JP5557237B2 - Small diameter endoscope and small diameter endoscope set - Google Patents

Description

INDUSTRIAL APPLICABILITY The present invention is used in combination with a small diameter endoscope and this small diameter endoscope for use with other endoscopes, for example, used for endoscopic submucosal dissection (ESD) and the like. The present invention relates to a small-diameter endoscope set. More specifically, the present invention includes a forceps port (channel) for use with other endoscopes, and an optical insertion tool including an illumination optical system and an objective optical system can be inserted into and removed from the channel. The present invention relates to a small diameter endoscope and a small diameter endoscope set including the small diameter endoscope.

  Conventionally, a lesioned part such as early gastric cancer is excised using an endoscope having an insertion part. When excising a lesion such as early gastric cancer, physiological saline is injected between the submucosa and muscle layers to raise the lesion, and an incision in the submucosa using a snare or a high-frequency knife (IT knife) Peeling is in progress. In this case, treatment is performed by alternately replacing and inserting endoscope treatment tools such as a saline injection tool, an IT knife, and a snare from one treatment tool guide channel of the endoscope.

  However, when the lesion is raised by locally injecting physiological saline as described above, the injected physiological saline diffuses into the submucosal layer over time, so that the artificially formed mucosal elevation gradually Go flat. Sufficient bulging of the lesion is necessary for incision and detachment of the lesion, and if the bulge of the lesion is not sufficient, the possibility of perforation of the muscle layer increases. Therefore, when excising the lesion, if the saline injected locally diffuses and the mucosal bulge becomes flat, the saline is injected again, or hyaluronic acid with a high water retention capacity is injected locally. Although the lesion is raised, it is also known to increase the distance between adjacent muscle layers or normal tissues using other means in combination.

  For example, Patent Document 1 below discloses an invention of a magnetic anchor guiding device that lifts a lesion by combining a magnetic anchor and a clip in order to make the lesion easily peelable. Patent Document 2 below discloses an invention of an endoscopic treatment device that lifts a lesioned portion with grasping forceps inserted into two treatment instrument guide insertion instrument channels provided in addition to the endoscope channel. Has been. Here, the apparatus disclosed in Patent Document 1 and Patent Document 2 below will be described with reference to FIGS.

  In addition, FIG. 9 is a figure which shows the use condition of the magnetic anchor guidance apparatus currently disclosed by the following patent document 1. FIG. FIG. 10 is a perspective view of an endoscopic treatment device disclosed in Patent Document 2 below.

  As shown in FIG. 9, a magnetic anchor guiding device 40 disclosed in Patent Document 1 below includes a clip 42 attached to a lesioned part 41 and a magnetic attached to the clip 42 via a connecting part 43. An anchor 44 and a magnetic derivative 45 that applies a driving force to the magnetic anchor 44 from the outside are provided. The magnetic anchor guide device 40 lifts the lesioned part 41 by the following operation. First, similarly to the conventional method, the lesioned part 41 is raised by injecting physiological saline 47 into the lower part of the lesioned part 41 using the endoscope 46. Next, the clip 42 is attached to the lesioned part 41 with the grasping forceps 48. Next, the endoscope 46 is pulled out, the magnetic anchor 44 is attached to the grasping forceps 48, the endoscope 46 is inserted again, and the external magnetic derivative 45 is operated to fix the magnetic anchor 44 at a predetermined position on the affected part.

  Thereafter, the endoscope 46 is pulled out, the connecting portion 43 is attached to the grasping forceps 48, the endoscope 46 is inserted again, one end of the connecting portion 43 is attached to the clip 42 in the affected area, and the other end of the connecting portion 43 is magnetically connected. Attach to the anchor 44. In this state, the lesioned part 41 can be lifted by operating the magnetic derivative 45 from the outside and pulling the clip 42. In this state, the lesioned part can be safely excised with an IT knife or the like. .

  In addition, the endoscope treatment apparatus 50 disclosed in Patent Document 2 below has a guide having one endoscope channel 51 and two treatment instrument guide insertion tool channels 52 as shown in FIG. An endoscope inserted into one endoscope channel 51 by using the tube 53 to lift the lesion by two forceps 54 and 55 respectively inserted from the two treatment instrument guide insertion instrument channels 52 The lesioned part is excised with an electric knife 57 passed through the inside 56.

JP 2004-105247 A JP 2000-325303 A

  However, the magnetic anchor guide device 40 disclosed in the above-mentioned Patent Document 1 is provided with the attachment of the clip 42 to the lesioned part 41, the attachment of the clip 42 and the magnetic anchor 44, and the operation of the external magnetic guide tool 45. Multistage operation such as fixing the affected part to a predetermined position and lifting the lesioned part by operating the external magnetic guiding tool 45 is necessary, and since the size of the magnetic anchor 44 is large, a plurality of steps are required before the lesioned part 41 is lifted. The endoscope 46 needs to be inserted and removed once, and the external magnetic guiding tool 45 cannot be operated by a person who operates the grasping forceps 48. Therefore, another person needs to operate it. Therefore, there is a problem that the operation is complicated and time-consuming, and it is not widely used at present.

  In addition, the endoscopic treatment device 50 disclosed in Patent Document 2 is configured to lift a lesioned portion by two forceps 54 and 55 inserted from two treatment instrument guide insertion tool channels 52, respectively. However, in such a configuration, since the outer diameter of the guide tube 53 is increased by the number of treatment instrument guide insertion tool channels, there is a problem that patient pain increases.

  On the other hand, in the submucosal dissection for early gastric cancer, if surgery is performed using two endoscopes instead of using one endoscope, a visual field can be secured, and the operation is highly safe and reliable. Is known to be possible. However, in the limited lumen of the gastrointestinal tract, the current endoscope has a large outer diameter, so when two endoscopes are inserted, accidental episodes such as tearing of the esophagogastric junction are likely to occur. For example, a normal endoscope uses an illumination optical system as a light source and an illuminated subject to guide the distal end of the endoscope to a predetermined lesion and to perform a predetermined treatment on the lesion. An objective optical system provided at the distal end of the endoscope for imaging is an indispensable constituent element, and information obtained by the illumination optical system and the objective optical system is imaged through a solid-state image sensor. Furthermore, in order to perform various treatments on a lesioned part, a channel for inserting a treatment tool is essential for an endoscope.

  When such three components of the illumination optical system, the objective optical system, and the channel are provided, the outer diameter of the endoscope is about 10 mm. Recently developed ultra-thin endoscopes such as a nasal endoscope (outer diameter 5 mm) and biliary endoscope (outer diameter 2.6 mm) sacrifice the components of the illumination optical system, objective optical system, and channel. Therefore, the image quality is deteriorated, or the treatment tool inserted into the channel is restricted to the ultrafine treatment tool only. Therefore, the same brightness and operation accuracy as those of the conventional illumination optical system and objective optical system can be secured, and a generally used durable endoscope forceps (outer diameter 2.6 mm) is used. It is desired to develop a thin endoscope that does not give a burden to the patient while using two endoscopes that can be used.

  On the other hand, when the inventors conducted an animal experiment of gastric submucosal dissection using two endoscopes, light interference occurred due to the two light sources, and the screen flew white and was observed. I encountered a difficult phenomenon. Therefore, when the lesion was excised, when the treatment was performed by turning off the light source of the endoscope on the side that lifted the lesion, the gastric submucosal dissection was effectively performed. confirmed. As a result, the inventors have a channel in the case of surgery using two endoscopes, since one endoscope does not necessarily require an illumination optical system and an objective optical system during the operation. However, it has been found that an ultrafine endoscope without an illumination optical system and an objective optical system is useful.

However, without the illumination optical system and the objective optical system, the tip of the endoscope cannot be guided to the lesion, and it is particularly difficult to insert the endoscope from the larynx into the esophagus. Therefore, the inventors have conducted various experiments, and as a result, if the illumination optical system and the objective optical system are inserted into and removed from the channel, they can be internally viewed when the illumination optical system and the objective optical system are inserted into the channel. The tip of the mirror can be guided to a predetermined position, and after the tip of the endoscope is guided to a predetermined position, the illumination optical system and the objective optical system are taken out from the channel, and a predetermined treatment tool is inserted into the channel. Thus, the present inventors have found that a predetermined treatment can be performed using an image obtained by an illumination optical system and an objective optical system of another endoscope, and the present invention has been completed.

That is, an object of the present invention is to provide a small-diameter endoscope having a channel for use with other endoscopes, in which an illumination optical system and an objective optical system are detachably disposed. There is to do. Furthermore, another object of the present invention is to provide a small-diameter endoscope in which the illumination optical system and the objective optical system are removable for use with other endoscopes, and the channel of the small-diameter endoscope. Another object of the present invention is to provide a small-diameter endoscope set comprising a combination of an optical system insertion tool including an illumination optical system and an objective optical system that can be inserted into a surgical instrument, and a treatment tool.

In order to achieve the above object, a small-diameter endoscope of the present invention is a small-diameter endoscope body in which a channel is formed, an optical that is detachable from the channel and includes an illumination optical system and an objective optical system. An insertion tool, and the channel is characterized in that a treatment tool can be inserted when the optical insertion tool is removed.

A conventional endoscope is integrally provided with an inner diameter channel into which a treatment instrument can be inserted, an illumination optical system, and an objective optical system. On the other hand, the small-diameter endoscope of the present invention includes a channel having an inner diameter capable of alternately inserting a treatment tool and an optical system insertion tool including an illumination optical system and an objective optical system . That is, the small-diameter endoscope of the present invention has a well-known configuration for controlling the movement of the distal end portion as in the case of the endoscope of the conventional example, but substantially only a channel is formed. and which, this channel can be inserted alternately and optics insertion tool comprises an illumination optical system and the objective optical system and the treatment instrument, the insertion of the treatment instrument and the illumination optical system and the objective optical system at the same time It has an inner diameter that cannot be Note that the small-diameter endoscope of the present invention is separately used simultaneously with the above-described conventional endoscope, but is completely independent of the conventional endoscope.

According to the small-diameter endoscope of the present invention, the small-diameter endoscope of the present invention is guided to a predetermined position by inserting an optical system insertion tool including an illumination optical system and an objective optical system into the channel. be able to. Thereafter, when the optical system insertion tool is pulled out from the channel and a predetermined treatment tool is inserted into the channel instead, the treatment tool can be easily introduced to a predetermined position. At this time, since the illumination optical system and the objective optical system are not formed in the small-diameter endoscope of the present invention, it is obtained by the illumination optical system and the objective optical system of another endoscope separately disposed near a predetermined position. A predetermined treatment can be performed using the obtained image. As described above, according to the small-diameter endoscope of the present invention, the illumination optical system and the objective optical system are detachable from the channel. Therefore, compared with the endoscope having the conventional insertion portion correspondingly. The outer diameter can be narrowed, for example, even if endoscopic submucosal dissection is performed in combination with an endoscope having another insertion portion, the burden on the patient can be greatly reduced, In addition, a predetermined treatment can be performed safely and reliably.

  In the small diameter endoscope of the present invention, it is preferable that the inner diameter of the channel is 2.0 mm or more and the outer diameter of the small diameter endoscope is 5.9 mm or less.

  If the inner diameter of the channel of the small-diameter endoscope of the present invention is set to 2.0 mm or more, it becomes unnecessary to use a special minute-sized illumination optical system, objective optical system, and minute-sized treatment tool. Moreover, the maximum outer diameter of a transnasal endoscope currently in practical use is 5.9 mm. When the outer diameter of the small-diameter endoscope of the present invention exceeds 5.9 mm, it is inserted into the esophagus nasally. It is not preferable because it becomes difficult to do so, and if the outer diameter of the small-diameter endoscope is 5.9 mm or less, the burden on the patient can be suppressed even when used with an endoscope having another insertion portion. It becomes like this. In addition, in order to be able to use various treatment instruments having a nominal outer diameter of 2.6 mm that are conventionally used, the inner diameter of the channel of the small-diameter endoscope of the present invention is 2.6 mm or more. It is preferable that

Furthermore, in order to achieve the above object, the small-diameter endoscope set of the present invention includes a small-diameter endoscope and a treatment instrument, and the thin-diameter endoscope has a small-diameter endoscope in which a channel is formed. An endoscope body and an optical insertion tool that is detachable with respect to the channel and includes an illumination optical system and an objective optical system, and the channel has the treatment tool when the optical insertion tool is removed. Can be inserted freely .

  In the small-diameter endoscope set of the present invention, it is preferable that the inner diameter of the channel is 2.0 mm or more and the outer diameter of the small-diameter endoscope is 5.9 mm or less.

  According to the small-diameter endoscope set of the present invention, the effect of the invention of the small-diameter endoscope of the present invention can be effectively exhibited. In addition, as an optical system insertion tool provided with an illumination optical system and an objective optical system, it is also possible to use an existing biliary endoscope (outer diameter 2.6 mm) without any special design.

  In the small-diameter endoscope set of the present invention, the treatment tool can be a grasping forceps or a biopsy forceps.

  When performing endoscopic submucosal dissection, it is necessary to grasp and raise the lesion. However, if grasping forceps are used as a treatment tool, the lesion can be easily grasped and raised. The possibility of perforation of the muscle layer can be reduced. In addition, since the thin endoscope in the thin endoscope set of the present invention is thin, it can be inserted while directly observing the biliary pancreatic duct bifurcation that has been inserted blindly in the prior art. It can be accurately inserted into the lumen. Therefore, in the small-diameter endoscope set of the present invention, the tissue can be easily grasped from a small and narrow part such as a bile duct or pancreatic duct by using the grasping forceps or the biopsy forceps after reaching a predetermined position. Or it can be collected.

  Moreover, in the small-diameter endoscope set of the present invention, it is preferable that the treatment instrument is configured such that the gripping forceps or biopsy forceps side can be bent by a wire action.

  The small-diameter endoscope set of the present invention is used simultaneously with a separate conventional endoscope. Conventional endoscopes can be bent vertically and horizontally or vertically and horizontally by wire action on the distal end side. When the small-diameter endoscope of the present invention is inserted into such a conventional endoscope, the small-diameter endoscope bends according to the bending of the conventional endoscope and protrudes from the distal end of the conventional endoscope. be able to. The protrusion processing of the small-diameter endoscope protruding from the distal end of the conventional endoscope can be freely set. When grasping forceps or biopsy forceps are inserted into the small-diameter endoscope, the grasping forceps or biopsy forceps can also be protruded from the distal end of the small-diameter endoscope. In addition, in the small-diameter endoscope set of the present invention, as the grasping forceps or the biopsy forceps, those that can be bent by a wire action are used, so that the grasping forceps protruded from the distal end of the small-diameter endoscope Alternatively, the biopsy forceps can be bent by wire action. Therefore, according to the small-diameter endoscope set of the present invention, without using an expensive double-action endoscope, a single-action endoscope can be used with a normal single-action endoscope. The same operation can be performed, and a treatment tool such as a grasping forceps or a biopsy forceps can be easily delivered to a place that is difficult to reach with a conventional single action endoscope such as a gastric arch. It becomes like this.

  In the invention of the small-diameter endoscope set according to the present invention, the treatment instrument may be an air supply tube having a balloon connected to the tip.

  A treatment instrument comprising an air supply tube having a balloon connected to the distal end of the present invention is inserted into an endoscope having another insertion portion together with a small diameter endoscope, and protrudes from the endoscope having the other insertion portion. Then, after introducing to a predetermined position, the treatment tool can be fixed at the predetermined position by inflating the balloon. The small-diameter endoscope in the small-diameter endoscope set of the present invention can be inserted into the deep portion further by using the large-intestine endoscope as a sheath, that is, a support. Therefore, the treatment instrument including an air supply tube having a balloon connected to the tip of the present invention can be easily protruded from an endoscope having another insertion portion and inserted to a predetermined position. After the treatment instrument comprising the air supply tube is introduced to a predetermined position, the balloon is inflated, the treatment instrument is fixed at the predetermined position, and an endoscope including another insertion portion is further inserted using the same part as a fulcrum. Even in the bent part of the large intestine where the endoscope is bent and the force is not transmitted, the propulsive force can be transmitted while using the small-diameter endoscope as a guide and can be easily inserted to a predetermined position.

In the small-diameter endoscope set aspect of the present invention, the pre-Symbol light science-based insert, includes a light emitting diode or laser diode as a light source, be assumed to have a solid-state image pickup device as an image detector Is preferred.

  Light emitting diodes and laser diodes as light sources are known in various wavelengths, and can be selected and used with the optimal wavelength according to the affected area and application, and since it is small in size, it can easily be used with an inner diameter. Can be incorporated into a small optical insert. In addition, since a solid-state imaging device as an image detector can be obtained with a small size and high resolution, it can be easily incorporated into an optical system insertion tool having a small inner diameter. Note that a well-known CCD (Charge Coupled Device) may be used as the solid-state imaging device.

1A is a side view of the distal end of a small-diameter endoscope used in each embodiment of the present invention, and FIG. 1B is an optical including an illumination optical system and an objective optical system to be used by being inserted into the channel of FIG. 1A. 1C is a schematic cross-sectional view of the distal end portion of the system insertion tool, FIG. 1C is a side view of the distal end of a grasping forceps for use by being inserted into the channel of FIG. 1A, and FIG. 1D is used by being inserted into the channel of FIG. It is a front end side view of an air supply tube with a balloon for doing. It is a schematic diagram explaining the process of guide | inducing the small diameter endoscope of 1st Embodiment to a lesioned part. It is a schematic diagram explaining the process of inserting a grasping forceps into the small diameter endoscope of 1st Embodiment. It is a mimetic diagram explaining the process of grasping a lesioned part with grasping forceps. It is a schematic diagram explaining the process of excising a lesioned part with an IT knife. 6A to 6F are schematic views for sequentially explaining the steps of inserting the small-diameter endoscope set according to the second embodiment to a predetermined position. FIG. 7A is a diagram showing a state where a conventional endoscope is inserted into the stomach, and FIG. 7B is a diagram showing a state where the small-diameter endoscope set of the third embodiment has reached the bowel part of the stomach. is there. It is a schematic diagram explaining the process of performing endoscopic submucosal dissection using the small diameter endoscope set of 3rd Embodiment. It is a figure which shows the use condition of the magnetic anchor guidance apparatus in the stomach of a prior art example. It is a perspective view of the endoscope treatment apparatus of a prior art example.

  Hereinafter, embodiments of the present invention will be described in detail with reference to FIGS. However, each embodiment shown below is a small-diameter endoscope set as an example for embodying the technical idea of the present invention, an endoscopic submucosal dissection using this small-diameter endoscope set, etc. However, the present invention is not intended to be limited to these embodiments, and is equally applicable to other embodiments included in the claims.

  First, a schematic configuration of a small-diameter endoscope set used in each embodiment of the present invention will be described with reference to FIGS. 1A to 1D. As shown in FIG. 1A, the small-diameter endoscope 10 used in the small-diameter endoscope set of each embodiment has a forceps hole (channel) 11 having an outer diameter L1 of, for example, 5 mm and an inner diameter L2 = 2.8 mm. Is formed. The thin endoscope 10 may be a endoscope that can change the angle of the tip portion up and down or left and right by a wire action as necessary. The configuration of the operation unit of the small-diameter endoscope 10 and the configuration for operating the small-diameter endoscope 10 are not different from those of the conventional endoscope except for the size. Description is omitted.

  Moreover, as shown in FIG. 1B, the optical system insertion tool 13 including the illumination optical system and the objective optical system used in the small-diameter endoscope set of each embodiment is a flexible sheath having an outer diameter L3 of 2.6 mm. 14 includes an illumination optical system 15 and an objective optical system 16 inserted in the camera. The illumination optical system 15 uses a light-emitting diode or laser diode as a light source. Since the light-emitting diode or laser diode has various wavelengths, an optimal wavelength is selected according to the affected part and application. What is necessary is just to select and use. In the objective optical system, a solid-state imaging device made of a CCD, for example, is used as a detector. Therefore, the wiring 17 connected to the light emitting diode or laser diode as the light source and the wiring 18 connected to the CCD are respectively extended in the flexible sheath 14 of the optical system insertion tool 13 from the vicinity of the operation unit (not shown). It is pulled out to the outside and is connected to a light source power source and an image processing apparatus (not shown).

  Light-emitting diodes or laser diodes as such light sources are small and have high output, and CCDs as solid-state imaging devices are also small and have high resolution, so that the outer diameter can be easily obtained. L3 can be incorporated in the optical system insertion tool 13 as thin as 2.6 mm. The optical system insertion tool 13 is also called an electronic endoscope, and a well-known biliary endoscope can be used as it is. The outer diameter L3 of the optical system insertion tool 13 is slightly smaller than the nominal inner diameter L2 of the thin endoscope 10, that is, the relationship L3 <L2 is satisfied.

  Further, the treatment tool 20a used in the small-diameter endoscope set of the first embodiment has, for example, a grasping forceps or a biopsy at the distal end portion of the operation rod 22 inserted into the insertion tool 21 having an outer diameter L4 of 2.6 mm. A forceps (hereinafter collectively referred to as “gripping forceps”) 23 is provided, and the operating forceps 22 are operated at an operation portion of the gripping forceps 23 (not shown), whereby the gripping forceps 23 are provided. Can be pushed and retracted, and the grasping forceps 23 can be opened and closed. In addition, since the structure for performing the opening / closing operation | movement of such grasping forceps 23 is known, the detailed description is abbreviate | omitted. As the treatment tool 20a, a known grasping forceps or biopsy forceps having a strong nominal outer diameter of 2.6 mm can be used as they are, so that the lesioned part can be securely grasped and raised, or the lesioned part can be excised. Will be able to. The outer diameter L4 of the treatment instrument 20a is slightly smaller than the nominal inner diameter L2 of the small diameter endoscope 10, that is, the relationship of L4 <L2 is satisfied. Moreover, you may use as this treatment tool 20a what can change the angle of a front-end | tip part up and down or right and left by a wire action as needed.

  In addition, the treatment instrument 20b used in the small-diameter endoscope set of the second embodiment includes an air supply tube 36 having one balloon 35 connected to the distal end, as shown in FIG. 1D. 1D shows a state where the balloon 35 is inflated by supplying air into the air supply tube 36. The diameter of the balloon in the inflated state is, for example, 3 cm, and the outer diameter of the air supply tube 36 is shown. Is about 2 mm. Further, the maximum outer diameter of the air supply tube 36 in a state in which the balloon 35 is deflated is set to be smaller than the nominal inner diameter L2 of the thin endoscope 10.

[First Embodiment]
Next, the steps of performing endoscopic submucosal dissection using the small-diameter endoscope set of the first embodiment shown in FIGS. 1A to 1C will be described with reference to FIGS. The small-diameter endoscope set used in the first embodiment is used simultaneously with the conventional endoscope 25a having an outer diameter of 10 mm, for example. The endoscope 25 a includes an illumination optical system 27 and an objective optical system 28 on the end surface of the sheath 26, and further includes a channel 29 for inserting a treatment instrument into the sheath 26. First, the endoscope 25a is inserted to a position near the lesion 31 where it is easy to incise, and physiological saline 34 is injected between the mucous membrane 32 and the muscle layer 33 at the position where the lesion 31 is present, The lesioned part 31 is raised so as to be easily grasped.

  Next, the optical system insertion tool 13 shown in FIG. 1B is inserted into the channel 11 of the small diameter endoscope 10 shown in FIG. 1A, and the distal end of the small diameter endoscope 10 is inserted into the lesioned part by the optical system insertion tool 13. Guide to the vicinity of 31. FIG. 2 shows the state at this time.

  Next, the optical system insertion tool 13 is pulled out while the distal end of the small diameter endoscope 10 is fixed, and then the treatment tool 20 shown in FIG. 1C is inserted into the channel 11 of the small diameter endoscope 10. At this time, the illumination optical system 27 and the objective optical system 28 of the endoscope 25a are operated. When the distal end of the treatment instrument 20 inserted into the small-diameter endoscope 10 protrudes from the distal end of the small-diameter endoscope 10, the image is captured by the objective optical system 28 of the endoscope 25a. A predetermined operation can be performed on the grasping forceps 23 arranged at the distal end of the treatment instrument 20 according to the obtained image. The state at this time is shown in FIG.

  Next, the distal end of the grasping forceps 23 is opened by driving the operating forceps 22 of the grasping forceps 23, and as shown in FIG. 4, the lesioned part 31 is grasped, and the treatment instrument 20 is slightly lifted to further raise the lesioned part 31. Let Thereafter, as shown in FIG. 5, a treatment instrument inserted into the small-diameter endoscope 10 together with an incision around the lesioned part 31 using, for example, an IT knife 30 inserted into the channel 29 of the endoscope 25 a. 20 is gradually lifted to lift the incised lesion 31, and finally the entire periphery of the lesion 31 is incised. Since the grasping forceps 23 are illuminated by the illumination light from the illumination optical system 27 of the endoscope 25a when the lesioned part is incised by the IT knife 30, the movement of the grasping forceps 23 is performed by the objective optical system 28 of the endoscope 25a. Therefore, the position of the grasping forceps 23 can be appropriately controlled in accordance with the movement of the IT knife 30.

  As described above, when the small-diameter endoscope set according to the first embodiment of the present invention is used, the outer diameter of the small-diameter endoscope 10 can be reduced to 5.9 mm or less. It can be easily inserted into a body cavity without causing pain to a patient together with a normal endoscope of a degree, and an endoscopic submucosal dissection can be performed safely. In addition, according to the small-diameter endoscope set of the first embodiment of the present invention, while using two endoscopes, illumination optics as in the conventional nasal endoscope and biliary endoscope Brightness and operation accuracy equivalent to those of conventional illumination optical system and objective optical system can be secured without sacrificing the performance of the system, objective optical system, and channel components, and it is generally used. It becomes possible to use a grasping forceps for an endoscope.

  Here, an example is shown in which the present invention is applied to excision of gastric cancer of ESD, but the small-diameter endoscope set of the first embodiment is also useful for observation and biopsy of bile ducts, pancreatic ducts and the like. That is, the distal end of the small-diameter endoscope 10 is guided to predetermined positions of the bile duct and pancreatic duct by inserting the optical system insertion tool 13 shown in FIG. 1B into the channel 11 of the small-diameter endoscope 10 shown in FIG. 1A. To do. In this case, unlike the conventional ERCP cannula (Boston Scientific Corporation), which is used for observation of the bile duct, pancreatic duct, etc., the small-diameter endoscope 10 easily inserts the bifurcation while visually observing. It can be accurately inserted into the lumen of either the bile duct or pancreatic duct. Then, after inserting the small diameter endoscope 10 to a predetermined position, the optical system insertion tool 13 is removed, and then a biopsy forceps 23 as shown in FIG. 1C is inserted into the channel 11 of the diameter endoscope 10. Can be collected by gnawing the organization. During this time, since the optical system insertion tool 13 is removed, it is confirmed whether or not the small-diameter endoscope 10 is misaligned by X-ray fluoroscopy from the outside.

[Second Embodiment]
Next, a process of performing a biopsy in the large intestine using the small-diameter endoscope set according to the second embodiment in the combination shown in FIGS. 1A, 1B, and 1D will be described with reference to FIG. The small-diameter endoscope set used in the second embodiment is used simultaneously with the conventional large-intestine endoscope 25b having an outer diameter of about 10 mm, for example, as in the first embodiment.

  In a normal case, the large intestine endoscope 25b can be easily inserted to the position of the cecum. However, when a colonoscopy is performed normally, the bowel of the large intestine becomes tight due to adhesion after past abdominal surgery, and the colonoscopy is bent and the force is not transmitted, so the driving force of the endoscope is obtained. The colonoscope may not be inserted into the cecum. On the other hand, when observing a very long intestinal tract such as the small intestine, or when it is known in advance that the case is difficult to insert an endoscope, it can be inserted using a double balloon fiber. .

  However, since double balloon fiber is expensive and disposable, it cannot be used unless it is prepared in advance. Therefore, when it becomes impossible to insert a normal large intestine endoscope to a predetermined position, there is a possibility that the large intestine may be broken if the examination is forcibly continued. Therefore, the examination is often interrupted and the large intestine fluoroscopy using barium is performed later. However, when the small-diameter endoscope set according to the second embodiment of the present invention is used, the colonoscope can be effectively inserted to a predetermined position even in such a case.

  First, as shown to FIG. 6A, it inserts until the large intestine endoscope can be inserted first using the normal large intestine endoscope 25b. When the large intestine endoscope 25b cannot be inserted any more, the small diameter endoscope 10 shown in FIG. 1A is inserted from the channel (not shown in FIG. 6) of the large intestine endoscope 25b. At this time, as shown in FIG. 6B, the optical system insertion tool 13 with the objective optical system shown in FIG. 1B is inserted into the channel 11 of the small-diameter endoscope, and guided by this optical system insertion tool 13. Meanwhile, the small-diameter endoscope 10 is introduced to a predetermined position.

  When the small-diameter endoscope 10 is inserted into the forceps opening of the large-intestine endoscope 25b, the small-diameter endoscope 10 is further inserted deeper with the large-intestine endoscope 25b as a sheath. Since the small-diameter endoscope 10 is smaller in diameter than the large-intestine endoscope 25b and rich in flexibility, it is possible to easily introduce the small-diameter endoscope into the ascending colon portion where the bending is large in the middle. it can.

  In order to enhance the insertion effect of the small-diameter endoscope 10, as shown in FIG. 6C, an attachment-type balloon 37 is provided on the outer periphery of the distal end of the large-intestine endoscope 25b. When the attachment type balloon 37 is inflated at the site where the insertion is no longer possible and the distal end of the large intestine endoscope 25b is fixed to the large intestine canal, the small diameter endoscope 10 can be inserted to a predetermined position even better. This is just a modification of the double balloon fiber. That is, in the conventional double balloon fiber, only the balloon and the air supply tube exist in the parent fiber, and the child fiber is the objective optical fiber.

  Next, after the small-diameter endoscope 10 is introduced to a predetermined position, the optical system insertion tool 13 with an objective optical system is taken out from the small-diameter endoscope 10 and a balloon is attached to the distal end as the treatment tool 20b shown in FIG. 1D. The air supply tube 36 with 35 is inserted. Then, as shown in FIG. 6D, the balloon 35 is inserted so as to be located behind the predetermined position (affected part), and the balloon 35 is inflated to fix the balloon 35.

  The balloon 35 is inserted and fixed as follows because the optical system insertion tool 13 with the objective optical system is taken out from the small-diameter endoscope 10 and cannot be inserted while confirming the position with an image. . That is, when the distal end of the deflated balloon 35 is aligned with the distal end of the small-diameter endoscope 10 in advance, the treatment instrument insertion port (illustrated) of the small-diameter endoscope 10 is provided on the proximal side of the air supply tube 36. If the long diameter when the balloon 35 is inflated is 3 cm, the mark A is 3 cm closer to the line A of the air supply tube 36. Write line B.

  Then, with the balloon 35 deflated, the balloon 35 is attached to the distal end as the treatment instrument 20b until the line A of the air supply tube 36 coincides with the entrance of the treatment instrument insertion port of the small-diameter endoscope 10. The air tube 36 is inserted into the channel 11 of the small diameter endoscope 10. At this time, since the small-diameter endoscope 10 functions as a sheath for insertion of the treatment instrument 20b, it can be smoothly inserted to a predetermined position. Next, without inserting the air supply tube 36 any more, the small diameter endoscope 10 is pulled out until the entrance of the treatment instrument insertion port of the small diameter endoscope 10 overlaps the line B of the air supply tube 36. Then, the air supply tube 36 with the balloon 35 attached to the distal end as the treatment instrument 20b protrudes from the distal end of the small diameter endoscope 10 by 3 cm. Therefore, the balloon 35 is inflated to fix the treatment tool 20b.

  Next, when the large intestine endoscope 25b is further inserted while the air supply tube 36 is pulled, the large intestine endoscope 25b is inserted to a predetermined position while being bent in accordance with the small diameter endoscope 10, as shown in FIG. 6E. . It should be noted that, in a complicatedly bent portion, the large intestine endoscope 25b can be inserted to a predetermined position by performing the above operation a plurality of times as necessary. At this time, when an attachment type balloon 37 attached to the large intestine endoscope 25b is used, the attachment type balloon 37 is deflated.

  In this state, when the balloon 35 of the treatment instrument 20b is deflated and the small-diameter endoscope 10 is taken out together with the treatment instrument 20b from the forceps opening of the large-intestine endoscope 25b, as shown in FIG. It will be in the state inserted to the predetermined position. Thereafter, an appropriate treatment tool is inserted into the forceps opening of the large intestine endoscope 25b to perform the treatment. Since the large-intestine endoscope 25b is provided with an objective optical system, it is possible to perform predetermined processing while confirming the position of the treatment instrument.

  Thus, the small-diameter endoscope set used in the second embodiment is difficult to insert with a general-purpose colonoscope even if an expensive disposable double balloon fiber is not prepared in advance. Only when the small-diameter endoscope 10 is inserted into the channel of the colonoscope and the above-described operation is performed, the colonoscope can be inserted to a predetermined position. Therefore, if the small-diameter endoscope set used in the second embodiment is prepared in advance, preparation of an expensive disposable double balloon fiber is not required in advance, and when it is found that it is an insertion difficult example, the large intestine The same effect as that of the double balloon fiber can be achieved without removing the endoscope.

[Third Embodiment]
Next, with reference to FIG. 7, a process of grasping or biopsying the gastro-aneurysm using the small-diameter endoscope set according to the third embodiment in the combination shown in FIGS. 1A, 1B, and 1C will be described. To do. However, the small-diameter endoscope set used in the third embodiment is used simultaneously with a conventional normal endoscope 25c having an outer diameter of about 10 mm, for example, as in the first embodiment. A gripping forceps capable of changing the angle of the distal end portion up and down or left and right by a wire action as the diameter endoscope 10 and a angle of the distal end portion of the insertion tool 21 up and down or left and right by a wire action as the treatment tool 20a. Or, a biopsy forceps (hereinafter, collectively referred to as “gripping forceps”) 23 is used. In FIG. 7B, for easy understanding, the scale of the grasping forceps 23 is changed to be larger than the actual size.

  The gastro-aneurysm portion is a portion located on the esophagus side of the stomach, and the normal endoscope 25c can be bent up and down, left and right or up and down and left and right, but is a so-called single-bending type with one bending point. Therefore, it is difficult to bring the tip close to the stomach arch. For example, after the normal endoscope 25c is inserted into the stomach, the tip is bent in a J-shape and the tip X is directed to the stomach arch, resulting in the state shown in FIG. 7A. Even if the endoscope 25c is further pushed in this state, the endoscope 25c only moves in the direction indicated by the arrow in FIG. 7A, and the distal end X of the endoscope 25c moves away from the gastric arch.

  At this time, there is a method in which the endoscope 25c is further pushed into contact with the lower stomach wall, and the distal end X of the endoscope 25c is brought close to the stomach arch using the repulsive force of the stomach wall. Is unfavorable because it increases. If a so-called double-bending endoscope is used instead of the single-bending endoscope 25, there are two bent portions, so that the distal end X can be brought close to the gastric arch. However, double-bending endoscopes are expensive and difficult to adopt immediately.

  Therefore, in the third embodiment, a combination with the normal endoscope 25c, as a small-diameter endoscope set as a small-diameter endoscope set, the tip portion can change the angle up and down or left and right by wire action and The treatment instrument 20a is provided with a grasping forceps 23 that can change the angle of the distal end portion of the insertion tool 21 up and down or left and right by a wire action. When such a small-diameter endoscope set is used, the endoscope 25c is bent once and the angle thereof is fixed (angle lock), and then the endoscope 25c is held (pulled), When the small-diameter endoscope 10 is inserted into the channel of the endoscope 25c, as shown in FIG. 7B, the distal end of the small-diameter endoscope 10 can be protruded from the distal end X of the normal endoscope 25c. . Here, if necessary, the angle of the distal end portion of the small-diameter endoscope 10 can be changed vertically or horizontally by a wire action. Furthermore, the forceps port 11 (see FIG. 1A) of the small-diameter endoscope 10 includes a grasping forceps 23 that can change the angle of the distal end portion of the insertion tool 21 up and down or left and right by a wire action as a treatment tool 20a. Is inserted, the grasping forceps 23 protrude from the distal end of the small-diameter endoscope 10, so that the grasping forceps 23 can be easily brought close to the stomach arch portion, and the tissue of the stomach arch portion can be easily grasped. You will be able to perform inspection.

  The projection distance L5 of the small-diameter endoscope 10 from the distal end X of the endoscope 25c can be set as appropriate, and the projection distance L6 of the insertion instrument 21 of the treatment instrument 20a from the distal end of the small-diameter endoscope 10 is also appropriate. Further, the abutment angle of the grasping forceps 23 with respect to the stomach arch portion can be arbitrarily set because the insertion tool 21 can be bent by a wire action. Therefore, if the small-diameter endoscope set of the third embodiment is used, the operation as a triple-bending type endoscope can be performed even if the normal endoscope 25c is used, which is shown in FIG. 7B. As described above, the grasping forceps 23 can be easily brought close to a position that is difficult to approach only with a normal endoscope 25c such as a gastric arch, so that the tissue can be grasped or biopsied.

  In addition, the conventional double-bending type endoscope has a limit in the position where the tip can be reached because the position of the bent portion is fixed, but the small-diameter endoscope set of the third embodiment Is used in combination with a normal endoscope 25c, the projection distance L5 of the distal end of the small-diameter endoscope 10 from the distal end X of the endoscope 25c, and the treatment tool 20a from the distal end of the small-diameter endoscope 10. Since the protrusion distance L6 of the insertion tool 21 can be set arbitrarily, the distance between the three bending positions can be changed, so that the distal end portion of the treatment tool 20a is more than the conventional double-bending endoscope. The reachable position becomes wider. In addition, if the small-diameter endoscope set of the third embodiment is used in combination with the normal endoscope 25c, the cost becomes lower than that of a conventional double-bending endoscope.

  In addition, when the small-diameter endoscope set according to the third embodiment is used, the entire range can be bent into an S shape, so that the application range can be further expanded. For example, when the endoscopic submucosal dissection applied in the first example is performed using the small-diameter endoscope set of the third embodiment, as shown in FIG. Inserting the diameter endoscope 10 from the same direction, bending the distal end side of the small diameter endoscope 10 upward by a wire action, and further inserting the treatment tool 20a inserted into the small diameter endoscope 10 If 21 is bent downward by the wire action, the grasping forceps 23 can be directed downward. After gripping the lesioned part 31 with the grasping forceps 23 in this state, the bending of the small-diameter endoscope 10 is further strengthened, so that the lesioned part 31 can be lifted more reliably to the stomach lumen side. Therefore, it becomes easy to perform an incision with the IT knife 30.

  In addition, as the small-diameter endoscope set of the third embodiment, the small-diameter endoscope 10 can change the angle up and down or left and right by wire action, and the treatment instrument 20a can be inserted by wire action. The tip 21 has a grasping forceps or a biopsy forceps 23 that can change the angle up and down or left and right. However, only the small-diameter endoscope 10 or only the treatment tool 20a can be used to change the tip by wire action. What can change an angle can also be used. In this case, the same operation as that of the conventional double bending type endoscope can be performed, but the distance between the two bending positions can still be changed, so that the conventional double bending type endoscope can be changed. There is an effect that the position where the distal end of the treatment instrument 20a can reach is wider than the mirror.

  DESCRIPTION OF SYMBOLS 10 ... Small diameter endoscope 11 ... Forceps hole (channel) 13 ... Optical system insertion tool 14 ... Flexible sheath 15 ... Illumination optical system 16 ... Objective optical system 17, 18 ... Wiring 20a, 20b ... Treatment tool 21 ... Insertion Tool 22 ... Operating rod 23 ... Grasping forceps (biopsy forceps) 25a to 25c ... Endoscope 26 ... Sheath 27 ... Illumination optical system 28 ... Objective optical system 29 ... Channel 30 ... IT knife 31 ... Lesion part 32 ... Mucosa layer 33 ... muscle layer 34 ... physiological saline 35 ... balloon 36 ... air supply tube 37 ... attachment type balloon

Claims (8)

A small-diameter endoscope body in which a channel is formed;
An optical inserter that is removable with respect to the channel and comprises an illumination optical system and an objective optical system;
Have
The channel is a small-diameter endoscope that allows a treatment tool to be inserted when the optical insertion tool is removed .   The small diameter endoscope according to claim 1, wherein an inner diameter of the channel is 2.0 mm or more, and an outer diameter of the small diameter endoscope is 5.9 mm or less. A small diameter endoscope,
A treatment tool,
With
The small diameter endoscope is:
A small-diameter endoscope body in which a channel is formed;
An optical inserter that is removable with respect to the channel and comprises an illumination optical system and an objective optical system;
Have
The channel is a small-diameter endoscope set in which the treatment instrument can be inserted when the optical insertion instrument is removed .   The small-diameter endoscope set according to claim 3, wherein an inner diameter of the channel is 2.0 mm or more and an outer diameter of the small-diameter endoscope is 5.9 mm or less.   4. The thin-diameter endoscope set according to claim 3, wherein at least one of the thin-diameter endoscope and the treatment instrument has a distal end side that can be bent by a wire action.   The small-diameter endoscope set according to claim 3, wherein the treatment tool is a grasping forceps or a biopsy forceps.   The small-diameter endoscope set according to claim 3, wherein the treatment tool includes an air supply tube having a balloon connected to a distal end. Before SL optical science based insert is provided with a light emitting diode or laser diode as a light source, a small diameter endoscope according to any one of claims 3-7, characterized in that it comprises a solid-state image pickup device as an image detector Mirror set.

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