WO2019087254A1 - Endoscope system - Google Patents

Endoscope system Download PDF

Info

Publication number
WO2019087254A1
WO2019087254A1 PCT/JP2017/039143 JP2017039143W WO2019087254A1 WO 2019087254 A1 WO2019087254 A1 WO 2019087254A1 JP 2017039143 W JP2017039143 W JP 2017039143W WO 2019087254 A1 WO2019087254 A1 WO 2019087254A1
Authority
WO
WIPO (PCT)
Prior art keywords
endoscope
sheath
distal end
balloon
insertion portion
Prior art date
Application number
PCT/JP2017/039143
Other languages
French (fr)
Japanese (ja)
Inventor
和敏 熊谷
尚也 杉本
善朗 岡崎
俊二 武井
祐介 野村
Original Assignee
オリンパス株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to PCT/JP2017/039143 priority Critical patent/WO2019087254A1/en
Publication of WO2019087254A1 publication Critical patent/WO2019087254A1/en

Links

Images

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/005—Flexible endoscopes
    • A61B1/01—Guiding arrangements therefore
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments

Definitions

  • the present invention relates to an endoscope system, and more particularly to an endoscope system for a pericardium.
  • the present invention has been made in view of the above-described circumstances, and holds the tip of the endoscope at a position away from the heart in the pericardial cavity, and secures a space around the tip of the endoscope. It is an object of the present invention to provide an endoscope system that can
  • One aspect of the present invention is an endoscope, an elongated medical device disposed in parallel with the endoscope and inserted into a body cavity with the endoscope, a distal end portion of the endoscope, and the medical device And an expansion member, which is expandable between the endoscope and the medical instrument in a parallel direction.
  • the dilation member expanding between the endoscope and the medical instrument juxtaposed to each other maintains a space in the parallel direction between the distal end portion of the endoscope and the medical instrument. Therefore, the distal end portion of the endoscope is pushed away from the heart while pushing up the pericardium by expanding the expandable member in a state where the distal end portion of the endoscope is arranged on the pericardial side and the expandable member is arranged on the cardiac side It is lifted and held away from the heart. Thereby, a space can be reliably secured around the tip of the endoscope.
  • the medical device is a tubular sheath into which the endoscope can be inserted in the longitudinal direction, and the expansion member is inserted into the inner surface of the sheath and the sheath. It may be disposed between the outer surface, and at least a distal end of the sheath may be configured to allow the parallel movement of the distal end of the endoscope by the expanding member.
  • the expansion member in the sheath is expanded in a state where it is disposed between the distal end of the endoscope and the heart, thereby moving the endoscope in the direction away from the heart in the sheath, and the distal end of the endoscope Can be lifted away from the heart.
  • the expansion member is fixed to the outer surface of the distal end portion of the endoscope, the distal end of the endoscope protrudes longitudinally from the distal end of the sheath, and the expansion member is inserted into the sheath
  • a positioning portion may be provided to position the sheath and the endoscope in the longitudinal direction.
  • the sheath may have an inner diameter that allows the distal end portion of the endoscope and the expansion member in a contracted state to move radially.
  • the distal end of the sheath may be radially expandable by the expanding member.
  • the medical instrument is a treatment instrument disposed outside the endoscope, and the expansion member is disposed between the outer surface of the treatment instrument and the outer surface of the distal end portion of the endoscope. It may be done. With the treatment tool on the heart side and the endoscope on the pericardial side, the dilation member is expanded to keep the tip of the endoscope away from the heart while being placed near the heart The treatment tool can treat the heart.
  • the treatment tool may have a flexible portion that can be bent in a direction intersecting in the longitudinal direction by the expanding member at the tip.
  • the dilation member is expanded in a state where it is disposed between the distal end of the endoscope and the soft part of the treatment tool, thereby curving the soft part toward the heart side and placing the tip of the treatment tool closer to the heart can do.
  • the expansion member may be a balloon. In this way, expansion and contraction of the balloon can be controlled by a simple operation of adjusting the amount of fluid in the balloon.
  • the expandable member can be deformed from an contracted shape extending in a direction along the longitudinal direction of the endoscope to an expanded shape having a larger dimension in the parallel direction than the contracted shape by an elastic restoring force It may be By doing so, the expansion member can be self-expanded by the elastic recovery force.
  • the endoscope includes a bending portion which can be bent downward corresponding to the downward direction of the endoscopic image acquired by the endoscope, and the expansion member is closer to the bending portion than the bending portion.
  • the proximal end side may be disposed below the endoscope.
  • the bending portion may be bendable in the upward direction opposite to the downward direction, and the expansion member may be disposed on the upper side of the endoscope.
  • the upper expansion member With the heart placed on the lower side of the endoscope, the upper expansion member is expanded to hold the tip of the endoscope away from the pericardium and subsequently bend the bending portion upward.
  • the tip of the endoscope is directed to the pericardium side and the pericardium is looked up.
  • the present invention it is possible to hold the tip of the endoscope at a position away from the heart in the pericardial cavity, and to secure the space around the tip of the endoscope.
  • FIG. 1A is a figure which shows the state which expanded the balloon. It is a side view which shows the structure of the sheath in the other modification of the endoscope system of FIG. 1A. It is a side view which shows the whole structure of the endoscope system which concerns on the 2nd Embodiment of this invention. It is a side view which shows the state which expanded the balloon of the endoscope system of FIG. 6A. It is a schematic front view which looked at the endoscope system of FIG. 6A in the longitudinal direction from the front end side. It is a side view which shows the whole structure of the modification of the endoscope system of FIG. 6A. It is a schematic front view which looked at the other modification of the endoscope system of FIG.
  • an endoscope system 100 includes a circular tubular elongated sheath (medical device) 1 inserted into a pericardial space, and a sheath within the sheath 1. 1, an elongated endoscope 2 disposed in parallel with 1, a balloon (expansion member) 3 disposed between the inner surface of the sheath 1 and the outer surface of the endoscope 2, and the sheath 1 and the endoscope 2 And a positioning portion 4 for mutually positioning in the longitudinal direction.
  • a circular tubular elongated sheath (medical device) 1 inserted into a pericardial space
  • a sheath within the sheath 1.
  • an elongated endoscope 2 disposed in parallel with 1
  • a balloon (expansion member) 3 disposed between the inner surface of the sheath 1 and the outer surface of the endoscope 2
  • a positioning portion 4 for mutually positioning in the longitudinal direction.
  • the sheath 1 has a lumen 5 which is open at the distal end surface and the proximal end surface and penetrates in the longitudinal direction.
  • the sheath 1 can maintain its shape against the radially outward force received from the balloon 3 expanded in the lumen 5 while having flexibility capable of being curved along the shape of tissue in the body It has rigidity.
  • the endoscope 2 is a direct-view type that acquires an endoscopic image of the field of view in front of the distal end surface.
  • the endoscope 2 includes a long insertion portion 6 to be inserted into the body, and an operation portion 7 connected to the proximal end of the insertion portion 6.
  • the insertion portion 6 has flexibility that can be curved along the shape of tissue in the body.
  • the distal end portion of the insertion portion 6 is provided with an optical member (specifically, an illumination lens and an objective lens) for observing the heart A, and a curved portion 8 positioned on the proximal side of the optical member There is.
  • the insertion portion 6 has a vertical direction corresponding to the vertical direction of the endoscopic image, which is a direction perpendicular to the longitudinal direction.
  • the bending portion 8 can be bent at least downward by the operation of a handle (not shown) provided on the operation portion 7.
  • the insertion portion 6 is longer than the sheath 1 and has a length such that the entire curved portion 8 can be protruded from the distal end of the sheath 1.
  • the balloon 3 is fixed to the outer surface of the distal end portion of the insertion portion 6 at a position proximal to the bending portion 8.
  • the insertion portion 6 has a connection port 6a to which an air supply device such as an air tube or a syringe connected to a pump can be connected, and an air lumen (not shown) communicating the inside of the balloon 3 with the connection port 6a. It is provided.
  • the connection port 6 a is provided at the proximal end of the insertion portion 6 which is disposed on the proximal side of the sheath 1.
  • the operator can expand the balloon 3 by supplying air into the balloon 3 through the air lumen by the air supply device, and exhaust air from inside the balloon 3 through the air lumen by the air supply device. And the balloon 3 can be deflated.
  • the balloon 3 is provided only on the lower side of the insertion portion 6 and expands and contracts at least in the vertical direction of the insertion portion 6 by the supply and discharge of air.
  • the lumen 5 is a total of the insertion portion 6 in the vertical direction and the balloon 3 in a contracted state so that a space is formed between the outer surface of the insertion portion 6 and the inner surface of the lumen 5 in a contracted state. It has an inner diameter larger than its dimensions. Therefore, the insertion portion 6 is movable in the longitudinal direction in the lumen 5 in the deflated state of the balloon 3, and the vertical movement of the insertion portion 6 and the deflated balloon 3 in the lumen 5 is permitted. It has become.
  • the expansion of the balloon 3 causes the insertion portion 6 to abut on the inner surface of the lumen 5 in the sheath 1. It is lifted upward and held at the top in the lumen 5. In this state, the insertion portion 6 is pressed against the inner surface of the lumen 5 by the balloon 3 so as to be fixed in the lumen 5 in the longitudinal and radial directions.
  • the positioning portion 4 has a longitudinal position of the insertion portion 6 in the lumen 5 such that the entire curved portion 8 protrudes outward from the tip of the sheath 1 and at least a portion of the balloon 3 is disposed in the sheath 1 regulate.
  • the positioning portion 4 shown in FIG. 1A is a flange-like stopper that is provided at the proximal end of the insertion portion 6 and protrudes radially outward from the side surface of the insertion portion 6.
  • the stopper has a diameter larger than the diameter of the opening of the lumen 5 at the proximal end surface of the sheath 1, and the stopper abuts on the proximal end surface of the sheath 1 so that the sheath 1 and the insertion portion 6 can be positioned relative to each other. There is.
  • FIG. 2 shows another example of the positioning unit 4.
  • the positioning portion 4 shown in FIG. 2 is a scale provided on the side surface of the proximal end of the insertion portion 6 and indicating the amount of insertion of the insertion portion 6 into the lumen 5.
  • the operator inserts into the lumen 5 based on the scale so that the entire curved portion 8 protrudes outward from the distal end of the sheath 1 and at least a part of the balloon 3 is disposed in the sheath 1 Control the insertion amount of 6.
  • the sheath 1 is inserted from under the xiphoid process to the pericardial cavity.
  • the sheath 1 disposed in the body is restricted by the adjacent skin, pericardium B, mediastinal tissue, etc., thereby restricting longitudinal movement and rotation around the longitudinal axis.
  • the insertion portion 6 is inserted into the pericardial cavity via the lumen 5.
  • the posture around the longitudinal axis of the insertion portion 6 in the lumen 5 is adjusted so that the balloon 3 is disposed on the heart A side.
  • the positioning portion 4 positions the sheath 1 and the insertion portion 6 with each other such that the entire curved portion 8 protrudes outward from the distal end of the sheath 1 and at least a portion of the balloon 3 is disposed in the sheath 1 .
  • the balloon 3 is expanded by supplying air into the balloon 3 using an air supply device connected to the connection port 6a.
  • the expanded balloon 3 moves the insertion portion 6 to the pericardium B side in the lumen 5.
  • the distal end portion of the insertion portion 6 located outside the sheath 1 is lifted in a direction away from the heart A while pushing up the pericardium B, and held at a position away from the heart A. Therefore, a space S is secured between the distal end of the insertion portion 6 and the heart A in front of the distal end of the sheath 1.
  • the heart A can be observed by curving the bending portion 8 downward so that the distal end surface of the insertion portion 6 faces the heart A.
  • the pressing force toward the heart A is achieved by the balloon 3 expanding in the parallel direction of the sheath 1 and the insertion portion 6 between the inner surface of the sheath 1 and the outer surface of the distal end of the insertion portion 6 Even in a situation where the force acts from the pericardium B to the tip of the insertion portion 6, the tip of the insertion portion 6 can be held at a position away from the heart A against the force from the pericardium B.
  • This has the advantage that the space S necessary for observation of the heart A can be reliably secured between the tip of the insertion portion 6 and the heart A.
  • the insertion portion 6 is pressed against the inner surface of the lumen 5, thereby restricting the longitudinal movement and rotation around the longitudinal axis of the insertion portion 6 in the lumen 5. Position and posture of the tip of the Therefore, there is an advantage that observation of the heart A can be performed stably.
  • the operator can easily control the distance between the tip of the insertion portion 6 and the heart A. There is.
  • the balloon 3 is fixed to the insertion portion 6, but instead, the balloon 3 may be fixed to the inner surface of the distal end portion of the lumen 5, and the insertion portion 6 and It may be separate from the sheath 1. Even in this case, the distal end portion of the insertion portion 6 can be lifted upward in the lumen 5 by expanding the balloon 3 in a state where the balloon 3 is disposed below the distal end portion of the insertion portion 6.
  • the sheath 1 is not deformed by the expansion of the balloon 3. Instead, as shown in FIGS. 3A and 3B, the distal end of the sheath 1 is expanded from the expanded balloon 3. It may be configured to expand radially by an applied radial outward force.
  • slits 9 extending in the longitudinal direction from the distal end are formed at two places spaced in the circumferential direction, and the distal end of the sheath 1 is circumferentially divided by the slits 9 It is divided into portions 1a and 1b. When the width of the slit 9 is expanded, the distal end of the sheath 1 is expanded in the radial direction.
  • the insertion portion 6 By expanding the balloon 3 in a state in which the slits 9 are disposed on the left and right sides of the insertion portion 6, the insertion portion 6 can be lifted upward while expanding the distal end portion of the sheath 1 in the vertical direction of the insertion portion 6. .
  • the insertion portion 6 can be lifted to a position further away from the heart A as compared with the case where the sheath 1 whose diameter of the distal end portion is fixed is used. Further, since the pericardium B is pushed up to a position further away from the heart A by the portion 1a positioned above the insertion portion 6, a wider space S can be secured.
  • the balloon 3 is provided both on the lower side and on the upper side of the insertion part 6.
  • the upper balloon 3 and the lower balloon 3 may be integral so as to simultaneously expand and contract, or separate so as to expand and contract independently of each other.
  • the relative rigidity of the two portions 1a and 1b and the position of the slit 9 are designed such that one of the two portions 1a and 1b divided by the slits 9 is preferentially deformed by the expanded balloon 3. May be
  • the bending portion 8 is preferably bendable in the upward direction. By doing in this way, looking up at the pericardium B by curving the bending portion 8 upward in a state where the distal end portion of the insertion portion 6 is held at a position separated from the pericardium B by the expanded upper balloon 3 As can be observed.
  • the balloon 3 When using the sheath 1 having the slit 9, the balloon 3 may be provided only on the lower side of the insertion portion 6 as shown in FIG. 4. Thus, when the balloon 3 is provided only on the lower side of the insertion portion 6, the insertion portion 6 is compared with the case where the balloon 3 is provided on both the lower side and the upper side. Can be lifted further away from the
  • the distal end portion of the sheath 1 may be configured to be expanded in the radial direction by the expansion of the balloon 3 by being formed of an elastic material that can expand and contract in the circumferential direction.
  • the insertion portion 6 and the balloon 3 in the contracted state do not necessarily have to be movable in the vertical direction in the lumen 5. It is sufficient that the insertion portion 6 and the balloon 3 in the contracted state have a minimum inner diameter that can move in the longitudinal direction.
  • one of the two portions 1a and 1b divided by the slit 9 may be shorter than the other.
  • An endoscope system 200 according to a second embodiment of the present invention will be described with reference to the drawings.
  • An endoscope system 200 according to the present embodiment includes a treatment tool 12 disposed outside the endoscope 2 as shown in FIGS. 6A and 6B, and the balloon 3 includes an insertion portion 6 and the treatment tool 12.
  • the balloon 3 includes an insertion portion 6 and the treatment tool 12.
  • the endoscope system 200 includes a sheath 1, an endoscope 2, a long treatment tool 12 disposed in parallel with the endoscope 2 in the sheath 1, and a balloon 3.
  • the treatment instrument 12 includes an elongated trunk 13 inserted into the body, and an end effector 14 connected to the tip of the trunk 13 for treating the heart A.
  • the body portion 13 has flexibility higher than that of the insertion portion 6 while having flexibility capable of being bent along the shape of tissue in the body.
  • the end effector 14 is, for example, a forceps or a ligation tool.
  • the total dimension of the vertical outer diameter of the insertion portion 6 and the balloon 3 in the contracted state and the outer diameter of the trunk portion 13 is smaller than the inner diameter of the lumen 5 of the sheath 1. That is, the insertion portion 6, the balloon 3 in the contracted state and the trunk portion 13 can be simultaneously disposed in the lumen 5, and in the contracted state of the balloon 3, the insertion portion 6 and the trunk portion 13 move longitudinally in the lumen 5 can do.
  • the balloon 3 disposed between the insertion portion 6 and the trunk portion 13 expands in the vertical direction
  • vertical force is applied to the insertion portion 6 and the body portion 13 in a direction away from each other.
  • the force from the balloon 3 lifts the insertion portion 6 upward to a position abutted against the inner surface of the lumen 5, and the body 13 is pushed downward to a position abutted against the inner surface of the lumen 5.
  • the insertion portion 6 having a rigidity lower than that of the body portion 13 is preferentially bent upward.
  • the sheath 1 is inserted from under the xiphoid process into the pericardial space.
  • the lumens are arranged such that the insertion portion 6 is disposed on the pericardium B side and the trunk portion 13 on the heart A side, and the balloon 3 is disposed between the insertion portion 6 and the trunk portion 13.
  • the insertion portion 6 and the body portion 13 are inserted into the pericardial cavity via the 5, and the bending portion 8, the balloon 3 and the end effector 14 are protruded outward from the distal end of the sheath 1.
  • the balloon 3 is expanded by supplying air into the balloon 3 using an air supply device connected to the connection port 6a.
  • the distal end of the insertion portion 6 is lifted to the side of the pericardium B by the expanded balloon 3 and held at a position away from the heart A, and the distal end of the trunk 13 is pushed downward to the heart A and located near the heart A Will be held by
  • the portion of the insertion portion 6 between the bending portion 8 and the tip of the sheath 1 is bent upward, and the tips of the bending portion 8 and the insertion portion 6 are further separated from the heart A.
  • a space S is secured between the distal end of the insertion portion 6 and the heart A in front of the distal end of the sheath 1.
  • the heart A can be observed by curving the bending portion 8 downward so that the distal end surface of the insertion portion 6 faces the heart A.
  • the balloon 3 expanded by air is elastically deformable, even when the body 13 is pressed toward the heart A by the expanded balloon 3, the longitudinal advancing and retracting of the body 13 and the rotation around the longitudinal axis are It is possible.
  • the operator advances and retracts and rotates the treatment tool 12 and treats the heart A with the end effector 14 as needed.
  • the pressing force from the pericardium B toward the heart A is expanded by the balloon 3 expanded in the parallel direction of the insertion portion 6 and the trunk portion 13 between the insertion portion 6 and the trunk portion 13.
  • the tip of the insertion portion 6 can be held at a position away from the heart A against the force from the pericardium B.
  • the tip of the insertion portion 6 is lifted to a position further away from the heart A as compared with the first embodiment in which the balloon 3 is expanded inside the sheath 1.
  • a larger space S can be secured.
  • the operator can easily control the distance between the tip of the insertion portion 6 and the heart A. There is.
  • the balloon 3 may have a flat shape in which the dimension in the left-right direction is larger than the dimension in the vertical direction in the contracted state.
  • FIG. 7 simply shows the arrangement of the sheath 1, the insertion portion 6, the body portion 13 and the balloon 3.
  • the relative position of the insertion portion 6 and the trunk portion 13 may be shifted in the left-right direction.
  • the trunk portion 13 has higher rigidity than the insertion portion 6 so that the trunk portion 13 is not bent by the expanded balloon 3, but instead, as shown in FIG.
  • the flexible portion 15 may be provided at the distal end portion of the body portion 13 so that both the body portion 13 and the insertion portion 6 are curved by the expanded balloon 3.
  • the flexible portion 15 is lower than the rigidity of the other portion of the body portion 13 and has substantially the same rigidity as the rigidity of the insertion portion 6.
  • the body portion 13 is formed of a coil sheath formed by spirally winding a metal thin wire
  • a coil sheath having different rigidity in the flexible portion 15 and other portions is used.
  • the distal end of the insertion portion 6 is positioned away from the heart A and the end effector 14 is positioned closer to the heart A as the insertion portion 6 is bent upward and the soft portion 15 is curved downward by the expanded balloon 3. , Each held. Thereby, the heart A can be easily treated by the end effector 14 disposed in the vicinity of the heart A.
  • FIG. 9 simply shows the arrangement of the sheath 1, the balloon 3 and the treatment instruments 12A and 12B.
  • the insertion portion 6 and the two trunks 13 are disposed in the lumen 5 so that the trunks 13 of the two treatment instruments 12A and 12B are aligned in the left-right direction on the lower side of the insertion portion 6.
  • the balloon 3 is disposed between the insertion portion 6 and the two trunks 13 so as to press the two trunks 13 downward simultaneously. Therefore, as in the case of the balloon 3 shown in FIG. 7, the balloon 3 is preferably wide in the left-right direction. As described above, the insertion portion 6 can be lifted more stably upward by pressing the two trunks 13 aligned in the left and right direction with the expanded balloon 3.
  • the expanding member is the balloon 3, but the expanding member may be a member other than the balloon 3. 10 and 11 show another example of the expanding member 3.
  • the expanding members 31 and 32 in FIGS. 10 and 11 are constituted by the tip of the wire longitudinally movably disposed in the wire lumen (not shown) formed longitudinally in the insertion portion 6 There is.
  • the wire is made of a shape memory material such as nickel titanium and has flexibility.
  • the wire lumen opens on the side surface of the distal end of the insertion portion 6 on the proximal side of the curved portion 8, and the distal end portions 31 and 32 of the wire are disposed outside the insertion portion 6 via the opening 6 b.
  • the distal end portions 31 and 32 of the wires have an expanded shape that spreads in a U-shape or a loop in a plane in the vertical direction of the insertion portion 6 below the insertion portion 6.
  • the proximal end of the wire is drawn outward from the proximal end of the insertion portion 6.
  • the distal end portions 31 and 32 of the wire are accommodated in the wire lumen while being elastically deformed into a contracted shape extending linearly along the longitudinal direction of the insertion portion 6 It has become.
  • the distal end portions 31 and 32 of the wire are configured to protrude downward to the outside of the insertion portion 6 while being deformed into the expanded shape by elastic restoring force. .
  • the use of the wire self-expanding in the expanded shape as the expanding members 31 and 32 allows the expansion of the expanding members 31 and 32 and the expansion and contraction of the expansion members 31 and 32 as compared with the case of using the balloon 3
  • the contraction can be performed more simply.
  • the endoscope 2 is a direct view type, but may be a perspective view type or a side view type instead. In the case of the perspective view type or side view type endoscope 2, the bending portion 8 may not be provided.
  • endoscope system 100, 200 endoscope system 1 sheath (medical device) 2 Endoscope 3 Balloon (expansion member) 31, 32 wire (expansion member) Reference Signs List 4 positioning unit 5 lumen 6 insertion unit 6a connection port 7 operation unit 8 bending unit 9 slit 12, 12A, 12B treatment tool (medical device) 13 body part 14 end effector 15 soft part A heart B pericardium S space

Abstract

This endoscope system (100) is provided with: an endoscope (2); an elongate medical device (1) that is parallelly arranged with the endoscope (2) and inserted into a body cavity together with the endoscope (2); and a dilation member (3) that is disposed between a distal end part of the endoscope (2) and the medical device (1) and is able to dilate in the direction in which the endoscope (2) and the medical device (1) are parallelly arranged.

Description

内視鏡システムEndoscope system
　本発明は、内視鏡システムに関し、特に心嚢用の内視鏡システムに関するものである。 The present invention relates to an endoscope system, and more particularly to an endoscope system for a pericardium.
　従来、剣状突起下から心膜腔に内視鏡を挿入し、開胸手術を行うことなく、心臓の疾患部位を観察する方法が知られている（例えば、特許文献１参照。）。 Conventionally, there is known a method of inserting an endoscope into the pericardial space from below the xiphoid process and observing a diseased part of the heart without performing a thoracotomy (e.g., see Patent Document 1).
米国特許出願公開第２００４／００６４１３８号明細書US Patent Application Publication No. 2004/0064138
　しかしながら、狭い心膜腔内では心臓および心膜が内視鏡の先端に近接し過ぎてしまい、内視鏡の先端の周囲に観察に必要な空間を確保することが難しいという問題がある。
　本発明は、上述した事情に鑑みてなされたものであって、心膜腔内において内視鏡の先端を心臓から離れた位置に保持し、内視鏡の先端の周囲に確実に空間を確保することができる内視鏡システムを提供することを目的とする。 However, in a narrow pericardial space, the heart and the pericardium are too close to the tip of the endoscope, and it is difficult to secure a space necessary for observation around the tip of the endoscope.
The present invention has been made in view of the above-described circumstances, and holds the tip of the endoscope at a position away from the heart in the pericardial cavity, and secures a space around the tip of the endoscope. It is an object of the present invention to provide an endoscope system that can
　上記目的を達成するため、本発明は以下の手段を提供する。
　本発明の一態様は、内視鏡と、該内視鏡と並列に配置され該内視鏡と共に体腔内に挿入される長尺の医療器具と、前記内視鏡の先端部と前記医療器具との間に配置され、前記内視鏡および前記医療器具の並列方向に拡張可能である拡張部材とを備える内視鏡システムである。 In order to achieve the above object, the present invention provides the following means.
One aspect of the present invention is an endoscope, an elongated medical device disposed in parallel with the endoscope and inserted into a body cavity with the endoscope, a distal end portion of the endoscope, and the medical device And an expansion member, which is expandable between the endoscope and the medical instrument in a parallel direction.
　本態様によれば、相互に並列する内視鏡および医療器具の間で拡張する拡張部材によって、内視鏡の先端部と医療器具との間に並列方向に間隔が保持される。したがって、内視鏡の先端部を心膜側に、拡張部材を心臓側に配置した状態で拡張部材を拡張させることで、内視鏡の先端部が心膜を押し上げながら心臓から離間する方向に持ち上げられて心臓から離れた位置に保持される。これにより、内視鏡の先端の周囲に確実に空間を確保することができる。 According to this aspect, the dilation member expanding between the endoscope and the medical instrument juxtaposed to each other maintains a space in the parallel direction between the distal end portion of the endoscope and the medical instrument. Therefore, the distal end portion of the endoscope is pushed away from the heart while pushing up the pericardium by expanding the expandable member in a state where the distal end portion of the endoscope is arranged on the pericardial side and the expandable member is arranged on the cardiac side It is lifted and held away from the heart. Thereby, a space can be reliably secured around the tip of the endoscope.
　上記態様においては、前記医療器具は、前記内視鏡が長手方向に挿入可能な管状のシースであり、前記拡張部材が、前記シースの内面と、該シース内に挿入された前記内視鏡の外面との間に配置され、前記シースの少なくとも先端部が、拡張した前記拡張部材による前記内視鏡の先端部の前記並列方向の移動を許容するように構成されていてもよい。
　シース内の拡張部材が内視鏡の先端部と心臓との間に配置された状態で拡張することで、シース内で内視鏡を心臓から離間する方向に移動させて、内視鏡の先端を心臓から離れた位置に持ち上げることができる。 In the above aspect, the medical device is a tubular sheath into which the endoscope can be inserted in the longitudinal direction, and the expansion member is inserted into the inner surface of the sheath and the sheath. It may be disposed between the outer surface, and at least a distal end of the sheath may be configured to allow the parallel movement of the distal end of the endoscope by the expanding member.
The expansion member in the sheath is expanded in a state where it is disposed between the distal end of the endoscope and the heart, thereby moving the endoscope in the direction away from the heart in the sheath, and the distal end of the endoscope Can be lifted away from the heart.
　上記態様においては、前記拡張部材が、前記内視鏡の先端部の外面に固定され、前記内視鏡の先端が前記シースの先端から長手方向に突出し、かつ、前記拡張部材が前記シース内に位置するように、前記シースおよび前記内視鏡を長手方向に相互に位置決めする位置決め部を備えていてもよい。
　このようにすることで、シースの先端から外側に突出した内視鏡の先端を持ち上げるのに適した位置に拡張部材が配置されるように、内視鏡に固定された拡張部材とシースとの相対位置を位置決め部によって容易に決定することができる。 In the above aspect, the expansion member is fixed to the outer surface of the distal end portion of the endoscope, the distal end of the endoscope protrudes longitudinally from the distal end of the sheath, and the expansion member is inserted into the sheath A positioning portion may be provided to position the sheath and the endoscope in the longitudinal direction.
By doing this, the expansion member is fixed to the endoscope so that the expansion member is disposed at a position suitable for lifting the end of the endoscope protruding outward from the end of the sheath. The relative position can be easily determined by the positioning unit.
　上記態様においては、前記シースは、前記内視鏡の先端部および収縮した状態の前記拡張部材が径方向に移動可能な内径を有していてもよい。あるいは、前記シースの先端部が、拡張する前記拡張部材によって径方向に拡張可能であってもよい。
　このようにすることで、拡張部材の拡張による内視鏡の先端部の移動を簡易な構成で許容することができる。 In the above aspect, the sheath may have an inner diameter that allows the distal end portion of the endoscope and the expansion member in a contracted state to move radially. Alternatively, the distal end of the sheath may be radially expandable by the expanding member.
By doing this, the movement of the distal end portion of the endoscope due to the expansion of the expansion member can be permitted with a simple configuration.
　上記態様においては、前記医療器具が、前記内視鏡の外側に配置される処置具であり、前記拡張部材が、前記処置具の外面と前記内視鏡の先端部の外面との間に配置されていてもよい。
　処置具を心臓側に、内視鏡を心膜側に配置した状態で拡張部材を拡張させることで、内視鏡の先端を心臓から離れた位置に保持しながら、心臓の近傍に配置された処置具によって心臓を処置することができる。 In the above aspect, the medical instrument is a treatment instrument disposed outside the endoscope, and the expansion member is disposed between the outer surface of the treatment instrument and the outer surface of the distal end portion of the endoscope. It may be done.
With the treatment tool on the heart side and the endoscope on the pericardial side, the dilation member is expanded to keep the tip of the endoscope away from the heart while being placed near the heart The treatment tool can treat the heart.
　上記態様においては、前記処置具が、拡張する前記拡張部材によって長手方向に交差する方向に湾曲可能な軟性部を先端部に有していてもよい。
　拡張部材が内視鏡の先端部と処置具の軟性部との間に配置された状態で拡張することで、軟性部を心臓側に湾曲させて処置具の先端を心臓により近接した位置に配置することができる。 In the above aspect, the treatment tool may have a flexible portion that can be bent in a direction intersecting in the longitudinal direction by the expanding member at the tip.
The dilation member is expanded in a state where it is disposed between the distal end of the endoscope and the soft part of the treatment tool, thereby curving the soft part toward the heart side and placing the tip of the treatment tool closer to the heart can do.
　上記態様においては、前記拡張部材が、バルーンであってもよい。
　このようにすることで、バルーン内の流体の量を調整する簡単な操作によってバルーンの拡張および収縮を制御することができる。 In the above aspect, the expansion member may be a balloon.
In this way, expansion and contraction of the balloon can be controlled by a simple operation of adjusting the amount of fluid in the balloon.
　上記態様においては、前記拡張部材が、前記内視鏡の長手方向に沿う方向に延びる収縮形状から、該収縮形状よりも前記並列方向に大きな寸法を有する拡張形状へ弾性復元力によって変形可能なワイヤであってもよい。
　このようにすることで、拡張部材を弾性復元力によって自己拡張させることができる。 In the above aspect, the expandable member can be deformed from an contracted shape extending in a direction along the longitudinal direction of the endoscope to an expanded shape having a larger dimension in the parallel direction than the contracted shape by an elastic restoring force It may be
By doing so, the expansion member can be self-expanded by the elastic recovery force.
　上記態様においては、前記内視鏡が、該内視鏡によって取得される内視鏡画像の下方向に対応する下方向に湾曲可能な湾曲部を備え、前記拡張部材が、前記湾曲部よりも基端側において前記内視鏡の下側に配置されていてもよい。
　このようにすることで、直視型の内視鏡による心臓の俯瞰観察に適した構成とすることができる。すなわち、内視鏡の下側に心臓が配置された状態で拡張部材を拡張させることで内視鏡の先端を心臓から離れた位置に保持し、続いて湾曲部を下方向に湾曲させることで、内視鏡の先端を心臓側に向けて心臓を俯瞰観察することができる。 In the above aspect, the endoscope includes a bending portion which can be bent downward corresponding to the downward direction of the endoscopic image acquired by the endoscope, and the expansion member is closer to the bending portion than the bending portion. The proximal end side may be disposed below the endoscope.
By doing this, it is possible to make a configuration suitable for the eyelid observation of the heart by a direct-viewing type endoscope. That is, the distal end of the endoscope is held at a position away from the heart by expanding the expansion member in a state in which the heart is placed below the endoscope, and then the bending portion is bent downward. The tip of the endoscope can be directed to the heart side to observe the heart.
　上記態様においては、前記湾曲部が、前記下方向とは反対の上方向に湾曲可能であり、前記拡張部材が、前記内視鏡の上側に配置されていてもよい。
　内視鏡の下側に心臓が配置された状態で上側の拡張部材を拡張させることで、内視鏡の先端を心膜から離れた位置に保持し、続いて湾曲部を上方向に湾曲させることで、内視鏡の先端を心膜側に向けて心膜を見上げるように観察することができる。 In the above aspect, the bending portion may be bendable in the upward direction opposite to the downward direction, and the expansion member may be disposed on the upper side of the endoscope.
With the heart placed on the lower side of the endoscope, the upper expansion member is expanded to hold the tip of the endoscope away from the pericardium and subsequently bend the bending portion upward. Thus, it can be observed that the tip of the endoscope is directed to the pericardium side and the pericardium is looked up.
　本発明によれば、心膜腔内において内視鏡の先端を心臓から離れた位置に保持し、内視鏡の先端の周囲に確実に空間を確保することができるという効果を奏する。 According to the present invention, it is possible to hold the tip of the endoscope at a position away from the heart in the pericardial cavity, and to secure the space around the tip of the endoscope.
本発明の第１の実施形態に係る内視鏡システムの全体構成を示す側面図である。BRIEF DESCRIPTION OF THE DRAWINGS It is a side view which shows the whole structure of the endoscope system which concerns on the 1st Embodiment of this invention. 図１Ａの内視鏡システムのバルーンを拡張させた状態を示す側面図である。It is a side view which shows the state which expanded the balloon of the endoscope system of FIG. 1A. 図１Ａの内視鏡システムにおける位置決め部の変形例を示す側面図である。It is a side view which shows the modification of the positioning part in the endoscope system of FIG. 1A. 図１Ａの内視鏡システムの変形例の先端部の構成を示す斜視図である。It is a perspective view which shows the structure of the front-end | tip part of the modification of the endoscope system of FIG. 1A. 図３Ａの内視鏡システムのバルーンを拡張させた状態を示す斜視図である。It is a perspective view which shows the state which expanded the balloon of the endoscope system of FIG. 3A. 図１Ａの内視鏡システムの他の変形例の先端部の構成を示す斜視図であり、バルーンを拡張させた状態を示す図である。It is a perspective view which shows the structure of the front-end | tip part of the other modification of the endoscope system of FIG. 1A, and is a figure which shows the state which expanded the balloon. 図１Ａの内視鏡システムの他の変形例におけるシースの構成を示す側面図である。It is a side view which shows the structure of the sheath in the other modification of the endoscope system of FIG. 1A. 本発明の第２の実施形態に係る内視鏡システムの全体構成を示す側面図である。It is a side view which shows the whole structure of the endoscope system which concerns on the 2nd Embodiment of this invention. 図６Ａの内視鏡システムのバルーンを拡張させた状態を示す側面図である。It is a side view which shows the state which expanded the balloon of the endoscope system of FIG. 6A. 図６Ａの内視鏡システムを先端側から長手方向に見た模式的な正面図である。It is a schematic front view which looked at the endoscope system of FIG. 6A in the longitudinal direction from the front end side. 図６Ａの内視鏡システムの変形例の全体構成を示す側面図である。It is a side view which shows the whole structure of the modification of the endoscope system of FIG. 6A. 図６Ａの内視鏡システムの他の変形例を先端側から長手方向に見た模式的な正面図である。It is a schematic front view which looked at the other modification of the endoscope system of FIG. 6A in the longitudinal direction from the front end side. 第１および第２の実施形態の内視鏡システムにおける拡張部材の変形例を示す図である。It is a figure which shows the modification of the expansion member in the endoscope system of 1st and 2nd embodiment. 第１および第２の実施形態の内視鏡システムにおける拡張部材の他の変形例を示す図である。It is a figure which shows the other modification of the expansion member in the endoscope system of 1st and 2nd embodiment.
（第１の実施形態）
　本発明の第１の実施形態に係る内視鏡システム１００について図面を参照して説明する。
　本実施形態に係る内視鏡システム１００は、図１Ａおよび図１Ｂに示されるように、心膜腔内に挿入される円管状の長尺のシース（医療器具）１と、シース１内にシース１と並列に配置される長尺の内視鏡２と、シース１の内面と内視鏡２の外面との間に配置されたバルーン（拡張部材）３と、シース１および内視鏡２を長手方向に相互に位置決めする位置決め部４とを備えている。 First Embodiment
An endoscope system 100 according to a first embodiment of the present invention will be described with reference to the drawings.
As shown in FIGS. 1A and 1B, an endoscope system 100 according to the present embodiment includes a circular tubular elongated sheath (medical device) 1 inserted into a pericardial space, and a sheath within the sheath 1. 1, an elongated endoscope 2 disposed in parallel with 1, a balloon (expansion member) 3 disposed between the inner surface of the sheath 1 and the outer surface of the endoscope 2, and the sheath 1 and the endoscope 2 And a positioning portion 4 for mutually positioning in the longitudinal direction.
　シース１は、先端面および基端面に開口し長手方向に貫通するルーメン５を有している。シース１は、体内の組織の形状に沿って湾曲可能な可撓性を有しつつ、ルーメン５内で拡張したバルーン３から受ける径方向外方の力に抗して形状を維持することができる剛性を有している。 The sheath 1 has a lumen 5 which is open at the distal end surface and the proximal end surface and penetrates in the longitudinal direction. The sheath 1 can maintain its shape against the radially outward force received from the balloon 3 expanded in the lumen 5 while having flexibility capable of being curved along the shape of tissue in the body It has rigidity.
　内視鏡２は、先端面の前方の視野の内視鏡画像を取得する直視型である。内視鏡２は、体内に挿入される長尺の挿入部６と、挿入部６の基端に接続された操作部７とを備えている。 The endoscope 2 is a direct-view type that acquires an endoscopic image of the field of view in front of the distal end surface. The endoscope 2 includes a long insertion portion 6 to be inserted into the body, and an operation portion 7 connected to the proximal end of the insertion portion 6.
　挿入部６は、体内の組織の形状に沿って湾曲可能な可撓性を有する。挿入部６の先端部には、心臓Ａを観察するための光学部材（具体的には、照明レンズおよび対物レンズ）と、光学部材よりも基端側に位置する湾曲部８とが設けられている。挿入部６は、長手方向に直交する方向であり内視鏡画像の上下方向に対応する上下方向を有する。湾曲部８は、操作部７に設けられたハンドル（図示略）の操作によって、少なくとも下方向に湾曲可能である。挿入部６は、シース１よりも長く、湾曲部８全体をシース１の先端から突出させることができる長さを有している。 The insertion portion 6 has flexibility that can be curved along the shape of tissue in the body. The distal end portion of the insertion portion 6 is provided with an optical member (specifically, an illumination lens and an objective lens) for observing the heart A, and a curved portion 8 positioned on the proximal side of the optical member There is. The insertion portion 6 has a vertical direction corresponding to the vertical direction of the endoscopic image, which is a direction perpendicular to the longitudinal direction. The bending portion 8 can be bent at least downward by the operation of a handle (not shown) provided on the operation portion 7. The insertion portion 6 is longer than the sheath 1 and has a length such that the entire curved portion 8 can be protruded from the distal end of the sheath 1.
　バルーン３は、湾曲部８よりも基端側の位置において挿入部６の先端部の外面に固定されている。挿入部６には、ポンプに接続されたエアチューブまたはシリンジのようなエア供給デバイスが接続可能な接続口６ａと、バルーン３の内部と接続口６ａとを連通するエアルーメン（図示略）とが設けられている。接続口６ａは、シース１よりも基端側に配置される挿入部６の基端部に設けられている。術者は、エア供給デバイスによってエアルーメンを介してバルーン３内にエアを供給することでバルーン３を拡張させることができ、エア供給デバイスによってエアルーメンを介してバルーン３内からエアを排出することでバルーン３を収縮させることができる。 The balloon 3 is fixed to the outer surface of the distal end portion of the insertion portion 6 at a position proximal to the bending portion 8. The insertion portion 6 has a connection port 6a to which an air supply device such as an air tube or a syringe connected to a pump can be connected, and an air lumen (not shown) communicating the inside of the balloon 3 with the connection port 6a. It is provided. The connection port 6 a is provided at the proximal end of the insertion portion 6 which is disposed on the proximal side of the sheath 1. The operator can expand the balloon 3 by supplying air into the balloon 3 through the air lumen by the air supply device, and exhaust air from inside the balloon 3 through the air lumen by the air supply device. And the balloon 3 can be deflated.
　バルーン３は、挿入部６の下側のみに設けられており、エアの供給および排出によって少なくとも挿入部６の上下方向に拡張および収縮する。ここで、バルーン３が収縮した状態において挿入部６の外面とルーメン５の内面との間に間隔が形成されるように、ルーメン５は、上下方向における挿入部６および収縮状態のバルーン３の合計寸法よりも大きい内径を有する。したがって、バルーン３の収縮状態において挿入部６はルーメン５内で長手方向に移動可能であるとともに、挿入部６および収縮状態のバルーン３のルーメン５内での上下方向の移動が許容されるようになっている。 The balloon 3 is provided only on the lower side of the insertion portion 6 and expands and contracts at least in the vertical direction of the insertion portion 6 by the supply and discharge of air. Here, the lumen 5 is a total of the insertion portion 6 in the vertical direction and the balloon 3 in a contracted state so that a space is formed between the outer surface of the insertion portion 6 and the inner surface of the lumen 5 in a contracted state. It has an inner diameter larger than its dimensions. Therefore, the insertion portion 6 is movable in the longitudinal direction in the lumen 5 in the deflated state of the balloon 3, and the vertical movement of the insertion portion 6 and the deflated balloon 3 in the lumen 5 is permitted. It has become.
　シース１は、拡張したバルーン３から加えられる径方向外方の力に抗する剛性を有しているので、バルーン３の拡張によって、挿入部６はシース１内でルーメン５の内面に突き当たる位置まで上方に持ち上げられてルーメン５内の上部に保持される。この状態において、挿入部６は、バルーン３によってルーメン５の内面に押し付けられてルーメン５内で長手方向および径方向に固定されるようになっている。 Since the sheath 1 has rigidity against radial outward force applied from the expanded balloon 3, the expansion of the balloon 3 causes the insertion portion 6 to abut on the inner surface of the lumen 5 in the sheath 1. It is lifted upward and held at the top in the lumen 5. In this state, the insertion portion 6 is pressed against the inner surface of the lumen 5 by the balloon 3 so as to be fixed in the lumen 5 in the longitudinal and radial directions.
　位置決め部４は、湾曲部８全体がシース１の先端から外側に突出し、かつ、バルーン３の少なくとも一部分がシース１内に配置されるように、ルーメン５内における挿入部６の長手方向の位置を規制する。図１Ａに示される位置決め部４は、挿入部６の基端部に設けられ、挿入部６の側面から径方向外方に突出するフランジ状のストッパである。ストッパは、シース１の基端面におけるルーメン５の開口の径よりも大きな径を有し、ストッパがシース１の基端面に突き当たることでシース１および挿入部６が相互に位置決めされるようになっている。 The positioning portion 4 has a longitudinal position of the insertion portion 6 in the lumen 5 such that the entire curved portion 8 protrudes outward from the tip of the sheath 1 and at least a portion of the balloon 3 is disposed in the sheath 1 regulate. The positioning portion 4 shown in FIG. 1A is a flange-like stopper that is provided at the proximal end of the insertion portion 6 and protrudes radially outward from the side surface of the insertion portion 6. The stopper has a diameter larger than the diameter of the opening of the lumen 5 at the proximal end surface of the sheath 1, and the stopper abuts on the proximal end surface of the sheath 1 so that the sheath 1 and the insertion portion 6 can be positioned relative to each other. There is.
　図２は、位置決め部４の他の例を示している。図２に示される位置決め部４は、挿入部６の基端部の側面に設けられ、ルーメン５内への挿入部６の挿入量を示す目盛である。この場合、術者が、湾曲部８全体がシース１の先端から外側に突出し、かつ、バルーン３の少なくとも一部分がシース１内に配置されるように、目盛に基づいてルーメン５内への挿入部６の挿入量を制御する。 FIG. 2 shows another example of the positioning unit 4. The positioning portion 4 shown in FIG. 2 is a scale provided on the side surface of the proximal end of the insertion portion 6 and indicating the amount of insertion of the insertion portion 6 into the lumen 5. In this case, the operator inserts into the lumen 5 based on the scale so that the entire curved portion 8 protrudes outward from the distal end of the sheath 1 and at least a part of the balloon 3 is disposed in the sheath 1 Control the insertion amount of 6.
　次に、内視鏡システム１００の作用について説明する。
　本実施形態に係る内視鏡システム１００を使用して心臓Ａを観察するためには、剣状突起下から心膜腔内までシース１を挿入する。体内に配置されたシース１は、隣接する皮膚や心膜Ｂ、縦隔組織等によって押さえられることで、長手方向の移動および長手軸回りの回転が制限される。 Next, the operation of the endoscope system 100 will be described.
In order to observe the heart A using the endoscope system 100 according to the present embodiment, the sheath 1 is inserted from under the xiphoid process to the pericardial cavity. The sheath 1 disposed in the body is restricted by the adjacent skin, pericardium B, mediastinal tissue, etc., thereby restricting longitudinal movement and rotation around the longitudinal axis.
　次に、ルーメン５を介して挿入部６を心膜腔内へ挿入する。次に、予め取得された心臓Ａのエコー画像またはＣＴ画像等に基づいて、バルーン３が心臓Ａ側に配置されるようにルーメン５内での挿入部６の長手軸回りの姿勢を調整する。
　次に、湾曲部８全体がシース１の先端から外側に突出し、かつ、バルーン３の少なくとも一部分がシース１内に配置されるように、位置決め部４によってシース１および挿入部６を相互に位置決めする。 Next, the insertion portion 6 is inserted into the pericardial cavity via the lumen 5. Next, based on echo images or CT images of the heart A acquired in advance, the posture around the longitudinal axis of the insertion portion 6 in the lumen 5 is adjusted so that the balloon 3 is disposed on the heart A side.
Next, the positioning portion 4 positions the sheath 1 and the insertion portion 6 with each other such that the entire curved portion 8 protrudes outward from the distal end of the sheath 1 and at least a portion of the balloon 3 is disposed in the sheath 1 .
　次に、接続口６ａに接続されたエア供給デバイスを使用してバルーン３内にエアを供給することでバルーン３を拡張させる。拡張したバルーン３によって、挿入部６はルーメン５内で心膜Ｂ側に移動する。このときに、シース１の外側に位置する挿入部６の先端部は、心膜Ｂを押し上げながら心臓Ａから離間する方向に持ち上げられ、心臓Ａから離れた位置に保持される。したがって、シース１の先端前方において、挿入部６の先端部と心臓Ａとの間に空間Ｓが確保される。この状態で湾曲部８を下方向に湾曲させて挿入部６の先端面を心臓Ａに対向させることで、心臓Ａを俯瞰観察することができる。 Next, the balloon 3 is expanded by supplying air into the balloon 3 using an air supply device connected to the connection port 6a. The expanded balloon 3 moves the insertion portion 6 to the pericardium B side in the lumen 5. At this time, the distal end portion of the insertion portion 6 located outside the sheath 1 is lifted in a direction away from the heart A while pushing up the pericardium B, and held at a position away from the heart A. Therefore, a space S is secured between the distal end of the insertion portion 6 and the heart A in front of the distal end of the sheath 1. In this state, the heart A can be observed by curving the bending portion 8 downward so that the distal end surface of the insertion portion 6 faces the heart A.
　このように、本実施形態によれば、シース１の内面と挿入部６の先端部の外面との間でシース１および挿入部６の並列方向に拡張するバルーン３によって、心臓Ａに向かう押圧力が心膜Ｂから挿入部６の先端に作用する状況においても、挿入部６の先端を心膜Ｂからの力に抗して心臓Ａから離れた位置に保持することができる。これにより、挿入部６の先端と心臓Ａとの間に、心臓Ａの観察に必要な空間Ｓを確実に確保することができるという利点がある。 Thus, according to the present embodiment, the pressing force toward the heart A is achieved by the balloon 3 expanding in the parallel direction of the sheath 1 and the insertion portion 6 between the inner surface of the sheath 1 and the outer surface of the distal end of the insertion portion 6 Even in a situation where the force acts from the pericardium B to the tip of the insertion portion 6, the tip of the insertion portion 6 can be held at a position away from the heart A against the force from the pericardium B. This has the advantage that the space S necessary for observation of the heart A can be reliably secured between the tip of the insertion portion 6 and the heart A.
　また、バルーン３が拡張した状態において、挿入部６がルーメン５の内面に押し付けられることで、ルーメン５内での挿入部６の長手方向の進退および長手軸回りの回転が制限され、挿入部６の先端の位置および姿勢が安定する。したがって、心臓Ａの観察を安定的に行うことができるという利点がある。
　また、バルーン３内へのエアの供給量を調整してバルーン３のサイズを制御することで、術者は、挿入部６の先端と心臓Ａとの距離を容易に制御することができるという利点がある。 Further, in the expanded state of the balloon 3, the insertion portion 6 is pressed against the inner surface of the lumen 5, thereby restricting the longitudinal movement and rotation around the longitudinal axis of the insertion portion 6 in the lumen 5. Position and posture of the tip of the Therefore, there is an advantage that observation of the heart A can be performed stably.
In addition, by adjusting the amount of air supplied into the balloon 3 to control the size of the balloon 3, the operator can easily control the distance between the tip of the insertion portion 6 and the heart A. There is.
　本実施形態においては、バルーン３が挿入部６に固定されていることとしたが、これに代えて、バルーン３が、ルーメン５の先端部の内面に固定されていてもよく、挿入部６およびシース１とは別体であってもよい。
　このようにしても、挿入部６の先端部の下側にバルーン３が配置された状態でバルーン３を拡張させることで、ルーメン５内で挿入部６の先端部を上方に持ち上げることができる。 In the present embodiment, the balloon 3 is fixed to the insertion portion 6, but instead, the balloon 3 may be fixed to the inner surface of the distal end portion of the lumen 5, and the insertion portion 6 and It may be separate from the sheath 1.
Even in this case, the distal end portion of the insertion portion 6 can be lifted upward in the lumen 5 by expanding the balloon 3 in a state where the balloon 3 is disposed below the distal end portion of the insertion portion 6.
　本実施形態においては、シース１が、バルーン３の拡張によって変形しないこととしたが、これに代えて、図３Ａおよび図３Ｂに示されるように、シース１の先端部が、拡張したバルーン３から加えられる径方向外方の力によって径方向に拡張するように構成されていてもよい。
　図３Ａおよび図３Ｂのシース１の先端部には、周方向に間隔をあけた２箇所に先端から長手方向に延びるスリット９が形成され、スリット９によってシース１の先端部が周方向に２つの部分１ａ，１ｂに分割されている。スリット９の幅が拡大することでシース１の先端部が径方向に拡張するようになっている。 In the present embodiment, the sheath 1 is not deformed by the expansion of the balloon 3. Instead, as shown in FIGS. 3A and 3B, the distal end of the sheath 1 is expanded from the expanded balloon 3. It may be configured to expand radially by an applied radial outward force.
At the distal end of the sheath 1 in FIGS. 3A and 3B, slits 9 extending in the longitudinal direction from the distal end are formed at two places spaced in the circumferential direction, and the distal end of the sheath 1 is circumferentially divided by the slits 9 It is divided into portions 1a and 1b. When the width of the slit 9 is expanded, the distal end of the sheath 1 is expanded in the radial direction.
　スリット９が挿入部６の左側および右側に配置された状態でバルーン３を拡張させることで、シース１の先端部を挿入部６の上下方向に拡張させながら挿入部６を上方に持ち上げることができる。
　本変形例によれば、先端部の径が固定であるシース１を用いた場合と比較して、挿入部６を、心臓Ａからより離れた位置まで持ち上げることができる。また、挿入部６よりも上側に位置する部分１ａによって、心膜Ｂが心臓Ａからより離れた位置まで押し上げられるので、より広い空間Ｓを確保することができる。 By expanding the balloon 3 in a state in which the slits 9 are disposed on the left and right sides of the insertion portion 6, the insertion portion 6 can be lifted upward while expanding the distal end portion of the sheath 1 in the vertical direction of the insertion portion 6. .
According to this modification, the insertion portion 6 can be lifted to a position further away from the heart A as compared with the case where the sheath 1 whose diameter of the distal end portion is fixed is used. Further, since the pericardium B is pushed up to a position further away from the heart A by the portion 1a positioned above the insertion portion 6, a wider space S can be secured.
　図３Ａおよび図３Ｂの変形例において、バルーン３は、挿入部６の下側および上側の両方に設けられている。上側のバルーン３と下側のバルーン３は、同時に拡張および収縮するように一体であってもよく、相互に独立に拡張および収縮するように別体であってもよい。
　スリット９によって分割された２つの部分１ａ，１ｂのうち一方が、拡張したバルーン３によって優先的に変形するように、２つの部分１ａ，１ｂの相対的な剛性やスリット９の位置が設計されていてもよい。 In the variant of FIGS. 3A and 3B, the balloon 3 is provided both on the lower side and on the upper side of the insertion part 6. The upper balloon 3 and the lower balloon 3 may be integral so as to simultaneously expand and contract, or separate so as to expand and contract independently of each other.
The relative rigidity of the two portions 1a and 1b and the position of the slit 9 are designed such that one of the two portions 1a and 1b divided by the slits 9 is preferentially deformed by the expanded balloon 3. May be
　バルーン３が挿入部６の上側にも設けられている場合、湾曲部８は、上方向にも湾曲可能であることが好ましい。
　このようにすることで、拡張した上側のバルーン３によって挿入部６の先端部を心膜Ｂから離れた位置に保持した状態で湾曲部８を上方向に湾曲させることで、心膜Ｂを見上げるように観察することができる。 When the balloon 3 is also provided on the upper side of the insertion portion 6, the bending portion 8 is preferably bendable in the upward direction.
By doing in this way, looking up at the pericardium B by curving the bending portion 8 upward in a state where the distal end portion of the insertion portion 6 is held at a position separated from the pericardium B by the expanded upper balloon 3 As can be observed.
　スリット９を有するシース１を使用する場合、バルーン３は、図４に示されるように、挿入部６の下側のみに設けられていてもよい。
　このように、バルーン３が挿入部６の下側のみに設けられている場合には、下側および上側の両方にバルーン３が設けられている場合と比較して、挿入部６を、心臓Ａからさらに離れた位置まで持ち上げることができる。 When using the sheath 1 having the slit 9, the balloon 3 may be provided only on the lower side of the insertion portion 6 as shown in FIG. 4.
Thus, when the balloon 3 is provided only on the lower side of the insertion portion 6, the insertion portion 6 is compared with the case where the balloon 3 is provided on both the lower side and the upper side. Can be lifted further away from the
　スリット９を設けることに代えて、シース１の先端部が周方向に伸縮可能な弾性材料から形成されることで、バルーン３の拡張によって径方向に拡張するように構成されていてもよい。
　また、先端部が径方向に拡張可能であるシース１を用いる場合には、挿入部６および収縮状態のバルーン３がルーメン５内で必ずしも上下方向に移動可能である必要はなく、ルーメン５は、挿入部６と収縮状態のバルーン３が長手方向に移動可能な最低限の内径を有していればよい。 Instead of providing the slits 9, the distal end portion of the sheath 1 may be configured to be expanded in the radial direction by the expansion of the balloon 3 by being formed of an elastic material that can expand and contract in the circumferential direction.
When the sheath 1 in which the distal end portion is radially expandable is used, the insertion portion 6 and the balloon 3 in the contracted state do not necessarily have to be movable in the vertical direction in the lumen 5. It is sufficient that the insertion portion 6 and the balloon 3 in the contracted state have a minimum inner diameter that can move in the longitudinal direction.
　スリット９が設けられたシース１において、図５に示されるように、スリット９によって分割された２つの部分１ａ，１ｂの一方が、他方よりも短くてもよい。
　短い方の部分１ｂを挿入部６と心臓Ａとの間に配置することで、心臓Ａのより基端側の領域も内視鏡２によって観察することができる。 In the sheath 1 in which the slit 9 is provided, as shown in FIG. 5, one of the two portions 1a and 1b divided by the slit 9 may be shorter than the other.
By arranging the shorter portion 1 b between the insertion portion 6 and the heart A, the region more proximal to the heart A can be observed by the endoscope 2.
（第２の実施形態）
　次に、本発明の第２の実施形態に係る内視鏡システム２００について図面を参照して説明する。
　本実施形態においては、第１の実施形態と異なる構成について説明し、第１の実施形態と共通する構成については同一の符号を付して説明を省略する。
　本実施形態に係る内視鏡システム２００は、図６Ａおよび図６Ｂに示されるように、内視鏡２の外側に配置される処置具１２を備え、バルーン３が挿入部６と処置具１２との間に配置される点において、第１の実施形態と異なっている。 Second Embodiment
Next, an endoscope system 200 according to a second embodiment of the present invention will be described with reference to the drawings.
In the present embodiment, a configuration different from the first embodiment will be described, and the configuration common to the first embodiment is assigned the same reference numeral and the description will be omitted.
An endoscope system 200 according to the present embodiment includes a treatment tool 12 disposed outside the endoscope 2 as shown in FIGS. 6A and 6B, and the balloon 3 includes an insertion portion 6 and the treatment tool 12. Are different from the first embodiment in that they are disposed between
　内視鏡システム２００は、シース１と、内視鏡２と、シース１内に内視鏡２と並列に配置される長尺の処置具１２と、バルーン３とを備えている。
　処置具１２は、体内に挿入される長尺の胴部１３と、胴部１３の先端に接続され心臓Ａを処置するためのエンドエフェクタ１４とを備えている。胴部１３は、体内の組織の形状に沿って湾曲可能な可撓性を有しつつ、挿入部６よりも高い剛性を有している。エンドエフェクタ１４は、例えば、鉗子や結紮具等である。 The endoscope system 200 includes a sheath 1, an endoscope 2, a long treatment tool 12 disposed in parallel with the endoscope 2 in the sheath 1, and a balloon 3.
The treatment instrument 12 includes an elongated trunk 13 inserted into the body, and an end effector 14 connected to the tip of the trunk 13 for treating the heart A. The body portion 13 has flexibility higher than that of the insertion portion 6 while having flexibility capable of being bent along the shape of tissue in the body. The end effector 14 is, for example, a forceps or a ligation tool.
　挿入部６および収縮状態のバルーン３の上下方向の外径と胴部１３の外径との合計寸法は、シース１のルーメン５の内径よりも小さい。すなわち、挿入部６、収縮状態のバルーン３および胴部１３を同時にルーメン５内に配置することができ、バルーン３の収縮状態において、挿入部６および胴部１３はルーメン５内で長手方向に移動することができる。 The total dimension of the vertical outer diameter of the insertion portion 6 and the balloon 3 in the contracted state and the outer diameter of the trunk portion 13 is smaller than the inner diameter of the lumen 5 of the sheath 1. That is, the insertion portion 6, the balloon 3 in the contracted state and the trunk portion 13 can be simultaneously disposed in the lumen 5, and in the contracted state of the balloon 3, the insertion portion 6 and the trunk portion 13 move longitudinally in the lumen 5 can do.
　シース１の先端から外側に挿入部６の先端部、胴部１３の先端部およびバルーン３が突出した状態で、挿入部６と胴部１３の間に配置されたバルーン３が上下方向に拡張することで、挿入部６および胴部１３には、相互に離間する方向の上下方向の力が加えられる。このバルーン３からの力によって、挿入部６は、ルーメン５の内面に突き当たる位置まで上方に持ち上げられ、胴部１３は、ルーメン５の内面に突き当たる位置まで下方に押し下げられる。この状態からさらにバルーン３が拡張することで、図６Ｂに示されるように、胴部１３よりも低い剛性を有する挿入部６が上方に優先的に湾曲するようになっている。 With the distal end of the insertion portion 6, the distal end of the trunk portion 13, and the balloon 3 projecting outward from the distal end of the sheath 1, the balloon 3 disposed between the insertion portion 6 and the trunk portion 13 expands in the vertical direction Thus, vertical force is applied to the insertion portion 6 and the body portion 13 in a direction away from each other. The force from the balloon 3 lifts the insertion portion 6 upward to a position abutted against the inner surface of the lumen 5, and the body 13 is pushed downward to a position abutted against the inner surface of the lumen 5. By further expanding the balloon 3 from this state, as shown in FIG. 6B, the insertion portion 6 having a rigidity lower than that of the body portion 13 is preferentially bent upward.
　次に、内視鏡システム２００の作用について説明する。
　本実施形態に係る内視鏡システム２００を使用して心臓Ａを観察および処置するためには、剣状突起下から心膜腔内までシース１を挿入する。
　次に、挿入部６が心膜Ｂ側、胴部１３が心臓Ａ側にそれぞれ配置されるように、かつ、バルーン３が挿入部６と胴部１３との間に配置されるように、ルーメン５を介して挿入部６および胴部１３を心膜腔内へ挿入し、湾曲部８、バルーン３およびエンドエフェクタ１４をシース１の先端から外側に突出させる。 Next, the operation of the endoscope system 200 will be described.
In order to observe and treat the heart A using the endoscope system 200 according to the present embodiment, the sheath 1 is inserted from under the xiphoid process into the pericardial space.
Next, the lumens are arranged such that the insertion portion 6 is disposed on the pericardium B side and the trunk portion 13 on the heart A side, and the balloon 3 is disposed between the insertion portion 6 and the trunk portion 13. The insertion portion 6 and the body portion 13 are inserted into the pericardial cavity via the 5, and the bending portion 8, the balloon 3 and the end effector 14 are protruded outward from the distal end of the sheath 1.
　次に、接続口６ａに接続されたエア供給デバイスを使用してバルーン３内にエアを供給することでバルーン３を拡張させる。拡張したバルーン３によって、挿入部６の先端部は心膜Ｂ側に持ち上げられて心臓Ａから離れた位置に保持され、胴部１３の先端部は心臓Ａ側に押し下げられて心臓Ａに近い位置に保持される。さらにバルーン３を拡張させると、挿入部６の、湾曲部８とシース１の先端との間の部分が上方向に湾曲して、湾曲部８および挿入部６の先端が心臓Ａからさらに離れた位置に保持される。したがって、シース１の先端前方において、挿入部６の先端部と心臓Ａとの間に空間Ｓが確保される。この状態で湾曲部８を下方向に湾曲させて挿入部６の先端面を心臓Ａに対向させることで、心臓Ａを俯瞰観察することができる。 Next, the balloon 3 is expanded by supplying air into the balloon 3 using an air supply device connected to the connection port 6a. The distal end of the insertion portion 6 is lifted to the side of the pericardium B by the expanded balloon 3 and held at a position away from the heart A, and the distal end of the trunk 13 is pushed downward to the heart A and located near the heart A Will be held by When the balloon 3 is further expanded, the portion of the insertion portion 6 between the bending portion 8 and the tip of the sheath 1 is bent upward, and the tips of the bending portion 8 and the insertion portion 6 are further separated from the heart A. Held in position. Therefore, a space S is secured between the distal end of the insertion portion 6 and the heart A in front of the distal end of the sheath 1. In this state, the heart A can be observed by curving the bending portion 8 downward so that the distal end surface of the insertion portion 6 faces the heart A.
　エアによって拡張したバルーン３は弾性変形可能であるので、拡張したバルーン３によって胴部１３が心臓Ａに向かって押圧された状態においても、胴部１３の長手方向の進退および長手軸回りの回転は可能である。術者は、必要に応じて、処置具１２を進退および回転させ、エンドエフェクタ１４によって心臓Ａの処置を行う。 Since the balloon 3 expanded by air is elastically deformable, even when the body 13 is pressed toward the heart A by the expanded balloon 3, the longitudinal advancing and retracting of the body 13 and the rotation around the longitudinal axis are It is possible. The operator advances and retracts and rotates the treatment tool 12 and treats the heart A with the end effector 14 as needed.
　このように、本実施形態によれば、挿入部６と胴部１３との間で挿入部６および胴部１３の並列方向に拡張するバルーン３によって、心臓Ａに向かう押圧力が心膜Ｂから挿入部６の先端に作用する状況においても、挿入部６の先端を心膜Ｂからの力に抗して心臓Ａから離れた位置に保持することができる。これにより、挿入部６の先端と心臓Ａとの間に、心臓Ａの観察および処置に必要な空間Ｓを確実に確保することができるという利点がある。 Thus, according to the present embodiment, the pressing force from the pericardium B toward the heart A is expanded by the balloon 3 expanded in the parallel direction of the insertion portion 6 and the trunk portion 13 between the insertion portion 6 and the trunk portion 13. Even in the situation of acting on the tip of the insertion portion 6, the tip of the insertion portion 6 can be held at a position away from the heart A against the force from the pericardium B. This has the advantage that the space S necessary for observation and treatment of the heart A can be reliably ensured between the tip of the insertion portion 6 and the heart A.
　また、バルーン３をシース１の外側で拡張させることで、シース１の内部でバルーン３を拡張させる第１の実施形態と比較して、心臓Ａからより離れた位置まで挿入部６の先端を持ち上げてより大きな空間Ｓを確保することができるという利点がある。
　また、バルーン３内へのエアの供給量を調整してバルーン３のサイズを制御することで、術者は、挿入部６の先端と心臓Ａとの距離を容易に制御することができるという利点がある。 Further, by expanding the balloon 3 outside the sheath 1, the tip of the insertion portion 6 is lifted to a position further away from the heart A as compared with the first embodiment in which the balloon 3 is expanded inside the sheath 1. There is an advantage that a larger space S can be secured.
In addition, by adjusting the amount of air supplied into the balloon 3 to control the size of the balloon 3, the operator can easily control the distance between the tip of the insertion portion 6 and the heart A. There is.
　本実施形態においては、バルーン３は、図７に示されるように、収縮した状態において、左右方向の寸法が上下方向の寸法よりも大きい扁平な形状を有していてもよい。図７は、シース１、挿入部６、胴部１３およびバルーン３の配置を簡易的に示している。
　シース１の外側では、挿入部６および胴部１３の相対位置が左右方向にずれてしまうこともある。このように挿入部６および胴部１３の相対位置が左右方向にずれた状態においても、左右方向に幅広のバルーン３によって、挿入部６および胴部１３に相互に離間する方向の力を確実に加えて、挿入部６の先端部を確実に持ち上げることができる。 In the present embodiment, as shown in FIG. 7, the balloon 3 may have a flat shape in which the dimension in the left-right direction is larger than the dimension in the vertical direction in the contracted state. FIG. 7 simply shows the arrangement of the sheath 1, the insertion portion 6, the body portion 13 and the balloon 3.
On the outer side of the sheath 1, the relative position of the insertion portion 6 and the trunk portion 13 may be shifted in the left-right direction. Thus, even in the state where the relative position of the insertion portion 6 and the trunk portion 13 is shifted in the left-right direction, the force in the direction of mutually separating the insertion portion 6 and the trunk portion 13 is reliably ensured In addition, the tip of the insertion portion 6 can be reliably lifted.
　本実施形態においては、拡張したバルーン３によって胴部１３が湾曲しないように、胴部１３が挿入部６よりも高い剛性を有することとしたが、これに代えて、図８に示されるように、拡張したバルーン３によって胴部１３および挿入部６の両方が湾曲するように、胴部１３の先端部に軟性部１５が設けられていてもよい。 In the present embodiment, the trunk portion 13 has higher rigidity than the insertion portion 6 so that the trunk portion 13 is not bent by the expanded balloon 3, but instead, as shown in FIG. The flexible portion 15 may be provided at the distal end portion of the body portion 13 so that both the body portion 13 and the insertion portion 6 are curved by the expanded balloon 3.
　軟性部１５は、胴部１３の他の部分の剛性よりも低く挿入部６の剛性と略同等の剛性を有する。例えば、胴部１３が、金属の細線を螺旋状に巻いてなるコイルシースから構成されている場合には、軟性部１５と他の部分とで剛性の異なるコイルシースが用いられる。
　拡張したバルーン３によって挿入部６が上方向に、軟性部１５が下方向にそれぞれ湾曲することで、挿入部６の先端は心臓Ａから離れた位置に、エンドエフェクタ１４は心臓Ａにより近い位置に、それぞれ保持される。これにより、心臓Ａの近傍に配置されたエンドエフェクタ１４によって心臓Ａを容易に処置することができる。 The flexible portion 15 is lower than the rigidity of the other portion of the body portion 13 and has substantially the same rigidity as the rigidity of the insertion portion 6. For example, in the case where the body portion 13 is formed of a coil sheath formed by spirally winding a metal thin wire, a coil sheath having different rigidity in the flexible portion 15 and other portions is used.
The distal end of the insertion portion 6 is positioned away from the heart A and the end effector 14 is positioned closer to the heart A as the insertion portion 6 is bent upward and the soft portion 15 is curved downward by the expanded balloon 3. , Each held. Thereby, the heart A can be easily treated by the end effector 14 disposed in the vicinity of the heart A.
　本実施形態においては、処置具１２を１本のみ備えることとしたが、これに代えて、図９に示されるように、２本の処置具１２Ａ，１２Ｂを備えていてもよい。例えば、一方の処置具１２Ａは把持鉗子であり、他方の処置具１２Ｂは、左心耳結紮用のデバイスである。図９は、シース１と、バルーン３と、処置具１２Ａ，１２Ｂの配置を簡易的に示している。 In the present embodiment, only one treatment tool 12 is provided, but instead, two treatment tools 12A and 12B may be provided as shown in FIG. For example, one treatment tool 12A is a grasping forceps, and the other treatment tool 12B is a device for left atrial appendage ligation. FIG. 9 simply shows the arrangement of the sheath 1, the balloon 3 and the treatment instruments 12A and 12B.
　２本の処置具１２Ａ，１２Ｂの胴部１３が挿入部６の下側において左右方向に並ぶように、挿入部６および２本の胴部１３はルーメン５内に配置される。バルーン３は、挿入部６と２本の胴部１３との間に配置され、２本の胴部１３を同時に下方に押圧するようになっている。したがって、バルーン３は、図７に示されるバルーン３と同様に、左右方向に幅広であることが好ましい。
　このように、左右に並ぶ２本の胴部１３を拡張したバルーン３で押圧することで、挿入部６をより安定的に上方に持ち上げることができる。 The insertion portion 6 and the two trunks 13 are disposed in the lumen 5 so that the trunks 13 of the two treatment instruments 12A and 12B are aligned in the left-right direction on the lower side of the insertion portion 6. The balloon 3 is disposed between the insertion portion 6 and the two trunks 13 so as to press the two trunks 13 downward simultaneously. Therefore, as in the case of the balloon 3 shown in FIG. 7, the balloon 3 is preferably wide in the left-right direction.
As described above, the insertion portion 6 can be lifted more stably upward by pressing the two trunks 13 aligned in the left and right direction with the expanded balloon 3.
　第１および第２の実施形態においては、拡張部材がバルーン３であることとしたが、拡張部材はバルーン３以外の部材であってもよい。
　図１０および図１１は、拡張部材３の他の例を示している。 In the first and second embodiments, the expanding member is the balloon 3, but the expanding member may be a member other than the balloon 3.
10 and 11 show another example of the expanding member 3.
　図１０および図１１の拡張部材３１，３２は、挿入部６内に長手方向に形成されたワイヤ用ルーメン（図示略）内に長手方向に移動可能に配置されたワイヤの先端部から構成されている。ワイヤは、ニッケルチタン等の形状記憶材料からなり可撓性を有する。ワイヤ用ルーメンは、湾曲部８よりも基端側において挿入部６の先端部の側面に開口し、この開口６ｂを介してワイヤの先端部３１，３２は挿入部６の外側に配置される。 The expanding members 31 and 32 in FIGS. 10 and 11 are constituted by the tip of the wire longitudinally movably disposed in the wire lumen (not shown) formed longitudinally in the insertion portion 6 There is. The wire is made of a shape memory material such as nickel titanium and has flexibility. The wire lumen opens on the side surface of the distal end of the insertion portion 6 on the proximal side of the curved portion 8, and the distal end portions 31 and 32 of the wire are disposed outside the insertion portion 6 via the opening 6 b.
　ワイヤの先端部３１，３２は、挿入部６の下側において、挿入部６の上下方向の平面内でＵ字状またはループ状に広がる拡張形状を有する。ワイヤの基端部は、挿入部６の基端部から外側に引き出されている。ワイヤの基端部が牽引されると、ワイヤの先端部３１，３２は、挿入部６の長手方向に沿って直線状に延びる収縮形状に弾性変形しながらワイヤ用ルーメン内に収容されるようになっている。また、ワイヤの基端部が押圧されると、ワイヤの先端部３１，３２は、弾性復元力によって拡張形状に変形しながら挿入部６の外側に下方向に向かって突出するようになっている。 The distal end portions 31 and 32 of the wires have an expanded shape that spreads in a U-shape or a loop in a plane in the vertical direction of the insertion portion 6 below the insertion portion 6. The proximal end of the wire is drawn outward from the proximal end of the insertion portion 6. When the proximal end portion of the wire is pulled, the distal end portions 31 and 32 of the wire are accommodated in the wire lumen while being elastically deformed into a contracted shape extending linearly along the longitudinal direction of the insertion portion 6 It has become. In addition, when the proximal end of the wire is pressed, the distal end portions 31 and 32 of the wire are configured to protrude downward to the outside of the insertion portion 6 while being deformed into the expanded shape by elastic restoring force. .
　このように、拡張部材３１，３２として拡張形状に自己拡張するワイヤを用いることで、エアの供給および排出によって拡張および収縮するバルーン３を用いる場合と比較して、拡張部材３１，３２の拡張および収縮をより簡便に行うことができる。 Thus, the use of the wire self-expanding in the expanded shape as the expanding members 31 and 32 allows the expansion of the expanding members 31 and 32 and the expansion and contraction of the expansion members 31 and 32 as compared with the case of using the balloon 3 The contraction can be performed more simply.
　第１および第２の実施形態においては、内視鏡２が直視型であることとしたが、これに代えて、斜視型または側視型であってもよい。斜視型または側視型の内視鏡２の場合には、湾曲部８が設けられていなくてもよい。 In the first and second embodiments, the endoscope 2 is a direct view type, but may be a perspective view type or a side view type instead. In the case of the perspective view type or side view type endoscope 2, the bending portion 8 may not be provided.
１００，２００　内視鏡システム
１　シース（医療器具）
２　内視鏡
３　バルーン（拡張部材）
３１，３２　ワイヤ（拡張部材）
４　位置決め部
５　ルーメン
６　挿入部
６ａ　接続口
７　操作部
８　湾曲部
９　スリット
１２，１２Ａ，１２Ｂ　処置具（医療器具）
１３　胴部
１４　エンドエフェクタ
１５　軟性部
Ａ　心臓
Ｂ　心膜
Ｓ　空間 100, 200 endoscope system 1 sheath (medical device)
2 Endoscope 3 Balloon (expansion member)
31, 32 wire (expansion member)
Reference Signs List 4 positioning unit 5 lumen 6 insertion unit 6a connection port 7 operation unit 8 bending unit 9 slit 12, 12A, 12B treatment tool (medical device)
13 body part 14 end effector 15 soft part A heart B pericardium S space

Claims (11)

  1. 　内視鏡と、
    　該内視鏡と並列に配置され該内視鏡と共に体腔内に挿入される長尺の医療器具と、
    　前記内視鏡の先端部と前記医療器具との間に配置され、前記内視鏡および前記医療器具の並列方向に拡張可能である拡張部材とを備える内視鏡システム。     Endoscope,
    An elongated medical device disposed in parallel with the endoscope and inserted into a body cavity with the endoscope;
    An endoscope system comprising: an expanding member disposed between the distal end of the endoscope and the medical instrument and expandable in the parallel direction of the endoscope and the medical instrument.
  2. 　前記医療器具は、前記内視鏡が長手方向に挿入可能な管状のシースであり、
    　前記拡張部材が、前記シースの内面と、該シース内に挿入された前記内視鏡の外面との間に配置され、
    　前記シースの少なくとも先端部が、拡張した前記拡張部材による前記内視鏡の先端部の前記並列方向の移動を許容するように構成されている請求項１に記載の内視鏡システム。     The medical device is a tubular sheath into which the endoscope can be inserted in the longitudinal direction,
    The expansion member is disposed between the inner surface of the sheath and the outer surface of the endoscope inserted into the sheath.
    The endoscope system according to claim 1, wherein at least a distal end portion of the sheath is configured to allow movement of the distal end portion of the endoscope in the parallel direction by the expanded expansion member.
  3. 　前記拡張部材が、前記内視鏡の先端部の外面に固定され、
    　前記内視鏡の先端が前記シースの先端から長手方向に突出し、かつ、前記拡張部材が前記シース内に位置するように、前記シースおよび前記内視鏡を長手方向に相互に位置決めする位置決め部を備える請求項２に記載の内視鏡システム。     The expanding member is fixed to the outer surface of the distal end of the endoscope;
    A positioning portion for mutually positioning the sheath and the endoscope in the longitudinal direction such that the distal end of the endoscope protrudes in the longitudinal direction from the distal end of the sheath and the expansion member is positioned in the sheath The endoscope system according to claim 2 comprising.
  4. 　前記シースは、前記内視鏡の先端部および収縮した状態の前記拡張部材が径方向に移動可能な内径を有する請求項２または請求項３に記載の内視鏡システム。 The endoscope system according to claim 2 or 3, wherein the sheath has a radially movable inner diameter of the distal end portion of the endoscope and the expansion member in a contracted state.
  5. 　前記シースの先端部が、拡張する前記拡張部材によって径方向に拡張可能である請求項２から請求項４のいずれかに記載の内視鏡システム。 The endoscope system according to any one of claims 2 to 4, wherein the distal end portion of the sheath is radially expandable by the expanding member.
  6. 　前記医療器具が、前記内視鏡の外側に配置される処置具であり、
    　前記拡張部材が、前記処置具の外面と前記内視鏡の先端部の外面との間に配置されている請求項１に記載の内視鏡システム。     The medical instrument is a treatment instrument disposed outside the endoscope.
    The endoscope system according to claim 1, wherein the expansion member is disposed between the outer surface of the treatment instrument and the outer surface of the distal end portion of the endoscope.
  7. 　前記処置具が、拡張する前記拡張部材によって長手方向に交差する方向に湾曲可能な軟性部を先端部に有する請求項６に記載の内視鏡システム。 The endoscope system according to claim 6, wherein the treatment tool has a flexible portion at its tip that can be bent in a direction that crosses in the longitudinal direction by the expanding member.
  8. 　前記拡張部材が、バルーンである請求項１から請求項７のいずれかに記載の内視鏡システム。 The endoscope system according to any one of claims 1 to 7, wherein the expansion member is a balloon.
  9. 　前記拡張部材が、前記内視鏡の長手方向に沿う方向に延びる収縮形状から、該収縮形状よりも前記並列方向に大きな寸法を有する拡張形状へ弾性復元力によって変形可能なワイヤである請求項１から請求項７のいずれかに記載の内視鏡システム。 The expandable member is a wire that can be deformed by an elastic restoring force from a contracted shape extending in a direction along the longitudinal direction of the endoscope to an expanded shape having a larger dimension in the parallel direction than the contracted shape. The endoscope system according to any one of claims 7 to 10.
  10. 　前記内視鏡が、該内視鏡によって取得される内視鏡画像の下方向に対応する下方向に湾曲可能な湾曲部を備え、
    　前記拡張部材が、前記湾曲部よりも基端側において前記内視鏡の下側に配置されている請求項１から請求項９のいずれかに記載の内視鏡システム。     The endoscope includes a downwardly bendable bending portion corresponding to the downward direction of the endoscopic image acquired by the endoscope.
    The endoscope system according to any one of claims 1 to 9, wherein the expansion member is disposed on the lower side of the endoscope on the proximal side of the bending portion.
  11. 　前記湾曲部が、前記下方向とは反対の上方向に湾曲可能であり、
    　前記拡張部材が、前記内視鏡の上側に配置されている請求項１０に記載の内視鏡システム。     The curved portion can be curved upward in the direction opposite to the downward direction,
    The endoscope system according to claim 10, wherein the expanding member is disposed on the upper side of the endoscope.
PCT/JP2017/039143 2017-10-30 2017-10-30 Endoscope system WO2019087254A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/JP2017/039143 WO2019087254A1 (en) 2017-10-30 2017-10-30 Endoscope system

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/JP2017/039143 WO2019087254A1 (en) 2017-10-30 2017-10-30 Endoscope system

Publications (1)

Publication Number Publication Date
WO2019087254A1 true WO2019087254A1 (en) 2019-05-09

Family

ID=66333460

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/JP2017/039143 WO2019087254A1 (en) 2017-10-30 2017-10-30 Endoscope system

Country Status (1)

Country Link
WO (1) WO2019087254A1 (en)

Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS58502037A (en) * 1981-12-01 1983-12-01 ザ　リ−ジエンツ　オブ　ザ　ユニバ−シテイ　オブ　カリフオルニア catheter assembly
WO2007052354A1 (en) * 2005-11-04 2007-05-10 Olympus Medical Systems Corp. Endoscope system, endoscope, supporting member and method of using endoscope system
US20100256447A1 (en) * 2007-09-24 2010-10-07 Shay Dubi Virtual channel enabling device for use in endoscopic instrument insertion and body cavity cleansing
JP2010284503A (en) * 2009-03-02 2010-12-24 Olympus Corp Endoscope
JP2011083487A (en) * 2009-10-16 2011-04-28 Hoya Corp Endoscope cover, and endoscope cover set
JP2011525132A (en) * 2008-06-18 2011-09-15 スターリング・エルシー Transparent endoscope head that defines focal length
JP2014239739A (en) * 2013-06-11 2014-12-25 オリンパス株式会社 Endoscope
WO2016203606A1 (en) * 2015-06-18 2016-12-22 オリンパス株式会社 Pericardial endoscope system
US20170035277A1 (en) * 2015-08-07 2017-02-09 Robert C. Kucharski Endoscope with Variable Profile Tip
WO2017090196A1 (en) * 2015-11-27 2017-06-01 オリンパス株式会社 Endoscope adapter, endoscope, and endoscope system

Patent Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS58502037A (en) * 1981-12-01 1983-12-01 ザ　リ−ジエンツ　オブ　ザ　ユニバ−シテイ　オブ　カリフオルニア catheter assembly
WO2007052354A1 (en) * 2005-11-04 2007-05-10 Olympus Medical Systems Corp. Endoscope system, endoscope, supporting member and method of using endoscope system
US20100256447A1 (en) * 2007-09-24 2010-10-07 Shay Dubi Virtual channel enabling device for use in endoscopic instrument insertion and body cavity cleansing
JP2011525132A (en) * 2008-06-18 2011-09-15 スターリング・エルシー Transparent endoscope head that defines focal length
JP2010284503A (en) * 2009-03-02 2010-12-24 Olympus Corp Endoscope
JP2011083487A (en) * 2009-10-16 2011-04-28 Hoya Corp Endoscope cover, and endoscope cover set
JP2014239739A (en) * 2013-06-11 2014-12-25 オリンパス株式会社 Endoscope
WO2016203606A1 (en) * 2015-06-18 2016-12-22 オリンパス株式会社 Pericardial endoscope system
US20170035277A1 (en) * 2015-08-07 2017-02-09 Robert C. Kucharski Endoscope with Variable Profile Tip
WO2017090196A1 (en) * 2015-11-27 2017-06-01 オリンパス株式会社 Endoscope adapter, endoscope, and endoscope system

Similar Documents

Publication Publication Date Title
US20220193371A1 (en) Method for manufacturing a steerable instrument and such steerable instrument
JP7144871B2 (en) Tissue clip application attachment set/retrofit set
JP5415925B2 (en) Endoscope
US20190150966A1 (en) Magnetic introducer systems and methods
JP6273298B2 (en) Operable medical device
JP5848445B2 (en) Endoscopic instrument with supporting foot
US20150327754A1 (en) Imaging apparatus and systems and methods for using them
US9737687B2 (en) Cable-driven morphable manipulator
EP2123227A1 (en) Endoscopic surgical procedure and surgical apparatus
JP6571183B2 (en) Pericardial endoscope system
EP3222240A1 (en) High frequency treatment tool and high frequency treatment system
WO2017216835A1 (en) Medical device
KR20190133719A (en) Apparatus and method for tissue retraction
JP2010207251A (en) Guide wire
JP5781249B2 (en) Medical instruments
JP2019500951A (en) Introducer system, apparatus and method for heart valve reduction
JP5268926B2 (en) Instrument with inflatable balloon
JP5914779B1 (en) Tissue grasping device
US20160287348A1 (en) Malleable waveguide
US20150320410A1 (en) Cardiac treatment apparatus
WO2019087254A1 (en) Endoscope system
KR102206393B1 (en) Surical device
KR20200097367A (en) Catheter having transformable head structure
JP5912473B2 (en) Micro Snake Retractor
JP2022048923A (en) Cutting balloon catheter

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 17930450

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 17930450

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: JP