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WO2019087343A1 - Système d'endoscope - Google Patents

Système d'endoscope Download PDF

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Publication number
WO2019087343A1
WO2019087343A1 PCT/JP2017/039659 JP2017039659W WO2019087343A1 WO 2019087343 A1 WO2019087343 A1 WO 2019087343A1 JP 2017039659 W JP2017039659 W JP 2017039659W WO 2019087343 A1 WO2019087343 A1 WO 2019087343A1
Authority
WO
WIPO (PCT)
Prior art keywords
endoscope
distal end
sheath
lumen
longitudinal direction
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/JP2017/039659
Other languages
English (en)
Japanese (ja)
Inventor
祐介 野村
善朗 岡崎
尚也 杉本
和敏 熊谷
俊二 武井
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 Corp
Original Assignee
Olympus 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 Corp filed Critical Olympus Corp
Priority to PCT/JP2017/039659 priority Critical patent/WO2019087343A1/fr
Publication of WO2019087343A1 publication Critical patent/WO2019087343A1/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
    • 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
    • A61B1/32—Devices for opening or enlarging the visual field, e.g. of a tube of the body

Definitions

  • the present invention relates to an endoscope system, and more particularly to an endoscope system for a pericardium.
  • Patent Document 1 Conventionally, there is known a method of inserting an endoscope into the pericardial space from below the xiphoid process and observing a diseased site without performing a thoracotomy (for example, see Patent Document 1). Since the gap between the heart and the pericardium is very narrow, in the pericardial endoscopy procedure of Patent Document 1, the pericardium covers the tip surface of the endoscope on which the optical member for observation is disposed, The vision of the endoscope is blocked by the pericardium. Therefore, a space securing device for pushing up the pericardium to secure a space around the tip of the endoscope has been proposed (see, for example, Patent Document 2).
  • the space securing device of Patent Document 2 is a separate body from the endoscope, it is necessary to separately arrange the endoscope and the space securing device in the pericardial cavity and position them relative to each other. Therefore, the procedure is complicated, and when the position of the space securing device and the endoscope are separated, the field of view of the endoscope can not be secured.
  • the device disposed in a narrow pericardial cavity have a small diameter
  • the device of Patent Document 1 has a problem that it is difficult to reduce the diameter.
  • the present invention has been made in view of the above-described circumstances, and an object of the present invention is to provide an endoscope system capable of reliably securing a space in a pericardial cavity with a narrow diameter structure.
  • One aspect of the present invention is an endoscope, an elongated sheath having a lumen which penetrates in the longitudinal direction and in which the endoscope is disposed along the longitudinal direction, and the distal end in the radial direction of the distal end opening of the lumen And a projection disposed on one side of the opening and projecting in the longitudinal direction beyond the tip opening, the projection being movable in the longitudinal direction in a direction in which the tip of the projection is separated from the tip opening It is an endoscope system.
  • the endoscope is inserted into the pericardial cavity through the lumen of the sheath percutaneously disposed from the outside to the pericardial cavity.
  • the sheath by disposing the sheath in the pericardial cavity so that the protruding portion is positioned on the pericardial side and the distal end opening of the lumen is on the cardiac side, the pericardium present in front of the distal end opening of the lumen is The projection lifts in a direction away from the heart, leaving a space in front of the tip opening.
  • the entire endoscope system can be configured to have a small diameter.
  • the sheath is divided in the radial direction into a first member including the lumen and a second member not including the lumen, and the first member and the second member
  • the projection may be formed from the tip of the second member which is relatively movable in the longitudinal direction and which protrudes in the longitudinal direction more than the tip of the first member.
  • the projecting portion is disposed opposite to the distal end surface of the sheath in the longitudinal direction, and is a member separate from the sheath, and the sheath extends through another lumen.
  • an elongated operation member disposed movably in the longitudinal direction in the other lumen and having a tip connected to the projection.
  • the distal end of the protrusion is disposed in the lumen such that the distal end of the protrusion is spaced apart from the distal end opening in the longitudinal direction than the distal end of the endoscope which protrudes from the distal end opening.
  • the endoscope may be positioned in the longitudinal direction. In this way, when the protrusion is disposed between the tip of the endoscope protruding from the tip opening to the outside of the sheath and the pericardium, the protrusion protrudes further than the tip of the endoscope. Extend to the Therefore, the pericardium in front of the distal end of the endoscope can be lifted by the protrusion in a direction away from the heart to secure a space in front of the distal end of the endoscope.
  • the endoscope has an up and down direction corresponding to the up and down direction of an endoscope image acquired by the endoscope, and further includes a bending portion which can be bent downward, the endoscope
  • the endoscope disposed in the lumen may be positioned about a longitudinal axis such that the projection is disposed on the upper side of the.
  • the protrusion arranged on the pericardium side lifts the pericardium to a position away from the heart, and then the bending portion By curving downward, the tip of the endoscope can be directed to the heart side to observe the heart.
  • the sheath may be connected to a base end of the sheath, and may be equipped with an operation part which operates the projection in the longitudinal direction. By doing this, the operator can manipulate the amount of protrusion of the protrusion in the pericardial cavity via the operation unit disposed outside the body.
  • an endoscope system 100 includes an elongated sheath 1 having a circular tubular shape, a hood (protrusion) 2 configured of a portion of the sheath 1, and a sheath
  • An endoscope 3 disposed in 1 and an operation unit 4 connected to a proximal end of the sheath 1 are provided.
  • the sheath 1 is a flexible member that can be bent along the shape of tissue in the body, and can be inserted into the pericardial space.
  • the sheath 1 has a lumen 5 which penetrates in the longitudinal direction and in which the endoscope 3 is disposed along the longitudinal direction.
  • the sheath 1 has an up-down direction and a left-right direction which are respectively orthogonal to the longitudinal axis and mutually orthogonal.
  • the sheath 1 is generally in the form of a generally circular tube, and is divided into upper and lower halves at a position above the lumen 5. That is, the sheath 1 consists of two members 11 and 12 arranged in contact with each other in the vertical direction.
  • the lower member is a lower sheath (first member) 11 including the lumen 5
  • the upper member is an upper sheath (second member) 12 not including the lumen 5.
  • the distal end opening 5 a of the lumen 5 is open at the distal end surface of the lower sheath 11.
  • one longitudinally extending dovetail tenon 6a is formed in one of the mutually contacting surfaces, and the other longitudinally extending dovetail tenon 6a engages An ant groove 6b is formed.
  • the dovetail tenon 6a By moving the dovetail tenon 6a in the longitudinal direction in the dovetail groove 6b, the lower sheath 11 and the upper sheath 12 can slide mutually in the longitudinal direction while maintaining the vertical connection of the lower sheath 11 and the upper sheath 12 It has become.
  • the distal end of the upper sheath 12 is disposed at a position projecting in the longitudinal direction from the distal end opening 5a in the distal end surface of the lower sheath 11, and the hood 2 Is formed. Therefore, the hood 2 is disposed only on the upper side of the lumen 5.
  • the relative movement of the lower sheath 11 and the upper sheath 12 in the direction in which the distal end of the hood 2 separates from the distal end opening 5a increases the length of the hood 2 in the longitudinal direction so that the hood 2 further protrudes from the distal end opening 5a It has become.
  • the endoscope 3 is a direct-view type that acquires an endoscopic image of the field of view in front of the distal end surface.
  • the distal end portion of the endoscope 3 is provided with an optical member (specifically, an illumination lens and an objective lens) 3a for observing a subject, and a curved portion 3b located on the proximal end side of the optical member 3a.
  • the endoscope 3 has a vertical direction corresponding to the vertical direction of the endoscopic image, which is a direction orthogonal to the longitudinal direction.
  • the bending portion 3b can be bent at least downward.
  • the endoscope 3 is positioned around the longitudinal axis in the lumen 5 so that the downward direction of the endoscope 3 coincides with the downward direction of the sheath 1.
  • the distal end of the endoscope 3 is positioned closer to the distal end opening 5 a than the distal end of the hood 2 in a state where the curved portion 3 b protrudes from the distal end opening 5 a and the curved portion 3 b extends straight. It is longitudinally positioned within the lumen 5 so as to be disposed.
  • the endoscope 3 is fixed in the lumen 5 in such a state of being positioned.
  • the tip of the hood 2 is disposed at a position projecting in the longitudinal direction from the tip of the endoscope 3 so that the hood 2 covers the upper portion of the tip of the endoscope 3 projecting outward from the tip opening 5a. It has become.
  • the operation unit 4 includes an operation member for the operator to operate the upper sheath 12 in the longitudinal direction.
  • the operation member is, for example, a slider 4a to which the proximal end portion of the upper sheath 12 is connected and which can be moved in the longitudinal direction of the upper sheath 12, as shown in FIG.
  • the operator By moving the operation member to the distal end side, the operator can move the upper sheath 12 to the distal side with respect to the lower sheath 11 and increase the amount of protrusion from the distal end opening 5a to the distal end of the hood 2 .
  • the endoscope 3 in the sheath 1 and the lumen 5 is inserted from under the xiphoid to the pericardial space, as shown in FIG. 3A.
  • the sheath 1 is disposed such that the heart A is located below the endoscope 3 and the pericardium B is located above the endoscope 3.
  • the hood 2 is disposed between the tip of the endoscope 3 and the pericardium B and protrudes from the tip of the endoscope 3. And a space S is secured in front of the distal end surface of the endoscope 3.
  • the heart A can be observed by curving the bending portion 3 b downward so that the distal end surface of the endoscope 3 faces the heart A.
  • the space S can be expanded to a position further away from the distal end surface of the endoscope 3 by operating the operation unit 4 to cause the hood 2 to further protrude, and the pericardial cavity Distant regions within can also be observed.
  • the letter C indicates the atrial appendage.
  • the hood 2 integral with the sheath 11 is provided on the upper side of the distal end opening 5a, the hood 2 is arranged around the longitudinal axis of the sheath 1 so as to be disposed on the pericardium B
  • the space S for observing the heart A in the pericardial cavity can be surely ensured only by adjusting the posture of the head.
  • the hood 2 has a structure extending along the longitudinal direction of the sheath 1, the endoscope system 100 can be configured to have a narrow diameter as a whole.
  • the hood 2 is formed from a part of the distal end portion of the sheath 1, it is easy to secure a large cross-sectional area of the hood 2 and a wide width in the lateral direction. Therefore, there is an advantage that it is possible to easily realize the hood 2 having high rigidity capable of stably maintaining the shape against the downward force from the pericardium B. Furthermore, the hood 2 with high rigidity can maintain its straight shape against the downward force from the pericardium B even when the length is increased, as shown in FIG. 3B. As a result, there is an advantage that the wide space S can be reliably ensured even at a position far from the tip of the endoscope 3.
  • an endoscope system 200 according to a second embodiment of the present invention will be described with reference to the drawings.
  • the present embodiment is different from the first embodiment in that the sheath 10 is a single member and the sheath 10 and the hood (projecting portion) 21 are separate members.
  • Endoscope system 200 is connected to the proximal end of sheath 10, an elongated sheath 10 having a circular tubular shape, an endoscope 3 disposed in sheath 10, and an endoscope system 200 as shown in FIGS. 4A and 4B.
  • An operation portion 41, a hood 21 disposed adjacent to the distal end surface of the sheath 10, and a long operation wire (operation member) 8 for operating the hood 21 in the longitudinal direction of the sheath 10 are provided.
  • the sheath 10 is a flexible tubular member which can be bent along the shape of tissue in the body, and can be inserted into the pericardial space.
  • the sheath 10 has a lumen 5 penetrating in the longitudinal direction and in which the endoscope 3 is disposed in the longitudinal direction, and another lumen 7 in which the operating wire 8 is disposed in the longitudinal direction and penetrating the longitudinal direction.
  • the distal end opening 5 a of the lumen 5 is open at the distal end surface of the sheath 10.
  • the sheath 10 has an up-down direction and a left-right direction which are respectively orthogonal to the longitudinal axis and mutually orthogonal.
  • the hood 21 is a columnar member extending along the longitudinal direction of the sheath 10.
  • the hood 21 is disposed to be longitudinally opposed to the distal end surface of the sheath 10, and disposed only on the upper side of the lumen 5, as shown in FIG. 4B.
  • FIGS. 4A and 4B a partial circle having the same radius of curvature as the sheath 10 so that the side surface of the sheath 10 and the side surface of the hood 21 smoothly continue with the hood 21 in contact with the distal end surface of the sheath 10
  • the shape of the hood 21 is not limited to this.
  • the hood 21 may be in the form of a column or plate having any cross-sectional shape.
  • the endoscope 3 is positioned around the longitudinal axis in the lumen 5 so that the downward direction of the endoscope 3 coincides with the downward direction of the sheath 10.
  • the distal end of the endoscope 3 is closer to the distal end opening 5 a than the distal end of the hood 21 in a state where the curved portion 3 b protrudes from the distal end opening 5 a and the curved portion 3 b extends straight. It is longitudinally positioned within the lumen 5 so as to be disposed.
  • the endoscope 3 is fixed in the lumen 5 in such a state of being positioned.
  • the tip of the hood 21 is disposed at a position projecting in the longitudinal direction from the tip of the endoscope 3, and the hood 21 covers the upper portion of the tip of the endoscope 3 projecting outward from the tip opening 5 a. It has become.
  • the manipulation wire 8 has an outer diameter smaller than the inner diameter of the lumen 7 and is longitudinally movable in the lumen 7.
  • the distal end portion of the operation wire 8 is connected to the hood 21, and the proximal end portion of the operation wire 8 is connected to the operation portion 41.
  • the operation unit 41 includes an operation member for the operator to operate the operation wire 8 in the longitudinal direction.
  • the operation member is, for example, a slider 41a to which the proximal end of the operation wire 8 is connected and which can be moved in the longitudinal direction of the operation wire 8, as shown in FIG.
  • the operator By moving the operating member to the distal end side, the operator can move the operating wire 8 to the distal end side to increase the amount of protrusion from the distal end opening 5 a to the distal end of the hood 21.
  • the endoscope system 200 In order to observe the heart A using the endoscope system 200 according to the present embodiment, the endoscope 3 in the sheath 10 and the lumen 5 is inserted from under the xiphoid to the pericardial space, as shown in FIG. 6A.
  • the endoscope system 200 is disposed such that the heart A is located below the endoscope 3 and the pericardium B is located above the endoscope 3 as shown in FIG.
  • the hood 21 is disposed between the tip of the endoscope 3 and the pericardium B and projects from the tip surface of the endoscope 3 by the hood 21 protruding from the tip of the endoscope 3.
  • a space S is secured in front of the distal end surface of the endoscope 3.
  • the heart A can be observed by curving the bending portion 3 b downward so that the distal end surface of the endoscope 3 faces the heart A.
  • the space S can be expanded to a position further away from the distal end surface of the endoscope 3 by operating the operation unit 4 to cause the hood 21 to further protrude, and the pericardial cavity Distant regions within can also be observed.
  • the sheath 10 since the hood 21 operated integrally with the sheath 10 is provided on the upper side of the distal end opening 5a, the sheath 10 is disposed such that the hood 21 is disposed on the pericardium B side.
  • the space S for observing the heart A in the pericardial cavity can be surely ensured only by adjusting the posture around the longitudinal axis of the above.
  • the hood 21 since the hood 21 is arranged in a row in the longitudinal direction with the sheath 10 and protrudes along the longitudinal direction of the sheath 10, the entire endoscope system 200 can have a narrow diameter structure.
  • the hood 21 disposed outside the sheath 10 can easily ensure a large cross-sectional area and width in the lateral direction, its shape can be stably stabilized against the downward force from the pericardium B. There is an advantage that the hood 21 having high maintainability can be easily realized.
  • the endoscope 3 is fixed to the sheaths 11 and 10.
  • longitudinal movement of the endoscope 3 in the lumen 5 and Rotation about the longitudinal axis may be possible.
  • the inside of the lumen 5 is arranged such that the curved portion 3b protrudes outward from the tip opening 5a and the tip of the endoscope 3 is closer to the tip opening 5a than the tips of the hoods 2 and 21.
  • means are provided for positioning the endoscope 3 in the longitudinal direction.
  • means are provided for positioning the endoscope 3 in the lumen 5 around the longitudinal axis such that the downward direction of the endoscope 3 and the downward direction of the sheaths 11 and 10 coincide with each other. .
  • the endoscope 3 is a direct view type, but may be a perspective view type or a side view type instead. In the case of the perspective or side-viewing endoscope 3, the bending portion 3 b may not be provided.
  • the distal end of the upper sheath 12 is disposed at a position projecting beyond the distal end of the lower sheath 11, but instead, in the longitudinal direction, as shown in FIG.
  • the movable range of the upper sheath 12 with respect to the lower sheath 11 may be designed so that the distal end of the upper sheath 12 can be disposed at the same position as the distal end opening 5a or at a position proximal to the distal end opening 5a.
  • the distal end of the hood 21 can be disposed at the same position as the distal end opening 5a or at a position proximal to the distal end opening 5a in the longitudinal direction.
  • the movable range of the hood 21 may be designed.
  • Reference numeral 10 a is a notch formed at the distal end of the sheath 10 to receive the hood 21.
  • the hood 21 may be configured of a part of the distal end portion of the sheath 10.

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

Abstract

L'invention concerne un système d'endoscope (100) qui comprend : un endoscope (3) ; une gaine allongée (1) avec une lumière (5) s'étendant à travers celle-ci dans la direction longitudinale et dans laquelle l'endoscope (3) est placé dans la direction longitudinale ; et une partie en saillie (2) disposée sur un côté d'une ouverture d'extrémité distale (5a) de la lumière (5) radialement par rapport à l'ouverture d'extrémité distale (5a), et qui fait saillie au-delà de l'ouverture d'extrémité distale (5a) dans la direction longitudinale. La partie en saillie (2) peut se déplacer dans la direction longitudinale de telle sorte que l'extrémité distale de la partie en saillie (2) s'éloigne de l'ouverture d'extrémité distale (5a).
PCT/JP2017/039659 2017-11-02 2017-11-02 Système d'endoscope Ceased WO2019087343A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/JP2017/039659 WO2019087343A1 (fr) 2017-11-02 2017-11-02 Système d'endoscope

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/JP2017/039659 WO2019087343A1 (fr) 2017-11-02 2017-11-02 Système d'endoscope

Publications (1)

Publication Number Publication Date
WO2019087343A1 true WO2019087343A1 (fr) 2019-05-09

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PCT/JP2017/039659 Ceased WO2019087343A1 (fr) 2017-11-02 2017-11-02 Système d'endoscope

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2011104333A (ja) * 2009-10-23 2011-06-02 Fujifilm Corp 内視鏡装置及びこれに用いる内視鏡用先端フード
JP2014239739A (ja) * 2013-06-11 2014-12-25 オリンパス株式会社 内視鏡
WO2016203606A1 (fr) * 2015-06-18 2016-12-22 オリンパス株式会社 Système d'endoscope péricardique
WO2017090196A1 (fr) * 2015-11-27 2017-06-01 オリンパス株式会社 Adaptateur d'endoscope, endoscope et système d'endoscope

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2011104333A (ja) * 2009-10-23 2011-06-02 Fujifilm Corp 内視鏡装置及びこれに用いる内視鏡用先端フード
JP2014239739A (ja) * 2013-06-11 2014-12-25 オリンパス株式会社 内視鏡
WO2016203606A1 (fr) * 2015-06-18 2016-12-22 オリンパス株式会社 Système d'endoscope péricardique
WO2017090196A1 (fr) * 2015-11-27 2017-06-01 オリンパス株式会社 Adaptateur d'endoscope, endoscope et système d'endoscope

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