WO2019181039A1 - Système endoscope et élément de guidage - Google Patents

Système endoscope et élément de guidage Download PDF

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Publication number
WO2019181039A1
WO2019181039A1 PCT/JP2018/039284 JP2018039284W WO2019181039A1 WO 2019181039 A1 WO2019181039 A1 WO 2019181039A1 JP 2018039284 W JP2018039284 W JP 2018039284W WO 2019181039 A1 WO2019181039 A1 WO 2019181039A1
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WO
WIPO (PCT)
Prior art keywords
endoscope
guide member
intersecting
linear
field
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Application number
PCT/JP2018/039284
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English (en)
Japanese (ja)
Inventor
悠次 酒井
武山　哲英
Original Assignee
オリンパス株式会社
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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
Publication of WO2019181039A1 publication Critical patent/WO2019181039A1/fr

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    • 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
    • A61B1/233—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 for the nose, i.e. nasoscopes, e.g. testing of patency of Eustachian tubes

Definitions

  • This invention relates to an endoscope system for observing the inside of a patient's sinus.
  • Patent Document 1 discloses an insertion assisting tool that can access a sinus such as a sinus.
  • a doctor needs to efficiently perform a complicated operation in a short time, such as sending an endoscope with one hand while feeding a guide member with one hand.
  • a guide member is sent in the nasal cavity, it is necessary to move the guide member forward while visually confirming the inside of the sinus with a subsequent endoscope.
  • an improvement for improving the convenience of the doctor has been desired in the insertion assisting tool and the endoscope system having the insertion assisting tool.
  • An endoscope system includes an endoscope that is inserted into a nasal cavity or a sinus cavity and includes a distal end configuration portion, and a guide member that guides the endoscope, and the guide
  • the member is a linear portion that guides the endoscope so that the endoscope can be advanced and retracted, and includes a linear portion including a holding mechanism that holds the endoscope at a position along the linear portion, and the linear portion is provided continuously.
  • An intersecting portion that extends in a direction intersecting with the direction in which the linear portion extends, and that guides the endoscope so that the endoscope can advance and retreat in the intersecting direction, and an operation portion that moves the endoscope forward and backward,
  • An operation unit that can be switched between a state in which the distal end constituent portion is along the straight portion and a state in which the distal end constituent portion is along the intersecting portion.
  • FIG. 1 is a schematic diagram illustrating an overall configuration of an endoscope system according to the embodiment.
  • FIG. 2 is a perspective view showing a distal end side (near an intersection) of the endoscope and guide member of the endoscope system shown in FIG.
  • FIG. 3 is a schematic diagram schematically showing the vicinity of the distal end configuration portion of the endoscope shown in FIG.
  • FIG. 4 is a schematic diagram showing a state in which the inside of the nasal cavity is observed with an endoscope from the inside of the transparent guide member in the endoscope system shown in FIG.
  • FIG. 5 is a schematic diagram schematically showing the guide member of the endoscope system shown in FIG. 1, the endoscope, the operation unit, and the lever unit at positions along the straight line portion of the guide member.
  • FIG. 1 is a schematic diagram illustrating an overall configuration of an endoscope system according to the embodiment.
  • FIG. 2 is a perspective view showing a distal end side (near an intersection) of the endoscope and guide member of the
  • FIG. 6 is a schematic diagram schematically showing the guide member of the endoscope system shown in FIG. 1, the endoscope at a position protruding from the guide member, the operation unit, and the lever unit.
  • FIG. 7 is a schematic diagram showing a state in which the endoscope of the endoscope system shown in FIG. 1 is protruded from the guide member and the endoscope is positioned near the entrance of the paranasal sinus (maxillary sinus).
  • FIG. 8 is a schematic diagram showing a state in which the endoscope of the endoscope system shown in FIG. 1 is protruded from the guide member and the endoscope is located inside the sinus (maxillary sinus).
  • FIG. 7 is a schematic diagram showing a state in which the endoscope of the endoscope system shown in FIG. 1 is protruded from the guide member and the endoscope is located inside the sinus (maxillary sinus).
  • FIG. 9 is a schematic diagram illustrating a guide member, an endoscope, a slider unit, and a fixing unit of an endoscope system according to a first modification.
  • FIG. 10 is a cross-sectional view taken along the line F10-F10 of the endoscope system shown in FIG.
  • FIG. 11 is a perspective view showing a guide member and a plurality of suction holes of the endoscope system of the second modified example.
  • FIG. 12 is a perspective view showing a state in which the endoscope is sucked and held on the guide member (straight line portion) by the suction force of the suction hole in the endoscope system shown in FIG. FIG.
  • FIG. 13 is a schematic diagram illustrating a guide member, an endoscope, a slider portion, and a holder portion of an endoscope system according to a third modification.
  • FIG. 14 is a schematic diagram illustrating a plurality of arm-shaped portions of a guide member of an endoscope system according to a fourth modified example.
  • FIG. 15 is a perspective view showing a guide member and an opening (field-of-view enlargement part) of an endoscope system according to a fifth modification.
  • FIG. 16 is a schematic diagram illustrating a guide member and a spacer (field-of-view enlargement unit) of an endoscope system according to a sixth modification.
  • FIG. 17 is a schematic diagram illustrating a guide member, an endoscope, and a bending mechanism (field-of-view enlargement unit) of an endoscope system according to a seventh modification.
  • the endoscope system 11 includes an endoscope 12 and a guide member 13 that guides the endoscope 12 into the examinee's sinus.
  • the endoscope 12 is a so-called soft endoscope having flexibility.
  • the endoscope 12 is configured by a general endoscope (soft endoscope) having a well-known structure, but may be configured by a scanning endoscope.
  • the endoscope 12 is provided in the vicinity of the distal end of the insertion portion 16 and an insertion portion 16 that is used by being inserted into the nasal cavity 14, the paranasal sinus (maxillary sinus 15), and the like.
  • a control unit 26 electrically connected to the unit 16 and the image sensor 25, and a display unit 27 connected to the control unit 26.
  • a central axis C is defined along the longitudinal direction of the endoscope 12.
  • the channel is provided over the entire length of the insertion portion 16, and the treatment instrument can be passed through the channel.
  • the display unit 27 is composed of a general liquid crystal monitor, and can display an image acquired by the endoscope 12 as an image.
  • the bending portion 18 has a pivotable joint portion and a pair of wires 28 and 28 passed between the tip constituting portion 17 and the handle portion 24.
  • the handle portion has, for example, a dial portion, and a pair of wires 28 and 28 are wound around a rotation shaft of the dial portion via a pulley or the like.
  • the user can pull the pair of wires 28, 28 by rotating the dial portion. That is, one of the pair of wires 28, 28 is pulled along with the rotation of the dial portion, and the other of the pair of wires 28, 28 sags, so that the tip constituting portion 17 is pulled and the bending portion 18 is pulled. Curved to the left or right. In this manner, the user can bend the bending portion 18 by operating the dial portion, and thereby change the extending direction of the tip constituting portion 17 to a desired direction.
  • the endoscope 12 has a structure capable of bending in the left-right direction (or up-down direction).
  • the bending direction of the bending portion 18 is an example, and may be the left-right direction of the paper surface as shown by the arrows in FIG. 7, or the bending portion 18 is curved to the back side and the front side of the paper surface in FIG.
  • the number of the wires 28 may be set to four so that the wire 28 can be bent in four directions, up, down, left, and right.
  • the illumination fiber 22 is optically connected to a light source provided adjacent to the control unit 26.
  • the illumination fiber 22 can irradiate illumination light to the outside via the illumination lens 21.
  • the plurality of light receiving fibers 23 are optically connected to the image sensor 25.
  • the tip of the light receiving fiber 23 is exposed to the outside via the light receiving lens 31 in the vicinity of the tip constituting portion 17. Therefore, the endoscope 12 can acquire an image with the light receiving fiber 23 in the distal end configuration portion 17.
  • the endoscope 12 can acquire an image around the central axis C shown in FIG.
  • the endoscope 12 has an image pickup device 25 configured by a CCD, a CMOS, or the like.
  • the endoscope 12 can acquire an image with the imaging element 25. More specifically, the image sensor 25 converts the light from the light receiving fiber 23 into an electrical signal and sends it to the control unit 26.
  • the plurality of light receiving fibers 23 receive return light from the subject and guide the light to the image sensor 25.
  • the image sensor 25 sends the light received by the plurality of light receiving fibers 23 to the control unit 26 as an electrical signal.
  • the control unit 26 converts the electrical signal into an image, appropriately performs image processing, and displays the image on the display unit 27.
  • the control unit 26 shown in FIG. 1 is configured by a general computer, for example.
  • the control unit 26 includes a housing, a circuit board 32 built in the housing, a CPU, a ROM, a RAM mounted on the circuit board 32, and an HDD 33 (hard disk drive) provided separately from the circuit board. And.
  • the control unit 26 can process and image an electrical signal corresponding to the image acquired by the imaging element 25 of the insertion unit 16 and display the image (endoscopic image) on the display unit 27.
  • the guide member 13 is provided in the gripping portion 34 that forms a portion gripped by the user, a rail portion 35 that linearly protrudes from the gripping portion 34, and the gripping portion 34. And a lever portion 36 for operation.
  • the rail part 35 is preferably formed of, for example, a transparent resin material.
  • the rail part 35 is preferably made of transparent, for example, polycarbonate resin or acrylic resin. In the case of an acrylic resin, it is preferably composed of, for example, PMMA (polymethyl methacrylate resin).
  • the entire rail portion 35 is formed of a transparent resin material. However, it is only necessary that at least a crossing portion 35B described later is formed of a transparent resin material, and a linear portion 35A described later is transparent. It does not have to be.
  • the rail portion 35 is an example of a holding mechanism that holds the flexible endoscope in a predetermined shape (holds at a position along the straight portion 35A). As shown in FIG. 2, the rail portion 35 is formed so that the tip end portion is bent sideways and has a substantially “L” shape as a whole.
  • the rail portion 35 is formed in a hollow pipe shape (cylindrical shape), and the insertion portion 16 of the endoscope 12 can be held inside the pipe shape.
  • the rail portion 35 is bent at a right angle in an elbow shape near the tip portion. That is, as shown in FIG. 5, the rail portion 35 includes a straight portion 35A connected to the grip portion 34 at one end portion, and an intersecting portion 35B provided continuously with the other end portion of the straight portion 35A. And a field-of-view enlargement portion 37 provided in at least one of the straight portion 35A and the intersecting portion 35B.
  • the hollow portion inside the straight portion 35A is continuous with the hollow portion inside the intersecting portion 35B.
  • the cross-sectional shapes of the straight portion 35A and the intersecting portion 35B are not completely circular, but are substantially circular with a notch 38 in part of the ring.
  • the straight portion 35A can guide the endoscope 12 so as to be able to advance and retreat.
  • the intersecting portion 35B extends in a direction intersecting with the direction in which the linear portion extends, and can guide the endoscope 12 in such a manner that the endoscope 12 can advance and retreat.
  • the width dimension of the notch 38 is smaller than the diameter of the insertion part 16 of the endoscope 12. For this reason, the endoscope 12 does not fall off from the inside of the rail portion 35.
  • the straight portion 35A extends linearly in the same direction as the direction in which the grip portion 34 extends.
  • the intersecting portion 35B extends in a direction intersecting with the extending direction of the straight portion 35A (for example, a direction orthogonal to the intersecting portion).
  • the cross-sectional shapes of the straight portion 35A and the intersecting portion 35B may be completely annular.
  • the rail portion 35 is formed of, for example, a transparent resin material. Therefore, as shown in FIG. 4, the visual field 29 of the endoscope 12 is not disturbed by the rail portion 35. Therefore, in this embodiment, the visual field expansion part 37 is comprised by the whole linear part 35A and the whole intersection part 35B.
  • the present invention is not limited to this example, and only the intersecting portion 35B may be formed of a transparent resin material, and the visual field expanding portion 37 may be configured by the entire intersecting portion 35B.
  • the lever portion 36 can slide along a long hole 41 formed in the grip portion 34.
  • the lever portion 36 is fixed to the endoscope 12 on the base side. For this reason, as shown in FIGS. 5 and 6, by moving the lever portion 36 forward and backward, the user causes the endoscope 12 to protrude from the guide member 13, or the endoscope 12 is stored in the guide member 13 again. You can do it. That is, the lever part 36 is an example of an operation part that moves the endoscope 12 back and forth along the straight part 35A and the intersecting part 35B.
  • the lever portion 36 is between the state in which the tip constituent portion 17 is along the straight portion 35A, the state in which the tip constituent portion 17 is along the intersecting portion 35B, and the state in which the tip constituent portion 17 protrudes from the intersecting portion 35B. Can be switched.
  • the user inserts the endoscope 12 inside the guide member 13 and integrates it.
  • the user can insert the endoscope 12 and the guide member 13 into the nasal cavity 14 of the examinee.
  • the user inserts the distal end of the guide member 13 into the nasal cavity 14 of the examinee through the outer nostril 42.
  • the endoscope 12 can advance the tip of the guide member 13 toward the back of the nasal cavity 14 while looking down at the inside of the nasal cavity 14.
  • the distal end portion (intersection portion 35B) of the guide member 13 is projected together with the nasal cavity 14 in the visual field 29 of the endoscope 12.
  • the visual field 29 of the endoscope 12 is not blocked by the guide member 13. For this reason, the user does not accidentally hit the tip of the rail portion 35 of the guide member 13 against the inner wall or the like of the nasal cavity 14.
  • the mirror 12 can be advanced into the maxillary sinus 15. As shown in FIG. 8, the user operates the handle portion 24 to bend the endoscope 12 by the bending portion 18 in a state where the distal end constituting portion 17 of the endoscope 12 has reached the maxillary sinus 15. The inside of the maxillary sinus 15 can be observed. Further, the user can perform treatment in the maxillary sinus 15 as necessary. After the observation or treatment in the maxillary sinus 15 is completed, when the user moves (retracts) the lever portion 36 in the direction opposite to the arrow in FIG. 6, the endoscope 12 is housed in the guide member 13. The In this state, the guide member 13 can be safely taken out from the nasal cavity 14 of the examinee while overlooking the nasal cavity 14 and the guide member 13 with the endoscope 12.
  • the endoscope system 11 includes an endoscope 12 that is inserted into the nasal cavity 14 or the paranasal sinuses, and a guide member 13 that guides the endoscope 12.
  • the guide member 13 advances and retracts the endoscope 12.
  • a linear portion 35A that can be guided and includes a linear portion 35A including a holding mechanism that holds the endoscope 12 at a position along the linear portion 35A, and the linear portion 35A.
  • An intersection portion 35B extending in a direction intersecting with the extending direction, and provided at at least one of the intersection portion 35B that guides the endoscope 12 so as to advance and retreat in the intersecting direction, and the linear portion 35A and the intersection portion 35B.
  • a visual field enlargement unit 37 that enlarges the visual field 29 of the endoscope 12.
  • the guide member 13 that guides the endoscope 12 into the nasal cavity 14 or the paranasal sinus is a linear portion 35A that guides the endoscope 12 so as to be able to advance and retreat, and holds the endoscope 12 at a position along the linear portion 35A.
  • the visual field enlargement portion 37 is provided, so that the guide member 13 does not block the visual field 29 of the endoscope 12. Therefore, when the user inserts and removes the guide member 13 and the endoscope 12 into and from the nasal cavity 14, the guide member 13 and the endoscope 12 can be inserted and removed while looking down on the inside of the nasal cavity 14. Will not hit the inner wall of the nasal cavity 14 or the like. As a result, the nasal cavity 14 and the paranasal sinus of the examinee can be observed safely and quickly without damaging the nasal cavity 14 of the examinee.
  • the holding mechanism has a substantially annular shape including a part of the notch 38, and the endoscope 12 is held inside the substantially annular holding mechanism. According to this configuration, the endoscope 12 can stably hold the posture of the endoscope 12 without dropping from the inside of the holding mechanism.
  • the field-of-view enlargement part 37 is provided in at least a part of the straight part 35A and the intersecting part 35B, and is formed of a transparent material. According to this configuration, the visual field 29 of the endoscope 12 is not blocked by the linear portion 35A and the intersecting portion 35B of the guide member 13. Thus, when the guide member 13 and the endoscope 12 are inserted into and removed from the nasal cavity 14 and the paranasal sinus of the examinee, the work can be performed safely and quickly. As a result, the burden on the examinee can be reduced.
  • the guide member 13 includes a grip portion 34 that constitutes a portion gripped by a user, a rail portion 35 that linearly protrudes from the grip portion 34, and an operation lever portion 36 provided on the grip portion 34. .
  • the rail portion 35 is formed so that the tip end portion is bent sideways and has a substantially “L” shape as a whole.
  • the rail portion 35 is an example of a holding mechanism that holds the endoscope 12 (soft endoscope) in a predetermined shape.
  • the cross-sectional shape of the rail portion 35 when cut along a plane intersecting (orthogonal) with the central axis C of the endoscope 12 is a circle that follows the cylindrical cross-sectional shape of the endoscope 12. It has an arc shape or a substantially flat plate shape.
  • the rail part 35 is preferably formed of, for example, a transparent resin material.
  • the field-of-view enlargement part 37 is composed of a transparent rail part 35, that is, the entire straight part 35A and the entire intersection part 35B.
  • the rail portion 35 protrudes from the main body portion 43, the main body portion 43, and in the longitudinal direction of the rail portion 35 (straight portion 35 ⁇ / b> A) (in the direction of the central axis C of the endoscope 12).
  • the guide portion 44 has a projecting shape that is continuous along the guide portion 44, the slider portion 45 is slidable with respect to the guide portion 44, and the fixing portion 46 is configured to fix the slider portion 45 and the endoscope 12.
  • the guide portion 44 is provided over the entire length in the longitudinal direction of the rail portion 35 (the straight portion 35A and the intersecting portion 35B).
  • the slider portion 45 can be fitted to the outside of the guide portion 44 and can slide along the guide portion 44.
  • the slider portion 45 is formed of, for example, a flexible material and can be bent along the curvature of the rail portion 35.
  • fixed part 46 is comprised with the sheet
  • the guide part 44 and the slider part 45 are an example of a holding mechanism that holds the endoscope 12 (soft endoscope) along the guide member 13 in a predetermined shape.
  • a method for observing the nasal cavity 14 and the paranasal sinuses using the endoscope system 11 of this modification will be described.
  • the user fixes the slider unit 45 to the endoscope 12 by the fixing unit 46. Further, the user engages the slider portion 45 with the guide portion 44.
  • the guide member 13 and the endoscope 12 are integrated, and the endoscope 12 is slidable with respect to the rail portion 35.
  • the user can insert the endoscope 12 and the guide member 13 into the nasal cavity 14 of the examinee.
  • the user inserts the distal end of the guide member 13 into the nasal cavity 14 of the examinee through the outer nostril 42.
  • the subsequent steps are the same as in the above embodiment.
  • the guide portion 44 is formed in a protruding shape protruding from the main body portion 43, but the shapes of the guide portion 44 and the slider portion 45 are not limited to this.
  • the shape of these irregularities may be reversed. That is, the guide part 44 may be formed as a groove formed in the main body portion 43 of the rail part 35 and continuously extending in the longitudinal direction of the rail part 35 (the central axis C direction).
  • the slider portion 45 is provided with a protrusion extending in the longitudinal direction of the rail portion 35, and this protrusion can freely slide in the groove of the guide portion 44. Even with such a structure, the endoscope 12 can be advanced and retracted with respect to the rail portion 35.
  • the holding mechanism includes a guide portion 44 provided along the longitudinal direction of the straight portion 35A, and a slider portion 45 that can be advanced and retracted along the guide portion 44. And a fixed slider portion 45.
  • a configuration in which the endoscope 12 can be moved back and forth with respect to the guide member 13 can be realized with a simple structure via the guide portion 44 and the slider portion 45.
  • the straight portion 35 ⁇ / b> A of the rail portion 35 has a plurality of suction holes 51 arranged along the longitudinal direction of the rail portion 35.
  • One suction hole 51 is arranged at a predetermined interval from the other suction holes 51.
  • the plurality of suction holes 51 are provided so as to be aligned in a line along the longitudinal direction of the rail portion 35, but this arrangement is an example.
  • the plurality of suction holes 51 may be provided so as to be arranged along a plurality of rows (for example, two rows and three rows).
  • Each suction hole 51 is connected to a suction part 52 (suction device).
  • the suction part 52 is provided separately from the guide member 13 and is connected to the guide member 13 by a tube 53 or the like.
  • An internal flow path 54 may be formed in the guide member 13 (rail portion 35), and the internal flow path 54 may be connected to the tube 53.
  • the suction part 52 is configured by, for example, a vacuum pump. When the suction part 52 is driven, air is sucked from the suction hole 51, and an adsorption force (negative pressure) can be generated in the suction hole 51.
  • the plurality of suction holes 51 are an example of a holding mechanism that holds the endoscope 12 (soft endoscope) in a predetermined shape along the guide member 13 (linear portion 35A).
  • the rail part 35 is preferably formed of, for example, a transparent resin material.
  • the visual field enlargement part 37 is configured by a transparent rail part 35.
  • a method for observing the nasal cavity 14 and the paranasal sinuses using the endoscope system 11 of this modification will be described.
  • the user places the endoscope 12 along the guide member 13 before inserting the guide member 13 and the endoscope 12 into the nasal cavity 14 of the examinee.
  • the driving of the suction part 52 is turned on, and a suction force is generated in each suction hole 51.
  • the suction force generated in each suction hole 51 is set to be slightly weak and can suck and hold the endoscope 12 in the vicinity of the suction hole 51, but hinders the forward and backward movement of the endoscope 12.
  • There is no adsorption power By turning on the driving of the suction part 52, the endoscope 12 can be integrated with the guide member 13 (rail part 35).
  • the user inserts the endoscope 12 and the guide member 13 into the nasal cavity 14 of the examinee.
  • the user inserts the distal end of the guide member 13 into the nasal cavity 14 of the examinee through the outer nostril 42.
  • the subsequent steps are the same as in the above embodiment.
  • the user can appropriately switch on and off the driving of the suction unit 52 as necessary during observation of the nasal cavity 14 and maxillary sinus 15 and during treatment thereof.
  • the holding mechanism has a plurality of suction holes 51 provided along the longitudinal direction of the straight portion 35A, and the endoscope 12 can be sucked to the straight portion 35A by the plurality of suction holes 51. It is.
  • the endoscope 12 and the guide member 13 can be integrated with the endoscope 12 along the straight portion 35 ⁇ / b> A with a simple structure via the suction hole 51.
  • the endoscope 12 is not dropped from the guide member 13, and the observation of the nasal cavity 14 and the paranasal sinuses and treatment thereof are smoothly performed. be able to.
  • the rail portion 35 is formed so that the tip end portion is bent sideways and has a substantially “L” shape as a whole.
  • the rail portion 35 is an example of a holding mechanism that holds the endoscope 12 (soft endoscope) in a predetermined shape.
  • the cross-sectional shape of the rail portion 35 when cut along a plane intersecting (orthogonal) with the central axis C of the endoscope 12 is an arc shape that follows the cylindrical outer shape of the endoscope 12 or a substantially flat plate shape. is there.
  • the rail part 35 is preferably formed of, for example, a transparent resin material. In this case, the visual field enlargement part 37 is configured by a transparent rail part 35.
  • the rail part 35 protrudes from the main body part 43 and the guide part 44 that protrudes from the main body part 43 and has a continuous protrusion shape along the longitudinal direction of the rail part 35 (straight line part 35A) (the central axis C direction of the endoscope). And a slider portion 45 that can slide relative to the guide portion 44, and a holder portion 55 (sheath portion) fixed to the slider portion 45.
  • the guide portion 44 is provided over the entire length in the longitudinal direction of the rail portion (the straight portion 35A and the intersecting portion 35B).
  • the slider portion 45 can be fitted to the outside of the guide portion 44 and can slide along the guide portion 44.
  • the holder portion 55 (sheath portion) is formed in an annular shape (cylindrical shape) or a substantially annular shape having a notch portion 38 in a part of the ring as in the above embodiment.
  • the endoscope can be held inside the holder portion 55.
  • the holder portion 55 may be formed of a transparent resin material, for example, a polycarbonate resin or an acrylic resin. In the case of an acrylic resin, it is preferably composed of, for example, PMMA (polymethyl methacrylate resin).
  • the guide unit 44, the slider unit 45, and the holder unit 55 are an example of a holding mechanism that holds the endoscope 12 (soft endoscope) in a predetermined shape.
  • a method for observing the nasal cavity 14 and the paranasal sinuses using the endoscope system 11 of this modification will be described.
  • the user inserts the endoscope 12 inside the holder portion 55 and integrates the guide member 13 and the endoscope 12.
  • the user can insert the endoscope 12 and the guide member 13 into the nasal cavity 14 of the examinee.
  • the user inserts the distal end of the guide member 13 into the nasal cavity 14 of the examinee through the outer nostril 42.
  • the endoscope 12 can advance the tip of the guide member 13 toward the back of the nasal cavity 14 while looking down at the inside of the nasal cavity 14.
  • the distal end portion of the guide member 13 is projected together with the nasal cavity 14 in the visual field 29 of the endoscope 12.
  • the visual field 29 of the endoscope 12 is not blocked by the guide member 13. For this reason, the user does not accidentally hit the tip of the rail portion 35 of the guide member 13 against the inner wall or the like of the nasal cavity 14.
  • the user observes the inside of the maxillary sinus 15 by bending the endoscope 12 with the bending portion 18 in a state where the distal end constituting portion 17 of the endoscope 12 has reached the maxillary sinus 15. it can. 5 to 8, the holder portion 55 is omitted, but the holder portion 55 is also inserted to the inside of the maxillary sinus 15 (the paranasal sinuses).
  • the user pulls only the endoscope 12 while pulling the proximal end side of the endoscope 12 and leaving the holder portion 55 and the guide member 13 as they are. it can.
  • treatment such as injecting a drug into the maxillary sinus 15 via the holder portion 55 or sucking / removing pus accumulated in the maxillary sinus 15 via the holder portion 55 is performed.
  • the user can observe the inside of the maxillary sinus 15 by inserting the endoscope 12 again into the holder portion 55 again as necessary.
  • the user After completion of the treatment, the user operates the lever portion 36 to retract the holder portion 55 to a position along the guide member 13. Then, the user can collect the guide member 13 and the holder portion 55 from the nasal cavity 14 of the examinee by pulling out the guide member 13.
  • the endoscope 12 When the endoscope 12 is reinserted into the holder portion 55, the guide member 13, the holder portion 55, the endoscope is viewed while looking around the guide member 13 using the endoscope 12 as necessary. The mirror 12 can be safely removed.
  • the endoscope system 11 is a cylindrical holder portion 55 fixed to the slider portion 45, and has a holder portion 55 that holds the endoscope 12 inside.
  • the endoscope 12 can be stably held by the cylindrical holder portion 55. For this reason, the endoscope 12 is not dropped from the guide member 13 when the guide member 13 is inserted into the nasal cavity 14.
  • the holder portion 55 has a cylindrical shape, a predetermined treatment can be performed on the nasal cavity 14 or the paranasal sinus of the examinee via the holder portion 55.
  • This predetermined treatment includes a treatment of injecting a drug into the nasal cavity 14 or the sinuses and a treatment of sucking and removing pus from the nasal cavity 14 or the sinuses.
  • a plurality of open portions 56 for exposing the endoscope 12 are provided in the straight portion 35A.
  • An arm-like portion 57 (holding element) is left between the open portions 56.
  • the plurality of arm-shaped portions 57 (holding elements) are formed at a plurality of locations along the longitudinal direction of the rail portion 35 (the straight portion 35A), and are provided side by side at intervals.
  • the cross-sectional shape cut at the plane intersecting the longitudinal direction of the rail portion 35 of each arm-shaped portion 57 (the direction of the central axis C of the endoscope 12) is similar to the cross-sectional shape of the rail portion 35 of the above embodiment. It has a substantially annular shape with a notch 38 in part. The width dimension of the notch 38 is smaller than the diameter of the insertion part 16 of the endoscope 12. For this reason, the endoscope 12 does not fall off from the inside of the arm-shaped portion 57.
  • the arm portion 57 is provided only on the straight portion 35 ⁇ / b> A of the rail portion 35, but may be provided on the intersection portion 35 ⁇ / b> B of the rail portion 35.
  • the plurality of arm-shaped portions 57 are an example of a holding mechanism that holds the endoscope 12 (soft endoscope) along the guide member 13 in a predetermined shape.
  • the observation method for the nasal cavity 14 and the paranasal sinuses using the endoscope system 11 of the present modification is the same as that in the above embodiment.
  • the endoscope 12 is inserted into the nasal cavity 14 from the guide member 13 by a simple structure in which a plurality of arm-like portions 57 are provided at predetermined intervals along the longitudinal direction of the rail portion 35. It is possible to realize a configuration that prevents the dropout.
  • a fifth modification of the endoscope system 11 will be described with reference to FIG.
  • the configuration of the field-of-view enlargement part 37 and the cross-sectional shape of the rail part 35 are different from those in the embodiment, but other parts are common to the embodiment. That is, in the embodiment and the first to fourth modifications described above, the field-of-view enlargement unit 37 is realized by forming the rail portion 35 and the like in a transparent manner. The implementation method of 37 is different.
  • the rail portion 35 is formed so that the tip end portion is bent sideways and has a substantially “L” shape as a whole.
  • the cross-sectional shape of the rail portion 35 when cut along a plane that intersects (orthogonally) the longitudinal direction of the rail portion 35 (the central axis C direction of the endoscope) is the cylindrical shape of the endoscope 12.
  • the cross-sectional shape of the rail part 35 is not restricted to this.
  • the second deformation is performed as a holding mechanism that holds the endoscope 12 (soft endoscope) in a predetermined shape along the guide member 13.
  • the endoscope 12 soft endoscope
  • the cross-sectional shape of the rail part 35 when cut along a plane that intersects the longitudinal direction of the rail part 35 (the direction of the central axis C of the endoscope 12) is similar to the above embodiment in that the notch part 38 is formed in a part of the ring. It may be substantially annular.
  • the rail portion 35 and the plurality of suction holes 51 are an example of a holding mechanism that holds the flexible endoscope in a predetermined shape.
  • An opening 61 for securing the visual field 29 of the endoscope 12 is provided in at least a part of the intersection 35B of the rail part 35.
  • the size (diameter) of the opening 61 is, for example, smaller than the diameter of the endoscope 12. For this reason, the endoscope 12 does not fall off from the rail portion 35 via the opening 61. That is, in the present embodiment, the field expansion unit 37 that expands the field 29 of the endoscope 12 is realized by the opening 61 provided in the intersection 35B.
  • the user integrates the endoscope 12 with the guide member 13 by suction or the like through the suction hole 51.
  • the user can insert the endoscope 12 and the guide member 13 into the nasal cavity 14 of the examinee.
  • the user inserts the distal end of the guide member 13 into the nasal cavity 14 of the examinee through the outer nostril 42.
  • the opening 61 field-enlargement portion 37
  • the field-of-view 29 of the endoscope 12 is not blocked by the intersection. Therefore, the user can advance the distal end portion of the guide member 13 toward the inner portion of the nasal cavity 14 while looking down the inside of the nasal cavity 14 with the endoscope 12.
  • the intersection portion 35 ⁇ / b> B of the guide member 13 is projected together with the nasal cavity 14 in the visual field 29 of the endoscope 12.
  • the subsequent steps are the same as in the above embodiment.
  • the guide member 13 and the endoscope 12 are taken out from the nasal cavity 14, the guide member 13 can be safely viewed while looking down at the nasal cavity 14 and the guide member 13 by the endoscope 12 through the opening 61 (field-of-view expanding portion 37). From the nasal cavity 14 of the examinee.
  • the visual field expanding portion 37 is configured by the opening 61 provided at least at a part of the intersecting portion 35B. According to this configuration, when the endoscope 12 and the guide member 13 are inserted into and removed from the nasal cavity 14, the visual field 29 of the endoscope 12 is not blocked by the intersecting portion 35 ⁇ / b> B. As a result, the guide member 13 can be advanced while looking down at the inside of the nasal cavity 14 by the visual field expanding portion 37 when the guide member 13 is inserted. Thereby, the nasal cavity 14 and the paranasal sinus can be observed and treated safely and quickly without damaging the inner wall of the nasal cavity 14 of the examinee.
  • the rail portion 35 (the straight portion 35 ⁇ / b> A) has a main body portion 43 and a spacer 62 protruding from the main body portion 43.
  • the rail portion 35 is formed so that the tip end portion is bent sideways and has a substantially “L” shape as a whole.
  • the cross-sectional shape of the rail portion 35 when cut along a plane that intersects (orthogonally) the longitudinal direction of the rail portion 35 (the direction of the central axis C of the endoscope 12) is the cylindrical shape of the endoscope 12.
  • the cross-sectional shape of the rail portion 35 is not limited to this.
  • the second deformation is performed as a holding mechanism that holds the endoscope 12 (soft endoscope) in a predetermined shape along the guide member 13.
  • the endoscope 12 soft endoscope
  • the rail portion 35 and the plurality of suction holes 51 are an example of a holding mechanism that holds the flexible endoscope in a predetermined shape.
  • the spacer 62 can deflect the direction in which the endoscope 12 extends in a direction different from the direction in which the linear portion 35A of the rail portion 35 extends. This prevents the field of view 29 of the endoscope 12 from being blocked by the intersection 35B of the rail portion 35. That is, in the present embodiment, the field expansion unit 37 that expands the field 29 of the endoscope 12 is realized by the spacer 62 provided on the rail unit 35.
  • the user integrates the endoscope 12 with the guide member 13 by suction or the like through the suction hole 51.
  • the user can insert the endoscope 12 and the guide member 13 into the nasal cavity 14 of the examinee.
  • the user inserts the distal end of the guide member 13 into the nasal cavity 14 of the examinee through the outer nostril 42.
  • the spacer 62 field expansion part 37
  • the spacer 62 lifts the endoscope 12 from the linear part 35A so that the intersecting part 35B is disengaged from the field of view 29 of the endoscope 12.
  • the visual field 29 of the endoscope 12 is not blocked by the intersecting portion 35B.
  • the user can advance the distal end portion of the guide member 13 toward the inner portion of the nasal cavity 14 while looking down the inside of the nasal cavity 14 with the endoscope 12.
  • the intersection portion 35 ⁇ / b> B of the guide member 13 is projected together with the nasal cavity 14 in the visual field 29 of the endoscope 12.
  • the subsequent steps are the same as in the above embodiment.
  • the guide member 13 and the endoscope 12 are taken out from the nasal cavity 14, the guide member 13 can be safely viewed while overlooking the nasal cavity 14 and the guide member 13 by the endoscope 12 using the spacer 62 (field-of-view enlargement unit 37). 13 can be removed from within the nasal cavity 14 of the examinee.
  • the field-of-view enlargement unit 37 is a spacer 62 provided in the straight line portion 35A, and the endoscope 12 is moved to the straight line portion 35A so that the intersecting portion 35B deviates from the field of view 29 of the endoscope 12. It is composed of a spacer 62 that floats from the surface. According to this configuration, since the field of view 29 of the endoscope 12 can be secured by the spacer 62, when the guide member 13 is inserted into and removed from the nasal cavity 14, the guide member 13 is moved while looking down at the inside of the nasal cavity 14 with the endoscope 12. Can be moved. Thereby, the nasal cavity 14 and the paranasal sinus can be observed and treated safely and quickly without damaging the inner wall of the nasal cavity 14 of the examinee.
  • the rail portion 35 is formed, for example, with a metal material or the like so as to form a long and narrow plate shape as a whole.
  • the rail portion 35 includes a straight portion 35A, a cross portion 35B that can extend in a direction crossing the straight portion 35A, and a bending mechanism 63 positioned between the straight portion 35A and the cross portion 35B.
  • the bending mechanism 63 includes a plurality of small pieces of bending pieces 64 and a plurality of pins 65 that connect the bending pieces 64 to each other.
  • a joint is constituted by the structure through the plurality of bending pieces 64 and the plurality of pins 65.
  • the bending mechanism 63 can freely rotate in the left-right direction in FIG. 17 by the joint configured as described above.
  • the rail portion 35 further includes a pair of wire members (a first wire member 71 and a second wire member 72) provided so as to extend across the intersecting portion 35B and the grip portion 34 of the guide member 13.
  • the pair of wire members 71 and 72 are embedded in the rail portion 35.
  • the first wire member 71 is disposed in the vicinity of the surface of the rail portion 35 that comes into contact with the endoscope 12.
  • the second wire member 72 is disposed in the vicinity of the surface of the rail portion 35 opposite to the surface that is in contact with the endoscope 12.
  • the rail portion 35 further has a pair of through holes (not shown) for allowing the first wire member 71 and the second wire member 72 to pass therethrough.
  • the intersecting portion 35B is pulled toward the grip portion 34 side (base side of the rail portion 35).
  • the bending mechanism 63 can be bent so that the intersecting portion 35B is orthogonal to the straight portion 35A.
  • the intersecting portion 35B is disposed at the intersecting position P2 intersecting with the extending direction of the straight portion 35A.
  • the bending mechanism 63 can return to a straight state.
  • the intersecting portion 35B is aligned with the straight portion 35A, the intersecting portion 35B is at the retracted position P1 retracted from the field of view 29 of the endoscope 12.
  • the intersecting portion 35B is retracted from the visual field 29 of the endoscope 12, and the visual field 29 of the endoscope 12 is not blocked by the intersecting portion 35B.
  • the intersecting portion 35B is not fixed in position as in the above embodiment, but has a structure that can be retracted as necessary.
  • the field-of-view enlargement unit 37 is realized by the bending mechanism 63 that can be bent and the intersection portion 35B that can change the position.
  • the cross-sectional shape of the rail portion 35 when cut along a plane that intersects (orthogonally) the longitudinal direction of the rail portion 35 (the direction of the central axis C of the endoscope 12) is the cylindrical shape of the endoscope 12.
  • the cross-sectional shape of the rail portion 35 is not limited to this.
  • the second deformation is performed as a holding mechanism that holds the endoscope 12 (soft endoscope) in a predetermined shape along the guide member 13.
  • the rail portion 35 and the plurality of suction holes 51 are an example of a holding mechanism that holds the flexible endoscope in a predetermined shape.
  • the user integrates the endoscope 12 with the guide member 13 by suction or the like through the suction hole 51. In this state, the user can insert the endoscope 12 and the guide member 13 into the nasal cavity 14 of the examinee.
  • the intersecting portion 35 ⁇ / b> B is disposed at the retracted position with the bending mechanism 63 in a straight state.
  • the user inserts the tip of the guide member 13 into the nasal cavity 14 of the examinee through the outer nostril 42.
  • the intersection portion 35B does not protrude in front of the endoscope 12
  • the visual field 29 of the endoscope 12 is not blocked by the intersection portion 35B. Therefore, the user can advance the intersecting portion 35 ⁇ / b> B of the guide member 13 toward the back of the nasal cavity 14 while looking down at the inside of the nasal cavity 14 with the endoscope 12.
  • the intersection portion 35 ⁇ / b> B of the guide member 13 is projected together with the nasal cavity 14 in the visual field 29 of the endoscope 12.
  • the visual field enlargement part 37 is a bending mechanism 63 provided between the straight part 35A and the intersection part 35B and capable of rotating the intersection part 35B.
  • This is a bending mechanism 63 capable of retracting the intersecting portion 35B.

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  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Optics & Photonics (AREA)
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  • Radiology & Medical Imaging (AREA)
  • Physics & Mathematics (AREA)
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  • Biomedical Technology (AREA)
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  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Otolaryngology (AREA)
  • Endoscopes (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un système d'endoscope comprenant : un endoscope qui est conçu pour être inséré dans une cavité nasale ou un sinus paranasal et qui comprend une partie constituante d'extrémité distale ; et un élément de guidage pour guider l'endoscope. L'élément de guidage comporte : une section linéaire qui guide l'endoscope de telle sorte que l'endoscope peut être avancé et rétracté, et qui comprend un mécanisme de maintien pour maintenir l'endoscope dans une position alignée avec la section linéaire ; une section d'intersection qui est disposée de manière continue par rapport à la section linéaire, qui s'étend dans une direction croisant une direction dans laquelle la section linéaire s'étend, et qui guide l'endoscope de telle sorte que l'endoscope peut être avancé et rétracté dans la direction d'intersection ; et une section d'actionnement pour avancer et rétracter l'endoscope, la section d'actionnement étant apte à commuter entre un état dans lequel la partie de constitution d'extrémité distale est alignée avec la section linéaire et un état dans lequel la partie constituante d'extrémité distale est alignée avec la section d'intersection.
PCT/JP2018/039284 2018-03-19 2018-10-23 Système endoscope et élément de guidage WO2019181039A1 (fr)

Applications Claiming Priority (2)

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JP2018-051241 2018-03-19
JP2018051241A JP2021126131A (ja) 2018-03-19 2018-03-19 内視鏡システム、ガイド部材

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2008048946A (ja) * 2006-08-25 2008-03-06 Olympus Corp 内視鏡用ガイドチューブ及び内視鏡装置
JP2012205717A (ja) * 2011-03-29 2012-10-25 Fujifilm Corp 内視鏡用挿入補助具
JP2015031802A (ja) * 2013-08-01 2015-02-16 オリンパス株式会社 内視鏡検査用固定具
WO2016117432A1 (fr) * 2015-01-20 2016-07-28 オリンパス株式会社 Outil d'assistance d'insertion et dispositif médical
WO2017138533A1 (fr) * 2016-02-12 2017-08-17 オリンパス株式会社 Ensemble dispositif d'insertion pour sinus paranasaux

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2008048946A (ja) * 2006-08-25 2008-03-06 Olympus Corp 内視鏡用ガイドチューブ及び内視鏡装置
JP2012205717A (ja) * 2011-03-29 2012-10-25 Fujifilm Corp 内視鏡用挿入補助具
JP2015031802A (ja) * 2013-08-01 2015-02-16 オリンパス株式会社 内視鏡検査用固定具
WO2016117432A1 (fr) * 2015-01-20 2016-07-28 オリンパス株式会社 Outil d'assistance d'insertion et dispositif médical
WO2017138533A1 (fr) * 2016-02-12 2017-08-17 オリンパス株式会社 Ensemble dispositif d'insertion pour sinus paranasaux

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