WO2018168070A1

WO2018168070A1 - Endoscope

Info

Publication number: WO2018168070A1
Application number: PCT/JP2017/040783
Authority: WO
Inventors: 安久井　伸章
Original assignee: オリンパス株式会社
Priority date: 2017-03-17
Filing date: 2017-11-13
Publication date: 2018-09-20

Abstract

Provided is an endoscope comprising: an elongated insertion portion to be inserted into a subject; a treatment tool channel tube (35) which is provided in the insertion portion (10) along an insertion portion longitudinal axis (a10) and has a first inner diameter (d1) that allows a treatment tool to be inserted therein; a distal end configuration portion (12) at which the distal end of the treatment tool channel tube is provided and which is the distal end portion of the insertion portion; a thin diameter portion (31, 31A) which is provided at the distal end configuration portion (12), communicates with the treatment tool channel tube (35) to configure a treatment tool channel (36), and has a second inner diameter (d2) smaller than the first inner diameter (d1); and a first opening (31m) which is provided to communicate with the thin diameter portion (31, 31A) provided at the distal end configuration portion (12) and opens toward the distal end of the distal end configuration portion.

Description

Endoscope

The present invention relates to an endoscope in which a treatment instrument channel is provided in an insertion portion.

A technique for guiding an elongated insertion part of an endoscope into a ureter and a renal pelvis through a bladder to perform observation or treatment is performed. For example, in a procedure for removing a calculus existing in a ureter, an endoscope sampling tool shown in Japanese Patent Application Laid-Open No. 2003-126101 is used.

The endoscope sampling tool is a so-called basket forceps and includes a basket portion. The basket portion is elastically deformable, and is led out from a treatment instrument channel provided in the insertion portion. After the calculus is taken into the basket portion, the basket portion is discharged outside the body. Therefore, when there are a plurality of stones, it is necessary to repeatedly take the stones into the basket portion.

In recent years, laser fibers have been used as a technique for efficiently removing stones. In this procedure, the laser fiber is led out from the treatment instrument channel toward the stone. The calculus is finely crushed so that the calculus can be naturally discharged by a laser beam abutting against the calculus and emitted from the tip of the fiber. In order to secure a visual field, for example, physiological saline is perfused through the treatment instrument channel.

However, the inner diameter of the treatment instrument channel is larger than the diameter of the basket forceps and the diameter of the laser fiber. Therefore, there is a possibility that the basket portion that is elastically deformable may be staggered, and the task of taking in stones becomes difficult due to the wobbling. Further, the physiological fiber is flowed into the treatment instrument channel through which the laser fiber is inserted, whereby the laser fiber is shaken. Then, the vibration is transmitted to the fiber tip, causing blurring, and the operation of bringing the fiber tip into contact with the calculus becomes difficult.

The present invention has been made in view of the above circumstances, and provides an endoscope that enables a rapid treatment by allowing a treatment instrument derived from a treatment instrument channel to approach a target site smoothly with high accuracy. The purpose is to do.

An endoscope according to an aspect of the present invention includes a long insertion portion that is inserted into a subject, and a first insertion device that can be inserted into the insertion portion along the longitudinal axis of the insertion portion and that can insert a treatment instrument. A treatment instrument channel tube having an inner diameter; a distal end configuration portion which is a distal end portion of the insertion portion provided at a distal end side of the treatment instrument channel tube; provided at the distal end configuration portion; and in communication with the treatment instrument channel tube A narrow diameter portion having a second inner diameter smaller than the first inner diameter constituting the treatment instrument channel, and a small diameter portion provided in the distal end configuration portion, provided in communication with the distal end of the distal end configuration portion A first opening that opens to the side.

The figure explaining the front-end | tip structure part which comprises the front-end | tip part of the insertion part of an endoscope The figure explaining the state by which the laser fiber which is a treatment tool is inserted in the through-hole of a treatment tool channel The figure explaining the state which the laser fiber passed the through-hole and was located in the taper part of the hole for treatment tool channels The figure explaining the state by which the front end side of the laser fiber was inserted in the small diameter part, and the fiber front end was derived | led-out from the 1st opening part. The figure explaining the state in which the physiological saline is flowing out from the 2nd opening part in the state where the fiber tip was derived | led-out from the 1st opening part The figure explaining the front-end | tip structure part which has the hole for treatment tool channels in which the central axis of the thin diameter part which has 1st opening cross | intersects an acute angle with respect to an insertion part longitudinal axis.

Embodiments of the present invention will be described below with reference to the drawings.
In each drawing used in the following description, the scale of each component may be different in order to make each component large enough to be recognized on the drawing. Further, the present invention is not limited only to the number of components described in these drawings, the shape of the components, the ratio of the sizes of the components, and the relative positional relationship between the components.

As shown in FIG. 1, the insertion portion 10 of the endoscope is inserted into the subject. The insertion portion 10 is long and includes a distal end constituting portion 12 constituting the distal end portion 11 on the distal end side. The distal end configuration portion 12 is a cylindrical body, and is provided with an observation optical system hole 20, an illumination optical system hole (not shown), and a treatment instrument channel hole 30.

The observation optical system hole 20 is provided with an observation window 21, a plurality of optical lenses 22, an image sensor 23, and the like. The optical image formed on the imaging surface of the image sensor 23 is converted into an electrical signal and transmitted through the signal line 24. The observation hole central axis c20 of the observation optical system hole 20 is parallel to the insertion portion longitudinal axis a10 including the distal end constituting portion 12, and is provided to coincide with or parallel to the optical axis of the observation optical system.

The illumination optical system hole is provided with one end of an illumination window (not shown) and an illumination bundle (not shown) for transmitting illumination light. An illumination hole central axis (not shown) of the illumination optical system hole is parallel to the insertion portion longitudinal axis a10.

The treatment instrument channel hole 30 includes a narrow-diameter portion 31, a tapered portion 32, a large-diameter portion 33, and a tube mounting recess 34 in order from the distal end surface 12f side. The tube mounting recess 34 has a bottomed hole shape and has an opening on the bottom surface 34 f, and one end of the treatment instrument channel tube 35 is disposed.

The treatment instrument channel tube 35 is provided with a through hole 35h having a first inner diameter d1 along the longitudinal axis. A treatment instrument introduced from a treatment instrument insertion port provided in an endoscope operation section (not shown) can be inserted into the through hole 35h.

The distal end of the treatment instrument channel tube 35 is integrally fixed to the tube mounting recess 34. As a result, the treatment instrument channel 36 is formed by communicating the through hole 35 h of the treatment instrument channel tube 35 with the treatment instrument channel hole 30.

In the insertion portion 10, a treatment instrument channel tube 35, a signal line 24, an illumination bundle, and the like are provided along the insertion portion longitudinal axis a10. Reference numeral 13 denotes an exterior member, which is, for example, a resin member having flexibility and insulation. The distal end portion of the exterior member 13 is fixed to the base end surface side step portion 14 of the distal end configuration portion 12.

In the present embodiment, the channel center axis c30 of the treatment instrument channel hole 30 is parallel to the insertion portion longitudinal axis a10. The small diameter portion 31 has a second inner diameter d2. The second inner diameter d2 is set smaller than the first inner diameter d1.

In the present embodiment, the second inner diameter d2 is set to a dimension within 1.3 times the outer diameter of the laser fiber, for example, a laser fiber that is a treatment tool for crushing stones can be inserted. Specifically, the second inner diameter d2 is formed by providing a clearance that allows the laser fiber led out to the outside to be smoothly led out without shaking.

The inner diameter of the large-diameter portion 33 is approximately the same as the first inner diameter d1. In the present embodiment, the inner diameter of the large-diameter portion 33 is set slightly larger than the first inner diameter d1. As a result, the distal end of the treatment instrument led out from the treatment instrument channel tube 35 is smoothly introduced into the large-diameter portion 33 without coming into contact with the bottom surface 34 f of the channel mounting recess 34.

The tapered portion 32 includes a tapered surface whose inner diameter continuously decreases from the proximal-side large-diameter portion 33 to the distal-side thin-diameter portion 31. The tapered portion 32 is reduced in diameter from the first inner diameter d1 to the second inner diameter d2.

The small diameter portion 31 has a straight hole having substantially the same size as the outer diameter of the laser fiber, and has a first opening 31m that is a first opening portion having a first inner diameter d1. A first opening 31m, an observation window 21, and an illumination window are provided on the distal end surface 12f of the distal end configuration portion 12.

The tip structure portion 12 is provided with a second opening 37m as a second opening in addition to the first opening 31m. The second opening 37m is provided laterally with respect to the direction of the insertion portion longitudinal axis a10. Specifically, a fluid hole 37 communicating with the outside of the distal component 12 from the treatment instrument channel 36 is formed in the distal component 12, and the second opening 37 m is formed at the distal component of the fluid hole 37. 12 is an opening that is provided on the side surface of 12 and communicates with the outside.

The inner diameter of the fluid hole 37 is set to a third inner diameter d3 that is larger than the second inner diameter d2. The third inner diameter d3 is set to be the same as, slightly larger than, or slightly smaller than the first inner diameter d1. That is, the third inner diameter d3 of the fluid hole 37 is substantially the same as the first inner diameter d1 of the through hole 35h of the treatment instrument channel tube 35.

The operation of the endoscope including the distal end constituting portion 12 configured as described above will be described.
The operator first performs an examination by inserting the insertion portion 10 of the endoscope into the ureter and renal pelvis. The surgeon introduces a laser fiber, which is a treatment tool, from a treatment tool insertion port provided in the endoscope operation unit when performing a procedure for crushing a calculus.

The laser fiber 40 introduced from the treatment instrument insertion port is inserted into the through hole 35h of the treatment instrument channel tube 35 constituting the treatment instrument channel 36 as shown in FIG. It will move forward toward.

As shown in FIG. 2B, the laser fiber 40 passes through the treatment instrument channel tube 35 and is then introduced into the large-diameter portion 33 and does not enter the fluid hole 37 located on the rear side, and enters the tapered portion 32. To proceed. As a result, the laser fiber 40 is smoothly introduced into the small-diameter portion 31 as indicated by a broken line.

Here, when the laser fiber 40 is further advanced, as shown in FIG. 2C, the laser fiber 40 passes through the small diameter portion 31 and is led out from the first opening 31m into the ureter and renal pelvis (not shown). .

At this time, since the second inner diameter d2 of the small-diameter portion 31 is set to a predetermined clearance, the laser fiber 40 led out from the first opening 31m is advanced toward the calculus 50 without wobbling. As a result, the fiber tip 41 of the laser fiber 40 can be pressed against the desired part of the calculus 50 with high accuracy.

Further, for example, physiological saline W is supplied as a perfusate into the through hole 35h of the treatment instrument channel tube 35 for the purpose of securing the observation visual field. As shown in FIG. 2D, the physiological saline W supplied into the through-hole 35h fills the treatment instrument channel hole 30, and then flows out from the second opening 37m toward the ureter and renal pelvis. .

In the state where the physiological saline W is supplied, a midway portion located on the fiber tip 41 side of the laser fiber 40 is disposed in the small diameter portion 31. For this reason, even if the laser fiber 40 located in the vicinity of the large-diameter portion 33 is shaken by the flow of the physiological saline W, the vibration is transmitted to the fiber tip 41 side, and the fiber tip 41 is moved from the calculus. It can prevent breakage and perform reliable crushing.

As described above, the distal end component portion 12 is provided with the treatment instrument channel hole 30 including the narrow diameter portion 31 having the first opening 31m, the tapered portion 32, and the large diameter portion 33 in order from the distal end surface 12f side. As a result, the treatment instrument that advances in the through hole 35h of the treatment instrument channel tube 35 that constitutes the treatment instrument channel 36 is smoothly introduced into the small diameter portion 31, and from the first opening 31m of the small diameter portion 31. It can be derived without wobbling.

Further, in addition to the first opening 31m, a second opening 37m is provided laterally with respect to the direction of the insertion portion longitudinal axis a10 of the tip constituting portion 12. Thus, the perfusate supplied to the through-hole 35h in a state where the treatment tool protrudes from the first opening 31m flows out from the second opening 37m, and the observation visual field can be reliably ensured.

In the embodiment described above, the channel center axis c30 of the treatment instrument channel hole 30 is parallel to the insertion portion longitudinal axis a10. However, as shown in FIG. 3, the central axis c31A of the small diameter portion 31A having the first opening 31m constituting the treatment instrument channel hole 30 is at an acute angle with respect to the observation hole central axis c20 which is the optical axis of the observation optical system. You may make it cross. Alternatively, the central axis c31A of the small-diameter portion 31A having the first opening 31m constituting the treatment instrument channel hole 30 is changed to the observation hole central axis c20 which is the optical axis of the observation optical system on the distal end side with respect to the distal end configuration portion 12. Alternatively, they may be arranged at a so-called twisted position so as to approach each other (that is, arranged so that the central axis c31A intersects the central axis c20 at an acute angle). In the above configuration, the insertion portion longitudinal axis a10 and the observation hole central axis c20 are provided in parallel, but the insertion portion longitudinal axis a10 and the observation hole central axis c20 may not be parallel.

According to this configuration, it is possible to guide the laser fiber 40 led out from the first opening 31m of the small diameter portion 31A toward the observation hole central axis c20 of the observation optical system hole 20 without wobbling. As a result, the fiber tip 41 of the laser fiber 40 can be led out toward the center of the screen (not shown) on which the endoscopic observation image is displayed.

In the above-described embodiment, the treatment tool is a laser fiber that crushes stones. However, the treatment tool is not limited to the laser fiber, and may be, for example, a basket forceps. When the treatment instrument is a basket forceps, the second inner diameter d2 of the small-diameter portion 31 is set with a clearance that allows the basket forceps led out to the outside to be smoothly led out without shaking.

According to this configuration, it is possible to smoothly perform the stone taking-in operation by preventing the elastically deformable basket portion from being greatly shaken.
The endoscope described above may be either a reuse type or a disposable type.

The present invention is not limited to the embodiments described above, and various modifications can be made without departing from the spirit of the invention.

This application is filed on the basis of the priority claim of Japanese Patent Application No. 2017-52847 filed in Japan on March 17, 2017. The above disclosure is included in the present specification and claims. Shall be quoted.

Claims

A long insertion part to be inserted into the subject;
A treatment instrument channel tube provided in the insertion section along the longitudinal axis of the insertion section and having a first inner diameter into which a treatment instrument can be inserted;
A distal end configuration portion that is a distal end portion of the insertion portion, provided on the distal end side of the treatment instrument channel tube;
A small-diameter portion having a second inner diameter smaller than the first inner diameter, which is provided at the distal end configuration portion and communicates with the treatment instrument channel tube to constitute a treatment instrument channel;
A first opening provided in communication with the narrow-diameter portion provided in the tip configuration portion and opening to a tip side of the tip configuration portion;
An endoscope comprising:
In addition to the tip component
The second opening portion having a third inner diameter larger than the second inner diameter that communicates with the treatment instrument channel tube and opens to the outside from the distal end component portion, is provided. Endoscope.
The endoscope according to claim 2, wherein the third inner diameter is substantially the same as the first inner diameter.
The endoscope according to claim 2, wherein the second opening is open laterally with respect to the direction of the insertion portion longitudinal axis.
The endoscope according to claim 1, wherein a central axis of the first opening is parallel to the longitudinal axis of the insertion part.
The endoscope according to claim 1, wherein the central axis of the first opening intersects the optical axis of the observation optical system at an acute angle.
The endoscope according to claim 1, wherein a central axis of the first opening is arranged so as to be closer to an optical axis of an observation optical system on a distal end side than the distal end constituent portion.
The said 2nd internal diameter is a dimension within 1.3 times the outer diameter of the front-end | tip part of the said treatment tool while being able to insert the treatment tool which crushes a calculus, The Claim 2 characterized by the above-mentioned. Endoscope.
The endoscope according to claim 8, wherein the treatment instrument is a laser fiber.
2. The endoscope according to claim 1, wherein the distal end configuration portion has a tapered portion that decreases in diameter from the first inner diameter to the second inner diameter from the proximal end side to the distal end side.