WO1994010896A1 - Endoscope for intestines - Google Patents

Abstract

An endoscope for intestines capable of being inserted into intestines easily and speedily and characterized in that it is provided with a sucker (2) fitted around a part of the outer circumferential surface of a bent portion (1b) of the endoscope and having a suction chamber (2b) therein and a plurality of suction holes (2a) in the outer circumferential wall thereof, and a suction tube (3) connected at one end thereof to the sucker (2) and extending along an insert portion (1) of the endoscope and connected at the other end thereof to a suction pump (5).

Description

 Akira TO Endoscopy Technology Field

 The present invention relates to an endoscope for the intestinal tract from the rectum to the s-shaped, descending, transverse, and ascending colons, and more particularly to the structure of an enteroscopy made in consideration of the ease and safety of its insertion operation. . Background.Technology

 This type of enteroscopy is different from those of the digestive organs such as the stomach and esophagus, which have relatively simple structures. Performing examinations and other necessary medical procedures on the internal organs through a scope to the depth of the organs requires a fairly high level of skill and skill, and the most problematic is the scope of the scope of the free intestine.移行 The transition to the intermediate position where the traffic and the leading end are left. In other words, anatomically, unlike the so-called ascending and descending colons that belong to the fixed intestine, the free intestinal part is freely deformed by the insertion of the scope, and the intestinal wall with high extensibility is flexed freely by pushing the scope. It is well known that there are various difficulties for a person with a scope, such as being stretched out or making a curve like a haze to prevent its progress.

In this type of intestinal endoscope, the usual technique for introducing a scope is to use the flexibility and straightness of the scope to remove the inner wall of the intestinal tract. It is a method of pushing while sliding, and using an endoscope to check the state of the lumen of the intestinal tract and operate the scope freely, or to swing the scope bending part that can be bent. In addition, we will try to insert deeper into the back while searching for an insertable path.

 At this time, if the scope of the free intestine, such as the sigmoid colon or the transverse colon, is obstructed, the insufflation of the intestinal tract can be performed by blowing air from the end of the scope as needed. Manipulate the scope back and forth while expanding, or bend the scope curve, apply the bent tip to the bend formed on the inner wall of the intestinal tract, pull back, and stand in the insertion direction and forward. The above obstacle is removed by performing operations such as correcting the bent part of the intestinal tract into a gentle curve, and further insertion into the back

However, all of these methods are inefficient and irrational. For example, the above-mentioned insufflation into the intestinal lumen does not always provide a desired endoscope visual field. The diameter and length of the intestinal tract near the mouth are unnecessarily expanded, or the formation of a hepatine curve located in front of the advancing direction is further promoted, resulting in a difficult insertion state, and the pain caused by extension of the mesentery. Bring to the subject. In addition, the operation of pulling back the intestinal tract, which is performed by bending the curved portion of the scope, is inefficient at the intestinal inner wall where the other party is deformable and cannot be promoted, and this operation is performed while the visual field at the tip of the scope is blocked. If this is not possible, the mucosal tissue on the inner wall of the intestinal tract may be damaged. From the above, it is necessary to have considerable experience and skill to perform the insertion operation of the enteroscope properly. However, the operation time is not short, especially when the subject has prolonged colon disease. In fact, it takes more time and effort to process the hairpin curve, etc., and the burden on the subject is not small, and the development of a more efficient and rational method is desired. Disclosure of the invention

 The present invention focuses on the problems of the conventional methods as described above, and aims to provide a method and means capable of fundamentally solving those problems.

 According to the inventor's knowledge regarding this kind of scope insertion operation, the scope pushed into the free intestine physically has a strong tendency to always go straight and push the inner wall of the intestine like a rubber balloon. Therefore, the scope that can move inside the curved free intestine can only slide on the gentle slope of the intestinal lining with the help of a lubricant such as jelly applied to the scope surface, in other words, However, it is difficult to change the direction of travel no matter how the input angle of the scope is manipulated.

 Conditions that allow the course of the scope to change are bending due to resistance to pressing against hard tissue around the intestinal tract, and bending due to gravity applied to the distal end of the scope. When the scope bends, the intestinal tract also changes. The original shape is to bend.

Based on the above, in the present invention, the property of the intestinal tract, which has conventionally been used as a network for the insertion operation, that is, the deformable easy extensibility, is considered. Conversely, the bowel is deformed due to the above-mentioned bending of the scope, and the inner wall of the intestinal tract is deformed by the suction operation from the side of the scope, which will be described later. Using this phenomenon, we have developed an operation method and means that make insertion of scope easier and more reliable. In other words, a suction mechanism is provided on the outer periphery of the curved portion located on the distal end side of the scope insertion portion. When necessary, suction is performed to decompress the lumen of the intestinal tract from the insertion side to the insertion end. The inner wall of the intestine is adsorbed and captured, and by using the adsorbing power, both traction can be performed, and the intestinal bent portion such as a loop or a heap pin curve is straightened.

In order to achieve the above object, according to the present invention, there is provided a scope insertion portion including a flexible portion and a curved portion that can be bent, and is provided so as to surround an outer periphery of the curved portion. A suction tool having a large number of suction holes in a part thereof, one end of which is connected to the suction tool and communicates with the suction space, and the other end extends along the scope inlet and is connected to a suction pump device. And an aspirating tube. The suction device configured as described above and provided so as to surround the outer periphery of the curved portion on the distal end side of the scope insertion portion can easily perform the insertion operation into the lumen of the intestinal tract without obstructing the scope of the distal end of the scope. It can be carried out. In addition, the suction hole formed on the outside of the suction tool is located on the side of the scope entrance, and if suction is applied, the lumen of the intestinal tract from the Scope insertion hand side to the insertion end is equally depressurized. The intestinal lining is quickly adsorbed and trapped around the scoping entrance Is done. Therefore, when the scope is pulled, the intestinal tract is pulled toward the hand side and folded in a bellows shape, and the intestinal tract located in front of the scope insertion end is also pulled back, and the bend is gradually released to straighten. Therefore, the correction and release of loops and hairpin curves occurring in the free intestine can be performed extremely quickly and skillfully. This straightening secures the scope insertion passage, improves the transmission of external insertion force to the tip of the scope insertion part, and makes the insertion operation easier and smoother.

 The suction tool applied to the present invention is constituted by a tubular body or a tubular body having an outer shape of a sleeve shape or a spindle shape, each of which has a large number of suction holes on an outer portion thereof, and the former has an outer periphery of a scope curved portion. The latter is wound spirally, and the latter is covered with the outer periphery of the curved portion, thereby forming a suction portion surrounding the curved portion of the scope. In addition, a series of suction mechanisms is configured by connecting one end of a suction pipe having a distal end to the suction pump device to the suction section. The suction pump device is suctioned and stopped by turning on and off a foot pedal switch provided in the device.

 The size of the above suction device is such that it does not hinder the insertion of the scope into the intestinal lumen.For example, the overall length is 20 to 40 mm, and the outer diameter is about 1 to 3 mm larger than the scope insertion part. Form with In addition, it is desirable that the mounting position is set at an intermediate position where the distal end of the curved portion is left so as not to hinder the bending operation and the distal end operation at the curved portion of the scope.

In addition, the above-mentioned suction tool is formed inside when suction is performed. For example, a cylinder or tube made of synthetic resin such as silicone resin is used so that the suction space has sufficient rigidity so as not to collapse. In addition, a large number of small-diameter holes are formed on the outer side of the hole, in order to both secure the suction function necessary for decompressing the lumen of the intestinal tract and prevent the intestinal wall mucous membrane from being sucked during suction. provided, for example, when a pore size of about 1 mm, it is appropriate to set 3 about four Z cm ² per unit area. The suction pipe connected to the suction tool is made of a flexible material such as synthetic resin or rubber. One end of the suction pipe is connected to the suction tool, and the suction pipe extending along the opening of the scope is located behind the suction tool. At a position about 10 cm apart, fix it to the scope insertion part with tape or other appropriate means, and extend the following part freely along the insertion part and connect it to the above-mentioned suction pump device. When the suction tube is configured to be inserted through the bore of the scope, a small opening is provided at the side of the scope insertion portion or the curved portion, and the suction tube is led out through the slot. Then, it is connected and connected to the suction tool arranged on the outer periphery of the curved part. BRIEF DESCRIPTION OF THE FIGURES

 FIG. 1 is a schematic view of an intestinal endoscope equipped with a suction device according to one embodiment of the present invention.

 FIG. 2 is an enlarged view showing a configuration of the suction tool in the embodiment. FIG. 3 is an enlarged view showing a configuration of a suction tool according to another embodiment of the present invention.

FIG. 4 is an enlarged view of the structure of a suction tool according to still another embodiment of the present invention. FIG.

 FIG. 5 is an explanatory view schematically showing the operation of inserting a scope from the rectum into the intestinal tract from the rectum to the transition part S DJ between the sigmoid colon and the descending colon, as viewed from the back of the left lateral recumbent position.

 FIG. 6 is an explanatory view schematically showing a scope insertion operation at the same site as in FIG. 5 in the case of an excessively long sigmoid colon. BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, embodiments of the present invention will be described with reference to the drawings.

 FIG. 1 is a schematic view of an intestinal endoscope equipped with a suction device according to one embodiment of the present invention, wherein 1 is a scope insertion portion, which comprises a flexible portion la and a bendable bending portion 1b, Reference numeral 2 denotes a suction tool mounted on the outer circumference of the curved portion lb, and reference numeral 3 denotes a suction pipe, one end of which is connected to the suction tool 2 and the other end of which is connected to the suction pump device 5, respectively. Reference numeral 4 denotes a foot pedal switch provided on the suction pump device 5, and the pump device 5 is operated by depressing the pedal. Reference numeral 6 denotes an operation unit of the enteroscope apparatus.

 Furthermore, as shown in Fig. 2, the structure of the suction tool is as follows. The suction tool body is composed of a sleeve-like outer member, and its total length is about 30 mm. It has an outer diameter about 2 mm larger than the outer diameter, and on its outer side, for example, about 40 to 60 small holes 2a having a hole diameter of about 1 mm are provided.

By attaching the outer jacket to the outer periphery of the curved portion, a suction space 2b is formed which surrounds the outer peripheral surface of the curved portion and surrounds it with a small gap between the outer surface and the surface. And after the mantle By connecting a suction tube to the end, it communicates with the upper self-suction space.

A flange 2c is provided which is closely engaged with the outer periphery of 1b. The flange 2c is tightened and fixed by an appropriate fixing means 2d such as a band, a ring or a bayonet by an ordinary method. I have. Next, the operation of the enteroscope equipped with the suction device 2 will be described. With the subject in the left lateral position, the scope insertion part 1 is inserted from the anus, advanced while rotating clockwise or counterclockwise, and inserted beyond the rectum into the S-shaped colon. The movement of the scope in the sigmoid colon is naturally guided.

 That is, the distal end of the scope insertion portion is bent by the sacrum toward the anterior abdominal wall, curved by the resistance of the wall and gravity, and proceeds along the left abdominal wall, and then changes its traveling direction due to the resistance of the left iliac bone. Then, head toward the left pelvic cavity and proceed to the position shown in Fig. 5 (a) facing the entrance of the descending colon (D), that is, the transition (SDJ) between the sigmoid colon (S) and the descending colon (D).

After reaching the above position, the pedal switch 4 of the suction pump device 5 is stepped on to operate the suction pump device 5, and suction is performed from the suction device 2 provided on the curved portion 1b of the scope. Due to this suction, the lumen of the intestinal tract from the periphery of the suction device 2 to the rectum is decompressed, and the inner wall of the intestinal tract is adsorbed and captured over the entire outer periphery of the inserted scope insertion part. The intestinal tract is dragged by pulling the scope entrance 1 toward the hand, and the intestine is folded in a bellows shape as shown in Fig. 5 (b). Further towing the scope, The looped distal end of the curved portion enters the left iliac fossa adjacent to the arcade (A) of the internal iliac artery and vein and is locked. Here, by rotating the scope clockwise by the required angle, the bent tip rotates in the left iliac fossa, and the scope tip changes from downward to upward so that the transition ( SDJ). Therefore, the scope is inserted and advanced to enter the descending colon (D) over the transition (SDJ).

 In the case of an excessively long S-shaped colon, as shown in Figs. 6 (a) and 6 (b), the insertion path of the scope in the S-shaped colon becomes longer, but as in the above-mentioned operation, the intestine is passed through the suction tool The cavity is decompressed, and the scope is inserted and advanced while performing suction and traction. Through the operations shown in Figs. 5 (b) and 5 (c) above, the scope advances to the transition section (over the SD and into the descending colon. Descending colon (D) The scope enters the intestinal lumen fixed to the posterior surface of the peritoneum and reaches the spleen curve approximately linearly, at which point the scope tip is swung to find the lumen of the transverse colon. After confirming it in the endoscopic view, advance the scope through the splenic curvature into the transverse colon.

Use the resistance of the anterior abdominal wall to slide the scoop in the transverse colon, and in particular, in the case of an excessively long transverse colon, insert the scope while rotating the scope counterclockwise. Therefore, the intestinal tract is advanced while being folded. If a U-shaped hairpin curve is formed just before the hepatic curve and the endoscopic field of view is lost, rotate the scope counterclockwise and pull by suction to pull the U-shaped transverse colon. Is inverted to a U-shape, the hairpin curve is eliminated, and the liver curve opens forward. In this position If the suction is performed without pushing the loop, the ascending colon collapses and the scope tip automatically enters the ascending colon. The cecum is then reached by inserting the scope in small increments and advancing it.

 When the scope is retracted while performing return observation from the above position, the suction device must be appropriately operated to prevent the S-shaped colon (S) and the intestinal tract of the transverse colon from coming out at once. Use and provide necessary observations and medical treatment while slowly retreating.

 As described above, suction is performed from the side of the scope through the suction tool attached to the outer periphery of the curved part of the scope, the inner wall of the intestinal tract is sucked and captured around the scope entrance, and the scope is inserted while towing. The scope can always be operated in a nearly linear state. Therefore, the external force applied from outside the operator's body to the end of the scope is transmitted well, and the operation can be performed extremely easily and skillfully, and the time required is greatly reduced. In contrast to this, it took only a very short time, about 5 to 15 minutes, to perform the endoscope insertion operation without putting extra pain and burden on the subject.

FIG. 3 shows another embodiment of the present invention, in which a suction tube 3 is inserted and arranged by utilizing the space of the lumen of the scope insertion portion 1, and the insertion end is provided on the side of the curved portion of the scope. The suction pipe is connected to the suction chamber 2b of the suction tool 2 so that the suction pipe is not exposed to the outside of the scope, thus improving its operability. Can be done. FIG. 4 shows still another embodiment of the present invention. As shown in the figure, the main body of the suction tool is constituted by a flexible tubular body S provided with a number of suction holes 8a on the outer periphery, and this is spirally wound around the outer periphery of the scope curved portion and fixed. At the same time, the winding end of the tubular body 8 is connected to the suction tube 3, or the tubular body 8 provided with a suction hole only in the spiral winding portion is used as a suction tube, and this is used as a scope. It may be configured to extend along the insertion portion and connect the extension end to the suction pump device 5.

 As described above, according to the present invention, the intestinal lumen is suctioned by the suction device provided on the outer periphery of the scope curved portion to make it in a decompressed state, and the intestinal tract is sucked and captured around the scope insertion portion to be pulled, thereby folding the intestinal tract. By moving the scope forward while inserting, the insertion operation into the free intestine, such as the sigmoid colon and the transverse colon, becomes much easier than in the past, greatly reducing the operation time and significantly reducing the burden on the subject. This makes it possible to provide a very advantageous and rational operation method for this type of enteroscopy <

Claims

The scope of the claims 1. A scope insertion portion comprising a flexible portion and a curved portion capable of bending operation, and a suction device provided so as to surround the outer periphery of the curved portion, having a suction space on the inner side and a number of suction holes on the outer side. An intestinal endoscope having a suction tube connected at one end to the suction tool, communicating with the suction space, and extending at the other end along the scope inlet, and connected to a suction pump device.  2. The suction tool is a tubular body having a number of suction holes on an outer peripheral portion, and is spirally wound around the outer periphery of the curved portion and one end thereof is connected to the suction tube. 2. The enteroscope according to claim 1, wherein:  3. The suction tool is a hollow cylindrical body having an annular suction chamber in a circumferential direction and having a number of suction holes on an outer wall thereof, and is attached so as to surround a portion of the curved portion. 2. The enteroscope according to claim 1, which is characterized in that:  4. The suction tool is composed of a mantle-shaped member having a large number of suction holes in an outer wall portion, is covered so as to surround the outer periphery of the curved portion, and forms a suction space inside the curved portion. 2. The enteroscope according to claim 1, wherein:  5. The enteroscope according to any one of claims 1 to 4, wherein the suction device is provided at an intermediate position where a distal end of the curved portion is left. 6. The suction tube is disposed through the lumen of the scope insertion portion, and the communication end thereof is led out from the side wall of the scope insertion portion. The enteroscope according to any one of claims 1 to 5, wherein the endoscope is connected to and connected to the suction device.