JPH07289503A - Guide for insertion of long-sized object - Google Patents

Abstract

PURPOSE:To make it possible to insert a long-sized object into the celom and to smoothly guide this object to a desired section by providing a base end side of expanding bodies expansible and contractable by injecting and discharging of working fluid into and from annular spaces with supporting parts for supporting the inserting object. CONSTITUTION:This guide 1 for the long-sized inserting object is a guide for insertion of the endoscope which inserts the endoscope 7 into the colon and guides the endoscope into the deep part. The guide is composed of the expanding body 2 which is expansible by injection of the working fluid, the expanding body 3 for supporting which is a supporting part of the endoscope 7 installed on the base end side of the expanding body 2, a traction means which pulls the front end side of the expanding body 2 to the base end side and a fluid supplying means 5 which supplies the working fluid into the expanding body 2 and the expanding body 3 for supporting. The expanding body 2 has a first node 21, second node 22 and third node 23 successively from the front end side along the axial direction. The first node 21 is formed by molding a film composed of a material having resilience to a hollow annular shape and is internally formed with the annular space 24. The second node 22 and the third node 23 are constituted in the same manner as the first node 21 except that the length in the axial direction varies. The annular spaces 25, 26 are formed in these nodes.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a long object insertion guide used for inserting an endoscope into a body cavity such as the large intestine or the digestive tract.

[0002]

2. Description of the Related Art In endoscopic examination of the large intestine, an endoscope is inserted through the anus, and the endoscope is moved forward and backward, rotated, and endoscopically observed under X-ray fluoroscopy or under observation of a monitor image of the endoscope. Gradually insert it into the inner part while appropriately combining the bending operation of the tip part of the mirror.

In the rectum, since the intestine is relatively straight, insertion of an endoscope can be performed easily and smoothly. However, in the sigmoid colon following the rectum, the intestine bends into an S shape. Moreover, since there are individual differences in the shape and the bending direction, a technique is required to insert the endoscope. The operation is
It is as follows.

When the tip of the endoscope enters the sigmoid colon, the examinee who was in the left lateral decubitus position is placed in the supine position to confirm the position.
In many cases, since the distal end of the endoscope is curved to the left, the surgeon rotates the endoscope while helping the operator to press the abdominal wall of the examinee with his or her hand and Allow it to flip to the right, which causes the sigmoid colon to move to the right, creating an inverted "" shape. In this state, the distal end of the endoscope is advanced / retracted while adjusting the degree of bending, and the endoscope is gradually inserted while searching for the direction of the intestinal lumen. The endoscope is advanced in an inverted "" shape along the shape of the sigmoid, beyond the sigmoid colon, and further into the descending colon, left lateral flexion, transverse colon.

The insertion of an endoscope into the sigmoid colon is almost impossible to insert into the descending colon or more deeply without using the above-mentioned reverse "shaped" insertion method. The operation of inserting the endoscope with the sigmoid colon shaped like an inverted "" is not only difficult and requires skill, but also the subject suffers a lot of pain. In particular, the inner wall of the intestine (intestinal mucosa) may be damaged by the tip of the endoscope when passing through the bent portion of the intestinal tract.

In addition, if the mesentery of the sigmoid colon is short, S
When the sigmoid colon extends to the right and reaches the cecum or liver, adhesions in the abdominal cavity are strong, the abdominal wall is significantly tense, or the subject is obese, the endoscope The inverted "" -shaped insertion into the sigmoid colon becomes very difficult. Therefore, the success rate of endoscopic examination of the large intestine was low.

[0007]

DISCLOSURE OF THE INVENTION The object of the present invention is to make it possible to smoothly insert a long insert such as an endoscope into a body cavity and guide it to a target site, which is highly safe and painless. It is to provide a guide for inserting a long object with a small number.

[0008]

The above objects are achieved by the present invention described in (1) to (12) below.

(1) A guide for inserting a long insert to a target site in a body cavity, the guide having a plurality of annular spaces along the axial direction, and the working fluid to the annular spaces. An expandable body that can be expanded / contracted by injecting / discharging, and a support portion provided on the proximal end side of the expandable body and supporting the insert;
A guide for inserting a long object, comprising: a fluid supply means for supplying the working fluid to each of the annular spaces.

(2) The elongated object insertion guide according to (1), further having a pulling means for pulling the distal end portion of the expansion body toward the base end side.

(3) The pulling means is arranged along the longitudinal direction of the expandable body, and one end of the pulling means is composed of at least one wire fixed to the distal end portion of the expandable body. Guide for inserting long objects described in.

(4) The supporting portion has an annular space,
The long object insertion guide according to any one of (1) to (3) above, which is configured by a support expansion body that expands by injecting a working fluid into the annular space and comes into close contact with the outer periphery of the insert.

(5) The long object insertion guide according to (4), wherein the outer diameter of the supporting expansion body is smaller than the outer diameter of the expansion body.

(6) The long object according to any one of the above (1) to (5), wherein the fluid supply means is configured to independently supply a working fluid to each of the annular spaces. Insertion guide.

(7) The fluid supply means according to any one of the above (1) to (6) is configured so that the working fluid can be discharged from each of the annular spaces from the annular space on the base end side. Guide for inserting long objects.

(8) The guide for inserting a long object according to any one of (1) to (7), wherein the fluid supply means is capable of adjusting a filling amount of the working fluid into each of the annular spaces. .

(9) The fluid supply means comprises an elastically deformable hollow cuff, a tube communicating with the cuff, and a plurality of branch tubes branching from the tube and communicating with the annular spaces. The guide for inserting a long object according to any one of (1) to (8) above.

(10) The above-mentioned (9), which has a flow path opening / closing means capable of closing / opening the inner cavities of the respective branch tubes.
Guide for inserting long objects described in.

(11) The guide for inserting a long object according to any one of (1) to (10), which has X-ray contrast.

(12) A guide for inserting a long object according to any one of the above (1) to (11), wherein a layer having lubricity is formed on an inner peripheral surface and / or an outer peripheral surface of the expansion body. .

[0021]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The guide for inserting a long object of the present invention will be described in detail below with reference to the preferred embodiments shown in the accompanying drawings.

FIG. 1 is a plan view showing a structural example of a guide for inserting a long object of the present invention, and FIG. 2 is a partial vertical sectional view showing a structure of a tip end portion of the guide for inserting a long object shown in FIG. is there. In addition,
In the following description, the lower side in FIGS.
The upper side is called "tip", moving toward the tip is called "forward", and moving toward the base is called "back".

As shown in FIGS. 1 and 2, the long object insertion guide 1 is an endoscope for inserting the endoscope 7 which is a long object into the large intestine and guiding it to the inner part thereof. Expansion body 2 which is a mirror insertion guide and can be expanded by injecting a working fluid
A support expansion body 3 that is a support portion of the endoscope 7 installed on the proximal end side of the expansion body 2, a traction means 4 for pulling the distal end portion of the expansion body 2 toward the proximal end side, and the expansion body 2 and supporting extension 3
And a fluid supply means 5 for supplying a working fluid therein. Hereinafter, these components will be sequentially described.

The expander 2 has a first node 21, a second node 22 and a third node 23 in order from the tip side along the axial direction. The first section 21 is formed by molding a film made of a flexible material, which will be described later, into a hollow ring shape, and has an annular space 24 formed therein. Also, the second node 22 and the third node 23 have the same configuration as the first node 21 except that the axial lengths thereof are different, and the annular spaces 25 and 26 are formed therein, respectively. ing. Then, the end faces of the first joint 21 and the second joint 22 and the end faces of the second joint 22 and the third joint 23 are bonded or fused to each other to form the expandable body 2 having one continuous lumen 27. I am configuring.

First section 21, second section 22 and third section 23
Examples of the constituent material of the film of the above are soft polyvinyl chloride, polyethylene, polypropylene, polyolefin such as ethylene-vinyl acetate copolymer (EVA), polyester such as polyethylene terephthalate (PET) and polybutylene terephthalate (PBT). , Polyamide, polytetrafluoroethylene, polyurethane, silicone rubber, polyamide elastomer, polyester elastomer, polystyrene elastomer, and polyolefin elastomer. Among them, soft polyvinyl chloride, polyethylene, and polyurethane are particularly preferable. In this case, the sections 21 to 23 are respectively
It may be configured by stacking a plurality of films of the same or different materials.

First section 21, second section 22 and third section 23
The thickness of the film is not particularly limited, but is 0.1
It is preferably about -5 mm, especially about 0.3-3 mm. In this case, the thickness of each node may be the same or different, and for example, the first node 21, the second node 22, and the third node 2 may be used.
The film thickness can be made thinner or thicker in the order of 3.

First section 21, second section 22 and third section 23
The outer diameter and inner diameter of is not particularly limited, but the outer diameter (when expanded)
Is preferably about 15 to 40 mm, particularly about 20 to 35 mm, and the inner diameter (when expanded) is 10 to 35 mm.
It is preferably about mm, especially about 14 to 30 mm. The outer diameter and the inner diameter of each node 21 to 23 may be uniform over the entire length of the expansion body 2 or may change along the longitudinal direction of the expansion body 2. For example, the distal end side of the expansion body 2 can be tapered so as to have a small diameter so that the expansion body 2 can be inserted into a body cavity and can be advanced more smoothly during expansion.

The total length of the expandable body 2 varies depending on the case, etc., but when the proximal end is in the rectum 15, it is preferable that the distal end thereof extends beyond the sigmoid colon 17 when expanded. Specifically, the total length (when expanded) is 200 to 1000 mm
It is preferably about 400 to 800 mm.

On the base end side of the extension body 2, a support extension body 3 is installed as a support portion for supporting the endoscope 7. The support expansion body 3 has the same structure as the first section 21 and has an annular space 31 inside. The tip end surface of the support expansion body 3 is fixed to the expansion body 2 by being bonded or fused to the base end surface of the third joint 23.

An annular space 3 is formed by a fluid supply means 5 described later.
When the working fluid is injected into 1, the supporting expansion body 3 expands,
The outer peripheral surface of the endoscope 7 inserted through the inner cavity and the belt 8 that tightens the inner surface of the endoscope 3 come into close contact with each other to support and fix the endoscope 7.

The outer diameter and the inner diameter of the support expansion body 3 are not particularly limited, but the outer diameter (when expanded) is about 20 to 28 mm,
In particular, it is preferable that the diameter is about 25 to 28 mm, and the inner diameter (when expanded) is preferably a value slightly larger than the outer diameter of the endoscope 7 to be inserted. In this case, the outer diameter of the support expansion body 3 is preferably smaller than the outer diameter of the expansion body 2 (preferably about 80 to 90% of the outer diameter of the expansion body 2). Thereby, as will be described later, when the endoscope 7 is advanced while the contraction is sequentially performed from the proximal end side node among the nodes 21 to 23, the support body expansion body 3 is moved to the inside of each node 21 to 23. The nodes 21 to 23 can be contracted by being pushed in, and the contraction can be easily performed.

In the long object insertion guide 1 of the present invention, in order to make it possible to confirm the insertion into the large intestine under fluoroscopy,
It is preferable that the expansion body 2 and the support expansion body 3 have X-ray contrast. As means for imparting the X-ray contrast property to the expansion body 2 and the support expansion body 3, for example, a material having an X-ray contrast property is kneaded into a constituent material of a film forming the expansion body 2 or a predetermined amount thereof. A marker (not shown) made of a substance having an X-ray contrast property is installed at a location (for example, at a predetermined interval from near the distal end of the expandable body 2 toward the base end or at the distal end of the expandable body 2). It can be mentioned.

Examples of the substance having an X-ray contrast property include metals such as gold, platinum, tungsten and alloys containing these, and metal compounds such as barium sulfate and bismuth oxide. When these substances are kneaded into the constituent materials of the film, it is preferable to make them into a filler form (powder granules). Further, the shape of the marker is not particularly limited, and for example, a plate shape, a ring shape, or the like is possible, and the installation position thereof is
For example, the inner peripheral surface, the outer peripheral surface of the expansion body 2 or the support expansion body 3,
The inside of the annular spaces 24, 25, 26, 31 can be mentioned.

A layer having lubricity (hereinafter referred to as a lubricating layer) may be formed in advance on the inner peripheral surface and / or the outer peripheral surface of the expansion body 2 and the support expansion body 3. Such a lubricating layer includes, for example, oils such as silicone oil, olive oil, and glycerin, xylocaine jelly, polyvinyl alcohol, polyvinylpyrrolidone, maleic anhydride, water-soluble nylon, cellulose-based (CMC, M
(C, HEC, HPC, etc.) or a polyethylene oxide-based hydrophilic polymer substance or a substance containing any of these, and these can be formed by coating, for example.

By providing such a lubricating layer, the expansion body 2 can be inserted into the intestinal tract and the endoscope 7 into the lumen 27 of the expansion body 2 more smoothly. In particular, as will be described later, when the expansion body 2 is expanded and the inside of the sigmoid colon 17 is advanced to the inner part along the curve, the frictional resistance can be reduced, and the expansion and advancement can be performed smoothly. .

The pulling means 4 is composed of a pair of wires 41, 42 arranged along the longitudinal direction of the expansion body 2. These wires 41 and 42 are arranged inside the inner cavity 27 of the expandable body 2 along the inner peripheral surface thereof, and the tips thereof are fixed to the tip of the expandable body 2. Further, the wires 41 and 42 are respectively inserted into the small holes 81 formed in each belt 8, and the ring-shaped pulling operation tool 43 is installed at the base end thereof. Further, the wires 41 and 42 are respectively attached to the belt 8 located at the most proximal side by the set screw 82 when necessary.
It is clamped and fixed against.

With the fixing by the set screw 82 released,
When the wires 41, 42 are pulled toward the proximal end side by the pulling operation tool 43, the distal end portion (the portion including at least the first joint 21) of the expansion body 2 moves toward the proximal end side and contracts, and the distal end of the endoscope 7 is pulled. 71 can be made to protrude from the tip opening 28 of the lumen 27 (see FIG. 5).

As the wires 41 and 42, for example, stainless steel, brass, tungsten, aluminum, copper,
Metal wire made of carbon steel, super elastic alloy, etc. and fibers such as polyamide (wholly aromatic polyamide), polyester, high molecular weight polyethylene, fluorine resin, polycarbonate, polypropylene, hard polyvinyl chloride, carbon fiber, etc. It can be used, or an aggregate thereof.

The wires 41 and 4 for the expansion body 2
The arrangement of 2 is not limited to that shown in the figure, and for example, each section 2
1 to 23 may be configured by a laminated body in which an inner layer and an outer layer are joined, and wires 41 and 42 may be embedded between the inner layer and the outer layer. Furthermore, the wires 41 and 42 illustrated in FIG. May be extended to form a loop for fixing to the belt 8 through the outer peripheral surface of the expansion body 2 and the interface between the third joint 23 and the supporting expansion body 3.

The fluid supply means 5 includes the annular spaces 24,
The working fluid is injected into or discharged from 25, 26 and 31. The fluid supply means 5 in this embodiment is an air supply pump that is manually operated, and includes an elastically deformable hollow cuff 51, a check valve (one-way valve) 52 installed at the base end of the cuff 51, and a cuff. An exhaust port 53 installed at the tip of the cuff 51, a tube 55 whose proximal end is connected to the tip of the cuff 51 so as to communicate with the inside of the cuff 51, and a tube 4 branched from the tube 55.
Book branch tubes 56a, 56b, 56c and 56d
And a connector 57 that hermetically connects the distal end of the tube 55 and the proximal end of each branch tube 56.
And the branch tubes 56a, 56b, 56c and 5
The tip of 6d communicates with the annular spaces 24, 25, 26 and 31, respectively.

The cuff 51 is made of an elastic material such as natural rubber, isoprene rubber, butyl rubber, butadiene rubber, styrene-butadiene rubber, or silicone rubber. The check valve 52 has a function of allowing the inflow of air (working fluid) into the cuff 51, but blocking the outflow of air from the cuff 51.

The exhaust port 53 is provided with a lid 54 which is screwed into the exhaust port 53, and when the lid 54 seals the exhaust port 53, the flow of air through the exhaust port 53 is blocked. ,
When the lid 54 is rotated and loosened, a gap is formed and the exhaust port 5
It is possible for the air to flow out from 3. Branch tube 56a
A channel opening / closing means 6 capable of independently closing / opening the inner cavities is installed in the middle of 56d to 56d.

FIG. 6 is a sectional view showing a structural example of the flow path opening / closing means 6. As shown in FIG.
The housing 61 has a housing 61 for accommodating the branch tubes 56a to 56d, and an inner bottom surface of the housing 61 includes the branch tubes 56a.
Circular arc-shaped grooves 62a, 62 for mounting the respective ~ 56d
b, 62c and 62d are formed. On the other hand, on the upper part of the casing 61, screws 63a and 63 for closing the branch tubes are respectively provided at positions corresponding to the grooves 62a to 62d.
b, 63c and 63d are screwed together.

A screw 6 such as the screw 63b shown.
If 3b is raised, the lumen of the branch tube 56b is opened, and the working fluid can flow.
On the other hand, like the illustrated screw 63a, when the screw 63a is rotated to close the branch tube 56a between the tip of the screw 63a and the groove 62a, the lumen of the branch tube 56a is closed and the working fluid is prevented from flowing. It Such blocking / opening of the branch tube lumen can be performed independently for each of the branch tubes 56a to 56d.

In the fluid supply means 5 having the flow passage opening / closing means 6 as described above, air is supplied to the nodes 21 to 23 and the annular spaces 24, 25, 26 and 31 of the support expansion body 3 to expand them. In this case, first, one (one or more) to be expanded is selected from the joints 21 to 23 and the support expansion body 3, and the corresponding lumen of the branch tube is screwed in the passage opening / closing means 6 with the screws 63a to 63d. Open by the operation of
Next, with the exhaust port 53 sealed by the lid 54, the operation of gripping or releasing the cuff 51 with a hand is repeated several times. As a result, the air in the cuff 51 and the check valve 52
Air flowing into the cuff 51 via the tube 55,
It is delivered to the desired annular space via a connector 57 and a branch tube with an open lumen.

As the amount of air injected into the annular space increases,
The pressure increases, and the expansion degree (rigidity) of each of the nodes 21 to 23 and the support expansion body 3 increases. In this case, the annular space 24,
Since there is a certain correlation between the pressures of 25, 26, 31 and the expansion degree (rigidity) of each of the nodes 21 to 23 and the support expansion body 3, for example, the pressure of the annular space depends on the number of times the cuff 51 is gripped with a hand. The degree of expansion of each of the nodes 21 to 23 and the support expansion body 3 can be arbitrarily set by adjusting the.

The nodes 21 to 23 and the supporting expansion body 3 which have been expanded once retain the expansion degree as they are because the check valve 52 prevents the discharge of air.
In this case, the branch tubes 56a to 56d may be closed and sealed by the flow path opening / closing means 6 in order to prevent air leakage more reliably.

When the nodes 21 to 23 and the support expansion body 3 in the expanded state are contracted, first, the one of the nodes 21 to 23 and the support expansion body 3 that is contracted and the one that maintains the expanded state are selected. By selecting and operating the screws 63a to 63d in the flow path opening / closing means 6, the lumen of the branch tube corresponding to the one to be contracted is opened, and the branch tube corresponding to the one maintaining the expanded state is closed. Next, the lid 54 is rotated and loosened. As a result, the air in the annular space is discharged from the exhaust port 53 through the branch tube, the connector 57 and the tube 55 of which the inner cavity is open. The internal pressures of the nodes 21 to 23 and the support expansion body 3 from which the air has been exhausted are reduced, and the nodes expand.

FIG. 3, FIG. 4 and FIG. 5 are perspective views showing a state in which a part of the expansion body is contracted. By the fluid supply means 5 and the flow path opening / closing means 6 described above, the first section 2
1, the second section 22 and the support expansion body 3 are in an expanded state,
When the third joint 23 is contracted, the state shown in FIG. 3 is obtained.

When the first joint 21 and the support expansion body 3 are expanded and the second joint 22 and the third joint 23 are contracted, the distal end 71 of the endoscope 7 is expanded as shown in FIG. The body 2 is located near the tip opening 28.

When the support expansion body 3 is expanded and all the nodes 21 to 23 are contracted and the wires 41 and 42 of the pulling means 4 are pulled, the nodes 21 to 23 are brought closer to the base end side. , The tip 7 of the endoscope 7 as shown in FIG.
1 is projected from the tip end opening 28 of the expansion body 2,
The field of view is secured and observation is possible. In this case, each section 2
1 to 23 may be used only, but by using the contraction of each of the joints 21 to 23 and the traction by the traction means 4 together, the contracted joints 21 to 23 do not cover the distal end 71 of the endoscope 7, The tip 71 can be reliably projected from the tip opening 28.

In the present invention, the fluid supply means 5
Is not limited to the configuration shown in the figure, and may be, for example, a syringe, a pump, a compressor, or a cylinder that supplies a working fluid. The working fluid is not limited to air, but may be, for example, a gas such as nitrogen gas or an inert gas such as helium, an oxygen gas, or a liquid such as water, alcohol, or oil.

The endoscope 7 has an optical fiber (light guide) for transmitting illumination light and an optical fiber (image fiber) for receiving light. As shown in FIG. A section 9 is provided. In addition, the endoscope 7 is operated by operating the handle 91 of the operation unit 9.
The distal end portion of the endoscope 7 is configured to bend in a desired direction. Belts 8 are attached to the outer circumference of the endoscope 7 along the longitudinal direction of the endoscope 7 at predetermined intervals.

Next, the operation of the guide for inserting a long object of the present invention will be described by taking the case of endoscopic examination of the large intestine as an example. 7 to 10 are perspective views showing procedures when the long object insertion guide 1 is used for endoscopic examination of the large intestine.

First, the endoscope 7 having a diameter of 10 mm with the belt 8 attached at a predetermined position is inserted into a desired length from the base end side opening of the supporting expansion body 3, and the supporting expansion body 3 is expanded. While supporting and fixing the endoscope 7, the nodes 21 and 2 of the expansion body 2
Keep 3 contracted. In addition, the support expansion body 3 is the rectum 1
It may be expanded after it is inserted into No. 5.

Then, the inner wall of the intestinal tract was washed, and a large intestine X-ray examination was performed by an enema method. When it was confirmed that there were no lesions in the rectum 15, sigmoid colon 17 and descending colon 19, the examinee was examined. In the left lateral decubitus position, under fluoroscopy, the distal end 71 of the endoscope 7 with the expanded body 2 in a contracted state is inserted through the anus 14 and gradually moved forward in the rectum 15.

When the endoscope 7 is inserted about 200 mm from the anus 14, the insertion resistance increases, and the distal end 7 of the endoscope 7 increases.
Since it is confirmed that 1 has reached the vicinity of the boundary 16 between the rectum 15 and the sigmoid colon 17 (see FIG. 7), the insertion of the endoscope 7 is temporarily stopped.

Next, as described above, the fluid supply means 5 and the flow path opening / closing means 6 are operated to operate the nodes 21 to 2 of the expansion body 2.
A predetermined amount of air is injected into each of the 3 to expand them. Along with this expansion, the expansion body 2 advances inside the sigmoid colon 17 along its curve toward the inner part. At this time, the nodes 21 to 23 may be simultaneously expanded, but in order to smoothly advance the expandable body 2 in the sigmoid colon 17, the third node 2 is used.
It is preferable to expand in the order of 3, the second section 22 and the first section 21.

When each of the nodes 21 to 23 is expanded to a desired expansion degree, the tip of the expansion body 2 reaches the boundary portion 18 between the sigmoid colon 17 and the descending colon 19, and beyond that, the descending colon 1 is reached.
9 is inserted in the lower part (see FIGS. 1 and 8). In this state, the outer peripheral surface of the expansion body 2 comes into close contact with the inner walls of the sigmoid colon 17 and the descending colon 19 and fixes their intestinal tracts. In addition,
At this time, the branch tubes 56a to
It is preferable to block and seal 56d to reliably prevent air leakage.

Next, in the flow path opening / closing means 6, only the branch tube 56c is unblocked, the lid 54 is loosened, and the annular space 2 is closed.
6 air is discharged to shrink the third joint 23,
The endoscope 7 is advanced. As a result, the expanded support body 3 in the expanded state is pushed toward the third joint 23 side and the third joint 23 is folded, so that the distal end 71 of the endoscope 7 is guided along the inner cavity 27, and the second Advance into the lumen of node 22 (see FIGS. 3 and 9).

Further, in the flow path opening / closing means 6, the blockage of the branch tube 56b is released, the air in the annular space 25 is discharged to contract the second joint 22, and the endoscope 7 is further advanced. Thereby, the support expansion body 3 in the expanded state
Is pushed toward the distal end side, and the second segment 22 is also folded, so that the distal end 71 of the endoscope 7 is guided along the lumen 27 and advanced into the lumen of the first segment 21, that is, into the descending colon 19. (See FIGS. 4 and 10).

When the endoscope 7 is moved forward, the distal end portion of the endoscope 7 is moved by the rotation operation of the handle 91 on the operation portion 9 so that the distal end side of the endoscope 7 is along the curve of the lumen 27. It is preferable to bend it appropriately.

Next, in the passage opening / closing means 6, the blockage of the branch tube 56a is released, the air in the annular space 24 is discharged to contract the first joint 21, and the wires 41, 4 are used.
2 is pulled toward the base end side to bring the joints 21 to 23 toward the base end side, and further, the set screw 82 is rotated to rotate both wires 41, 4 together.
2 is fixed to the base end of the endoscope 7 and the pulled state is maintained.
As a result, the distal end 71 of the endoscope 7 projects from the distal end opening 28 of the expandable body 2, a visual field is secured, and observation is possible (see FIGS. 4 and 11).

The tip 71 of the endoscope 7 is attached to the tip opening 28.
As another method of further projecting, the distal end 71 of the endoscope 7 may be advanced after all the nodes 21 to 23 are contracted (in this case, the pulling means 4 may be omitted). In the method of pulling the nodes 21 to 23 toward the proximal end side, the distal end 71 of the endoscope 7 is not moved, so that there is no possibility that the distal end 71 of the endoscope 7 damages the intestinal wall (intestinal mucosa).

After the tip 71 of the endoscope 7 reaches the lower part of the descending colon 19 as described above, the support expansion body 3 is contracted to release the support and fixation of the endoscope 7. The endoscope 7 is advanced while visually recognizing the front, and its tip 71 is inserted into the upper part of the descending colon 19 and the deeper part thereof, such as the transverse colon, the ascending colon, the cecum, and the ileocecal region (all not shown). However, these observations can be made. When the observation with the endoscope 7 is completed, the extension body 2 and the support extension body 3 are returned to the state shown in FIG. 7, the endoscope 7 is retracted, and the endoscope 7 is pulled out from the intestine.

In the endoscopic examination of the large intestine by the guide 1 for inserting a long object of the present invention, the recumbent position of the examinee is changed, the abdominal wall of the examinee is pressed by the operator, as in the above-mentioned conventional method. It is not necessary to move the sigmoid colon 19 to the right and make it into an inverted “” shape. Further, the expansion body 2 has such a rigidity that the expansion tube can surely fix the intestinal tract and guide the endoscope 7 along the lumen 27 thereof by expansion, so that the endoscope 7 can be easily inserted. be able to.

The long object insertion guide of the present invention has been described above with reference to the illustrated structural example, but the present invention is not limited to this. For example, the support portion that supports the endoscope 7 is not limited to the support expansion body 3 as shown in the drawing, but may be a gripping member that grips the endoscope by a screwing, a clip mechanism, or the like.

Further, the structure of the expansion body 2 is not limited to that shown in the drawing, and for example, the nodes 21 to 23 may be in communication with each other and the working fluid may be supplied to them at the same time. In this case, by appropriately changing the volume and flexibility of the annular space of each of the nodes 21 to 23 (material and film thickness of the film), and further the size of the hole communicating with each of the nodes 21 to 23,
It is also possible to set the order of expansion or contraction of 3.
Further, the number of nodes forming the extension body 2 is not limited to that shown in the figure.

Further, for example, the branch tubes 56a to 56
The inner diameter of c may be increased in the order of the branch tubes 56c, 56b and 56a so that the third section 23, the second section 22 and the first section 21 can be quickly expanded in the order of injection of the working fluid. With this configuration, at the time of injecting the working fluid, the third, second and first operation is performed only by the supply operation from the fluid supply means 5 without operating the screws 63a to 63d of the flow path opening / closing means 6.
The clauses can be expanded in this order, improving operability.

The site for inserting the guide for inserting a long object of the present invention is not limited to the large intestine described above, but may be other body cavities such as digestive tract such as esophagus and stomach, trachea, bile duct, vagina, blood vessel. It may be.

Further, the guide for inserting a long object of the present invention is not limited to the one for inserting and guiding an endoscope, but for example, a long insert such as an optical fiber for laser irradiation, a catheter tube, forceps is inserted into a body cavity. It can also be used to

[0072]

As described above, according to the guide for inserting a long object of the present invention, when the long insert such as an endoscope or a catheter tube is inserted into the body cavity, the expandable body is kept inside the body cavity. Since it is expanded and preceded and the long insert is guided while being inserted along its inner cavity, especially when the body cavity is curved,
The insertion can be performed easily and smoothly, and the safety is higher and the suffering of the examinee is less than that of inserting the long insert directly into the body cavity.

In particular, when the guide for inserting a long object of the present invention is used for endoscopic examination of the large intestine, when the mesentery of the sigmoid colon is short, the sigmoid colon is curved to the right and extends to the cecum. Or, even if it reaches the liver, if the adhesion in the abdominal cavity is strong, if the abdominal wall is significantly tense, or if the subject is obese, etc., the endoscope can be easily inserted into the sigmoid colon or deeper part. It will be possible to dramatically improve the success rate of endoscopic examination of the large intestine.

Further, when the pulling means is provided, the tip of the endoscope can be reliably projected from the tip opening of the expansion body, and the safety at that time is high. Further, when the working fluid is configured to be able to be supplied to each of the annular spaces independently, the expansion or contraction pattern of the expansion body can be set as desired, and the expansion body can be more easily inserted into the body cavity. It can be done smoothly and reliably.

[Brief description of drawings]

FIG. 1 is a plan view showing a configuration example of a guide for inserting a long object of the present invention.

FIG. 2 is a partial vertical cross-sectional view showing the configuration of the distal end portion of the long object insertion guide shown in FIG.

FIG. 3 is a perspective view showing a state in which the expansion body is partially contracted in the long object insertion guide of the present invention.

FIG. 4 is a perspective view showing a state in which the expansion body is partially contracted in the long object insertion guide of the present invention.

FIG. 5 is a perspective view showing a state when the expansion body is partially contracted and the traction means is operated in the long object insertion guide of the present invention.

FIG. 6 is a cross-sectional view showing a configuration example of the flow path opening / closing means in the present invention.

FIG. 7 is a perspective view showing a procedure for using the long object insertion guide of the present invention.

FIG. 8 is a perspective view showing a procedure for using the long object insertion guide of the present invention.

FIG. 9 is a perspective view showing a procedure when using the long object insertion guide of the present invention.

FIG. 10 is a perspective view showing a procedure for using the long object insertion guide of the present invention.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Long object insertion guide 2 Expansion body 21 1st section 22 2nd section 23 3rd section 24, 25, 26 Annular space 27 Lumen 28 Tip opening 3 Supporting expansion body 31 Annular space 4 Traction means 41, 42 Wire 43 Traction operation tool 5 Fluid supply means 51 Cuff 52 Check valve 53 Exhaust port 54 Lid 55 Tubes 56a, 56b, 56c, 56d Branch tube 57 Connector 6 Flow path opening / closing means 61 Housing 62a, 62b, 62c, 62d Groove 63a, 63b, 63c, 63d Screw 7 Endoscope 71 Tip 8 Belt 81 Small hole 82 Set screw 9 Operation part 91 Handle 14 Anus 15 Rectum 16 Boundary part 17 Sigmoid colon 18 Boundary part 19 Descending colon

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[Procedure amendment]

[Submission date] August 24, 1994

[Procedure Amendment 1]

[Document name to be amended] Statement

[Name of item to be corrected] Fig. 11

[Correction method] Added

[Correction content]

FIG. 11 is a perspective view showing a procedure for using the long object insertion guide of the present invention.

Claims (1)

[Claims] 1. A long object insertion guide for guiding a long insert to a target site in a body cavity, the guide having a plurality of annular spaces along the axial direction. An expansion body that can be expanded / contracted by injection / discharge, a support portion that is provided on the proximal end side of the expansion body and that supports the insert, and a fluid supply unit that supplies the working fluid to each of the annular spaces. A guide for inserting a long object characterized by having.