal of the insertion portion 11 as shown in FIG. It is like this.

Further, 20 is a guide pipe, and this guide pipe
The endoscope 20 is inserted into the outer tube 3 so that the endoscope 10
The insertion portion 11 is configured to serve as a guide when the insertion portion 11 is inserted into and removed from the outer tube 3. The guide pipe 20 is composed of a cylindrical metal pipe or the like, the outer diameter of which is slightly smaller than the inner diameter of the tubular portion 3a of the outer tube 3 and the insertion portion of the endoscope 10.
The diameter is slightly larger than the outer diameter of 11, and a large diameter portion 20a is formed at the base end portion thereof.

As shown in FIG. 5, the guide pipe 20 is inserted into the guide tube 20 until the distal end of the guide pipe 20 reaches a position near the distal end portion of the outer tube 3, and as shown in FIG. It can be slidably displaced between the curved portion and the retracted position retracted to the base end side. Then, in order to position the guide pipe 20 at the endoscope guide position and the retracted position, a click device hole is formed in the large diameter portion 3b of the outer tube 3.
21 is formed, and a click ball 22 is biased by a spring 23 in the click device hole 21 so as to project from the inner surface of the outer tube 3, and the click ball 22 engages with the outer surface of the guide pipe 20. Circular recesses 24a, 24b that mate with each other are recessed.

At the position where the click ball 22 is engaged with the one recess 24a, the portion of the guide pipe 20 where the split piece 4 is formed is pushed outward in the radial direction, and the insertion portion 11 of the endoscope 10 is made thinner.
It can be inserted without making contact with. Further, at the position where the click ball 22 engages with the other concave portion 24b, the tip end portion of the guide pipe 20 is located closer to the base end portion than the curved portion of the split piece 4, and as a result, the outer tube 3 The thinned portion 3c is in a free state, and is curved inward so as to contact the outer surface of the insertion portion 11.

The present embodiment is configured as described above, and when performing internal diagnosis or the like using the endoscope 10, first, the mantle tube 3 is used.
The trocar 1 having the inner needle 2 inserted therein is inserted through the body skin, and the tip thereof is guided into the body cavity to be diagnosed. Here, the thinned portion 3c at the distal end portion of the outer tube 3 is split, and a plurality of split pieces 4 are formed. Since the split pieces 4 are curved inward, a space is formed between them and the inner needle 2. Since there is almost no step, the operability for insertion is improved. Then, when the inner needle 2 of the trocar 1 is pulled out, the outer tube 3 secures an insertion path into the body cavity.

In this state, the guide pipe 20 is inserted into the outer tube 3 until it reaches the endoscope guide position, and the split piece 4 at the tip of the guide pipe 20 is expanded. This allows the endoscope
The insertion portion 11 of 10 is a split piece 4 which is originally deformed inward.
It can be smoothly inserted to a predetermined position in a non-contact state, and there is no risk of damaging the insertion portion 11.

In this way, the insertion portion 11 of the endoscope 10 is guided into the body cavity,
At this time, the insertion route into the body cavity is the outer tube 3
From the relationship secured by the above, the portion protruding from the tip of the outer tube 3 is the tip hard portion 11a and the tip hard portion 11a.
From the angle portion 11b for directing the desired direction to the connecting portion 1
It suffices that the portion connected to 1c, that is, the position where the one-way restricting portion 12 projects from the tip of the outer tube 3 is sufficient. In this state, by appropriately bending the angle portion 11b, the distal end hard portion 11a can be oriented in a desired direction to observe and diagnose the inside of the body cavity, or to perform treatment or the like.

By the way, in order to obtain a wide observation field of view by the endoscope 10 in the body cavity, and in order to protect the wall of the body cavity, incombustible gas may be supplied to the inside of the body cavity. In order to prevent leakage as much as possible, it may be preferable to bring the outer tube 3 and the insertion portion 11 into close contact with each other. In such a case, the guide pipe 20 may be displaced to the retracted position so that the split piece 4 of the outer tube 3 is brought into a free state, and the distal end portion thereof is brought into close contact with the insertion portion 11.

After the operation of the endoscope 10 is completed in this way, in order to take out the endoscope 10 from the body cavity, the insertion section 11 is pulled out from the body cavity, but at this time, the guide pipe 20 is set as the endoscope guide position. By placing the insertion portion 11, the insertion portion 11 can be pulled out smoothly without resistance, and the outer skin layer surface is not damaged.

Further, after operating the endoscope 10 while holding the guide pipe 20 at the retracted position, the insertion portion 11 may be pulled out without displacing the endoscope 10 to the endoscope guide position. In this case, the step portion 12b of the one-way restricting portion 12 provided between the angle portion 11b and the connecting portion 11c engages with the split piece 4 of the outer sheath tube 3 to separate the insertion portion 11 from the outer sheath tube 3. When the operation of pulling out the insertion portion 11 from the body cavity is stopped, the outer tube 3 is also pulled out, and the angled portion 11 is formed by the pointed portion of the thinned portion 3c of the outer tube 3.
It is possible to reliably prevent the inconvenience such as the outer skin layer surface of b being damaged, and the foreign matter scraped off inside the body remaining.

In addition, in the above-described embodiment, the case where the endoscope is used as the insertion member inserted through the outer tube 3 of the trocar 1 has been described, but various surgical tools and the like other than the endoscope are described. It goes without saying that it can be used.
Further, the arranging position of the one-way restricting portion 12 is not limited to the connecting portion 11c of the angle portion 11b, and for example, the angle portion is continuously provided with a flexible portion having a rubber or synthetic resin outer skin layer,
In the case where the soft portion is also structured to be led out from the outer tube 3 of the trocar 1 into the body, the one-way regulating portion may be arranged at a position near the base end of the portion to be inserted into the body. .

[Effects of the Invention] As described above, according to the present invention, a split is formed in the tip portion of the outer tube of the trocar, the split piece is curved inward, and the insertion member is A guide pipe for engaging and disengaging the split pieces in a non-contact manner is fitted so as to be relatively movable with respect to the outer tube, and further, in one direction at the base end side position of the portion of the insertion member that is guided into the body from the outer tube. Since the regulation portion is formed, when the insertion member is inserted into or removed from the outer tube, the action of the guide pipe causes
It can be inserted and removed very easily in a state where it is not in contact with the mantle tube with a sharp tip, and when performing diagnosis or treatment, the guide pipe is displaced so that the tip part of the mantle tube is brought into close contact with the insertion member. It is also possible, and even if you try to pull out the insertion part without covering the split piece of the outer tube with the guide pipe, the split piece engages with the one-way restricting part of the insertion member, and the outer tube is inserted together with the insertion member. Because it is pulled out, the surface of the angled part of the insertion member etc. is scraped off and damaged,
It is possible to reliably prevent a situation in which foreign matter remains in the body.

[Brief description of drawings]

1 to 4 show a first embodiment of the present invention. FIG. 1 is a half sectional view of a trocar, FIG. 2 is an external view of an outer tube, and FIG. 3 is an internal view of the outer tube. FIG. 4 is an operation explanatory view showing a state in which a mirror is inserted, FIG. 4 is an enlarged view of a main part of FIG. 3, and FIG. 5 is an apparatus configuration diagram showing an endoscope guide position of a guide pipe. 1: trocar, 2: inner needle, 3: outer tube, 3a: tubular part, 3b: large diameter part, 3c: thinned part, 4: split piece, 10: endoscope, 11: insertion part, 1
1a: tip hard part, 11b: angle part, 11c: connecting part, 12: one-way restricting part, 12a: inclined part, 12b: step part, 20: guide pipe, 21: click device hole, 22: click ball, 23 : Springs, 24a, 24b: Recesses.

Claims (1)

[Scope of utility model registration request] 1. A trocar having a mantle tube and an inner needle that is inserted into the mantle tube, and an insertion member such as an endoscope and a surgical instrument that is inserted into the mantle tube of the trocar. A plurality of splits are provided in the distal end portion in the axial direction, each split piece is curved inward, and each split piece is pushed open to the outer tube so that the insertion member does not contact with each split piece. A guide pipe for inserting and removing is provided so that it can be inserted and removed, and the insertion portion is provided at a position on the proximal end side of a portion of the insertion portion of the insertion member that is guided into the body from the outer tube. When moved in the direction to pull out from the mantle tube,
An in-vivo diagnostic / treatment device characterized in that it is configured to engage with the split piece to form a one-way restricting portion for restricting its movement.