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WO2007032085A1 - Auxiliaire d’insertion - Google Patents

Auxiliaire d’insertion Download PDF

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Publication number
WO2007032085A1
WO2007032085A1 PCT/JP2005/017183 JP2005017183W WO2007032085A1 WO 2007032085 A1 WO2007032085 A1 WO 2007032085A1 JP 2005017183 W JP2005017183 W JP 2005017183W WO 2007032085 A1 WO2007032085 A1 WO 2007032085A1
Authority
WO
WIPO (PCT)
Prior art keywords
propulsive force
force generating
insertion portion
guide tube
assisting tool
Prior art date
Legal status (The legal status 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 status listed.)
Ceased
Application number
PCT/JP2005/017183
Other languages
English (en)
Japanese (ja)
Inventor
Satoshi Makiyama
Ryosuke Ishizaki
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Medical Systems Corp
Original Assignee
Olympus Medical Systems Corp
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 Olympus Medical Systems Corp filed Critical Olympus Medical Systems Corp
Priority to JP2007535363A priority Critical patent/JPWO2007032085A1/ja
Priority to PCT/JP2005/017183 priority patent/WO2007032085A1/fr
Publication of WO2007032085A1 publication Critical patent/WO2007032085A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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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
    • A61B1/31—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 rectum, e.g. proctoscopes, sigmoidoscopes, colonoscopes

Definitions

  • the present invention relates to an insertion assisting tool that generates a propulsive force in a medical device that is used when an insertion portion constituting a part of an endoscope is inserted into a body cavity.
  • an endoscope having an elongated insertion portion is provided with a bending portion on the distal end side of the insertion portion.
  • the bending portion bends in, for example, the up and down direction and the left and right direction by moving the operation wire connected to the bending piece constituting the bending portion back and forth.
  • the operation wire can be advanced and retracted by rotating, for example, a bending knob provided on the operation unit by the operator.
  • Japanese Patent Application Laid-Open No. 10-113396 discloses a medical device propulsion device that can easily guide a minimally invasive medical device to a deep portion of a living body tube.
  • the rotating member is provided with an inclined rib with respect to the axial direction of the rotating member. For this reason, by rotating the rotating member, the rotational force of the rotating member is changed to a propulsive force by the rib. In other words, the medical device connected to the propulsion device is moved in the deep direction by the propulsive force.
  • the tip portion of the rotating member is caught by an intestinal fold or a small dent, which prevents smooth advancement. Moe.
  • the propulsion device for the above-described medical device has flexibility similar to an endoscope, and is introduced by an anal force, for example, which serves as an introduction port into the large intestine while being held by an operator.
  • an anal force for example, which serves as an introduction port into the large intestine while being held by an operator.
  • the propulsion device of the medical device may be squeezed or twisted, and the insertion property may be hindered.
  • the medical device when the medical device is introduced into the anus, it may be difficult to smoothly introduce it into the large intestine due to resistance due to tightening of the anus.
  • the present invention has been made in view of the above-described points, and the purpose thereof is to promote a medical device that can guide an insertion portion of an endoscope to a desired site.
  • a medical device that can guide an insertion portion of an endoscope to a desired site.
  • An object of the present invention is to provide an insertion aid that can be used.
  • the insertion assisting tool of the present invention that achieves the above-described object guides an endoscope insertion portion into a body cavity, and includes a long insertion portion guide member having a spiral groove formed on the outer periphery.
  • a tube body provided with a holding portion, and a proximal end of the tube body A first opening into which the guide member is inserted, a second opening at the tip of the tube body from which the guide member protrudes, and the insertion portion guide to rotate.
  • a propulsive force generating member that generates a propulsive force by pressing the outer periphery of the material.
  • FIG. 1 is an external view of an insertion assisting tool of the present invention according to a first embodiment.
  • FIG. 2 is an exploded perspective view of the holding portion of the insertion assisting tool.
  • FIG. 3 is a partial cross-sectional view of the insertion assisting device partially cut along the longitudinal direction.
  • FIG. 4 is an enlarged partial sectional view of the vicinity of the holding portion of the insertion assisting tool shown in FIG.
  • FIG. 5 is a plan view of the thrust generating member.
  • FIG. 6 is a diagram illustrating a schematic configuration of a first endoscope system.
  • FIG. 7 is a diagram illustrating a configuration of an insertion portion guide member.
  • FIG. 8 is a diagram illustrating a schematic configuration of a second endoscope system.
  • FIG. 9 is a diagram for explaining the configuration of the introduction tube of the second endoscope system.
  • FIG. 10 is a view showing a state where the insertion assisting tool of the present invention according to the first embodiment is inserted into the rectum from the patient's anus.
  • FIG. 11 is a partial sectional view showing the inside of the holding portion of the portion surrounded by circle A in FIG.
  • FIG. 12 is a diagram for explaining an insertion state of the insertion portion guide member in the large intestine in the endoscope system.
  • FIG. 13 is a view showing an insertion portion guide member in which the insertion portion guide member is inserted to the vicinity of the cecum in the endoscope system.
  • FIG. 14 is a diagram illustrating a procedure for inserting the insertion portion guide member in the endoscope system into the treatment instrument insertion channel provided in the insertion portion of the endoscope.
  • FIG. 15 is a diagram illustrating a state in which the insertion portion of the endoscope is inserted into the large intestine with the insertion portion guide member in the endoscope system as a guide.
  • FIG. 16 is an exploded perspective view of the insertion assisting tool of the present invention according to a second embodiment.
  • FIG. 17 is a diagram illustrating a procedure for extrapolating a stationary ring to a guide tube.
  • FIG. 18 is a view for explaining the procedure for assembling the second propulsion force generating member after the fixed ring is put on the guide tube.
  • FIG. 19 is a diagram for explaining a procedure for extrapolating the holding ring to the guide tube after assembling the second propulsive force generating member.
  • FIG. 20 is a view for explaining the procedure for assembling the first propulsive force generating member after the holding ring is put on the guide tube.
  • the first propulsive force generating member is mounted on the fixed ring and each propulsive force generating member.
  • FIG. 22 is a plan view of the propulsion force generating unit with the guide tube inserted therethrough.
  • FIG. 23 is a cross-sectional view of the propulsion force generating unit cut along line ⁇ - ⁇ in FIG.
  • FIG. 24 is an exploded perspective view of the propulsive force generating unit and the tube body before connection.
  • FIG. 25 is a plan view of the insertion assisting tool in a state in which the propulsive force generating unit and the tube main body are connected to each other.
  • FIG. 26 is a plan view showing a modified example of the insertion assisting tool and showing a state in which the propulsive force generating unit is housed in the holding portion of the tube body.
  • FIG. 27 is a plan view showing a modification of the propulsive force generating member.
  • FIG. 28 is a view for explaining the action of the propulsive force generating member in FIG. 27.
  • FIG. 29 is a plan view in which the propulsion force generating unit of the insertion assisting tool is attached to a medical garment.
  • FIG. 30 is a partial cross-sectional view of the propulsive force generating unit of FIG. 29, and is a view of the medical clothing also showing lateral force.
  • FIG. 31 is a view for explaining a rotation preventing means for preventing rotation of an insertion assisting tool attached to a patient.
  • FIG. 32 is a diagram for explaining a rotation preventing means for preventing rotation of the insertion assisting tool attached to the patient.
  • FIG. 1 to 5 relate to the first embodiment showing the configuration of the insertion assisting tool of the present invention
  • FIG. 1 is an external view of the insertion assisting tool of the present invention
  • FIG. 2 is an exploded view of the holding portion of the insertion assisting tool
  • 3 is a partial cross-sectional view of the insertion aid partially cut along the longitudinal direction
  • FIG. 4 is an enlarged partial cross-sectional view of the vicinity of the holding portion of the insertion aid shown in FIG. 3
  • FIG. 5 is a propulsion. It is a top view of a force generation member.
  • the insertion assisting tool 1 of the present embodiment includes an insertion portion 2, a stray prevention portion 3 that is a stray prevention means, and a female screw portion 4b on the inner peripheral surface.
  • the formed holding portion 4, the stationary ring 5 having the male screw portion 5b formed on the outer peripheral surface, the holding ring 6, and the first and second propulsive force generating members 7a and 7b (in the following explanation, It may be described as a propulsion generating member 7).
  • the insertion portion 2 has a substantially cylindrical shape, and is a substantially annular shape made of a synthetic resin having flexibility such as silicon having a tapered outer periphery so as to be tapered.
  • the distal end insertion portion 2a, the insertion cylinder 2b forming the main body of the insertion portion 2, and the distal insertion portion 2a and the insertion barrel 2b are connected on the inner peripheral side to have a connecting ring 2c. It is configured as
  • This insertion cylinder 2b includes, in order from the outer surface side, an outer tube 2d formed of a synthetic resin such as polyurethane, a blade 2e formed in a cylindrical shape by weaving metal wires in a mesh shape, And a flexible tube 2f, and an inner tube 2g formed of a synthetic resin such as polyurethane.
  • the outer tube 2d, the blade 2e, the flexible tube 2f, and the inner tube 2g have a four-layer structure and are fixed so that the corresponding members are integrated by bonding or the like.
  • the insertion cylinder 2b is a flexible tube having a predetermined rigidity.
  • the insertion cylinder 2b may be formed as a tube body made of a single member if the predetermined rigidity and the predetermined flexibility are sufficiently obtained. Further, the insertion cylinder 2b may be provided with a coating such as Teflon (registered trademark) processing for improving the slipperiness on the outer peripheral surface and the inner peripheral surface thereof.
  • Teflon registered trademark
  • An intrusion prevention portion 3 which is a hollow disk made of a synthetic resin such as silicon is disposed at the base end portion of the insertion cylinder 2b.
  • the intrusion prevention part 3 has a hole diameter set smaller than the outer shape of the insertion cylinder 2b, and has a predetermined holding strength due to its elastic deformation. It is tightly fixed to the cylinder 2b. As a result, by changing the position of the intrusion prevention unit 3, the desired insertion length into the body cavity applied to the proximal end of the distal end force of the insertion unit 2 can be set.
  • the proximal end portion of the insertion cylinder 2b has a three-layer structure of a blade 2e, a flex tube 2f, and an inner tube 2g, and is bonded to an annular base 4a. It is fixed by.
  • the holding portion 4 is a substantially cylindrical metal ring having a shape in which outer peripheral portions at both ends protrude in the outer diameter direction.
  • the holding portion 4 is screwed to a base 4a fixed to the base end portion of the insertion cylinder 2b of the insertion portion 2.
  • a pressing ring 6 made of a metal ring (which may be a force ring such as plastic) and two propulsion force generating members 7 which are friction members which are elastic member forces such as silicon rubber and urethane.
  • the holding part 4 has a fixed ring 5 screwed inside the base end part as described later.
  • the tube body 8 has an opening 8a that is a distal end opening of the above-described distal end insertion portion 2a at the distal end, and an opening 8b that is a proximal end opening of the holding portion 4 described above at a proximal end.
  • the opening 8a constitutes a first opening in the insertion aid 1 of the present invention for projecting a guide tube described later.
  • the fixed ring 5 includes a substantially annular fixed ring main body 5a made of metal having the male screw portion 5b formed on the outer peripheral surface, and silicon coated on the outer periphery of the base end of the fixed ring main body 5a. And a cap 5c made of synthetic resin.
  • the fixed ring 5 is screwed to the base end portion of the holding portion 4 by the male screw portion 5b being screwed into the female screw portion 4b of the holding portion 4.
  • the fixed ring 5, the holding ring 6 and the two propulsion force generating members 7 have substantially the same outer diameter.
  • the outer diameter is set to be approximately the same as the hole diameter of the holding portion 4.
  • Reference numeral 5d denotes an opening for inserting a guide tube, which will be described later, and constitutes a second opening in the insertion aid 1 of the present invention! /
  • the propulsive force generating member 7 has a substantially disk shape having a predetermined thickness which is an elastic body force. As shown in FIG. 5, a hole 9a formed at a substantially center and the hole 9a Two slits 9b formed so as to intersect substantially orthogonally, and formed at both ends of each slit 9b on the outer peripheral side It has a tear prevention hole 9c for preventing tearing.
  • the first propulsive force generating member 7a is disposed so as to abut against the base end of the base 4a, and is then accommodated in the holding portion 4 in the order of the presser ring 6 and the second propulsive force generating member 7b. . That is, in this state, the first propulsive force generating member 7a, the pressing ring 6 and the second propulsive force generating member 7b are arranged in the holding portion 4 in this order from the front end side.
  • the fixed ring 5 is inserted into the proximal end opening of the holding part 4, and the male screw part 5 b of the fixed ring 5 and the female screw part 4 b of the holding part 4 are screwed together.
  • the first propulsive force generating member 7a is in a state where its circumferential portion is in contact with the proximal end circumferential portion of the base 4a and the distal end circumferential portion of the holding ring 6 and is sandwiched between the members.
  • the second propulsive force generating member 7b is in a state of being sandwiched between the respective members, with the circumferential portion thereof being in contact with the proximal end circumferential portion of the holding ring 6 and the distal end circumferential portion of the fixed ring 5. .
  • the base 4a, the retaining ring 6 and the stationary ring 5 of the holding part 4 have a length in the axial direction so that the first and second thrust generating members 7a and 7b can be clamped with a predetermined pressing force, respectively. It is set.
  • the distance between the opposing surfaces of the first propulsive force generating member 7a and the second propulsive force generating member 7b is the same as the axial length of the presser ring 6. Therefore, the first propulsive force generating member 7a and the second propulsive force generating member 7b are set to be separated from each other by a predetermined distance depending on the axial length of the presser ring 6.
  • a rough surface that is a means for preventing misalignment, such as an uneven surface for preventing misalignment, may be formed.
  • the first and second propulsive force generating members 7a and 7b have a rough surface on both end surfaces 6a and 6b of the presser ring 6, so that a large frictional force is generated on the contact surface with these rough surfaces.
  • the insertion assisting tool 1 of the present invention configured as described above is used together with an endoscope system that is a medical device capable of examining and treating a body cavity such as the large intestine.
  • FIG. 6 is a diagram illustrating a schematic configuration of the first endoscope system
  • FIG. 7 is a diagram illustrating a configuration of the insertion portion guide member.
  • the first endoscope system 100 is mainly composed of an endoscope 102 and a first first endoscope insertion assisting device 103.
  • the endoscope 102 includes an insertion portion 111, an operation portion 112 provided on the proximal end side of the insertion portion 111, and a universal cord 113 that extends from the side portion of the operation portion 112. ⁇ .
  • the insertion portion 111 is configured by connecting a distal end rigid portion 114 in order from the distal end side, a bending portion 115 configured to be curved in the vertical and horizontal directions, and a flexible flexible tube portion 116, for example. ing.
  • the operation section 112 of the endoscope 102 has a treatment communicated with a treatment instrument insertion channel which is an endoscope conduit provided in the insertion section 111 for inserting a treatment instrument (not shown in particular).
  • a tool inlet 117 is provided.
  • the endoscope 102 includes a light source device 104, a video processor 105, and a motor 106 as external devices.
  • the light source device 104 supplies illumination light to the endoscope 102.
  • the video processor 105 has a signal processing circuit, and supplies a drive signal for driving an image pickup device (not shown) provided in the endoscope 102, and the electric signal that is photoelectrically converted and transmitted by the image pickup device.
  • the signal is converted into a video signal and the generated video signal is output to the monitor 106.
  • An endoscopic image is displayed on the screen of the monitor 106 in response to the video signal output from the video processor 105.
  • the first endoscope insertion assisting device 103 is mainly configured by a guide tube 121 that is an insertion portion guide member and a guide tube rotating device 122.
  • the guide tube rotating device 122 has a motor 123 and a guide tube fixing portion 124.
  • the motor 123 rotates the guide tube 121 in a predetermined direction around the longitudinal axis of the guide tube (hereinafter abbreviated as “around the shaft”).
  • the motor 123 is installed on a table 125a of a rotary device cart (hereinafter abbreviated as a cart) 125 disposed near the bed 108 on which the patient 300 lies.
  • the motor 123 is fixed to a predetermined fixing member (not shown) on the base 125a. In this case, click on the motor shaft 123ai of the motor 123 or the car 125 base 125a. It is set to be parallel to the partial plane.
  • a guide tube fixing portion 124 is fixed to the motor shaft 123a of the motor 123.
  • a proximal end which is one end of the guide tube 121, is detachably attached to the guide tube fixing portion 124. Therefore, when the motor 123 is driven and the motor shaft 123a rotates, the guide tube 121 attached to the guide tube fixing portion 124 that is integrally fixed to the motor shaft 123a rotates about the shaft. .
  • the guide tube 121 is covered with a protective tube 126 that also serves as a tubular member that prevents the guide tube 121 from directly touching the floor in the operating room and the guide tube 121 from being twisted. .
  • the guide tube 121 is inserted into the inner hole of the protective tube 126 in a loosely fitted state. This prevents the guide tube 121 from directly contacting the floor or the like.
  • Both end portions 126a and 126b of the protective tube 126 are detachably attached and fixed to the protective tube holding members 127 and 128, respectively.
  • one protective tube holding member 127 is disposed on the bed 108 via, for example, a stand 129 that can be adjusted in height, and the other protective tube holding member 128 is disposed on a table 125b provided on the cart 125.
  • the motor 123 is disposed at a position facing the motor 123.
  • the guide tube rotating device 122 includes a control circuit that performs drive control of the motor 123 and a plurality of operation members, for example, and is a rotation control device that performs rotation control of the guide tube 121.
  • the rotation control box is connected.
  • the guide tube 121 shown in FIG. 7 is a spiral tube that allows for insertion into a body cavity.
  • a stainless steel or plastic metal strand 131 having a predetermined diameter is spirally formed in two layers. It is formed so as to have a predetermined flexibility. It may also be wound in multiple lines (for example, line 4). When spirally wound, the adhesion between the metal strands can be increased, and various spiral angles can be set.
  • the outer surface of the guide tube 121 is provided with a spiral portion 121a formed by the surface of the metal wire 131.
  • the outer diameter dimension of the guide tube 121 is set to a dimension that allows insertion into the treatment instrument insertion channel of the endoscope 102.
  • the guide tube 121 may be configured like a second endoscope system 200 in which the guide tube 121 is extrapolated to the insertion portion 111 of the endoscope 102.
  • FIG. 8 is a diagram for explaining the schematic configuration of the second endoscope system
  • FIG. 9 is a diagram for explaining the configuration of the introduction tube of the second endoscope system. is there.
  • the second endoscope system 200 is mainly configured by the endoscope 102 and the second endoscope insertion aid 203 described above.
  • the second endoscope insertion aid 203 is mainly composed of an introduction tube 210 and a rotation device 240.
  • the introduction tube 210 includes a distal end portion main body 221, a proximal end portion main body 222, a cover member 223, and a spiral tube 224 that is a guide tube that generates a propulsive force.
  • the spiral tube 224 is formed of, for example, stainless steel and spirally wound with a metal wire 224a having a predetermined diameter so as to have a predetermined flexibility. is there . Accordingly, a spiral portion 224b formed on the surface of the metal strand 224a is provided on the outer surface of the spiral tube 224.
  • the spiral tube 224 is fixed to the outer casing so as to be integrated with the introduction tube 210.
  • the cover member 223 constituting the introduction pipe 210 is formed in a long and thin tube shape having a low frictional resistance, for example, a Teflon (registered trademark) -processed resin.
  • the distal end main body 221 constituting the introduction pipe 210 is cylindrical and is formed of, for example, polycarbonate, which is a transparent resin member having optical characteristics.
  • the distal end main body 221 is disposed so as to cover the distal rigid portion 114 constituting the insertion portion 111 of the endoscope 102. That is, the distal end surface of the distal end portion main body 221 is configured as an observation window 221 a for ensuring the field of view of the endoscope 102.
  • the base end portion body 222 constituting the introduction tube 210 is tubular and is made of, for example, polyacetal, which is a resin member having good sliding properties.
  • the proximal end body 222 is pivotally connected to the distal end portion of the operation unit 112 of the endoscope 102.
  • the distal end main body 221, the proximal end main body 222, the cover member 223, and the helical tube 224 constituting the introduction pipe 210 described above are fixedly associated with each other so as to be integrated.
  • the introduction tube 210 is a flexible tube body that accommodates the insertion portion 111 of the endoscope 102, and a rotational force is transmitted by the rotation device 240, thereby causing the insertion portion 111 to move in the direction around the axis. It starts to rotate! /
  • FIG. 10 is a view showing a state in which the insertion assisting device of the present invention is inserted into the rectum from the patient's anal canal
  • FIG. 11 is a partial cross-sectional view showing the inside of the holding portion surrounded by a circle A in FIG.
  • FIG. 13 is a diagram for explaining an insertion state of the insertion portion guide member in the large intestine in the endoscope system
  • FIG. 13 is a diagram showing the insertion portion guide member in which the insertion portion guide member in the endoscope system is inserted to the vicinity of the cecum.
  • FIG. 14 is a diagram illustrating a procedure for inserting the insertion portion guide member in the endoscope system into the treatment instrument insertion channel provided in the insertion portion of the endoscope
  • FIG. 15 is an insertion portion guide member in the endoscope system.
  • FIG. 6 is a diagram for explaining a state in which the insertion portion of the endoscope is inserted into the large intestine with reference to FIG.
  • the protective tube 126 of the first endoscope system 100 and the desired tube A guide tube 121 having insertability is prepared. Then, the staff fixes the respective end portions of the protective tube 126 to the protective tube holding members 127 and 128.
  • the staff inserts the guide tube 121 through the inner hole of the protective tube 126.
  • the base end portion of the guide tube 121 protruding from the protective tube 126 is attached to the guide tube fixing portion 124 that is fixed to the motor shaft 123a of the motor 123, and the other end side is, for example, on the bed 108 or the stand 129.
  • the preparation for inserting the guide tube 121 into the large intestine is completed.
  • the preparation of the first endoscope insertion assisting device 103, the endoscope 102, the light source device 104, the video processor 105, and the monitor 106 are also prepared.
  • the staff also inserts the anal force of the patient 300 lying on the bed 108 with the insertion aid 1 of the present invention.
  • the insertion assisting tool 1 is inserted only into the rectum 172 from the anus 171 by the intrusion prevention part 3 coming into contact with the buttocks 180 near the anus 171 of the patient 300. It is in the state. That is, the insertion aid 1 can be inserted entirely into the rectum 172 by the intrusion prevention unit 3. Is prevented.
  • the insertion force 2 is inserted into the anus of the subject so that the propulsive force generating members 7a, 7b, 7b can be mounted on the subject. That is, the insertion part 2 is a mounting means for mounting the propelling force generating members 7a and 7b to the subject.
  • the surgeon grasps the distal end portion of the guide tube 121 and guides it from the proximal end opening of the insertion aid 1 inserted into the anus, here the opening 5d of the stationary ring 5.
  • the tip of the tube 121 is inserted into the insertion aid 1 and protrudes from the opening 8 a of the insertion portion 2 of the tube body 8.
  • the operator may insert the distal end of the guide tube 121 into the insertion aid 1 in advance before inserting the insertion aid 1 from the anus of the patient 300.
  • the guide tube 121 inserted into the insertion aid 1 is in a state of being pressed into contact with the propulsion force generating members 7a and 7b in the holding portion 4. That is, when the operator inserts the guide tube 121 into the insertion assisting tool 1, the guide tube 121 corresponds to the hole 9a (see FIG. 5) formed in the approximate center of each of the propulsive force generating members 7a and 7b. It penetrates with. At this time, each of the propulsive force generating members 7a and 7b holds the guide tube 121 in a state of giving a predetermined frictional resistance at substantially the center by the four portions divided by the respective slits 9b.
  • the four portions are pressed against each other in a state where a predetermined frictional resistance is applied to the spiral-shaped portion 121a formed on the outer surface of the guide tube 121 whose surface is in contact with the guide tube 121.
  • the contact state between the contact portion of the four parts that presses the outer periphery of the guide tube 121 inserted through each of the propulsion force generating members 7a and 7b and the spiral-shaped portion 121a formed on the guide tube 121 is frictional. This is the relationship between male and female threads.
  • the staff puts the motor 123 of the guide tube rotating device 122 into a rotationally driven state. Then, the guide tube fixing portion 124 rotates, and the base end portion of the guide tube 121 attached to the guide tube fixing portion 124 rotates a predetermined amount. This rotation is transmitted from the proximal end portion to the distal end side, and as shown by the arrows in FIGS. 10 and 11, the helically shaped portion 121a of the guide tube 121 rotates around the axis so that the proximal end force also moves toward the distal end side. Rotate in the direction.
  • the guide tube 121 is moved forward so that the male screw moves relative to the female screw at the contact portion between the propulsive force generating members 7a and 7b and the spiral-shaped portion 121a of the rotated guide tube 121. Propulsive force is generated. Then, the guide tube 121 is moved deeper in the large intestine by the propulsive force. Proceed toward. At this time, the surgeon does not grasp and push the guide tube 121 and gently grasps the holding portion 4 of the insertion assisting tool 1 and pushes the guide tube 121 in the large intestine only by the propulsive force by the propulsive force generating members 7a and 7b. It can be advanced toward the deep part.
  • the spiral-shaped portion 121a formed on the outer surface of the guide tube 121 contacts the intestinal wall.
  • the contact state between the spiral-shaped portion 121a formed in the guide tube 121 and the fold of the intestinal wall is the relationship between the male screw and the female screw.
  • the guide tube 121 moves forward smoothly by the propulsive force generated by the propulsive force generating members 7a, 7b of the insertion assisting tool 1 and the propulsive force generated by contact with the folds of the intestinal wall.
  • the guide tube 121 advances from the rectum 172 toward the sigmoid colon 173 by the driving force. Then, the guide tube 121 reaches the sigmoid colon 173 as shown in FIG. At this time, the guide tube 121 is in a state where the propulsive force generated by the insertion assisting tool 1 is always applied, and the contact length between the spiral-shaped portion 121a and the intestinal wall becomes long.
  • the guide tube 121 in a rotated state passes through the sigmoid colon 173, and thereafter, the bent portion, the descending colon, which is a boundary between the sigmoid colon 173 and the descending colon 174 having poor mobility.
  • the spleen curve 176 is the boundary between the 174 and the mobile transverse colon 175, and the liver curve 177 is the boundary between the transverse colon 175 and the ascending colon 178. For example, it reaches the vicinity of the cecum 179 which is the target site without changing the running state of the large intestine.
  • the staff If it is determined by the surgeon that the guide tube 121 has reached the vicinity of the cecum 179, the staff operates the rotation off button of the rotation control box (not shown) based on the instruction from the surgeon. The rotation driving state of the motor 123 of the tube rotating device 122 is turned off.
  • the staff removes the proximal end portion of the guide tube 121 protruding from the protective tube 126 from the guide tube fixing portion 124, and then removes the guide tube 121 from the protective tube 12 Remove from 6.
  • the operator removes the insertion aid 1 inserted into the rectum 172 from the anus 171 of the patient 300, and removes the guide tube 121 from the insertion aid 1 while maintaining insertion into the large intestine. .
  • the surgeon places the proximal end portion of the guide tube 121 extracted from the protective tube 126 on the distal end surface 114a of the distal rigid portion 114 as shown by the arrow in FIG. Insertion is made from the communicating tip opening 114b toward the operation unit 112 side. Then, the proximal end portion of the guide tube 121 is provided in the operation portion 112 as shown by the alternate long and short dash line in the figure, and protrudes from the treatment instrument insertion port 117.
  • the operator After confirming that the guide tube 121 has protruded from the treatment instrument insertion port 117 by a predetermined amount, the operator places the endoscope 102 in an observable state in order to insert the insertion portion 111 into the large intestine. Then, the operator inserts the distal rigid portion 114 constituting the insertion portion 111 into the large intestine from the anus 171 in a state where the guide tube 121 is passed through the treatment instrument penetration channel 111a of the insertion portion 111. Then, the observation image in the large intestine illuminated by the illumination light emitted from the illumination window 114c (Fig. 14) provided on the distal end surface of the distal rigid portion 114 passes through the observation window 114d (Fig. 14). An endoscopic image including the image of the guide tube 121 is displayed on the screen of the monitor 106 after being imaged on the imaging surface.
  • the operator turns the bending portion 115 or twists the insertion portion 111 while confirming the extending direction of the guide tube 121 passed through the large intestine on the screen of the monitor 106.
  • the distal end hard portion 114 of the insertion portion 111 is inserted toward the deep portion of the large intestine as shown in FIG.
  • the guide tube 121 inserted in the large intestine in advance serves as a mark indicating the direction in which the insertion portion 111 is inserted, the operator can smoothly move the distal rigid portion 114 of the insertion portion 111 without losing sight of the insertion direction. Can be inserted up to 179 cecum.
  • the insertion aid 1 of the present invention used in combination with the first endoscope system 100 described above can easily insert the guide tube 121 into the deep part of the large intestine. Accordingly, the insertion property of the insertion portion 111 of the endoscope 102 can be improved.
  • This insertion assisting tool 1 is inserted and placed in the rectum 172 at the position of the anus 171 of the patient 300 as described above. Therefore, the surgeon grasps the guide tube 121 and pushes it by hand operation, and the propulsive force and the guide tube 121 due to the contact between the guide force generating members 7a and 7b between the guide tube 121 and the guide tube 121. It can be inserted smoothly to the deep part of the large intestine due to the propulsive force caused by the contact between the body and the intestinal wall.
  • the guide tube 121 before being inserted into the body cavity is not subjected to resistance such as tightening by the anus 171 of the patient 300 by the insertion assisting tool 1, so that it is possible to reduce the occurrence of itchiness and to rotate. Is prevented from twisting.
  • the guide tube 121 does not directly contact the anus 17 1 when introduced into the large intestine by the insertion aid 1. For this reason, the highly flexible guide tube 121 does not receive resistance such as tightening by the anus 171, so that the introduction into the large intestine is improved.
  • two propulsion force generating members 7a, 7b are provided in the insertion assisting tool 1 of the present invention, and these first and second propulsive force generating members 7a, 7b are in the axial direction of the presser ring 6. Since the guide tube 121 is spaced apart by a distance equal to the length of the guide tube 121, the insertion direction of the guide tube 121 is improved and a stable propulsive force is generated.
  • the insertion assisting tool 1 of the present invention generates a propulsive force on the guide tube 121 of the first endoscope system 100 and introduces the guide tube 121 into the body cavity, here the large intestine. And insertability can be improved.
  • the contact surfaces that contact the first and second thrust generating members 7a and 7b are rough surfaces such as irregularities. May form although not described in detail, like the first endoscope system 100 described above, the insertion aid 1 of the present invention allows the insertion portion of the endoscope 102 to be inserted in the second endoscope system 200 as well.
  • the introduction tube 210 externally attached to 111, together with the insertion portion 111, the propulsive force generated by the contact between the helical tube 224 and each of the propulsive force generating members 7a and 7b of the insertion aid 1, and the helical tube 224 and the intestinal wall It smoothly advances to the deep part of the large intestine by the driving force generated by contact with the heel. As a result, the above-described effects applied to the first endoscope system 100 can be obtained.
  • FIG. 16 relates to a second embodiment showing the configuration of the insertion aid of the present invention
  • FIG. 16 is an exploded perspective view of the insertion aid of the present invention.
  • the insertion assisting tool in the present embodiment is given the same reference numeral to the same configuration as the insertion assisting tool according to the first embodiment, and a description of the same operation and effect as those configurations is omitted.
  • the insertion assisting tool la of the present embodiment has a configuration in which the insertion assisting tool 1 of the first embodiment has a substantially cylindrical outer body ring 11 made of metal.
  • the outer ring 11 has a male screw portion 1 la that engages with the female screw portion 4b of the holding portion 4 on the outer peripheral surface of one end portion, and the male ring of the fixed ring 5 on the inner peripheral surface of the other end portion. It has a female screw portion 1 lb to be screwed with the screw portion 5b.
  • the exterior body ring 11 accommodates the propulsion force generating members 7a, 7b and the presser ring 6 interposed between the propulsive force generation members 7a, 7b.
  • Fixed ring 5 is screwed.
  • the exterior main body ring 11, the fixed ring 5, the holding ring 6, and the first and second propulsive force generating members 7a and 7b constitute a propulsive force generating unit described later in the insertion assisting tool la.
  • the exterior main body ring 11, the fixed ring 5, the holding ring 6, and the first and second propulsive force generating members 7a and 7b constituting the propulsive force generating unit will be described as an example.
  • FIG. 17 is a diagram for explaining the procedure for extrapolating the stationary ring to the guide tube
  • FIG. 19 is a diagram for explaining the procedure for assembling the second propulsive force generating member after the outer ring of the fixed ring.
  • FIG. 19 is a diagram for explaining the procedure for extrapolating the holding ring to the guide tube after assembling the second propulsive force generating member.
  • Fig. 20 is a diagram for explaining the procedure for assembling the first propulsive force generating member after the holding ring is placed on the guide tube
  • Fig. 21 is the fixed ring and the respective propulsive forces after assembling the first propulsive force generating member.
  • FIG. 22 is a plan view of the propulsion generating unit with the guide tube inserted, and Fig. 23 is cut along line ⁇ - ⁇ in Fig. 22.
  • FIG. 24 is an exploded perspective view of the propulsive force generating unit and the tube main body before connection, and FIG. 25 is a plan view of the insertion assisting device in a state where the propulsive force generating unit and the tube main body are connected. .
  • the operator extrapolates the stationary ring 5 from the distal end side of the guide tube 121 and installs it at the distal end portion of the guide tube 121 as shown in FIGS. Then, as shown in FIG. 19, the surgeon penetrates the guide tube 121 through the second propulsive force generating member 7b from the distal end side of the guide tube 121 so that the distal end portion of the guide tube 121 protrudes, Install it at the position where it comes into contact with the fixed ring 5.
  • the operator extrapolates the holding ring 6 from the distal end side of the guide tube 121 and installs it at a position where it comes into contact with the second propulsive force generating member 7b. Thereafter, the operator penetrates the guide tube 121 so that the first thrust generating member 7a protrudes from the distal end side of the guide tube 121 so that the distal end portion of the guide tube 121 protrudes, and comes into contact with the holding ring 6. Install in position.
  • the surgeon inserts the outer body ring 11 also with the distal end side force of the guide tube 121, so that the female screw portion l ib (not shown) of the outer body ring 11 and the fixed ring
  • the outer threaded ring 5 and the stationary ring 5 are screwed together by screwing the male screw 5b of 5 into the screw.
  • the propulsion force generation unit 12 including the exterior body ring 11, the fixed ring 5, the pressing ring 6, and the first and second propulsion force generation members 7a and 7b is assembled.
  • the female screw 4b of the holding part 4 and the exterior body ring are taken into consideration when the propulsion force generating unit 12 is removed from the holding part 4 with the insertion assisting device la attached to the patient.
  • the screwing rotation direction of the male screw 11a of 11 and the screwing rotation direction of the female screw ib of the exterior body ring 11 and the male screw part 5b of the stationary ring 5 are set to be opposite screw grooves.
  • the propulsive force generating unit 12 is inserted into the guide tube 121.
  • the guide tube 121 is held substantially at the center by the first and second propulsive force generating members 7a and 7b inside.
  • a protrusion 1 lc that protrudes around the inner periphery forming an inward flange is formed on the inner periphery of the front end of the exterior body ring 11.
  • the peripheral edge portion of the first propulsive force generating member 7 a is sandwiched between the proximal end portion of the projection 11 c of the outer body ring 11 and the distal end portion of the press ring 6,
  • the peripheral portion of the second propulsive force generating member 7b is sandwiched between the base end portion of the ring 6 and the distal end portion of the stationary ring 5.
  • the exterior body ring 11, the fixed ring 5 and the holding ring 6 are set so that the lengths in the axial direction of the exterior body ring 11 can hold the first and second propulsive force generating members 7a and 7b with a predetermined pressing force, respectively. Has been.
  • the propulsive force generating unit 12 assembled as described above and holding the guide tube 121 through is operated by the operator with the male screw portion 11a and the female screw portion 4b. Are screwed together and screwed onto the holding portion 4 of the tube body 8.
  • the insertion aid la according to the present embodiment is assembled when it is used.
  • the tube main body 8 including the insertion portion 2, the intrusion prevention portion 3, and the holding portion 4 is first inserted into the anus 171 of the patient 300. After that, the propulsive force generating unit 12 can be assembled with the guide tube 121 being held through.
  • the insertion assisting tool la of the present embodiment generates a flexible guide tube 121 when the propulsive force generating unit 12 is assembled. Since the members 7a and 7b are inserted one by one, the guide tube 121 can be prevented from buckling and the guide tube 121 can be further introduced.
  • the propulsive force generation unit 12 may be stored in the holding portion 4 of the tube body 8.
  • a female screw (not shown) is formed on the inner peripheral surface of the holding portion 4, and the female screw portion l ib of the exterior body ring 11 of the propulsive force generating unit 12 is inserted into the female screw by the operator. Combined.
  • the propulsive force generating unit 12 is accommodated in the holding portion 4 of the tube body 8 and screwed.
  • FIG. 26 is a plan view of an insertion assisting tool la showing a modified example in which the thrust generating unit 12 is housed in the holding portion 4 of the tube body 8.
  • the distal end surface of the propulsive force generating unit 12 is placed on the patient's buttocks 180 (not shown). Since it is located near the intrusion prevention part 3 of the tube main body 8 that comes into contact, the distance between each of the propulsive force generating members 7a and 7b in the propulsive force generating unit 12 and the anus 171 (not shown) of the patient can be shortened. . As a result, the guide tube 121 receives the propulsive force due to the contact with the intestinal wall at a short distance in the forward part to which the propulsive force is given by the propulsive force generating members 7a and 7b. The force is increased and the insertability is improved.
  • FIG. 27 is a plan view showing a modification of the propulsive force generating member 7
  • FIG. 28 is a view for explaining the operation of the propulsive force generating member 7 of FIG.
  • the propulsive force generating member 7 has a slit 9b that passes through a substantially central hole 9d, and both ends are connected to a tear-preventing hole 9c, and the slit 9b and the hole 9d are substantially orthogonal to each other.
  • One end may be connected to the tear-preventing hole 9c, and the other end may have a slit 9d extending to the outer edge of the thrust generating member 7.
  • the surgeon has an end portion that extends to the outer edge portion of the thrust generating member 7 that is the other end of the slit 9d of the thrust generating member 7.
  • the guide tube 121 can be mounted from the side, and can be replaced even during the treatment. That is, in particular, in the case of the insertion assisting tool la shown in the second embodiment, the propulsive force generating unit 12 can be detached from the tube main body 8, so that the guide tube 121 inserted into the body cavity of the patient is used. Only the propulsive force generating member 7 without removing the can be replaced.
  • the propulsive force generating member 7 which is a friction member that is also an elastic member such as silicon rubber may be worn out and deteriorated by friction with the guide tube 121 during the treatment. It can be configured to be easily replaceable when it is no longer possible to apply propulsion
  • the insertion assisting tool 1, la of the present invention can have various modified configurations as shown in Figs.
  • Fig. 29 is a plan view of the propulsive force generating unit of the insertion assisting tool la attached to a medical garment
  • Fig. 30 shows a partial cross section of the propulsive force generating unit of Fig. 29.
  • the medical garment is viewed from the side.
  • FIG. 31, FIG. 31 and FIG. 32 are diagrams for explaining the rotation preventing means for preventing the rotation of the insertion assisting tool 1, la attached to the patient.
  • a propulsive force generating unit 31 having a propulsive force generating member 7 is attached to a medical clothing (pants) 30, which is a wearing means worn by a patient (subject) during treatment. May be attached.
  • the rotation preventing means that also serves as a mounting means for preventing the insertion assisting tool 1 la mounted on the patient from interlocking with the rotation of the guide tube 121. You may set up.
  • the adhesive tape 40 which is the first rotation preventing means serving also as the mounting means shown in FIG. 31, is inserted here by fixing the substantially square intrusion prevention part 3a and the patient's buttocks 180. Assistance tool 1 (la) is prevented from rotating.
  • the fixing band 50 which is the second anti-rotation means that also serves as the attachment means shown in FIG. 32, is connected to the stray prevention part 3, wound around the patient's waist and buttocks 180, and the insertion aid 1 (la ) Is prevented from rotating.
  • the insertion aid 1 (la) of the present invention rotates without being affected by the rotation of the guide tube 121. It can be fixed to the patient without any need. As a result, the insertion assisting tool 1 (la) can generate a reliable propelling force in the guide tube 121.
  • the guide tube 121 is squeezed, twisted, etc. It may not be delivered smoothly into the large intestine.
  • the propulsive force generating member 7 can be fixed in the vicinity of the anus by attaching the propulsive force generating unit 31 to the medical clothing 30 described above or by fixing the insertion aid 1 (la) with the fixing band 50. Therefore, the guide tube 121 is prevented from being twisted or twisted, and the guide tube 121 receiving the propulsive force can be smoothly fed into the large intestine.
  • the guide tube of the medical device is connected to the body cavity.
  • the insertion of the insertion part of the endoscope is accordingly accompanied. Improves.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Biomedical Technology (AREA)
  • Medical Informatics (AREA)
  • Optics & Photonics (AREA)
  • Pathology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Biophysics (AREA)
  • Engineering & Computer Science (AREA)
  • Physics & Mathematics (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Instruments For Viewing The Inside Of Hollow Bodies (AREA)
  • Endoscopes (AREA)

Abstract

La présente invention concerne un auxiliaire d’insertion (1, 1a) destiné à guider une partie d’insertion d’endoscope dans une cavité corporelle et utilisé conjointement avec un dispositif médical (100, 200) équipé d’un long élément de guidage de la partie d’insertion (121) comportant une rainure en forme de spirale dans celui-ci. L’auxiliaire d’insertion (1, 1a) comporte un corps de tube (8) comportant une partie de support (4), une première ouverture (5d) formée au niveau de l’extrémité proximale du corps de tube dans laquelle ledit élément de guidage est inséré, une seconde ouverture (8a) formée au niveau de l’extrémité distale du corps de tube et à partir de laquelle ledit élément de guidage fait saillie, ainsi qu’un élément générant une force de propulsion (7) venant en contact par pression avec la circonférence externe de l’élément de guidage de la partie d’insertion pour générer une force de propulsion.
PCT/JP2005/017183 2005-09-16 2005-09-16 Auxiliaire d’insertion Ceased WO2007032085A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
JP2007535363A JPWO2007032085A1 (ja) 2005-09-16 2005-09-16 挿入補助具
PCT/JP2005/017183 WO2007032085A1 (fr) 2005-09-16 2005-09-16 Auxiliaire d’insertion

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/JP2005/017183 WO2007032085A1 (fr) 2005-09-16 2005-09-16 Auxiliaire d’insertion

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WO2007032085A1 true WO2007032085A1 (fr) 2007-03-22

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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2368482A1 (fr) 2010-03-25 2011-09-28 Fujifilm Corporation Dispositif à poignée et appareil sur-tube
JP2017196040A (ja) * 2016-04-26 2017-11-02 オリンパス株式会社 挿入装置及び挿入装置の制御方法

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Publication number Priority date Publication date Assignee Title
JPS59181122A (ja) * 1983-03-31 1984-10-15 オリンパス光学工業株式会社 内視鏡等における進退誘導装置
JP2002065594A (ja) * 2000-08-24 2002-03-05 Olympus Optical Co Ltd 大腸内視鏡挿入補助具
JP2004524903A (ja) * 2001-03-08 2004-08-19 アトロポス・リミテッド 結腸オーバーチューブ

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JPH061121Y2 (ja) * 1988-08-01 1994-01-12 富士写真光機株式会社 トラカール
JP3174074B2 (ja) * 1991-01-08 2001-06-11 オリンパス光学工業株式会社 手術装置
JP3460204B2 (ja) * 1997-12-24 2003-10-27 住友ベークライト株式会社 医療用腹腔鏡挿入用外套管
JP2005192707A (ja) * 2004-01-05 2005-07-21 Olympus Corp 内視鏡システム
JP2005230450A (ja) * 2004-02-23 2005-09-02 Olympus Corp ガイドワイヤ式カプセル内視鏡装置
JP2005230449A (ja) * 2004-02-23 2005-09-02 Olympus Corp カプセル内視鏡用ガイドワイヤ

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPS59181122A (ja) * 1983-03-31 1984-10-15 オリンパス光学工業株式会社 内視鏡等における進退誘導装置
JP2002065594A (ja) * 2000-08-24 2002-03-05 Olympus Optical Co Ltd 大腸内視鏡挿入補助具
JP2004524903A (ja) * 2001-03-08 2004-08-19 アトロポス・リミテッド 結腸オーバーチューブ

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2368482A1 (fr) 2010-03-25 2011-09-28 Fujifilm Corporation Dispositif à poignée et appareil sur-tube
JP2011200403A (ja) * 2010-03-25 2011-10-13 Fujifilm Corp オーバーチューブ把手及びオーバーチューブ
JP2017196040A (ja) * 2016-04-26 2017-11-02 オリンパス株式会社 挿入装置及び挿入装置の制御方法

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