WO2011092899A1

WO2011092899A1 - Duodenoscope

Info

Publication number: WO2011092899A1
Application number: PCT/JP2010/067585
Authority: WO
Inventors: 明宏島津
Original assignee: オリンパスメディカルシステムズ株式会社
Priority date: 2010-01-28
Filing date: 2010-10-06
Publication date: 2011-08-04
Also published as: JPWO2011092899A1

Abstract

A duodenoscope comprises: a front end section (21) provided to the front end of an insertion section (11) in the insertion direction (S); a first curve section (24) provided to the insertion section (11) at a position on the base end side of the front end section (21) in the insertion direction; and a second curve section (25) provided to the insertion section (11) at a position on the base end side of the first curve section (24) in the insertion direction. The length (e) in the insertion direction (S) from the front end of the front end section (21) in the insertion direction (S) to the base end of the second curve section (25) in the insertion direction (S) is set in the range from 73 mm to 100 mm.

Description

Duodenoscope

The present invention relates to an endoscope for duodenum provided with an elongated insertion portion to be inserted into the duodenum.

In recent years, there has been a so-called ERCP (Endoscopic Retrograde Cholangio pancreatography) in which an imaging optical system is disposed at the distal end of the insertion portion, for example, a side-viewing endoscope is inserted orally into the duodenum and the pancreaticobiliary system is examined. Has been done.

As ERCP using this endoscope, in addition to examinations such as imaging the bile duct and pancreatic duct with a treatment instrument such as a catheter, treatment such as collecting gallstones present in the common bile duct etc. with a treatment instrument such as a balloon or a basket Treatment and the like.

In EPRC, first, the distal end of the endoscope insertion part is inserted to the vicinity of the duodenal papilla, and under observation, the distance between the nipple and the endoscope insertion part is determined by advancing / retreating or bending operation of the endoscope insertion part itself. The angle of the endoscope is adjusted to secure an endoscope field of view (hereinafter, this operation is referred to as front view), and then the treatment instrument insertion conduit formed on the side of the distal end of the insertion portion is observed under the imaging optical system. The treatment tool is protruded from the opening of the treatment instrument insertion duct from the opening, and the protruded treatment tool is inserted into the bile duct or pancreatic duct via the nipple.

Thus, in order to select and insert the treatment tool into the bile duct or pancreatic duct, the insertion is performed by aligning the axis of the opening of the treatment instrument insertion duct at the distal end of the insertion section and the opening of the bile duct or pancreatic duct The positional relationship between the bile duct and pancreatic duct with respect to the nipple is greatly different among individuals, and the position of the opening of the bile duct and pancreatic duct differs from subject to subject.

Furthermore, the pancreatic duct and the bile duct are close to each other, and a technique for appropriately adjusting the position and angle of the distal end is required to select and insert a treatment instrument such as a catheter.

Here, normally, for example, one bending portion that can be bent in the four directions of up, down, left, and right is provided on the distal end side of the insertion portion of the endoscope for duodenum, but the insertion portion provided with only one bending portion is provided. Even if it is inserted into the duodenum and the nipple is viewed from the front using the curvature of the curved part, the bending angle of the curved part is limited, and the positional relationship between the bile duct and pancreatic duct is affected by individual differences. In some cases, it is difficult to position the imaging optical system at an appropriate observation distance (for example, the distance from the nipple to the cover covered by the tip of the insertion portion is 3 mm to 15 mm) or at an angle.

Therefore, in Japanese Patent Application Laid-Open Nos. 2002-143084 and 2003-38418, two bending portions are provided along the insertion direction on the distal end side of the insertion portion, and each bending portion is bent, thereby bending the bending portion. An endoscope is disclosed in which the angle is increased to improve the insertion property on the distal end side of the insertion portion.

If two bending portions are provided in the insertion portion in this way, in the configuration in which one bending portion is provided, the nipple can be observed from an angle that has not been approached. In addition to making the system close to the appropriate observation distance, the above-described axial alignment of the opening at the distal end of the insertion portion and the bile duct or pancreatic duct is also facilitated.
By the way, it is known from the anatomical knowledge that the distance from the nipple to the stomach pylorus is usually about 100 mm. Further, as shown in Japanese Patent Application Laid-Open Nos. 2002-143084 and 2003-38418, an endoscope in which two bending portions are provided on the distal end side of the insertion portion is provided with only one bending portion. Naturally, the distance from the distal end of the insertion portion to the proximal end of the bending portion is longer than that of the endoscope.

Therefore, the endoscope provided with two curved portions disclosed in Japanese Patent Application Laid-Open Nos. 2002-143084 and 2003-38418 is orally inserted into the duodenum, and the imaging optical system has an appropriate observation distance. When the nipple is viewed from the front, the proximal end of the curved portion (hereinafter referred to as the second curved portion) of the two curved portions protrudes from the pylorus to the stomach side. .

When the proximal end of the second curved portion protrudes from the pylorus to the stomach side, unnecessary force is applied from the sphincter of the pylorus to the second curved portion in contact with the stomach wall of the pylorus. Since the curved part does not show the original behavior, it becomes difficult to adjust the distance of the imaging optical system with respect to the nipple, and the above-mentioned axis alignment of the opening at the distal end of the insertion part and the bile duct or pancreatic duct becomes difficult. There is a problem that it becomes difficult to insert a treatment tool, a guide wire, or the like.

Furthermore, when performing normal ERCP, in order to improve the operability of the endoscope, when inserting into the duodenum, when the distal end enters the descending portion of the duodenum, by pulling the base side of the insertion portion, A method in which a part of the insertion part is brought into contact with the wall of the pylorus from the duodenal bulb, the distal end side of the insertion part is slid toward the duodenum, and the nipple is inserted to a position where it can be viewed from the front, and at the same time the scope is bent Hereinafter, this is referred to as linearization).

However, if the proximal end of the second curved portion protrudes from the pylorus to the stomach side, in addition to the weight of the stomach, the force applied from the pyloric sphincter to the second curved portion that contacts the stomach wall of the pylorus The second curved portion is bent in an S shape, and the insertion portion existing from the duodenal bulb to the stomach cannot be sufficiently linearized. For this reason, compared with the conventional case where the insertion portion of the endoscope provided with only one bending portion is linearized, the travel of the insertion portion in the duodenum changes, which gives the operator a sense of incongruity. In addition, it may be difficult to bend the second bending portion to a desired angle.

In view of such a problem, the length of the bending portion (hereinafter referred to as the first bending portion) provided on the distal end side of the two bending portions is shortened, and the proximal end of the second bending portion is formed. It is also conceivable that the gas does not protrude from the pylorus to the stomach side. However, in this case, when only the first bending portion is bent, the bending portion of the endoscope provided with only one bending portion is bent as much as the first bending portion is shortened. In addition, since the behavior on the distal end side in the insertion direction changes, there is a problem that the operator feels uncomfortable and that it is difficult to align the opening at the distal end of the insertion portion with the aforementioned bile duct or pancreatic duct. It was.

The present invention has been made in view of the above problems, and even when two curved portions are provided in the insertion portion, the approach to the nipple is improved without being affected by the shape of the organ. An object of the present invention is to provide a duodenoscope having a configuration that can be used.

The endoscope for duodenum of the present invention is an endoscope for duodenum provided with a long and thin insertion portion inserted into the duodenum, the distal end portion provided at the distal end in the insertion direction of the insertion portion, and the insertion A first bending portion provided on the proximal side of the distal end portion in the insertion direction, and a second bending portion provided on the proximal side of the insertion portion of the first bending portion in the insertion portion; The length along the insertion direction from the distal end of the distal end portion in the insertion direction to the proximal end in the insertion direction of the second bending portion is set to 73 mm to 100 mm. Features.

The perspective view which shows the outline of a structure of the endoscope apparatus which comprises the endoscope for duodenum of this Embodiment. The perspective view which expands and shows the endoscope of FIG. The figure which expands and shows the external appearance of the front end side of the insertion part of FIG. Sectional drawing which shows schematically the structure of the front-end | tip part in alignment with the IV-IV line in FIG. Sectional drawing which shows schematically the structure of the 1st bending part and middle part which follow the VV line in FIG. Sectional drawing which shows schematically the structure of the 2nd bending part and the flexible tube part along the VI-VI line in FIG. The figure which shows a mode that the insertion part of the endoscope of FIG. 1 is inserted in the duodenum, and a nipple is observed with the objective lens provided in the front-end | tip part. The figure which shows a mode that the insertion part is linearized using the endoscope which has two conventional curved parts, and the duodenum and the stomach are linearized. The figure which shows a mode that the insertion part is linearized using the endoscope of FIG. 1, and the duodenum and the stomach are linearized. The figure which shows the modification which provided the knob which operates a 2nd bending part under the holding part of an operation part. The figure which shows the modification which provided the nut which operates a 2nd bending part under the holding part of an operation part.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. The drawings are schematic, and it should be noted that the relationship between the thickness and width of each member, the ratio of the thickness of each member, and the like are different from the actual ones. Of course, the part from which the relationship and ratio of a mutual dimension differ is contained.

FIG. 1 is a perspective view showing an outline of the configuration of an endoscope apparatus including a duodenoscope according to the present embodiment, and FIG. 2 is an enlarged perspective view showing the endoscope of FIG.

As shown in FIG. 1, an endoscope apparatus 1 includes a duodenoscope (hereinafter simply referred to as an endoscope) 2, a light source device 3, a video processor 4, and a monitor 5, and the main part is configured. ing.

The endoscope 2 is detachably attached to the light source device 3 via a connector 14. The light source device 3 supplies illumination light to the endoscope 2 when the endoscope 2 is mounted.

The endoscope 2 is detachably attached to the video processor 4 via a connector 14. When the endoscope 2 is mounted, the video processor 4 controls the operation of an imaging unit 66 (see FIG. 4) described later provided in the distal end portion 21 of the insertion portion 11 of the endoscope 2 and performs imaging. It has a function of processing a signal obtained by the unit 66 and outputting a standard video signal. The monitor 5 has a function of displaying a video signal output from the video processor 4, that is, an endoscopic image.

The endoscope 2 includes an elongated insertion portion 11 along an insertion direction S to be inserted into a duodenum 102 (see FIG. 7), which will be described later, and an insertion direction proximal end side (hereinafter simply referred to as a proximal end side) A universal cord 13 extending from a side surface of the grip portion 12 of the operation portion 12a, and a connector 14 provided at an end portion of the universal cord 13. The main part is composed.

The insertion portion 11 includes a distal end portion 21 provided at a distal end in the insertion direction S (hereinafter simply referred to as a distal end), a bending portion 22 provided on the proximal end side of the distal end portion 21, and a base of the bending portion 22. It has a flexible tube portion 23 provided on the end side and having flexibility, and a main portion is configured.

The bending portion 22 is provided on the proximal end side of the distal end portion 21, for example, a first bending portion 24 that can be bent in four directions, and a hard portion provided on the proximal end side of the first bending portion 24. A main portion having a middle portion 26 and a second curved portion 25 which is provided on the proximal end side of the middle portion 26 and can be bent in, for example, two directions independently of the first curved portion 24. Is configured. Note that the second bending portion 25 may be provided on the proximal end side of the first bending portion 24 without providing the intermediate portion 26. The detailed configuration of the insertion portion 11 will be described later with reference to FIGS.

Further, as shown in FIG. 2, the operation unit 12 a includes a main bending operation unit 36 where main operations are performed, and a sub-curvature provided on the base end side of the main bending operation unit 36, that is, at the upper part in FIG. 2. The main part is comprised with the operation part 27. FIG.

A known air / water supply operation button 31, suction operation button 32, and a plurality of remote switches 33 are provided on the sides of the main bending operation unit 36.

In addition, a treatment instrument that serves as an opening on the proximal end side of a treatment instrument insertion conduit (not shown) provided in the insertion section 11 is provided on the distal end side (hereinafter simply referred to as the distal end side) of the grasping section 12 in the insertion direction S. An insertion port 34 is provided. The treatment instrument insertion port 34 is normally closed by a forceps plug 34a when not in use. The distal end side of the treatment instrument insertion conduit is opened at a notch portion 21k (see FIG. 4) described later on the outer peripheral surface of the distal end portion 21.

When the first bending portion 24 is bent in the vertical direction by the main bending operation portion 36, the first bending portion up / down operation knob 41 to be operated and the first bending portion up / down operation knob 41 are fixed at a desired rotational position. The first bending portion up / down fixing lever 42, the first bending portion left / right operation knob 43 that is operated when the first bending portion 24 is bent in the left-right direction, and the first bending portion left / right operation knob 43. And a first bending portion right / left fixing knob 44 for fixing at a desired rotational position.

In addition, the secondary bending operation unit 27 has a second bending unit up / down operation knob 45 that is operated when the second bending unit 25 is bent in the vertical direction, and the second bending unit up / down operation knob 45 is rotated as desired. A second bending portion up / down fixing lever 46 for fixing at a position is provided.

Next, the structure of the insertion portion 11 will be described with reference to FIGS. 3 is an enlarged view showing the appearance of the distal end side of the insertion portion in FIG. 1, FIG. 4 is a cross-sectional view schematically showing the configuration of the distal end portion along the line IV-IV in FIG. 3, and FIG. FIG. 6 is a cross-sectional view schematically showing the configuration of the first bending portion and the intermediate portion along the VV line in FIG. 3, and FIG. 6 is the second bending portion and the flexible tube along the VI-VI line in FIG. It is sectional drawing which shows the structure of the front end side of a part roughly.

FIG. 7 is a view showing a state in which the insertion portion of the endoscope of FIG. 1 is inserted into the duodenum and the nipple is observed with an objective lens provided at the distal end portion, and FIG. FIG. 8B is a diagram schematically showing how the duodenum and stomach are straightened by using two endoscopes to straighten the insertion portion, and FIG. 8B shows the insertion portion using the endoscope of FIG. It is a figure which shows roughly a mode that it makes it straighten and straightens the duodenum and the stomach.

As shown in FIG. 4, in the present embodiment, a concave notch portion 21 k that is notched on one outer peripheral surface side is formed on a part of the outer peripheral surface of the distal end portion 21 of the insertion portion 11 of the endoscope 2. The distal end side of the above-mentioned treatment instrument insertion conduit is opened in the notch 21k.

Although not shown, a known treatment tool raising base (not shown) for raising a treatment tool such as a catheter or a guide wire (none of which is shown) is disposed in the vicinity of the distal end opening in the treatment instrument insertion conduit. It is installed.

The treatment instrument raising base treats the advancing direction of the treatment instrument or guide wire inserted into the treatment instrument insertion conduit from the treatment instrument insertion port 34 from the advancing direction in the treatment instrument insertion channel along the insertion direction S. It is made to change to the direction of the front-end | tip opening of the instrument insertion pipe line.

As shown in FIG. 4, a distal end hard member 70 is provided at the distal end portion 21. Further, a distal end cover 71 made of a non-conductive member such as a resin is provided on the outer periphery of the distal end hard member 70 excluding the notch 21k and the distal end in the insertion direction S so as to cover the outer periphery and the distal end.

An imaging unit arrangement hole 72 in which the imaging unit 66 is provided is formed in the distal end hard member 70. Specifically, the imaging unit arrangement hole 72 includes a space 72 a formed along the insertion direction S, and along the direction K inclined from the insertion direction S by the set angle θ, An imaging unit 66 is provided so as to intersect with the distal end side and open to the notch 21k of the distal end portion 21 and open to the notch 21k. The imaging unit 66 is provided in the

spaces

72a and 72b so that the objective lens 66t faces the notch 21k. It has been. That is, the endoscope 2 according to the present embodiment is a side-view type endoscope in which the objective lens 66t observes a direction K having a set angle θ with respect to the insertion direction S.

In addition, since the structure of the imaging unit 66 is known, the description is abbreviate | omitted. A signal cable 69 that electrically connects the image pickup unit 66 and the video processor 4 (see FIG. 1) extends from the image pickup unit 66. The signal cable 69 includes the insertion portion 11, the operation portion 12a, and the universal cord. 13, and the extended end of the connector 14 is electrically connected to the video processor 4.

Furthermore, the imaging unit arrangement hole 72 includes a space 72c that opens to the notch 21k and is formed so as to intersect the space 72a with respect to the distal end side rather than a position where the space 72b intersects.

In the space 72a, the light guide 67 is inserted on the bottom side (lower side in FIG. 4) of the imaging unit 66. The light guide 67 is inserted into the insertion portion 11, the operation portion 12a, and the universal cord 13, and the connector 14 is configured to be supplied with light from the light source device 3 (see FIG. 1) from the proximal end side. Have.

The front end side of the light guide 67 inserted in the space 72a is provided at a position facing the illumination lens 68 provided so as to face the opening in the notch 21k of the space 72c after being inserted in the space 72c.

Further, as shown in FIG. 5, in the first bending portion 24, a plurality of bending pieces 24 a are rotated along the insertion direction S, for example, in four directions, up, down, left, and right, inside covered with the bending rubber 51. It is configured by being connected so as to be free. Normally, a known blade member is provided between the outer periphery of the plurality of bending pieces 24a and the bending rubber 51. However, in order to simplify the drawing, the blade member is omitted in FIG. is there.

Further, among the plurality of bending pieces 24a, the bending piece 24a positioned on the most distal side in the insertion direction S has four bending operation wires (hereinafter simply referred to as wires) 61 through which the insertion portion 11 is inserted. 64 (only the wire 64 is not shown in FIG. 5) is fixed.

The base ends of the wires 61 to 64 are wound around a sprocket (not shown) that is rotated by the operation of the first bending portion up / down operation knob 41, for example, when the

wires

61, 62 are up / down bending wires. In the case where the wires 63 and 64 are left and right bending wires, the wires 63 and 64 are wound and fixed on a sprocket (not shown) that is rotated by the operation of the first bending portion left and right operation knob 43.

As a result, as the first bending portion up / down operation knob 41 is rotated, the first bending portion 24 is bent in the up / down direction by pulling the

wire

61 or 62, and the first bending portion left / right operation knob 43 is rotated. With the moving operation, the first bending portion 24 is bent in the left-right direction by pulling the wire 63 or 64.

Further, as shown in FIG. 6, in the second bending portion 25, the plurality of bending pieces 25 a are rotatable along the insertion direction S in, for example, two directions, up and down, in the interior covered with the bending rubber 51. It is comprised by connecting so that it may become. Normally, a known blade member is provided between the outer periphery of the plurality of bending pieces 25a and the bending rubber 51. However, in order to simplify the drawing, the blade member is omitted in FIG. is there.

Further, among the plurality of bending pieces 25a, the bending piece 25a positioned on the most distal side in the insertion direction S has two bending operation wires (hereinafter simply referred to as wires) 161 inserted through the insertion portion 11. The tip of 162 is fixed.

The base ends of the

wires

161 and 162 are wound around and fixed to a sprocket (not shown) that is rotated by the operation of the second bending portion up / down operation knob 45.

Thus, the second bending portion 25 is bent in the vertical direction by the pulling of the

wire

161 or 162 in accordance with the turning operation of the second bending portion up / down operation knob 45.

Note that the maximum bending angle of the second bending portion 25 is set to 45 °. This is because, from an anatomical perspective, the inner diameter of the lumen of the duodenum 102 is about 24 mm on average, so that the distal end portion 21 and the bending portion 22 of the insertion portion 11 are separated from the stomach 100 as shown in FIG. In the state where the objective lens 66t is inserted into the duodenum 102 via the pylorus 101 and the objective lens 66t is viewed from the front of the nipple 103, the distance of the objective lens 66t with respect to the nipple 103 is adjusted by curving the second bending portion 25. This is because the second bending portion 25 is sufficient if it can be bent by 45 °. In other words, when the objective lens 66t is viewed from the front of the nipple 103, the second bending portion 25 cannot be bent more than 45 ° in consideration of the inner diameter of the lumen of the duodenum 102.

Note that the second bending portion 25 may be configured to bend in the four directions of the left and right directions and the up and down direction, similarly to the first bending portion 24, by using known four-direction pieces for the plurality of bending pieces 25a. I do not care.

As shown in FIG. 3, in the insertion portion 11, the distal end portion 21 is set to a length a (a = 20 mm to 32 mm) along the insertion direction S, and the first bending portion 24 is The length b is set along the insertion direction S (b = 38 mm to 42 mm), and the intermediate portion 26 is set to the length c along the insertion direction S (c = 2 mm to 11 mm). The second bending portion 25 is set to a length d (d = 13 mm to 15 mm) along the insertion direction S. Thus, the length e along the insertion direction S from the distal end of the distal end portion 21 to the proximal end of the second bending portion 25 is set to 73 mm to 100 mm.

Note that the length a of the distal end portion 21 and the length b of the second curved portion 24 are the length of the distal end portion in a duodenal endoscope in which only one bending portion is provided in a conventional insertion portion. And the length of the curved portion. In other words, the length c of the intermediate portion 26 and the length d of the second bending portion 25 are changed from those of the conventional duodenoscope. This is to prevent the operator from feeling uncomfortable with the bending operability of the first bending portion by changing the lengths of the first bending portion 24 and the distal end portion 21. In other words, this is because the operability of the first bending portion 24 is desired to be ensured with the same operational feeling as that of a conventional duodenal endoscope.

Thus, in the present embodiment, in the insertion portion 11, the length e along the insertion direction S from the distal end of the distal end portion 21 to the proximal end of the second bending portion 25 is set to 73 mm to 100 mm. I showed that.

According to this, as shown in FIG. 7, the distal end portion 21 and the curved portion 22 of the insertion portion 11 are inserted into the duodenum 102 from the stomach 100 through the pylorus 101, and the objective lens 66 t is viewed from the front of the nipple 103. In this state, when the objective lens 66t is positioned at an appropriate observation distance from the nipple 103, specifically, the distance from the nipple 103 to the tip cover 71 positioned on the notch 21k side is 3 mm to 15 mm apart. When inserting a treatment instrument, a guide wire or the like into the bile duct 104 or the pancreatic duct 105 through the nipple 103 from the opening of the treatment instrument insertion passage of the notch 21k, the nipple 103 to the stomach 100 Since the distance to the pylorus 101 is about 100 mm, the proximal end of the second curved portion 25 may not be positioned to protrude from the pylorus 101 to the stomach 100 side. .

Therefore, the base end of the second bending portion 25 protrudes from the pylorus 101 to the stomach 100 side and comes into contact with the stomach wall of the pylorus 101 like a conventional duodenal endoscope in which two insertion portions are provided in the insertion portion. Since unnecessary force is applied from the sphincter of the pylorus 101 to the second curved portion 25, the second curved portion 25 does not exhibit the original behavior, and thus the distance adjustment of the objective lens 66t with respect to the nipple 103 is performed. In addition, it is difficult to align the opening at the distal end of the insertion portion and the bile duct or pancreatic duct, and it is difficult to insert a treatment instrument, a guide wire, or the like into the nipple 103. Further, the second bending portion 25 does not give an extra force to the stomach wall.

Furthermore, in order to improve the operability of the endoscope 2, when the distal end portion 21 enters the descending portion of the duodenum 102 when being inserted into the duodenum 102, by pulling the base side of the insertion portion 11, A part of the insertion portion 11 is brought into contact with the wall surface of the pylorus 101 from the bulb portion of the duodenum 102, and the distal end side of the insertion portion 11 is slid toward the duodenum 102 so that the teat 103 can be inserted to a position where it can be viewed from the front. When performing straightening to take the deflection of the scope, as shown in FIG. 8A, the proximal end of the second bending portion 25 protrudes from the pylorus 101 to the stomach 100 side, as in a conventional duodenal endoscope. In addition to the weight of the stomach 100, the force applied from the sphincter of the pylorus 101 to the second curved portion 25 that contacts the stomach wall of the pylorus 101 causes the second curved portion 25 to be bent into an S shape, Ball of the duodenum 102 Linearization of the insertion portion 11 that exists toward Luo stomach 100. can not be sufficiently performed. For this reason, the travel of the insertion portion 11 in the duodenum 102 changes compared to the case where the insertion portion of the endoscope provided with only one bending portion is linearized, so that the operator feels uncomfortable. In addition, the second bending portion 25 may be difficult to bend to a desired angle.

However, in the endoscope 2 according to the present embodiment, as shown in FIG. 8B, the nipple 103 is viewed from the objective lens 66t in front, and the objective lens 66t and the nipple 103 are separated from each other by an appropriate observation distance (3 mm to 15 mm). In this state, the proximal end of the second bending portion 25 does not protrude from the pylorus 101 toward the stomach 100, so that no force is applied to the second bending portion 25 from the pylorus 101. For this reason, as shown in FIG. 8B, in addition to facilitating the above-described linearization of the distal end side of the insertion portion 11, the second bending portion 25 can be easily bent to a desired angle. Insertability of tools and guide wires is improved.

From the above, even if the insertion portion 11 is provided with two curved portions, the duodenal interior having a configuration capable of improving the approachability to the teat 103 without being affected by the shape of the organ. The endoscope 2 can be provided.

In the present embodiment, as the duodenoscope 2, a side-view type endoscope in which the objective lens 66 t faces the notch portion 21 k formed on the outer peripheral surface of the distal end portion 21 is taken as an example. Although shown, it is needless to say that the present invention is not limited to this and can be applied to a direct-view type endoscope.

By the way, as shown in FIG. 2, the second bending portion up / down operation knob 45 for bending operation of the second bending portion 25 includes a first bending portion up / down operation knob 41 for bending operation of the first bending portion 24, Since the first bending portion left / right operation knob 43 is provided on the upper side in FIG. 2, there is a problem that the weight balance of the entire endoscope operation portion 12a is deteriorated.

In general, the operator holds the grip portion 12 with the left hand, performs the insertion operation by gripping the proximal end side of the insertion portion 11 with the right hand, and performs the first bending portion up / down operation knob 41 and the first bending portion left / right operation. The knob 43 is operated with the left hand while gripping the grip portion 12, and the second bending portion up / down operation knob 45 is operated with the right hand, but when operating the second bending portion up / down operation knob 45, There was a problem that it had to be moved from the base end side to the uppermost part of the operation unit 12a.
Hereinafter, in view of the above problems, a configuration for improving the operability of the knob that operates the second bending portion will be described with reference to FIGS. 9 and 10. FIG. 9 is a diagram showing a modification in which a knob for operating the second bending portion is provided below the grip portion of the operation portion, and FIG. 10 is a diagram illustrating a second bending portion provided below the grip portion of the operation portion. It is a figure which shows the modification which provided the nut to operate.

As shown in FIGS. 9 and 10, the second bending portion operating member may be provided on the distal end side of the grip portion 12, that is, on the lower portion in FIGS. 9 and 10. As shown in FIG. 9, the second bending portion operation member may be a knob 201 that is rotatable in the same direction as the bending operation knob of the first bending portion 24. FIG. As shown, the nut 202 may be rotated around the insertion axis of the insertion portion 11.

As described above, if the second bending portion operating member is provided at the lower portion of the grip portion 12, the weight balance of the operating portion 12a is improved, and when the second bending portion operating member is operated, The person can operate the second bending portion operating member by moving the right hand slightly upward from the proximal end side of the insertion portion 11, or while holding the proximal end side of the insertion portion 11 with the right hand. Since the second bending portion operation member can be operated, the amount of movement of the right hand can be reduced and the second bending portion operation member can be easily operated, so that the operability is improved.

This application is filed on the basis of the priority claim of Japanese Patent Application No. 2010-0117168 filed in Japan on January 28, 2010. The above description includes the present specification, claims, and drawings. Is quoted in

Claims

An endoscope for a duodenum provided with an elongated insertion portion to be inserted into the duodenum,
A tip provided at the tip of the insertion portion in the insertion direction;
A first bending portion provided on the insertion direction base end side of the distal end portion in the insertion portion;
A second bending portion provided on the insertion direction base end side of the first bending portion in the insertion portion;
Comprising
The length along the insertion direction from the distal end of the distal end in the insertion direction to the proximal end in the insertion direction of the second bending portion is set to 73 mm to 100 mm. Endoscope.
The endoscope for a duodenum according to claim 1, wherein a hard intermediate portion is provided between the first curved portion and the second curved portion.
The duodenoscope according to claim 2, wherein the length of the intermediate portion along the insertion direction is set to 2 mm to 11 mm.
The duodenoscope according to any one of claims 1 to 3, wherein a length along the insertion direction of the distal end portion is set to 20 mm to 32 mm.
The duodenoscope according to any one of claims 1 to 4, wherein a length along the insertion direction of the first curved portion is set to 38 mm to 42 mm.
The duodenoscope according to any one of claims 1 to 5, wherein a length along the insertion direction of the second bending portion is set to 13 mm to 15 mm.
An objective lens for observing the inside of the duodenum is provided on at least a part of the outer peripheral surface of the distal end portion of the insertion portion,
The duodenoscope according to any one of claims 1 to 6, wherein the objective lens observes a direction having a set angle with respect to the insertion direction in the duodenum.