CN101073492A - Endoscope - Google Patents

Abstract

The present invention provides an endoscope. The endoscope has: a treatment instrument lifting base, which has an abutment surface abutting against the treatment instrument, and is freely rotatably arranged in the front end portion. The treatment instrument is raised; the abutment part is arranged in the front end and is configured to be in contact with the treatment instrument when the treatment instrument lifting seat is lifted; the first guide part is arranged on the treatment instrument lift The abutment surface of the seat is used to guide the treatment instrument to a predetermined position on the abutment surface along with the rotation of the lifting seat of the treatment instrument; the holding unit is arranged on the abutment surface and the abutment part, in order to guide the treatment instrument to a predetermined position on the abutment surface; 1. The treatment instrument guided by the guide part until the diameter of a predetermined size is clamped between the contact surface and the contact part to have a grip surface of a predetermined size; and a second guide part is provided on the contact part, and the The treatment instrument that exceeds the size of the holding surface of the holding unit is guided in a direction away from the holding unit and held there.

Description

endoscope

This application claims the priority of Japanese Patent Application No. 2006-138302 filed on May 17, 2006 and Japanese Patent Application No. 2006-234520 filed on August 30, 2006, the contents of which are incorporated by reference.

technical field

The present invention relates to an endoscope, and in particular, to an endoscope suitable for exchanging treatment instruments using a guide wire in endoscopic examination of the pancreaticobiliary system and endoscopic operations.

Background technique

In recent years, in the treatment of diseases in the digestive system and the pancreaticobiliary system, endoscopic treatment using an endoscope has been increasing. In the treatment of the pancreaticobiliary system using the existing endoscope, in addition to the diagnostic treatment of the biliary duct or pancreatic duct contrast using the endoscope, there is also a treatment of the common bile duct and the like by using a balloon or holding a treatment instrument. The gallstones in the gallstones are recovered for treatment and disposal.

In addition, when using an endoscope to perform endoscopic treatment of pancreatic duct, bile duct, hepatic duct, etc., the operator generally performs as follows: Insert the distal end of the endoscope insertion part into the duodenal papilla From there, under X-ray fluoroscopy, using a guide wire as a guide, surgical instruments such as a catheter are selectively inserted into the pancreatic duct or bile duct.

In such endoscopic examination of the pancreaticobiliary system and operations performed under the endoscope, when observing/treating the pancreaticobiliary system with an endoscope, when the treatment instrument such as a catheter is inserted into the endoscope When using the through channel, the guide wire is inserted into the treatment instrument.

Therefore, when the treatment instrument is moved relative to the endoscope, the guide wire also moves at the same time. Therefore, for example, when the treatment instrument is replaced with the guide wire as a guide in the state where the tip of the guide wire is inserted into the nipple, in order to keep the guide wire In the state where the front end of the wire is inserted into the nipple, the guide wire must be held in the front end of the insertion part.

Therefore, in view of such a requirement, in the prior art, for example, Japanese Patent Application Laid-Open No. 2002-034905 has disclosed an endoscope in which a guide wire fixing unit is provided in the insertion portion, and the guide wire fixing unit Lock the guide wire in a lockable and disengageable manner.

The endoscope of this Japanese Patent Application Laid-Open No. 2002-034905 is constituted to have: an operation part connected to the end part near the side of the insertion part; The operation of the operation part can be operated; a cutout as a guide wire fixing unit is provided on the top of the guide surface of the lifting base of the above-mentioned treatment instrument, and the guide wire is lifted by operating the lifting base of the treatment equipment through the operation part, so that the cutout Only the guide wire can be blocked.

In the endoscope device having such a structure, when the endoscope is used to observe/treat the pancreaticobiliary system, the reaction force of the guide wire itself after being inserted into the nipple is utilized by raising the treatment instrument lifting base. , so that the guide wire is pressed and engaged in the substantially V-shaped notch (wire locking groove) provided at the bottom of the lifting base of the treatment instrument, and by pressing on the substantially planar upper surface of the hard front end body side, thereby being mechanically fixed.

In addition, in an endoscope having a treatment instrument lifting base at the front end, in order not to cause the problem that the protruding guide wire and other treatment instruments are caught by the lifting wire, there is, for example, Japanese Patent Laid-Open No. 2005-304586 As disclosed in the gazette, an endoscope in which a treatment instrument lifting base is lifted by a drive arm provided inside a side surface of a distal end portion.

However, in the conventional endoscope described in the aforementioned Japanese Unexamined Patent Application Publication No. 2002-034905, there is a structure in which the guide wire is pressed and engaged with the handle of the treatment instrument only by the reaction force of the guide wire itself. In the substantially V-shaped cutout (wire locking groove) of the bottom of the seat, and by pressing against the upper side of the substantially planar shape of the front end body, it is fixed. Therefore, if a guide wire with a small outer diameter is used, The self-reaction force of the guide wire is reduced, and at the same time, a gap is formed between the cutout of the treatment instrument lifting base and the upper surface of the front end body. Therefore, the holding force of the guide wire becomes small, and there is a problem that the guide wire cannot be fixed completely.

In addition, the above-mentioned holding structure mainly relies on the reaction force of the guide wire itself. Therefore, when an external force is applied to the guide wire through the movement of the insertion part, etc., the holding force of the guide wire may become smaller as described above, and there is a possibility that There is a problem that the guide wire cannot be completely fixed due to detachment from the incision.

Contents of the invention

Therefore, the present invention has been made in view of the above-mentioned problems, and an object of the present invention is to provide an endoscope having a treatment instrument holding mechanism capable of Position and fix the guide wire and other treatment instruments on the appropriate position of the treatment instrument lifting base.

In addition, in the endoscope disclosed in JP-A-2005-304586, since the drive arm provided inside the distal end side is a thin member, the durability of the drive arm may decrease due to force applied to the drive arm. In addition, when the rotation range of the driving arm cannot be limited, when the lifting wire is pulled excessively in the state where the treatment instrument such as a guide wire is in contact with the treatment instrument lifting base, the shaft connecting the driving arm and the treatment instrument lifting base will be damaged. The parts are stressed, and the durability of the shaft part may be reduced as described above.

Therefore, according to the present invention, it is also possible to provide an endoscope in which the movable range of the driving arm can be restricted, thereby improving the durability of the driving arm.

The endoscope according to the first aspect of the present invention has: an insertion portion having a distal end portion on the distal end side for insertion into a body cavity; a treatment instrument insertion channel disposed in the insertion portion and communicating with the distal end part; a treatment instrument lifting seat, which has an abutment surface that abuts against the treatment instrument penetrating into the treatment instrument penetration channel, and is freely rotatably provided in the front end, for use according to the operation The operation of the part, through the abutment of the abutment surface, the treatment instrument is lifted; the abutment part is arranged in the front end part, and is set to be lifted on the treatment instrument lifting seat In the case of the treatment instrument, it can abut against the treatment instrument; the first guide part is arranged on the contact surface of the treatment instrument lifting base, and is used to follow the rotation of the treatment instrument lifting base to The treatment instrument is guided to a predetermined position on the abutment surface; a holding unit is provided on the abutment surface and the abutment portion to hold the diameter guided by the first guide portion up to a predetermined size. The treatment instrument is clamped between the abutting surface and the abutting portion, and has a gripping surface of a predetermined size; and a second guide portion, which is provided on the abutting portion, for The treatment instrument that exceeds the size of the holding surface of the holding unit is guided in a direction away from the holding unit and held.

The endoscope according to the second aspect of the present invention has: an insertion portion having a distal end portion on the distal end side for insertion into a body cavity; a treatment instrument insertion channel disposed in the insertion portion and communicating with the distal end part; a treatment instrument lifting seat, which has an abutment surface that abuts against the treatment instrument penetrating into the treatment instrument penetration channel, and is freely rotatably provided in the front end, for use according to the operation The operation of the part, through the abutment of the abutment surface, the treatment instrument is lifted; the abutment part is arranged in the front end part, and is set to be lifted on the treatment instrument lifting seat Under the condition of being in contact with the treatment instrument; a guide part, which is used to guide the treatment instrument to a predetermined position of the abutting part with the rotation of the treatment instrument lifting base; and hold the fixing unit , which is provided on the abutment surface and the abutment portion, and has a gripping surface for clamping the treatment instrument guided by the guide portion up to a predetermined diameter on the abutment between the contact surface and the abutment portion.

The endoscope according to the third aspect of the present invention has: an insertion portion having a distal end portion on the distal end side for insertion into a body cavity; a treatment instrument insertion channel disposed in the insertion portion and communicating with the distal end part; a treatment instrument lifting seat, which is freely rotatably arranged in the front end part, and lifts the first treatment instrument or the second treatment instrument that penetrates into the treatment instrument penetration channel according to the operation of the operation part ; a fixing member, which is arranged in the front end portion and serves as a fulcrum when the lifting seat of the treatment instrument is moved to displace the direction of the first or second treatment instrument; the first treatment instrument holding part , which is arranged on the lifting seat of the treatment instrument, and holds the first treatment instrument penetrating into the channel for passing the treatment instrument at the first position; the second treatment instrument holding part is arranged on the treatment instrument On the instrument lifting seat, the second treatment instrument penetrating through the passage for the treatment instrument is kept at a second position different from the first position; holding and fixing units are respectively arranged on the lifting position of the treatment instrument. on the seat and the fixing part, for clamping the first treatment instrument lifted by the treatment instrument lifting seat between the treatment instrument lifting seat and the fixing part; and a guide part, which is arranged on The fixing member does not guide the second treatment instrument that is lifted up with the rotation of the treatment instrument lifting base to the holding and fixing unit, but guides the second treatment instrument that is lifted with the rotation of the treatment instrument lifting base to the holding and fixing unit. The raised first treatment instrument is guided to the holding and fixing unit of the fixing member.

The above and other objects, features and advantages of the present invention will be more clearly understood from the following description with reference to the accompanying drawings.

Description of drawings

1 is a perspective view showing a schematic configuration of an entire system of an endoscope device assembled with an endoscope and various external devices according to a first embodiment of the present invention.

2 is a longitudinal sectional view of main parts showing the internal structure of the distal end portion of the insertion portion in the endoscope according to the first embodiment of the present invention.

3 is a perspective view showing an appearance structure of a distal end portion having a treatment instrument holding mechanism according to the first embodiment of the present invention.

4 is a perspective view showing the structure of a treatment instrument lifting base provided in a distal end portion according to the first embodiment of the present invention.

5 is a perspective view showing the structure of a contact portion provided in a front end portion according to the first embodiment of the present invention.

6 is a perspective view showing a state in which the guide wire is fixed by being sandwiched between the treatment instrument lifting base and the contact portion during the lifting operation according to the first embodiment of the present invention.

7 is a plan view showing a specific structure of a holding and fixing portion of the abutting portion of FIG. 5 according to the first embodiment of the present invention.

8 is a diagram for explaining the operation of the first embodiment, and is a perspective view showing the appearance of the distal end in a state before the guide wire is inserted into the distal end body and the treatment instrument lifting base is lifted.

Fig. 9 is a diagram for explaining the action of the first embodiment, showing a process in which the treatment instrument lifting base is lifted from the state shown in Fig. 8 and the guide wire is guided to a fixed position by the first guide part of the treatment instrument lifting base; A perspective view of the appearance of the front end of the state.

Fig. 10 is a diagram for explaining the operation of the first embodiment, and also shows the distal end portion in a state where the guide wire is further moved from the state shown in Fig. 9 to a fixed position and fixed by the lifting operation of the treatment instrument lifting base perspective view of the exterior.

11 is a diagram illustrating how a large-diameter treatment instrument including a catheter and other treatment instruments is guided to the maximum lift by the second guide portion of the abutting portion through the lifting operation of the treatment instrument lifting base according to the first embodiment of the present invention. A perspective view of the appearance of the front end in a state where it has been raised and fixed.

Fig. 12 is the state in Fig. 10 in which the guide wire is gripped by the holding part of the treatment instrument lifting base and the end part of the holding and fixing part of the abutting part according to the first embodiment of the present invention; A cross-sectional view of the front end along the direction of the insertion axis.

Fig. 13 is a view of Fig. 10 in a state where the guide wire is gripped by the surface of the holding part of the lifting base of the treatment instrument and the surface of the holding and fixing part of the abutting part according to the first embodiment of the present invention. Cross-sectional view of the front end along the insertion axis.

Fig. 14 relates to the first embodiment of the present invention, and is an operation diagram for explaining operations from the state shown in Fig. 8 to the states shown in Figs. 10 and 11 .

15 is a partially exploded perspective view of the endoscope according to the second embodiment of the present invention in a state in which the driving arm of the distal end portion of the endoscope is rotated.

Fig. 16 is a perspective view showing the appearance structure of the distal end portion of the endoscope in a state where the treatment instrument raising base according to the third embodiment of the present invention is down.

Fig. 17 relates to a third embodiment of the endoscope of the present invention, and is a perspective view showing the distal end portion of the endoscope in Fig. 16 viewed from the front direction.

Fig. 18 is a perspective view showing an appearance structure of a distal end portion in a raised state of a treatment instrument lifting base according to a third embodiment of the endoscope according to the present invention.

Fig. 19 is a perspective view showing the appearance of a treatment instrument lifting base according to a third embodiment of the endoscope of the present invention.

Fig. 20 relates to a third embodiment of the endoscope of the present invention, and is a front view of the treatment instrument lifter shown in Fig. 19 .

21 is an exploded perspective view showing a treatment instrument lifting base and a mounted drive arm according to a third embodiment of the endoscope of the present invention.

Fig. 22 is a perspective view showing a treatment instrument lifter to which a drive arm is attached according to a third embodiment of the endoscope of the present invention.

23 is a partial sectional view showing an assembled state of the treatment instrument raising base and the rotation shaft of the driving arm according to the third embodiment of the endoscope of the present invention.

24 is a perspective view showing the distal end portion of the endoscope in a state showing the drive arm according to the third embodiment of the endoscope of the present invention.

Fig. 25 shows a modified example of the endoscope according to the third embodiment of the present invention, and is a partial cross-sectional view showing an assembled state of the treatment instrument lifting base and the rotation shaft of the driving arm.

Fig. 26 is a cross-sectional view of a protective tube and a coil through which a conventional operating wire penetrates.

Fig. 27 is a cross-sectional view of the protective tube through which the operating wire penetrates and the coil when the coil of Fig. 26 is damaged.

28 is a cross-sectional view of a protective tube through which an operating wire is inserted and a coil tube according to a third embodiment of the endoscope of the present invention.

29 is a cross-sectional view of a protective tube through which an operating wire is inserted and a coil when the coil of FIG. 28 is damaged, relating to a third embodiment of the endoscope of the present invention.

30 is a perspective view showing an insulating block according to a third embodiment of the endoscope of the present invention.

FIG. 31 is a perspective view showing an insulating block viewed from a different angle from FIG. 30 , relating to a third embodiment of the endoscope of the present invention.

32 is a front view showing the distal end portion in a state where a surgical instrument lifter and an insulating block are attached to the distal hard portion of the endoscope according to the third embodiment of the present invention.

33 is a plan view showing the distal end portion in a state where a surgical instrument lifter and an insulating block are attached to the distal hard portion of the endoscope according to the third embodiment of the present invention.

Fig. 34 is a diagram for explaining the operation of the third embodiment, and is a diagram showing a state before the guide wire is inserted into the distal end body and the treatment instrument lifting base performs a lifting operation.

Fig. 35 is a diagram for explaining the operation of the third embodiment, and is a diagram showing a state before the lifting operation of the treatment instrument lifting base as seen from an angle different from that of Fig. 34 .

Fig. 36 is a diagram for explaining the operation of the third embodiment, and is a diagram showing an initial state in which the guide wire is guided to the guide wire holding portion 51b by the guide surface of the treatment instrument lifting base.

Fig. 37 is a diagram for explaining the operation of the third embodiment, and is a diagram showing a state in which the treatment instrument lifting base is further lifted and the guide wire is guided to the treatment instrument holding portion.

Fig. 38 is a diagram for explaining the operation of the third embodiment, and is a diagram showing a state in which the wall portion of the further lifted treatment instrument lifting base enters the wall escape groove of the insulating block.

Fig. 39 is a diagram for explaining the operation of the third embodiment, and is a diagram showing a state in which the guide wire is clamped and fixed by the lifting base of the treatment instrument and the insulating block.

Fig. 40 is a diagram for explaining the operation of the third embodiment, and is a diagram showing a guiding state of the wire by the wire guiding part of the insulating block.

Fig. 41 is a diagram for explaining the operation of the third embodiment, and is a diagram showing a state in which a guide wire at a different angle from that of Fig. 39 is clamped and fixed by the lifting base of the treatment instrument and the insulating block.

Fig. 42 is a diagram for explaining the operation of the third embodiment, showing only the treatment instrument lifting base and the guide wire in a state where the guide wire is clamped and fixed by the treatment equipment lifting base and the insulating block.

Fig. 43 is a diagram for explaining the operation of the third embodiment, and is a diagram showing only the insulating block and the guide wire in a state where the guide wire is held and fixed by the lifting base of the treatment instrument and the insulating block.

Fig. 44 is a diagram for explaining the operation of the third embodiment, and is a diagram for explaining the treatment instrument lifting base when lifting the large-diameter treatment instrument.

Fig. 45 is a diagram for explaining the operation of the third embodiment, and is a front view of the treatment instrument lifting base of Fig. 44 .

Detailed ways

Hereinafter, embodiments of the present invention will be described with reference to the drawings.

(first embodiment)

The first embodiment of the present invention is shown from FIG. 1 to FIG. 14, and FIG. 1 is a perspective view showing a schematic configuration of an overall system of an endoscope device after assembling the endoscope of the first embodiment and various external devices. 2 is a longitudinal sectional view showing main parts of the internal structure of the distal end portion of the insertion portion in the endoscope, and FIG. 3 is a perspective view showing the appearance structure of the distal end portion having a treatment instrument holding mechanism.

As shown in FIG. 1 , an endoscope 1 according to the first embodiment is assembled with equipment such as a light source device 2 , an image processing device 3 , a monitor 4 , an input keyboard 5 , a suction pump device 6 , and a water bottle 7 as external devices. Combined to form an endoscope system. Furthermore, these devices are installed on a stand 9 with a career 8 .

The endoscope 1 is configured to have: an elongated insertion part 10 inserted into a body cavity; an operation part 11 connected to the base end of the insertion part 10 near the side; Cord (universal cord)12.

The insertion part 10 is configured to have: a flexible and elongated flexible tube part 13; a curved part 14 connected to the front end of the flexible tube part 13; Hard front end portion 15 at the front end position.

Furthermore, a connector 12 a is provided at the front end portion of the universal cord 12 connected to the operation portion 11 . The connector 12a is provided with a light guide connector part and an electric contact part. And, this connector 12a is connected to the light source device 2 as an external device.

In addition, this connector 12a is connected to the image processing device 3 through a signal cable 16a connected to an internal signal line.

On the outer peripheral surface of the distal end portion 15 of the endoscope 1, a recessed notch portion 15a is formed in which the side surface is notched. In addition, a passage opening 15A (see FIG. 2 ) is disposed on one side of the notch 15 a. In addition, as shown in FIG. 3 , an illumination lens (illumination window) 24 a of the illumination optical system and an objective lens (observation window) 24 b of the observation optical system are arranged side by side of the channel opening 15A.

Moreover, on the rear end wall surface 15b of the notch part 15a of the front end part 15, the nozzle 24c for air-feeding and water-feeding is provided protrudingly. The nozzle 24c sprays fluid such as water or air onto the outer surface of the objective lens 24b to clean the lens surface.

In addition, although not shown, a light guide as a light transmission path is connected to the illumination lens 24a. Inside the objective lens 24b, a CCD (Charge Coupled Device: Charge Coupled Device) serving as an imaging element constituting an observation optical system is arranged. The CCD is connected to a circuit substrate for extracting image signals.

In addition, the light guide, CCD, and circuit board, not shown above, are disposed in a storage portion formed in the distal rigid portion 24 constituting the distal end body in the distal portion 15 .

The operation section 11 of the endoscope 1 is provided with: a bending operation section 17 for bending the bending section 14 of the insertion section 10 in vertical or horizontal directions; an air and water supply button 18 ; and a suction operation button 19 . In addition, an insertion port 21 communicating with a treatment instrument insertion channel 26 (see FIG. 2 ) is arranged at a proximal end portion of the operation portion 11 .

In addition, the operator can selectively eject air and liquid from the nozzle 24 c of the distal end portion 15 by operating the air and water supply button 18 . In addition, by operating the suction operation button 19, the operator can selectively apply suction to the channel opening 15A of the distal end portion 15 through the treatment instrument insertion channel 26, thereby recovering mucus and the like in the body cavity.

In addition, although not shown, inside the operation unit 11 is built a lifting seat operating mechanism (not shown) for operating the lifting wire 30 connected to the treatment instrument lifting base 23 . In this lifting seat action mechanism (not shown), connecting members such as link members not shown are provided, and the base end portion of the lifting wire 30 is connected to the base end portion of the lifting wire 30 provided on the operating portion through the connecting members such as the link member. The lifting operation knob 16 on the 11 is connected.

Thus, by the operation of the lifting operation knob 16 of the operation part 11 by the operator, the lifting wire 30 is pulled and operated through the above-mentioned connecting members such as the link member constituting the moving mechanism of the lifting seat, and the treatment is performed. The lifting base 23 of the instrument is centered on the rotating fulcrum 28 of the lifting base for lifting. Thus, by lifting the treatment instrument lifting base 23 , the guide catheter and the guide wire 33 themselves inserted into the treatment instrument insertion channel 26 and led out from the channel opening 15A to the outside are lifted.

Next, the structure of the front end portion 15 of the insertion portion 10 will be described with reference to FIG. 2 .

As shown in FIG. 2 , the front end portion 15 is configured to have: for example, a front end hard portion 24 formed of a metal such as stainless steel as the main body of the front end portion; Front end cover 25.

The distal end cover 25 is fixed to the distal rigid portion 24 by adhesion or the like, and is attached to the distal rigid portion 24 for the purpose of insulating from the distal rigid portion 24 and ensuring an airtight state. In addition, the front end cover 25 may be a detachable disposable component.

In addition, an introduction guide passage 27 for guiding introduction of a treatment instrument and the like toward the front end side is formed in the distal end rigid portion 24 . The introduction guide passage 27 is formed to communicate with a treatment instrument insertion channel (through hole) 26 as a treatment instrument insertion guide passage disposed in the insertion portion 10 of the endoscope 1 .

A housing chamber 22 is formed on the front end side of the introduction guide passage 27 , and the housing chamber 22 is a space formed by the front hard part 24 and the front end cover 25 . And, a channel opening 15A constituting the front end opening of the treatment instrument insertion channel 26 is formed by the opening of the storage chamber 22 .

Arranged in the accommodation chamber 22 are: a guide wire 33 introduced through the treatment instrument insertion channel 26 ; and a treatment instrument lifter 23 for lifting a treatment instrument such as a guide catheter to a desired position. The treatment instrument lifting base 23 is pivotally supported by a lifting base rotation fulcrum 28 , one end of which is arranged on the front end hard portion 24 , so as to be rotatable.

The lifting base rotation fulcrum 28 is arranged at the lower side of the front end opening of the introduction guide passage 27 . And, the treatment instrument lifting base 23 is installed so as to be able to freely perform the lifting operation in the following manner: centering on the pivot point 28 of the lifting base, in the accommodation chamber 22, from the standby position indicated by the solid line in FIG. Rotate to the raised position of the procedure instrument shown by the phantom line in the figure.

In addition, the front end of the lifting wire 30 is fixed to the treatment instrument lifting base 23 . The lifting wire 30 is guided to the side of the operation part 11 by a guide tube 31 and a guide sleeve 32 penetrating through the insertion part 10, and is connected to the aforementioned unillustrated lifting seat operating mechanism. Furthermore, the treatment instrument lifting base 23 is configured to perform a lifting operation centering on the lifting base rotation fulcrum 28 as the lifting wire 30 is pulled.

In the endoscope 1 of this embodiment, it can be improved that even when an external force is applied, a treatment instrument such as a guide wire can be positioned and fixed at an appropriate position of the treatment instrument lifting base 23 .

Such a specific configuration will be described with reference to FIGS. 2 to 7 .

In addition, FIG. 4 is a perspective view showing the structure of the lifting base of the treatment instrument provided in the front end, FIG. 5 is a perspective view showing the structure of the contact part provided in the front end, and FIG. 6 is a perspective view showing the structure of the guide wire when it is lifted. It is a perspective view of a state in which the lifting base of the treatment instrument and the abutment part are clamped and fixed. FIG. 7 is a plan view showing a specific structure of the holding and fixing part of the abutment part in FIG. 5 .

As shown in FIGS. 2 and 3 , an abutting surface 23 a that abuts on treatment instruments such as a guide wire 33 and a guide catheter is formed on the treatment instrument lifting base 23 . The abutting surface 23 a is formed of an inclined surface or the like inclined with respect to the introduction axis of the introduction guide passage 27 .

In addition, a first guide portion 23b is formed on the upper portion of the abutting surface 23a, and the first guide portion 23b comes into contact with a treatment instrument such as a guide wire 33 while being in contact with the treatment instrument lifting base 23 (lifting operation). It steers, while it steers.

The first guide portion 23b constitutes a part of the treatment instrument holding mechanism. Specifically, as shown in FIG. or surfaces.

In addition, the amount of inclination of the first guide portion 23b or the amount of curvature (R amount) of the curved surface can smoothly guide the contacting guide wire 33 to the holding portion 23c constituting the holding and fixing portion of the treatment instrument lifting base 23 described later. It only needs to be guided, and it is not particularly limited.

Furthermore, a holding portion 23c for clamping and fixing the guide wire 33 is provided on the first guide portion 23b of the treatment instrument lifting base 23 so as to be connected to at least the first guide portion 23b. And this holding part 23c is formed as a part of the said 1st guide part 23b.

As shown in FIG. 4 , the holding portion 23 c is formed to have a gripping surface of a predetermined size required to grip and hold the guide wire 33 guided by the first guide portion 23 b to a predetermined diameter together with the abutting portion 34 described later.

Also, the guide wire 33 up to a predetermined diameter is a member used in normal treatment, and corresponds to a guide wire 33 having a diameter of, for example, about 0.508 mm to about 1.016 mm (about 0.02 inch to about 0.04 inch). In addition, the guide wire 33 is not limited to such a diameter.

In addition, in order to increase the holding force on the guide wire 33, the shape of the grasping surface of the holding part 23c may be formed in an arc shape corresponding to the arc shape of the guide wire 33, or may be formed in a substantially V-shape, for example. shaped slot shape. In addition, the gripping surface may be formed in a shape in which the contact area with the guide wire 33 is enlarged. That is, regardless of the shape of the grasping surface, the holding portion 23c is formed so that the holding force for the guide wire 33 becomes large.

In the treatment instrument lifting base 23 of this structure, the front end hard part 24 is installed so as to be freely rotatable, as shown in FIGS. The abutment 34 is part of the mechanism.

The abutting portion 34 is made of, for example, an insulating member. As shown in FIGS. The guide wire 33 in the holding portion 23c of the stand 23 abuts and fixes it.

The holding and fixing portion 34 a is formed so as to face the holding portion 23 c of the treatment instrument lifting base 23 when the treatment instrument lifting base 23 is lifted, and protrudes toward the holding portion 23 c side.

FIG. 7 is a cross-section in the horizontal direction of the holding and fixing portion 34a of the abutting portion 34. As shown in FIG. A guide wire 33 up to a diameter (specifically, a thin guide wire 33 having a diameter of, for example, about 0.508 mm (0.02 inch)) abuts and fixes it to a desired width.

In this case, the width L of the holding portion 34a is preferably formed to be smaller than the radius G (see FIG. 14 ) of the large-diameter treatment instrument 33A including the aforementioned catheter and other treatment instruments. In addition, the width O of the effective holding portion 34 a 1 of the holding fixing portion 34 a is preferably substantially the same as the diameter of the thin guide wire 33 , or at least equal to or greater than the diameter of the guide wire 33 .

In addition, in order to easily guide the large-diameter treatment instrument 33A including a catheter and other treatment instruments thicker than the diameter of the guide wire 33 to the second guide part 34b described later, from the effective holding part 34a1 to the second guide part 34b described later, The corner portion 40a of the corner is formed in, for example, an arc shape (refer to FIG. 7 ).

In addition, the shape of the corner portion 40a is not limited to such an arc shape, and may be formed in a conical shape, for example. That is, the shape of the corner portion 40a may be any shape that can smoothly guide the large-diameter treatment instrument 33A including a treatment instrument such as a catheter to the second guide portion 34b.

In addition, a second guide portion 34b is formed on the upper portion of the contact portion 34, and the second guide portion 34b will exceed the size of the holding surface of the holding portion 23c along with the turning operation (lifting operation) of the treatment instrument lifting base 23. The large-diameter treatment instrument 33A including a treatment instrument such as a catheter is guided while being guided in a direction away from the holding and fixing portion 34a (a direction away from the objective lens 24b).

Also, the large-diameter treatment instrument 33A including treatment instruments such as catheters that exceeds the size of the gripping surface of the holding portion 23c is a treatment instrument having a diameter of, for example, approximately 1.016 mm (0.04 inch).

The second guide part 34b constitutes a part of the treatment instrument holding mechanism. Specifically, as shown in FIGS. surface.

In addition, the amount of inclination of the second guide part 34b or the amount of curvature (R amount) of the curved surface is sufficient as long as it can smoothly guide the contacting large-diameter treatment instrument 33A including a treatment instrument such as a catheter to the holding and fixing part 34d described later. , is not particularly limited.

In addition, a holding and fixing portion 34d is formed at a portion forming a part of the second guide portion 34b and a predetermined distance away from the holding and fixing portion 34a. To hold and fix the large-diameter treatment instrument 33A including the treatment instrument such as a catheter. Further, the holding and fixing portion 34d is provided at a position opposite to the holding and fixing portion 34a with respect to the second guide portion 34b.

The shape of the grasping surface of the holding and fixing portion 34d is the same as that of the holding portion 23c of the above-mentioned treatment instrument raising base 23, and may be, for example, a shape corresponding to the arc shape of the large-diameter treatment instrument 33A including a treatment instrument such as a catheter. It may be formed in an arc shape, or may be formed in a substantially V-shaped groove shape. In addition, the grasping surface may be formed in such a shape that the contact area with the large-diameter treatment instrument 33A including a treatment instrument such as a catheter is increased.

In addition, in this embodiment, the structure in which the holding and fixing portion 34d is provided on the second guide portion 34b of the contact portion 34 has been described, but it is not limited to this, and the holding and fixing portion 34d may not be provided, and the second Part of the guide portion 34b and the contact surface 23a of the treatment instrument lifting base 23 hold and fix the large-diameter treatment instrument 33A including the treatment instrument such as a catheter.

In addition, an escape groove 34c is formed at the base end portion of the second guide portion 34b of the contact portion 34, and the escape groove 34c is used to fit the end portion of the contact surface 23a of the treatment instrument lifting base 23 into the contact portion. 34 in the direction of avoidance. As a result, the treatment instrument lifting base 23 and the abutting portion 34 can clamp and hold and fix the guide wire 33 or the large-diameter treatment instrument 33A including treatment instruments such as catheters so as to obtain a predetermined holding force.

6 shows a state in which a small-diameter guide wire 33 is held and fixed by the treatment instrument lifting base 23 constituting the treatment instrument holding mechanism and the abutting portion 34 of the distal end hard portion 24 . That is, the guide wire 33 is positioned and firmly held and fixed by the holding surface of the holding portion 23 c of the treatment instrument lifting base 23 and the holding and fixing portion 34 a of the abutting portion 34 .

In addition, when the large-diameter treatment instrument 33A including a treatment instrument such as a catheter is used, after the large-diameter treatment instrument 33A including a treatment instrument such as a catheter is guided by the second guide part 34b via the holding and fixing part 34a of the contact part 34, Positioning is performed by the holding and fixing portion 34d on the second guide portion 34b and the contact surface 23a of the treatment instrument lifting base 23 .

Next, the operation of the endoscope 1 according to the present embodiment will be described with reference to FIGS. 8 to 14 .

8 to 14 are perspective views showing the appearance of the distal end corresponding to each stage for explaining the action of the first embodiment. FIG. The state before the lifting action, Figure 9 shows the state in which the treatment instrument lifting base is lifted from the state shown in Figure 8 and the guide wire is guided to a fixed position by the first guide part of the treatment instrument lifting base, Figure 10 shows The guide wire is further moved from the state shown in Figure 9 to the fixed position and fixed by the lifting action of the lifting base of the treatment instrument. The second guide part guides the large-diameter treatment instrument including the catheter and other treatment instruments to the maximum lift position and fixes it. Moreover, FIG. 12 is a cross-section of the front end portion in FIG. 10 along the direction of the insertion axis in a state where the guide wire is gripped by the holding portion of the lifting base of the treatment instrument and the end portion of the holding and fixing portion of the abutting portion. 13 is a sectional view of the front end in FIG. 10 along the direction of the insertion axis in a state where the guide wire is gripped by the surface of the holding part of the lifting base of the treatment instrument and the surface of the holding and fixing part of the abutting part. . FIG. 14 is an action diagram for explaining actions from the state shown in FIG. 8 to the states shown in FIGS. 10 and 11 . In addition, the directions of arrows A, B, C, and D shown in FIGS. 9 to 11 will be described as directions corresponding to the directions of arrows A, B, C, and D shown in FIG. 14 .

Now, assume that the operator observes or treats the pancreaticobiliary duct using the endoscope 1 of the first embodiment. In this case, the operator inserts the guide catheter into the treatment instrument insertion channel 26 from the insertion port 21 of the operation unit 11 of the endoscope 1 .

Furthermore, the operator protrudes the guide catheter outward from the channel opening 15A, and inserts it into the pancreatic/biliary duct (not shown) via the nipple. Then, the operator replaces the guide catheter in use with the treatment instrument to be used next.

In this case, the operator first inserts the guide wire 33 through the joint on the proximal end side of the guide catheter. Furthermore, under X-ray fluoroscopy, it is confirmed that the distal end portion of the guide wire 33 has been inserted into the pancreas/biliary duct, and the proximal end side of the guide wire 33 is grasped by hand.

Next, the operator performs an operation of pulling out the guide catheter in this state, and after confirming that the guide catheter has been pulled out from the nipple using the observation image, the operator pulls out the guide catheter sideways.

Then, the operator operates the lift operation knob 16 of the operation unit 11 in a state where the distal end of the guide catheter is accommodated in the channel opening 15A. In addition, FIG. 8 shows the state before the lifting operation knob 16 is operated and the treatment instrument lifting base 23 is lifted. That is, as shown in FIG. 8 , the guide wire 33 protruding from the channel opening 15A abuts against the abutting surface 23 a of the treatment instrument lifting base 23 or a part thereof by its own reaction force.

Furthermore, in this state, with the operation of lifting the operation knob 16, the lifting wire 30 is pulled and operated, so that the treatment instrument lifting base 23 rotates around the lifting base rotation fulcrum 28, as shown by the imaginary line (or as shown by the solid line in Figure 6).

FIG. 8 shows the state of the guide wire 33 accompanying the initial lifting operation of the treatment instrument lifting base 23 at this time. That is, as shown in FIG. 8, when the treatment instrument lifting base 23 starts to lift from the state shown in FIG. 8 (movement to lift in the direction of arrow A shown in FIG. The abutting surface 23a of the treatment instrument lifting base 23 is guided toward the holding portion 23c of the treatment instrument lifting base 23 while being in contact with the first guide portion 23b.

If the effect in this case is further described in detail, then as shown in FIG. The guide part 23b is guided in the arrow B direction shown in FIG. 14 while being in contact. That is, the guide wire 33 is guided by the first guide portion 23 b to the holding portion 23 c of the treatment instrument lifting base 23 .

In addition, in the case of using the large-diameter treatment instrument 33A including a treatment instrument such as a catheter, similarly, the large-diameter treatment instrument 33A including a treatment instrument such as a catheter passes through the abutting surface 23a and the first guide portion by a reaction force. 23b, as shown in FIG.

And, by further lifting the treatment instrument lifting base 23 in the direction of the arrow A shown in FIG. The base end portion (in the direction of the arrow C shown in FIG. 10 ) of 23b is guided while abutting against the holding portion 23c of the treatment instrument lifting base 23 . When the treatment instrument lifting base 23 is further lifted, the guide wire 33 moves in the direction of the arrow C1 shown in FIG. The abutting portion 34 of the distal end rigid portion 24 is held on the fixed portion 34a (see FIG. 14 ).

In this case, since a reaction force to maintain a straight line acts on the hard guide wire 33, the guide wire 33 is pressed into the holding portion 23c by the reaction force, and is firmly locked (locked). . At the same time, in this state, as shown in FIGS. 10 , 12 and 14 , the guide wire 33 is clamped by the holding portion 23 c and the holding portion 34 a of the abutting portion 34 , while passing through the contact with the holding portion 34 a. However, it is positioned at a predetermined fixed position, that is, the holding portion 23c. In this state, the guide wire 33 is firmly mechanically fixed. 10 , 12 and 13 show that the guide wire 33 is firmly fixed at the predetermined position of the holding portion 23 c of the treatment instrument lifting base 23 by the holding and fixing portion 34 a of the abutting portion 34 .

That is, along with the lifting of the treatment instrument lifting base 23, as shown in FIG. 34a and the holding portion 23c are gripped and fixed. This can be adjusted by the operation amount of the operation part which is not shown in figure. In addition, it can also be adjusted by the difference in the hardness of the guide wire 33 itself.

On the other hand, in the case of using a large-diameter treatment instrument 33A including a treatment instrument such as a catheter, the first guide portion of the base 23 is lifted by the treatment instrument in the same way as the guide wire 33 . 23b is guided toward the base end portion of the first guide portion 23b (in the direction of arrow C shown in FIG. 14 ), but the function after that is different.

That is, for the large-diameter treatment instrument 33A including a treatment instrument such as a catheter, since its size exceeds the size of the gripping surface of the holding portion 23c (for example, width L: refer to FIGS. The force applied by the turning action (lifting action) of 23 is sent to the second guide part 34b (Fig. 11 and Fig. 11 and Fig. 14 in the direction of the arrow D) to guide. That is, the large-diameter treatment instrument 33A including a treatment instrument such as a catheter is not locked by the holding and fixing portion 34 a of the contact portion 34 .

Then, with the lifting of the treatment instrument lifting base 23, the large-diameter treatment instrument 33A including a treatment instrument such as a catheter is pressed by the contact surface 23a, and is moved from the above-mentioned holding and fixing part by the second guide part 34b of the contact part 34. The direction in which 34a leaves (that is, the direction away from the objective lens 24b, the arrow D direction shown in FIG. 11 and FIG. 14 ) guides and is guided.

Then, when the treatment instrument lifting base 23 is further lifted, the large-diameter treatment instrument 33A including a catheter and other treatment instruments is guided to a part of the second guide part 34b, or is guided to a part of the second guide part 34b. After holding the fixed portion 34d, it abuts and presses against the second guide portion 34b or the holding and fixed portion 34d provided on the second guide portion 34b (see FIG. 14 ).

Further, after confirming that the guide wire 33 is fixed, the operator completely pulls out the guide catheter from the operation portion 11 side of the endoscope 1 to the outside of the treatment instrument insertion channel 26 . Then, the operator inserts a treatment instrument to be used next from the base end side of the guide wire 33 .

In this case, the operator inserts the treatment instrument into the treatment instrument insertion channel 26 while using the guide wire 33 as a guide. Furthermore, the operator operates the lift operation knob 16 when the front end of the treatment instrument touches the treatment instrument lifter 23 to put down the treatment instrument lifter 23 . Thus, when the treatment instrument passes through the treatment instrument lifting base 23 , the guide wire 33 is pushed out from the holding portion 23 c by the pressing force of the treatment instrument at this time, and the fixed state of the guide wire 33 is released. Furthermore, the operator further inserts the treatment instrument into the pancreas/biliary duct.

Therefore, according to the first embodiment, the guide wire 33 serving as the treatment instrument is pinched and mechanically fixed by the holding portion 23c of the treatment instrument lifting base 23 and the holding and fixing portion 34a of the contact portion 34 . Therefore, even when an external force is applied to the guide wire 33 due to movement of the insertion part, etc., the endoscope 1 according to the present embodiment can securely fix and hold the guide wire 33 on the holding part 23c of the treatment instrument raising base 23 appropriate location within.

In addition, the endoscope 1 of the present embodiment has the first guide portion 23b of the treatment instrument lifting base 23 and the second guide portion 34b of the abutting portion 34, so that when using a large-diameter treatment instrument including a catheter or the like, In the case of 33A, only by raising the treatment instrument lifting base 23, the second guide portion 34b can smoothly guide the large-diameter treatment instrument 33A including the catheter and other treatment instruments to a predetermined maximum lift position. Therefore, the endoscope 1 of the present embodiment can prevent longitudinal bending of the treatment instrument.

In addition, in the endoscope 1 of the present embodiment, the gripping surfaces of the holding portion 23c of the treatment instrument lifting base 23 and the holding and fixing portion 34a of the abutting portion 34 are formed in a circular shape or a groove shape, so that even with respect to the outer diameter The slightly different guide wire 33 can also be stably and firmly locked on the holding portion 23c.

In addition, in the first embodiment, the arrangement of the first guide portion 23b and the holding portion 23c of the treatment instrument lifting base 23, and the holding and fixing portion 34a and the second guide portion 34b of the contact portion 34 are arranged as follows: The guide wire 33 is fixed near the objective lens 24b side, but is not limited thereto.

That is, if it is arranged as in the present embodiment, the fixed state of the guide wire 33 fixed and held in the distal end portion 15 and the like can be reliably confirmed through the endoscopic image. In addition, contrary to the above-mentioned first embodiment, if the first guide part 23b and the holding part 23c of the treatment instrument lifting base 23, and the holding and fixing part 34a and the second guide part 34b of the contact part 34 are arranged so that the guide If the wire 33 is fixed on the opposite side of the objective lens 24b, since the fixed guide wire 33 is included, the field of view can be expanded, and therefore, the effect of improving the handling property can also be obtained.

(second embodiment)

Next, a second embodiment of the endoscope of the present invention will be described with reference to FIG. 15 .

15 is a partially exploded perspective view of a second embodiment of the endoscope according to the present invention, and is a partially exploded perspective view of the endoscope in a state where the driving arm of the distal end portion has been rotated. In addition, in FIG. 15 , the same reference numerals are assigned to the same constituent elements as those of the first embodiment, and description thereof will be omitted, and only different parts will be described.

As shown in FIG. 15 , in the distal end hard portion 24 of the endoscope 1 according to the second embodiment, a drive arm 42 for rotating the treatment instrument lifter 23 is provided. The driving arm 42 is rotatably disposed in the concave portion 40 by remote control operation. The outer peripheral part is formed by indentation. The surface of the recess 40 is blocked by a cover member 41 .

The cover member 41 is used to seal the opening of the recess 40 so that the driving arm 42 does not malfunction due to body fluids. In addition, the cover member 41 is detachably attached to the front end hard portion 24 by bonding with an adhesive having a low adhesive force, or by applying a sealant and then fixing it with screws.

The operation wire 36 for rotating the driving arm 42 is operated forward and backward by lifting the operation knob 16 of the operation part 11 . The wire connecting member 42 a fixed to the front end of the operating wire 36 is rotatably mounted in a wire communicating hole 42 b formed near the front end of the driving arm 42 .

In addition, although not shown, the drive arm 42 is integrally formed with a connecting shaft facing in a perpendicular direction on the base end side, and the connecting shaft is rotatably pivotally supported by the distal end rigid portion 24 . In addition, the angular shaft portion formed at the front end portion of the connecting shaft portion is fitted into the shaft hole of the treatment instrument lifting base 23 .

With such a structure, when the operation wire 36 is moved forward and backward, the driving arm 42 is connected through the connecting shaft portion (not shown), so the lifting base 23 of the treatment instrument and the driving arm 42 are rotated with the rotation shaft (the lifting base rotates). fulcrum) 28 (refer to FIG. 2) as the center to rotate.

In addition, the drive arm 42 is provided with a first chamfer 42c and a second chamfer 42c for preventing contact due to variations in machining tolerances of the drive arm 42 and the concave portion 40 .

In this embodiment, a first restricting portion 43 that restricts the rotation of the driving arm 42 toward the operation portion 11 is provided on the side near the concave portion 40 of the distal rigid portion 24 . There is a second restricting portion 44 that restricts the rotation of the drive arm 42 in the insertion direction.

The first restricting portion 43 and the second restricting portion 44 have abutting surfaces, and are formed such that the thick portion forming the recess 40 protrudes by a predetermined amount in the direction of the driving arm 42 . That is, by bringing the driving arm 42 into contact with the first and second restricting portions 43 and 44, the rotation range of the rotating driving arm 42 can be restricted.

In addition, in the present embodiment, as means for preventing the durability against the driving arm 42 from being lowered, the third restricting portion 25 a or 25 b for restricting the rotational movement of the treatment instrument raising base 23 is provided.

The third restricting portion 25a or 25b is provided at a predetermined position inside the front end cover 25, for example, as shown in FIG. 2 or FIG. 15 . That is, these 3rd restricting part 25a or 25b has a contact surface, and is formed so that it may protrude inward by a predetermined amount. That is, by causing the treatment instrument lifting base 23 to abut against the third restricting portion 25a or 25b, the rotational movement of the treatment instrument lifting base 23 is restricted. As a result, for the treatment instrument lifting base 23 connected The driving arm 42 may also limit its rotational range.

The other structures and functions are the same as those of the first embodiment.

Therefore, according to this embodiment, in addition to the effect of the first embodiment, since the movable range of the driving arm 42 can be restricted, as a result, the effect of improving the durability of the driving arm 42 can be obtained.

In addition, in the second embodiment, the structure in which the first to third restricting parts 43, 44, 25a (25b) are provided has been described, but not all of them may be provided, and the same structure may be obtained by providing at least one of them. Effect. In addition, the first to third restricting parts 43, 44, 25a (25b) are not limited to the thickness of the recessed part 40 and the shape of the protruding part on the bottom surface of the front end cover 25. Or the movable range of lifting the seat 23 of the treatment instrument.

(third embodiment)

Next, a third embodiment of the endoscope of the present invention will be described with reference to FIGS. 16 to 33 .

16 to 33 relate to the third embodiment of the endoscope of the present invention, and FIG. 16 is a perspective view showing the appearance structure of the front end of the endoscope in a state where the treatment instrument lifting base is down, and FIG. 17 is viewed from the front. Observing the perspective view of the front end of the endoscope in FIG. 16, FIG. 18 is a perspective view showing the appearance structure of the front end when the treatment instrument lifting base is raised, and FIG. 19 is a perspective view showing the appearance of the treatment instrument lifting base. , FIG. 20 is a front view of the lifting base of the treatment instrument in FIG. 19, FIG. 21 is an exploded perspective view showing the lifting base of the treatment equipment and the installed driving arm, and FIG. 22 shows the lifting base of the treatment equipment equipped with the driving arm Fig. 23 is a partial cross-sectional view showing the assembly state of the lifting base of the treatment instrument and the rotation shaft of the driving arm, Fig. 24 is a perspective view showing the front end of the endoscope showing the state of the driving arm, Fig. 25 shows A modified example is a partial sectional view showing the assembled state of the lifting base of the treatment instrument and the rotating shaft of the driving arm. FIG. 28 is a cross-sectional view of the protective tube and the coil through which the operating wire penetrates in this embodiment, and FIG. 29 is the coil in FIG. 28 . When the tube is damaged, the protective tube and the coiled tube for the operation wire to penetrate are shown in Fig. 30. It is a perspective view showing an insulating block. Fig. 31 is a perspective view showing an insulating block viewed from a different angle from Fig. 30. Fig. 32 is It shows the front view of the front end in the state where the lifting base and the insulating block are assembled on the hard part of the front end. Fig. 33 shows the front end in the state where the lifting base and the insulating block are assembled on the hard part top view of the section.

In addition, in the following description, the same code|symbol is attached|subjected to the same component as 1st, 2nd embodiment, and description is abbreviate|omitted, and only a different part is demonstrated.

As shown in FIGS. 16 and 17 , in the distal end portion 15 of the endoscope 1 according to the present embodiment, a treatment instrument lifting base 51 and an insulating block 61 as a contact portion are arranged. The treatment instrument lifting base 51 in the laid down state is housed in the housing chamber 22 as in the first embodiment. In addition, the treatment instrument lifting base 51 is rotated toward the insulating block 61 to be in a lifted state as shown in FIG. 33. Or a catheter, a treatment instrument such as a papillotomy knife as a high-frequency cautery treatment instrument.

As shown in FIGS. 19 and 20 , the treatment instrument lifting base 51 of the present embodiment has a contact surface 51a formed on one surface to contact the guide wire 33 or various treatment instruments as in the first embodiment. The contact surface 51a has the same structure as the contact surface 23a (see FIG. 4 ) in the first embodiment.

In addition, a treatment instrument holding portion (hereinafter referred to as a guide wire holding portion) 51b is formed on the upper portion of the contact surface 51a. The treatment instrument holding portion 51b has a guide surface 51d that also serves as a first guide portion. It is used to guide the narrow-diameter guide wire 33 while contacting it with the turning operation (lifting operation) of the treatment instrument lifting base 51 . The guide wire holding part 51b of this embodiment constitutes a part of the treatment instrument holding mechanism, and has the same structure as the first guide part 23b in the first embodiment.

In addition, the amount of inclination of the wire holding portion 51b or the amount of curvature (R) of the curved surface (R amount) is sufficient as long as the small-diameter wire 33 in contact can be smoothly guided to and held by the wire fixing portion 51c described later. Yes, it is not particularly limited.

In addition, the treatment instrument lifting base 51 of the present embodiment has a wall portion 52 upward from the side portion of the guide wire holding portion 51b forming the one surface of the abutment surface 51a, and the right side portion toward the paper surface in FIG. 20 . square protrusion. The wall portion 52 forms the side surface of the guide wire holding portion 51b, and is extended in the direction of a base end direction of a later-described guide wire fixing portion 51c constituting the holding and fixing of the treatment instrument lifting base 51. department.

As shown in FIG. 20 , when the treatment instrument lifting base 51 is viewed from the front, the wall portion 52 is formed in a substantially U-shape continuous with the curved surface of the guide wire holding portion 51 b that guides and holds the guide wire 33 and the like, and separates from the curved surface of the guide wire holder 51 b. The upper side of the guide wire holding part 51b is covered at a predetermined interval. Thus, the wall portion 52 hooks and holds the guide wire 33 guided by the guide wire holding portion 51b on the guide wire holding portion 51b.

In addition, on the above-mentioned surface facing the proximal direction from the guide wire holding part 51b of the treatment instrument lifting base 51, a guide wire fixing part 51c is provided in a manner connected to the guide wire holding part 51b, and the guide wire fixing part 51c becomes The holding and fixing part is used for clamping and fixing the guide wire 33 with a small diameter. In addition, the wire fixing portion 51c is formed as a part of the wire holding portion 51b, and has the same structure as the holding portion 23c in the first embodiment.

As shown in FIG. 19 , the guidewire fixing part 51c is formed to clamp and hold the guidewire 33 having a small diameter up to a predetermined outer diameter guided and held by the guidewire holding part 51b together with an insulating block 61 described later. The predetermined size of the control surface.

In addition, the guide wire 33 having a narrow diameter up to a predetermined diameter is used in normal treatment, and corresponds to a guide wire having a diameter of, for example, about 0.508 mm to about 1.016 mm (about 0.02 inch to about 0.04 inch). In addition, it is not limited to the guide wire 33 having such a diameter.

In addition, the shape of the grasping surface of the guidewire fixing part 51c is also the same as that of the first embodiment. In order to improve the holding force of the treatment instrument such as the narrow guidewire 33 to be clamped, for example, it may be formed in an arc shape, or It may also be formed in a substantially V-shaped groove shape. In addition, the holding surface of the guide wire fixing part 51c is formed in such a shape that the contact area of the clamped treatment instrument etc. is increased, and it is formed so that the holding force of the treatment instrument etc. can be improved in any shape.

For the lifting base 51 of the treatment instrument with the above structure, as shown in FIG. The lifting seat of the drive arm 42 drives the shaft 45 . The connection hole portion 54 is formed in a cubic shape with a rectangular hole surface, and is set to approximately the same size as the lifter drive shaft 45 of the drive arm 42 . In addition, a threaded hole 55 is drilled from the approximate center of one side of the connection hole 54 toward the side surface of the rotation support portion 53. is 45 degrees).

A fixing screw 56 is screwed into the threaded hole 55 to fix the lifter drive shaft 45 in the connection hole portion 54 of the rotation support portion 53 . In this way, as shown in FIG. 22 , the driving arm 42 is connected and fixed to the rotation supporting portion 53 of the lifting base 51 of the treatment instrument. In addition, a flange portion 46 is provided on the driving arm 42, and when the lifting base drive shaft 45 is mounted on the treatment instrument lifting base 51, the flange portion 46 abuts against one surface of the rotation support portion 53 to limit the position. .

In this embodiment, as shown in FIG. 23 , the fixing screw 56 abuts against the corner of one side of the drive shaft 45 of the lifting seat, and here, it abuts against the corner of the lower left side of the paper to lift the The seat drive shaft 45 is fixedly held in the connection hole portion 54 of the rotation support portion 53 . In this state, the lifting seat drive shaft 45 abuts against the two surfaces of the rotation support portion 53 forming the connecting hole portion 54, which are the two sides constituting the corners of the circular dashed line α in FIG. 23 . The surface that the two surfaces contact is the surface that the two surfaces that constitute the corner portion of the upper right oblique part of the paper surface contact.

Therefore, the rotation support portion 53 of the treatment instrument lifting base 51 and the driving shaft 45 of the lifting base are reliably fixed, thereby preventing loosening during assembly. Thereby, the fixing force between the treatment instrument lifting base 51 and the drive arm 42 can be ensured, and the lifting angle operation of the treatment instrument lifting base 51 can always be stably performed.

In addition, as shown in FIG. 24 , the driving arm 42 is accommodated in a concave portion 40 formed in a concave shape from the outer peripheral portion of the front end portion 15 as in the second embodiment. The lifting seat 51 of the treatment instrument is rotated by the loosening of the traction of the operating wire 36, so that the lifting seat 51 of the treatment instrument moves to the state of lifting and laying down.

In addition, the fixing screw 56 may be configured such that the abutting surface abutting against the lifting base drive shaft 45 is formed as a slope, or it may be configured such that when tightened, it is connected to the above-mentioned two corners forming the above-mentioned corner of the lifting base drive shaft 45 . One surface and the above-mentioned two surfaces forming the connection hole 54 are reliably abutted against.

Moreover, as shown in FIG. 25, the lifter drive shaft 45 may have the contact surface 45a formed by making the part which the fixing screw 56 contact|abuts a flat surface. As a result, the fixing screw 56 can be reliably brought into contact with the lifting base drive shaft 45 , and the fixing force between the treatment instrument lifting base 51 and the driving arm 42 can be further ensured. In addition, since the installation direction of the lifting base drive shaft 45 to the connection hole 54 is limited during assembly, it is possible to prevent the drive arm 42 from being incorrectly attached to the treatment instrument lifting base 51 .

However, the operation wire 36 used to pull the loose driving arm 42 to operate the treatment instrument lifting base 51 into the raised and lowered state is routed from the insertion portion 10 of the endoscope 1 to the operation portion 11 by using a coiled tube and Teflon. Long (registered trademark) catheter is covered by two layers of protective tubes. This is to prevent damage to the rubber of the bending part forming the outer skin of the bending part 14 due to the damaged section of the coil when the catheter is damaged for some reason, and the Teflon (registered trademark) catheter is used as the outermost outer skin. To wrap.

In the conventional structure, as shown in FIG. 26 , the protective tube 37 serving as a Teflon (registered trademark) conduit and the metal coil tube 38 are not in close contact, but a gap S exists. Therefore, when the coil tube 38 is damaged (cut, etc.) for some reason, the fractured surface of the damaged part B shown in FIG. , the inner surface of the protective tube 37 is damaged, and finally, the above-mentioned damaged portion B pierces the protective tube 37 , and the curved portion rubber of the curved portion 14 may be damaged.

In the present embodiment, as shown in FIG. 28 , the protective tube 37 and the coiled tube 38 are in close contact with each other. The protective tube 37 is a heat-shrinkable tube, and is heat-treated so as to be in close contact with the outer peripheral portion of the coiled tube 38 .

With such a structure, as shown in FIG. 29 , when the coiled tube 38 is damaged (cut, etc.) for some reason, the protective tube 37 is always in contact with the coiled tube even when the bending part 14 is bent. 38 is in close contact with the outer peripheral portion, so the coiled pipe 38 does not move freely, and therefore, the inner surface of the protection tube 37 is not damaged by the broken surface of the damaged portion B.

As a result, the damaged portion B of the coil tube 38 does not pierce the protection tube 37 and thus does not damage the bending portion rubber of the bending portion 14 .

Next, the insulating block 61 of this embodiment is demonstrated using FIG.30 and FIG.31.

The insulating block 61 of the present embodiment corresponds to the abutting portion 34 in the first embodiment, and has: a wire holding and fixing portion 61a for fixing the small-diameter guide wire 33; The guide wire guide part 61b of the curved inclined surface that holds the fixed part 61a to guide; the escape groove 61c for the end of the abutment surface 51a of the treatment instrument lifting base 51 to be embedded; and the wall part 52 for the treatment instrument lifting base 51 The embedded wall avoids the groove 61d.

The corner portion of the wire holding and fixing portion 61 a on the side of the wall escape groove 61 d is formed into a curved shape by chamfering, and the wire holding and fixing portion 61 a serves as an abutment surface against which the small diameter guide wire 33 abuts. In addition, the wire guide portion 61b is formed such that the corner portion on the side of the wall avoiding groove 61d is further chamfered from the lower side in a curved shape than the wire holding and fixing portion 61a.

In addition, reference numeral 62 is a holding and fixing portion for a large-diameter surgical instrument having the same structure, function, and effect as those of the first embodiment, and a detailed description of the holding and fixing portion 62 will be omitted.

As shown in FIGS. 32 and 33 , the treatment instrument lifter 51 and insulating block 61 of this embodiment configured as described above are assembled in the distal rigid portion 24 of the distal portion 15 in the same manner as the first embodiment.

In this assembled state, the guidewire fixing part 51c of the treatment instrument lifting base 51 and the guidewire holding and fixing part 61a of the insulating block 61 are arranged substantially on the same straight line. In detail, dotted lines L1 and L2 in FIG. 32 and FIG. 33 indicate the surface through which the trajectory formed by the movement of the guide wire fixing part 51c passes when the treatment instrument lifting base 51 is lifted by rotation.

The guidewire fixing part 51c of the treatment instrument lifting base 51 and the guidewire holding and fixing part 61a of the insulating block 61 are located within a plane including two lines L1 and L2. That is, the guidewire holding and fixing part 61 a of the insulating block 61 is located in a plane including the trajectory plane formed by the movement of the guidewire fixing part 51 c of the treatment instrument lifting base 51 .

As a result, the narrow guide wire 33 held by the guide wire fixing portion 51c of the treatment instrument lifting base 51 moves in the above-mentioned plane along with the lifting action of the treatment instrument lifting base 51, and is efficiently moved toward the bottom of the insulating block 61. The guide wire is guided by the fixing part 61a, and is reliably clamped and fixed by the lifting base 51 and the insulating block 61 of the treatment instrument.

Next, the operation of the endoscope 1 according to this embodiment will be described with reference to FIGS. 34 to 45 .

34 to 42 are perspective views showing the lifting base of the treatment instrument, the insulating block, and the guide wire with a small diameter corresponding to each stage for explaining the action of the third embodiment, and FIG. 34 shows that the guide wire is inserted. 35 is a view showing the state before the lifting operation of the treatment instrument lifting base viewed from a different angle from FIG. 34 , Fig. 36 is a diagram showing the initial state where the guide wire is guided to the guide wire holding part 51b by the guide surface of the treatment instrument lifting base, and Fig. 37 shows that the treatment instrument lifting base is further lifted and the guide wire is guided to the treatment instrument holding part Fig. 38 is a diagram showing the state after the wall portion of the lifting seat of the treatment instrument after further lifting enters the wall avoidance groove of the insulating block, and Fig. 39 shows that the guide wire is lifted by the treatment instrument lifting seat and Figure 40 is a diagram showing the guiding state of the guide wire based on the guide wire guide part of the insulating block, and Figure 41 is a view showing the guide wire being lifted by the treatment instrument at a different angle from that of Figure 39 Figure 42 is a diagram showing only the lifting base of the treatment instrument and the guide wire in the state after the guide wire is clamped and fixed by the lifting base of the treatment equipment and the insulating block, Figure 43 It is a diagram showing only the insulating block and the guide wire in the state where the guide wire is clamped and fixed by the lifting base of the treatment instrument and the insulating block. FIG. Figure 45 is a front view of the lifting base of the treatment instrument in Figure 44.

In the following description, it is assumed that the operator observes or treats the pancreaticobiliary duct using the endoscope 1 as in the first embodiment. In the description here, only the action of the state in which the guide wire 33 is clamped by the treatment instrument lifter 51 and the insulating block 61 of this embodiment will be described, and other operations will be the same as those of the first embodiment.

The operator inserts the guide catheter into the pancreas/biliary duct (not shown) through the nipple as in the first embodiment, and inserts the guide wire 33 from the joint on the proximal end side of the guide catheter. Furthermore, under X-ray fluoroscopy, it is confirmed that the distal end portion of the guide wire 33 has been inserted into the pancreas/biliary duct, and the proximal end side of the guide wire 33 is grasped by hand.

Next, the operator performs an operation of pulling out the guide catheter, and after confirming that the guide catheter has been pulled out from the nipple by observing the image, the operator pulls out the guide catheter sideways. Furthermore, the operator operates the lift operation knob 16 of the operation unit 11 .

When the lifting operation knob 16 of the operation part 11 is operated, the treatment instrument lifting base 51 in the laid down state shown in FIGS. 34 and 35 starts to lift. Furthermore, as the treatment instrument lifting base 51 is lifted, the guide wire 33 contacts the guide surface 51d shown in FIG. 35 by its own reaction force, and is guided by the guide wire holding portion 51b as shown in FIG. 36 .

Furthermore, when the treatment instrument lifting base 51 is lifted, the guide wire 33 is held by the guide wire holding portion 51b while being hooked by the wall portion 52 forming the side surface of the guide wire holding portion 51b. As shown in FIG. 37 , the treatment instrument lifting base 51 rotates toward the insulating block 61 side while maintaining the state where the guide wire 33 is hooked to the holding portion 51 b by the wall portion 52 , and further lifts up. At this time, since the guide wire 33 has a reaction force to maintain a straight line, it is firmly locked by being pressed into the guide wire fixing portion 51c of the treatment instrument lifting base 51 .

Furthermore, for the treatment instrument lifting base 51 that has been lifted further, as shown in FIGS. 38 and 39 , the wall portion 52 enters into the wall portion escape groove 61 d of the insulating block 61 . At this time, while the guide wire 33 is held by the guide wire holding portion 51b, as shown in FIG. Arrow M direction) guides and is guided.

Furthermore, as shown in FIG. 39 and FIGS. 41 to 43 , the guide wire 33 is firmly clamped by the guide wire fixing portion 51 c of the treatment instrument lifting base 51 and the guide wire holding and fixing portion 61 a of the insulating block 61 .

On the other hand, in the large-diameter treatment instrument 33A including a treatment instrument such as a catheter, as shown in FIG. Guided, but does not enter the guidewire fixing part 51c by abutting against the wall part 52, and is not held by the guidewire fixing part 51c. That is, as shown in FIG. 45 , the guide wire 33 passes through the wall portion 52 of the treatment instrument lifting base 51, is guided by the guide wire holding portion 51b, is hooked at the first position entering the guide wire fixing portion 51c, and becomes held. state, but the large-diameter treatment instrument 33A does not enter the wire fixing portion 51c through the wall portion 52, but is held at the second position hung on the contact surface 51a.

In other words, when the treatment instrument lifting base 51 is lifted, the guidewire holding portion 51b formed on the abutting surface 51a abutting against and holding the guidewire 33 or various large-diameter treatment instruments 33A is used to hold the guidewire. In the case of 33, it is guided to the guide wire fixing part 51c at the first position, and in the case of the large-diameter treatment instrument 33A having a predetermined diameter or more, it abuts and is held on the contact surface 51a at the second position. That is, the guide wire holding portion 51 b constitutes a lifter-side guide portion that guides the guide wire 33 or various large-diameter treatment instruments 33A as the treatment instrument lifter 51 is lifted.

That is, in the present embodiment, the wall portion 52 of the treatment instrument lifting base 51 is dimensioned so that the large-diameter treatment instrument 33A including a catheter and other treatment instruments, for example, having a diameter of 1.016 mm (0.04 inches) or more does not enter. Guide wire holding part 51b. Furthermore, since the function of holding and fixing the large-diameter treatment instrument 33A in the raised state of the treatment instrument lifting base 51 is the same as that of the first embodiment, description thereof will be omitted.

As described above, in the endoscope 1 of the present embodiment, the same effect as that of the first embodiment can be obtained, and by providing the side wall of the guide wire holding part 51 b on the treatment instrument raising base 51 The portion 52 can minimize the occurrence of unnecessary movements such as swinging the guide wire 33 or the large-diameter treatment instrument 33A to the left and right when the guide wire 33 or the large-diameter treatment instrument 33A is lifted while being hooked. . Therefore, for the operator, the decrease in operability and visibility caused by the unnecessary movement of the guide wire 33 or the large-diameter treatment instrument 33A projected on the screen of the monitor 4 can be prevented, and at the same time, the on-screen operation can be reduced. sense of incongruity.

The inventions described in the above embodiments are not limited to the embodiments and modifications, and various modifications can be made during the implementation stage without departing from the gist thereof. Furthermore, the above-described embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements.

For example, even if some structural elements are deleted from all the structural elements shown in the embodiment, when the problems described in the column of problems to be solved by the invention can be solved and the effects described in the effect of the invention can be obtained , the structure after the structural element is deleted can also be proposed as an invention.

While preferred embodiments of the present invention have been described with reference to the accompanying drawings, it should be understood that the present invention is not limited to the precise embodiments described above, and that those skilled in the art may devise without departing from the spirit or scope of the invention as defined in the appended claims. , with various changes and modifications.

Claims (15)

1. A kind of endoscope, this endoscope comprises: an insertion part having a front end on the front end side and used to be inserted into a body cavity; a channel for passing treatment instruments, which is arranged in the insertion part and communicates with the front end part; The treatment instrument lifting base has an abutment surface that abuts against the treatment instrument penetrating into the treatment instrument insertion channel, and is freely rotatably provided in the front end portion for Operation, through the abutment of the abutment surface, the treatment instrument is lifted; an abutment part, which is arranged in the front end part, and is configured to abut against the treatment instrument when the treatment instrument lifting base is lifted; A first guide part, which is provided on the abutment surface of the treatment instrument lifting base, and is used to guide the treatment instrument to the abutment surface along with the rotation movement of the treatment instrument lifting base reserved location; a holding unit provided on the abutting surface and the abutting portion for clamping the treatment instrument guided by the first guide portion up to a predetermined diameter between the abutting surface and the abutting portion; Between the abutting parts, there is a gripping surface with a predetermined size; and The second guide part is provided on the abutting part, and is used to guide and hold the treatment instrument exceeding the size of the holding surface of the holding unit in a direction away from the holding unit. 2. The endoscope according to claim 1, wherein: The first guide portion is configured as an inclined surface or a curved surface that guides the treatment instrument to an end portion of the contact surface of the treatment instrument lifting base. 3. The endoscope according to claim 2, wherein: The holding unit is configured such that the gripping surface is arranged at an end of the abutting surface when the treatment instrument lifting base is lifted. 4. The endoscope of claim 1, wherein: The second guide portion is configured as an inclined surface or a curved surface that guides the treatment instrument to a predetermined fixed position. 5. The endoscope according to claim 1, wherein: The treatment instrument is a guide wire. 6. The endoscope according to claim 5, wherein: The diameter of the guidewire is at least 0.508mm to 1.016mm. 7. An endoscope comprising: an insertion part having a front end on the front end side and used to be inserted into a body cavity; a channel for passing treatment instruments, which is arranged in the insertion part and communicates with the front end part; The treatment instrument lifting base has an abutment surface that abuts against the treatment instrument penetrating into the treatment instrument insertion channel, and is freely rotatably provided in the front end portion for Operation, through the abutment of the abutment surface, the treatment instrument is lifted; an abutment part, which is arranged in the front end part, and is configured to abut against the treatment instrument when the treatment instrument lifting base is lifted; a guide part, which is used to guide the treatment instrument to a predetermined position of the abutting part along with the rotation action of the treatment instrument lifting base; and a holding and fixing unit provided on the abutting surface and the abutting portion, and having a gripping surface for clamping the treatment instrument guided by the guide portion up to a predetermined size diameter between the abutting surface and the abutting portion. 8. The endoscope according to claim 7, wherein: The guide portion is a slope or a curved surface. 9. An endoscope comprising: an insertion part having a front end on the front end side and used to be inserted into a body cavity; a channel for passing treatment instruments, which is arranged in the insertion part and communicates with the front end part; a treatment instrument lifting seat, which is freely rotatably provided in the front end portion, and lifts the first treatment instrument or the second treatment instrument inserted into the treatment instrument penetration channel according to the operation of the operation part; a fixing member disposed at the front end and serving as a fulcrum when the treatment instrument lifter is operated to displace the direction of the first or second treatment instrument; a first treatment instrument holding part, which is provided on the treatment instrument lifting base, and holds the first treatment instrument penetrating into the treatment instrument insertion channel at a first position; a second treatment instrument holding part, which is provided on the treatment instrument lifting base, and holds the second treatment instrument inserted into the treatment instrument insertion channel at a second position different from the first position; holding and fixing units, which are respectively arranged on the treatment instrument lifting base and the fixing part, and are used to clamp the first treatment instrument lifted by the treatment instrument lifting base on the treatment instrument lifting base with the fixed part; and a guide part, which is provided on the fixing member, and does not guide the second treatment instrument lifted up with the rotation of the treatment instrument lifting base to the holding and fixing unit, but guides the second treatment instrument The first treatment instrument lifted by the turning operation of the lifting base is guided to the holding and fixing unit of the fixing member. 10. The endoscope according to claim 9, wherein: The holding and fixing unit of the fixing member is arranged in a plane including a trajectory plane on which the first treatment instrument holding unit moves according to the rotation operation of the treatment instrument raising base. 11. The endoscope according to claim 9, wherein: The guide portion is a slope or a curved surface formed on the fixing member. 12. The endoscope of claim 10, wherein: The guide portion is a slope or a curved surface formed on the fixing member. 13. The endoscope of claim 9, wherein: The first treatment instrument is a guide wire whose outer diameter is not more than a predetermined diameter, The second treatment instrument is a treatment instrument having an outer diameter larger than a predetermined diameter. 14. The endoscope of claim 9, wherein: The treatment instrument lifting base has an abutment surface abutting against the first or second treatment instrument penetrating into the treatment instrument passage, A lifting seat-side guide portion is formed on the abutting surface, and the lifting seat-side guide portion accompanies the rotation of the treatment instrument lifting base to abut and hold the first treatment instrument on the first treatment instrument. position, and a manner of abutting and holding the second treatment instrument at the second position. 15. The endoscope of claim 9, wherein: The first treatment instrument holder has a wall for hooking the first treatment instrument.

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