JP4504367B2 - Insertion device - Google Patents

Description

  The present invention relates to an insertion device used when an insertion portion of an endoscope is introduced in order to perform endoscopic examination in a body cavity, particularly in the large intestine.

  2. Description of the Related Art In recent years, an endoscope provided with an elongated and flexible insertion portion has been used for examination or treatment in the medical field. In this endoscope, by inserting the insertion portion into the body cavity, not only can an organ in the body cavity be observed without incision, but also a treatment instrument insertion channel provided in the insertion portion can be provided as necessary. Various treatments and treatments can be performed by introducing the treatment tool into the body cavity. In the endoscope, a bending portion is provided on the distal end side of the insertion portion. The bending portion is configured to bend in the vertical direction or the left-right direction, for example, by moving the operation wire connected to the bending piece constituting the bending portion back and forth. The operation wire is moved forward and backward by, for example, turning a bending knob provided in the operation unit.

  When performing endoscopy, the insertion section must be inserted into a complicated body cavity. When inserting the insertion portion into a complicated lumen such as a large intestine, such as the large intestine, the surgeon operates the bending knob to bend the bending portion and insert the bending portion. The distal end of the insertion portion is introduced toward the observation target site by performing a hand operation such as twisting the portion.

  However, skill is required before the insertion portion can be smoothly introduced in a short time without causing pain to the patient up to the complicated deep part of the large intestine. In other words, an inexperienced surgeon may lose sight of the insertion direction when inserting the insertion part to the deep part, or may take time to insert the insertion part, or when inserting the insertion part toward the deep part. There was a risk of deforming the running state of the car. For this reason, various proposals for improving the insertability of the insertion portion have been made.

  For example, Japanese Patent Application Laid-Open No. 10-113396 discloses a medical device propulsion device that can guide a medical device to a deep portion of a living body tube easily and with minimal invasiveness. In this propulsion device, the rotating member is provided with an inclined rib with respect to the axial direction of the rotating member. For this reason, by rotating the rotating member, the rotational force of the rotating member is converted into a propulsive force by the rib, and the medical device connected to the propulsion device is moved in the depth direction by the propulsive force.

  However, in the medical device propulsion apparatus disclosed in Japanese Patent Laid-Open No. 10-113396, a doctor or the like numerically confirms the insertion length of the propulsion apparatus when the propulsion apparatus is inserted into the large intestine, for example. I can't. For this reason, there is a problem that it is impossible to determine where the tip of the propulsion device is located in the large intestine.

  The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an insertion device capable of grasping the insertion length of an insertion portion and performing an insertion operation.

The insertion device of the present invention is constituted by a long member inserted into a subject, and the endoscope insertion portion is inserted when the endoscope insertion portion is inserted into the subject after being inserted into the subject in advance. A guide tube for guiding, a propulsive force generating portion provided on the outer surface of the guide tube, a rotating portion for rotating the propulsive force generating portion around the longitudinal axis of the guide tube, and an index member provided on the guide tube And a detector for detecting the indicator member, and an observation means for observing the inside of the subject is provided at the tip of the guide tube.

The figure explaining the structure of the endoscope system provided with the insertion apparatus The figure explaining the composition of a guide pipe The figure explaining the leading member provided in the front-end | tip part of a guide tube The figure explaining the structural example which made the leading member the capsule endoscope The figure explaining the other structural example of the guide tube provided with a capsule endoscope The figure explaining the guide tube which passes the sigmoid colon part of a large intestine The figure explaining the guide tube which passed the sigmoid colon part of the large intestine in a loop The figure explaining the guide tube which reached the sigmoid colon part The figure explaining the state which the guide tube is advancing in contact with the intestinal wall of the sigmoid colon and the mucous membrane FIG. 9 is a diagram for explaining a state in which the guide tube passes from the position shown in FIG. 9 while drawing the sigmoid colon in an α loop. The figure explaining the guide tube which passed the sigmoid colon part drawn in alpha loop The figure explaining the guide tube which provided the transponder which is an index member at equal intervals The figure explaining the composition of an insertion device

Embodiments of the present invention will be described below with reference to the drawings.
A first embodiment of the present invention will be described with reference to FIGS.
As shown in FIG. 1, the endoscope system 1 of the present embodiment is mainly composed of an endoscope 2 that is a medical device and includes an observation unit, and an insertion device 3.

  The endoscope 2 includes an insertion portion 11, an operation portion 12 provided on the proximal end side of the insertion portion 11, and a universal cord 13 extending from the side portion of the operation portion 12. The insertion portion 11 is configured by connecting a distal end rigid portion 14 in order from the distal end side, a bending portion 15 configured to be able to be bent in the vertical and horizontal directions, and a flexible tube portion 16 having flexibility. The operation unit 12 of the endoscope 2 is provided with a treatment instrument insertion port 17. The treatment instrument insertion port 17 is provided in the insertion portion 11 and communicates with a treatment instrument insertion channel for inserting a treatment instrument (not shown).

  The endoscope 2 includes a light source device 4, a video processor 5, and a monitor 6 as external devices. The light source device 4 supplies illumination light to the endoscope 2. The video processor 5 has a signal processing circuit, and supplies a drive signal for driving an image pickup device (not shown) provided in the endoscope 2 and also receives an electrical signal that is photoelectrically converted by the image pickup device and transmitted. The video signal is converted into a video signal, and the generated video signal is output to the monitor 6. An endoscope image is displayed on the screen of the monitor 6 in response to the video signal output from the video processor 5.

The insertion device 3 is mainly composed of a guide tube 21 as an insertion portion and a guide tube rotating device 22.
The guide tube rotating device 22 includes a motor 23 that is a rotating portion and a guide tube fixing portion 24. The motor 23 mainly rotates the guide tube 21 in the left direction around the longitudinal axis (hereinafter abbreviated as “around the axis”) in the insertion direction. The motor 23 is installed on a table 25a of a cart for rotating device (hereinafter abbreviated as cart) 25. The cart 25 is, for example, arranged near the bed 8 on which the patient 7 lies. Specifically, the motor 23 is fixed to a predetermined fixing member (not shown) on the table 25a. In this case, the motor shaft 23 a of the motor 23 is set to be parallel to the upper plane of the base 25 a of the cart 25.

  A guide tube fixing portion 24 is integrally fixed to the motor shaft 23 a of the motor 23. The guide tube fixing portion 24 is detachably attached with a proximal end portion which is one end portion of the guide tube 21. Then, in a state where the guide tube 21 is attached to the guide tube fixing portion 24, the motor 23 is set in a driving state so as to rotate counterclockwise. Then, the motor shaft 23a of the motor 23 rotates, and the guide tube 21 attached to the guide tube fixing portion 24 fixed integrally with the motor shaft 23a is rotated leftward about the shaft.

  The guide tube 21 is covered with a protective tube 26 made of a tubular member. The protective tube 26 prevents the guide tube 21 from directly touching the floor or the like in the operating room. The protective tube 26 is provided with an inner hole, and the guide tube 21 is inserted into the inner hole in a loosely fitted state. Both end portions 26a and 26b of the protective tube 26 are detachably attached and fixed to the protective tube holding members 27 and 28, respectively. Here, the one protective tube holding member 27 is disposed on the bed 8 via a stand 29 whose height position can be adjusted, for example. On the other hand, the other protective tube holding member 28 is disposed on a table 25 b provided in the cart 25 at a position facing the motor 23. Instead of the protective tube 26, for example, a concave member or the like having one surface opened in the longitudinal direction and having flexibility as a whole, such as a rain gutter shape, may be disposed.

  Next, the guide tube 21 will be described with reference to FIG.

  The guide tube 21 shown in FIG. 2 is a spiral tube in consideration of flexibility. The guide tube 21 is made of, for example, a stainless steel metal wire 21a, which is a wire member having a predetermined diameter, left-handed from the distal end toward the proximal direction. In this embodiment, the metal guide wire 21a is wound in two layers to form the spiral guide tube 21. That is, the guide tube 21 is wound so as to have a spiral in the same direction as the thread groove of the left-hand thread. In the present embodiment, the winding direction of the metal strand 21a constituting the guide tube 21 is left-handed. Accordingly, the outer surface of the guide tube 21 is provided with a spiral-shaped portion 21b which is a thrust generating portion having a left-handed spiral groove formed by the surface of the metal strand 21a from the distal end toward the proximal end.

  The diameter of the guide tube 21 is set so that it can be inserted into the treatment instrument insertion channel of the endoscope 2. Further, the guide tube 21 is not limited to the one formed by winding the metal wire 21a into two layers, but may be formed by winding it into multiple lines, for example, four lines. Further, when the metal strand 21a is wound in a left-handed spiral shape from the distal end toward the proximal direction, the guide tube can be changed by changing the degree of adhesion between the metal strands 21a or changing the angle of the spiral. Various characteristics can be set.

  As shown in FIG. 3, the guide tube 21 is provided with a leading member 30 at the tip. The leading member 30 includes a wire shaft member (hereinafter abbreviated as a wire member) 31 and a leading element 32 that is a substantially spherical body constituting a curved surface guide portion. The wire member 31 is fixed so as to extend from the distal end surface of the guide tube 21. For example, the guide 32 is fixed to the tip of the wire member 31. In the large intestine, the guide tube 21 provided with the leading member 30 can easily get over the guiding surface, which is the surface of the leading element 32, without being caught by a fold of the large intestine. That is, by providing the leading member 30 having the leading element 32 at the distal end portion of the guide tube 21, the insertability can be further improved.

In addition, you may make it arrange | position the endoscope capsule 2A shown in FIG. 4 and FIG.
The endoscope capsule 2A shown in FIG. 4 is configured in a small capsule shape, and a guide surface 2a which is a curved surface guide portion formed of a hemispherical portion is provided at the distal end portion. The endoscope capsule 2 </ b> A is disposed at the distal end portion of the guide tube 21 via a fixing member 41. In the large intestine, the guide tube 21 can easily get over the guide surface 2a formed of the hemispherical portion of the endoscope capsule 2A without being caught by a fold or the like of the large intestine. That is, by providing the endoscope capsule 2A at the distal end portion of the guide tube 21, it is possible to improve the insertability in the same manner as described above.

  Note that a bearing 41 a is provided between the endoscope capsule 2 </ b> A and the fixing member 41. By providing the bearing 41 a, the endoscope capsule 2 </ b> A is disposed so as to be rotatable with respect to the guide tube 21. Therefore, the rotation of the guide tube 21 is prevented from being transmitted to the endoscope capsule 2A. In other words, even when the guide tube 21 rotates, the endoscope capsule 2A does not rotate with it.

  In addition, an observation optical system 42 including, for example, an image sensor (not shown) and an illumination optical system 43 including a plurality of light emitting diodes are provided on the guide surface of the endoscope capsule 2A. A signal line extending from the imaging device and a power line extending from the light emitting diode are inserted as a signal cable 44 through the guide tube interior 45 and the motor 23 and connected to the processor 5A, for example. The processor 5A performs various signal processing in response to drive control of the endoscope capsule 2A and signals from the endoscope capsule 2A. As a result, the endoscope image captured by the image sensor is displayed on the screen of the monitor 6 connected to the processor 5A without rotating.

  Therefore, in the guide tube 21 configured in this way, an endoscopic image captured by the endoscope capsule 2A is displayed on a monitor, and a propulsive force is obtained while observing the inside of the large intestine, thereby obtaining a desired in-body cavity. It is possible to safely and smoothly insert into the region.

  In addition, as shown in FIG. 5, you may make it comprise the diameter dimension of the guide tube 21A by the substantially same dimension as the outer diameter of the endoscope capsule 2A. In this case, the diameter of the fixing member 41A is also adjusted according to the diameter of the guide tube 21A. As a result, the guide tube 21 shown in FIG. 4 has a small diameter and excellent flexibility, whereas the guide tube 21A shown in FIG. ing. Therefore, the region for obtaining the propulsive force when inserting the endoscope capsule 2A into the body cavity can be expanded to the vicinity of the endoscope capsule 2A, and the insertion work by the propulsive force can be performed more easily.

Hereinafter, the operation of the endoscope system 1 will be described.
First, preparation for inserting the guide tube 21 into, for example, the large intestine will be described.
When inserting the insertion portion 11 of the endoscope 2 up to, for example, the cecum 100g (see FIG. 6 and the like) of the large intestine, a medical person such as a doctor or a nurse (hereinafter referred to as a staff member) The guide tube 21 having a diameter size and flexibility is prepared. Then, the respective end portions of the protective tube 26 are fixed to the protective tube holding members 27 and 28. Next, the guide tube 21 is inserted through the tube of the protective tube 26. Then, the base end portion of the guide tube 21 protruding from the protective tube 26 is attached to the guide tube fixing portion 24 fixed to the motor shaft 23 a of the motor 23. On the other hand, the other end side of the guide tube 21 is disposed on the bed 8 or the stand 29, for example. This completes the preparation for inserting the guide tube 21 into the large intestine.

The procedure for inserting the guide tube 21 toward the deep part of the large intestine will be described with reference to FIGS.
As shown in FIG. 6, the large intestine is in order from the anus 100 toward the deep part of the body cavity, the lower rectal part 101a, the upper rectal part 101b, the rectal sigmoid part 101c, the sigmoid colon part 100a, the descending colon part 100b, and the spleen A curved portion 100c, a transverse colon portion 100d, a liver curved portion 100e, an ascending colon portion 100f, and a cecum portion 100g are provided. The rectal group consisting of the lower rectal portion 101a, the upper rectal portion 101b, and the rectal sigmoid portion 101c, the descending colon portion 100b, and the ascending colon portion 100f are fixed to the peritoneum, and the other portions have mobility.

  First, in the state where the patient 7 is laid on the bed 8 as shown in FIG. 1, the operator inserts the guide tube 21 from the anus 100 shown in FIG. Then, the outer surface of the guide tube 21 comes into contact with the intestinal wall. At this time, the contact state between the spiral-shaped portion 21b formed on the outer surface of the guide tube 21, the intestinal wall fold, and the mucous membrane becomes the relationship between the male screw and the female screw.

  In this inserted state, the surgeon drives the motor 23 of the guide tube rotating device 22 in a predetermined direction. Then, the leftward rotation of the motor shaft 23 a of the motor 23 is transmitted to the guide tube 21. As a result, the guide tube 21 rotates in the left direction around the axis from the proximal end toward the distal end. At this time, the driving force of the same action as the left-hand screw acts on the guide tube 21. That is, in the guide tube 21, the male screw turns into the female screw while generating a propulsive force by bringing the spiral-shaped portion 21 b of the guide tube 21 into contact with the lower rectal portion 101 a and the intestinal wall of the upper rectal portion 101 b and the mucous membrane. It moves forward toward the deep part of the large intestine while rotating counterclockwise so as to move. That is, the guide tube 21 inserted from the anus 100 passes through the rectum, which is the lower rectal portion 101a, the upper rectal portion 101b, and the rectal sigmoid portion 101c, and proceeds to the sigmoid colon portion 100a.

  As shown in FIG. 6, when the guide tube 21 passes through the sigmoid colon portion 100a of the large intestine, if the guide tube 21 is bent at an extreme bending angle, it becomes very difficult to pass toward the deep portion. This is because the curved portion of the sigmoid colon portion 100a has easy movability such as movement and expansion / contraction, and the intestinal wall is pushed by the bent portion of the guide tube 21, and the sigmoid colon portion 100a is deformed. The curved portion is a curved portion that is extremely bent. Then, the curved portion of the sigmoid colon 100a is made into a curved portion that is extremely bent, which may cause pain to the patient.

  On the other hand, as shown in FIG. 7, the guide tube 21 is passed through the sigmoid colon portion 100a so as to draw an α-shaped loop (hereinafter simply referred to as α loop) from the rectal S-shaped portion 101c side. . Then, the guide tube 21 is inserted into the sigmoid colon 100a more smoothly than the guide tube 21 passes through the extremely bent portion of the sigmoid colon 100a shown in FIG. It is not given. That is, when the guide tube 21 is inserted toward the deep part of the large intestine, the sigmoid colon portion 100a is formed in an α loop shape, thereby improving the insertability.

  The action when the guide tube 21 passes through the large intestine, here, the sigmoid colon 100a will be described with reference to FIGS.

  As shown in FIG. 8, the sigmoid colon 100a is normally in a folded state, that is, in a contracted state. The guide tube 21 passes through the rectal group while rotating counterclockwise and reaches the sigmoid colon portion 100a. At this time, the distal end of the guide tube 21 contacts the curved portion of the sigmoid colon portion 100a. Then, the guide tube 21 is temporarily in an idle state by being prevented from progressing inside the rectal group. That is, the guide tube 21 performs a counterclockwise rotation.

  Here, the left-handed metal strand 21a constituting the guide tube 21 receives a twisting stress in the strangling direction. In other words, the guide tube 21 receives a torsional moment in the left direction with respect to the traveling direction and is twisted to the left rotation direction side. Then, a slip change and a shear stress are generated inside the metal strand 21a, while a reaction force that tries to avoid a slip change and a shear stress in the left direction acts on the metal strand 21a. For this reason, the guide tube 21 tends to move from the tip side to the right side toward the paper surface of FIG. That is, as shown by the arrow in FIG. 8, the guide tube 21 is moved to the right intestinal wall side toward the paper surface in the lower rectal portion 101a, the upper rectal portion 101b, and the rectal sigmoid portion 101c.

  As a result, the spiral-shaped portion 21b of the guide tube 21 is in a state of reliably contacting the intestinal wall of the sigmoid colon portion 100a and the mucous membrane. At this time, the guide tube 21 is always pressed against the intestinal wall on the outer peripheral side of the inner contour of the curved portion of the sigmoid colon portion 100a. Therefore, the spiral-shaped portion 21b of the guide tube 21 moves toward the deep portion while rotating counterclockwise so that the male screw moves relative to the female screw while reliably contacting the folds and mucous membranes of the intestinal wall.

  Thereafter, as shown in FIG. 9, the guide tube 21 advances so as to draw a loop along the curved portion of the sigmoid colon 100a while extending the sigmoid colon 100a. In addition, the guide tube 21 is surely applied to the intestinal wall and the mucous membrane of the intestinal wall of the sigmoid colon portion 100a by the repulsive force generated by being bent along the curved portion. Close contact. For this reason, the guide tube 21 further proceeds while drawing a loop along the curved portion of the sigmoid colon portion 100a.

  As the guide tube 21 continues to advance for a while, the sigmoid colon portion 100a is extended to draw an α loop as shown in FIG. When the contraction force of the sigmoid colon portion 100a having the α loop shape is applied to the guide tube 21, the guide tube 21 enters a state of progressing toward the curved portion on the descending colon portion 100b side.

  Thus, as shown in FIG. 11, the guide tube 21 advances to the descending colon portion 100b while extending the sigmoid colon portion 100a into an α loop shape. That is, the distal end portion of the guide tube 21 has a twisting moment to the left in the traveling direction due to the left rotation, a repulsive force generated when the guide tube 21 is bent, a contraction force of the α loop of the sigmoid colon portion 100a, and the like. The sigmoid colon portion 100a comes into contact with the outer peripheral side of the inner contour of the curved portion, that is, the intestinal wall on the side with the larger bending angle to generate a propulsive force and smoothly proceed and pass.

  In the large intestine, the distal end portion of the guide tube 21 that has passed through the sigmoid colon portion 100a that is most difficult to pass advances while contacting the intestinal wall and mucous membrane of the descending colon portion 100b. In the spleen curved portion 100c between the descending colon portion 100b and the transverse colon portion 100d and the liver curved portion 100e between the transverse colon portion 100d and the ascending colon portion 100d shown in FIG. The twisting moment to the left in the direction of travel due to the left rotation and the repulsive force generated by bending the guide tube 21 work. For this reason, the guide tube 21 is in contact with the intestinal wall on the outer periphery side of the curved portion, that is, the intestinal wall on the side with a large bending angle to generate a propulsive force so that it smoothly proceeds and passes through the vicinity of the cecal portion 100g. To reach.

  If the guide tube 21 reaches the vicinity of the cecum part 100g as described above, the operator inserts the insertion part 11 of the endoscope 2 into the large intestine. At that time, the operator first removes the guide tube 21 from the protective tube 26 and then inserts the proximal end portion of the guide tube 21 into the treatment instrument insertion channel from the distal end surface of the distal end rigid portion 14. Then, the surgeon projects the proximal end portion of the guide tube 21 from the treatment instrument insertion port 17.

  Here, in order to insert the insertion portion 11 into the large intestine, the endoscope 2 is brought into an observable state. Then, the distal end portion of the insertion portion 11 is inserted from the anus 100 into the large intestine while the guide tube 21 is inserted into the treatment instrument insertion channel. Then, an image in the large intestine illuminated by illumination light emitted from the illumination window provided on the distal end surface of the distal rigid portion 14 is displayed on the screen of the monitor 6.

  Here, the surgeon confirms the extending direction of the guide tube 21 inserted into the large intestine. Then, an operation for bending the bending portion 15 and an operation for twisting the insertion portion 11 are performed, and the distal end portion of the insertion portion 11 is pushed toward the deep part of the large intestine while confirming the traveling direction of the guide tube 21. At this time, since the guide tube 21 serves as a mark indicating the insertion direction, the insertion direction is not lost. Therefore, the surgeon can smoothly perform the insertion operation of inserting the insertion portion 11 of the endoscope 2 up to the vicinity of the cecum 100g.

  Then, when the operator confirms on the screen of the monitor 6 that the insertion portion 11 has reached the vicinity of the cecum portion 100g, the surgeon shifts to endoscopic examination in the large intestine. At that time, for example, the insertion portion 11 is pulled back while the guide tube 21 is inserted into the treatment instrument insertion channel. That is, the large intestine is observed with an endoscope while the endoscope 2 is pulled back.

  In addition, when performing an endoscopic observation of the large intestine, the surgeon may previously remove the guide tube 21 from the treatment instrument insertion channel of the endoscope 2 and then perform the endoscopic observation.

  When the guide tube 21 is returned from the deep part of the large intestine to the anus while the insertion portion 11 of the endoscope 2 is inserted into the large intestine, the operator again performs the above-described guide tube 21. Work to advance toward the deep part of the large intestine. At this time, the base end portion of the guide tube 21 is attached to the guide tube fixing portion 24 fixed to the motor shaft 23 a of the motor 23 in a state where the guide tube 21 is inserted into the treatment instrument insertion channel. Accordingly, the surgeon causes the distal end portion of the guide tube 21 to reach, for example, the vicinity of the cecal portion 100g, and then performs the operation of inserting the insertion portion 11 of the endoscope 2 again toward the target site.

  As a result, according to the endoscope system 1 according to the present embodiment, the motor 23 is driven to rotate the motor shaft 23a in a predetermined direction with the guide tube 21 inserted into the large intestine or the like that is a lumen. Thus, the guide tube 21 can be rotated leftward about the axis. At this time, the spiral-shaped portion 21b, which is a left-handed spiral shape provided on the outer surface of the guide tube 21, is in contact with the intestinal wall and the mucous membrane. Therefore, the guide tube 21 can advance toward the deep portion in the large intestine while generating a propulsive force in which the male screw moves relative to the female screw.

  Further, by providing the guide tube 21 with the left-handed spiral-shaped spiral-shaped portion 21b, when the distal end portion of the guide tube 21 reaches the sigmoid colon portion 100a or each curved portion, the guide tube 21 rotates around the axis. It is rotated to the left. For this reason, the guide tube 21 is moved to the intestinal wall side where the bending angle is large at the curved portion by the twisting moment to the left, and comes into contact so that the spiral-shaped portion 21b of the guide tube 21 is pressed against the intestinal wall. As a result, the guide tube 21 continues to advance by generating a stable driving force. Therefore, the surgeon can smoothly and easily reach the vicinity of the cecum 100g of the large intestine by the propulsive force generated from the guide tube 21. Thereafter, by marking the guide tube 21 to indicate the insertion direction, the insertion portion 11 of the endoscope 2 can be easily inserted to the vicinity of the cecum 100g of the large intestine without losing sight of the insertion direction.

  Furthermore, in the guide tube 21 provided with the spiral-shaped portion 21b which is a left-handed spiral shape, the guide tube 21 is moved to the intestinal wall side having a large bending angle in the curved portion by the twisting moment to the left side. For this reason, when the guide tube 21 passes through the sigmoid colon portion 100a, which is difficult to insert the insertion portion 11 of the endoscope 2 and is causing pain to the patient when the insertion portion 11 is inserted, this S-shape. The colon portion 100a can be formed in an α loop shape that reduces the burden on the patient.

  In the guide tube 21 of this embodiment, the metal wire 21a is wound to form a spiral portion 21b so as to form a spiral in the same direction as the thread groove similar to the left screw. A spiral groove similar to the thread groove of the left-hand thread may be simply formed on the outer surface of the flexible member.

A second embodiment of the present invention will be described with reference to FIGS.
In the description of the insertion device 9 in the present embodiment, the same configuration and operation as those of the insertion device 3 in the first embodiment are denoted by the same reference numerals and description thereof is omitted. Moreover, you may make it comprise the endoscope system 1 combining with the endoscope 2 similarly to 1st Embodiment.

  As shown in FIG. 12, in the guide tube 21B of the present embodiment, a plurality of transponders 50 are arranged at regular intervals, for example, at 100 mm intervals, in the guide tube. The transponder 50 is an index member and transmits radio waves having a predetermined frequency. Similar to the guide tube 21 of the first embodiment, the guide tube 21B of the present embodiment is a spiral tube considering flexibility. For example, a metal strand 21a made of stainless steel and having a predetermined diameter is formed from the tip. It is formed in two layers by winding it counterclockwise toward the base end. Accordingly, the spiral-shaped portion 21b is provided on the outer surface of the guide tube 21B.

  As shown in FIG. 13, the insertion device 9 is mainly configured by a guide tube 21 </ b> B and a guide tube rotating device 22. The guide tube rotating device 22 includes a motor 23 and a guide tube fixing portion 24. The motor 23 rotates the guide tube 21B mainly in the left direction around the axis. For example, a radio frequency detection device (hereinafter referred to as a receiving antenna) 51 as a detection unit is installed on the bed 8 near the anus of the patient 7. The receiving antenna 51 is provided with a receiving unit 51a that receives a radio wave having a predetermined frequency transmitted from the transponder 50. A movable arm 55 a is fixed to one side of the bed 8. The movable arm 55a is provided with an X-ray imaging apparatus 55 as imaging means.

  The receiving antenna 51 is connected to the reader 52 via a signal cable. The reader 52 generates a detection result based on the detection signal received by the reception unit 51a and output from the reception antenna 51, and outputs the detection result as a detection signal. The X-ray imaging apparatus 55 is connected via a signal cable to a processor 53 on which an integrated circuit and the like constituting a calculation unit, an image processing unit, and the like are mounted. The reader 52 and the processor 53 are electrically connected. The processor 53 is connected to a monitor 54 which is a display means and also serves as a notification means.

The processor 53 receives the detection signal output from the reader 52, and calculates the movement distance of the guide tube 21B by the calculation unit 53a. Thereafter, the processor 53 outputs the calculation result to the monitor 54 as a control signal for displaying numerical values, for example. As a result, a numerical value indicating the insertion length is displayed on the screen of the monitor 54. Instead of displaying a numerical value for notifying the insertion length on the screen of the monitor 54, the insertion length may be notified by voice or the insertion length information to the communication terminal may be notified.
Here, the operation of each device when the guide tube 21B is inserted into the deep part of the large intestine of the patient 7 will be described. Since the procedure for inserting the guide tube 21B of the present embodiment into the large intestine of the patient 7 and the procedure for inserting the endoscope 2 into the large intestine are described in the first embodiment described above, Description is omitted.

  The surgeon advances the guide tube 21B into the large intestine of the patient 7. At that time, the transponder 50 provided in the tube of the guide tube 21B inserted by the operator passes over the reception antenna 51. Then, the radio wave transmitted from the transponder 50 is detected by the receiving unit 51a of the receiving antenna 51. Then, the detection signal is output from the receiving antenna 51 to the reader 52. The reader 52 acquires a detection result based on the detection signal, and outputs the detection result to the processor 53 as a detection signal. In the processor 53, the insertion length of the guide tube 21 </ b> B inserted in the large intestine of the patient 7 is calculated by the calculation unit 53 a based on the detection signal output from the reader 52. Then, a control signal including the calculation result is output to the monitor 54. As a result, the insertion length is displayed as a numerical value on the screen of the monitor 54.

  Here, a plurality of transponders 50 are built in the guide tube 21B at intervals of 100 mm. Therefore, every time one transponder 50 passes through the receiving antenna 51, the guide tube 21B is inserted into the large intestine by a length of 100 mm.

  The processor 53 and the guide tube rotating device 22 may be electrically connected so that a stop signal or a drive signal is output from the processor 53 to the guide tube rotating device 22. According to this configuration, the operator registers in advance as the insertion length how much the guide tube 21B is inserted into the body cavity in the processor 53. Thus, when the processor 53 determines that the insertion length of the guide tube 21B has reached a pre-registered insertion length, a stop signal can be output from the processor 53 to the guide tube rotating device 22. As a result, the driving of the motor 23 for rotating the guide tube 21B is stopped, and the progress of the guide tube 21B by the propulsive force is stopped.

  Further, the processor 53 may be provided with a function of driving the X-ray imaging apparatus 55 in accordance with the insertion length of the guide tube 21B into the large intestine. Thus, the processor 53 outputs a drive signal to the X-ray imaging apparatus 55 when the insertion length of the guide tube 21B reaches a designated value. Then, the X-ray imaging apparatus 55 performs X-ray imaging based on the drive signal, and outputs an X-ray imaged image signal to the processor 53. The processor 53 generates a video signal from the input X-ray image signal and outputs it to the monitor 54. As a result, an X-ray image of the large intestine through which the guide tube 21B is inserted is displayed on the screen of the monitor 54.

  That is, when the transponder 50 built in the guide tube 21B passes over the receiving antenna 51, the insertion length of the guide tube 21B into the large intestine is automatically calculated by the processor 53. Then, the processor 53 compares the calculated insertion length with the registered insertion length. Here, if the processor 53 determines that the calculated insertion length matches the insertion length registered in advance, the processor 53 outputs a drive signal to the X-ray imaging apparatus 55 to output the large intestine of the patient 7. Perform X-ray imaging. Then, the image captured by the X-ray imaging apparatus 55 is output to the monitor 54 via the processor 53.

  As a result, an X-ray image of the large intestine of the patient 7 is displayed on the screen of the monitor 54. At this time, the guide tube 21 is displayed on the X-ray image of the large intestine displayed on the monitor 54. Therefore, the surgeon can visually grasp the insertion state and the insertion shape of the guide tube 21 in the large intestine. Note that the X-ray imaging apparatus 55 can also perform X-ray imaging by manual operation by staff such as an operator.

  As a result, according to the insertion device of the present embodiment, in addition to the effects of the first embodiment, the operator can grasp the insertion length of the guide tube inserted in the large intestine. Thus, the surgeon can perform the insertion work using this insertion length as a guide for inserting the guide tube 21B up to the cecum 100g.

  Further, by registering the insertion length of the guide tube 21B in advance, when the guide tube 21B is inserted into the large intestine, the guide tube rotating device 22 can be stopped at a desired insertion length. Thus, the guide tube 21B can be prevented from being inserted into the deep part of the large intestine beyond a predetermined length. Therefore, an insertion device with high safety is realized.

  Furthermore, the surgeon can grasp the insertion state and insertion shape of the guide tube 21 inserted in the large intestine from the X-ray image displayed on the monitor 54. Therefore, it can be easily confirmed whether or not the guide tube 21 is smoothly inserted in the large intestine.

  In the above-described embodiment, the transponder transmits radio waves. However, the transponder is not limited to radio waves, and may generate a magnetic field, light, sound, or the like, and can detect it.

  Note that the present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the spirit of the invention.

Claims (1)

A guide tube configured to be inserted into the subject and previously inserted into the subject, and then guiding the endoscope insertion portion when the endoscope insertion portion is inserted into the subject;
A propulsive force generator provided on the outer surface of the guide tube;
A rotating part for rotating the propulsive force generating part around the longitudinal axis of the guide tube;
An indicator member provided on the guide tube;
A detector for detecting the indicator member;
Equipped with,
An insertion device characterized in that an observation means for observing the inside of a subject is provided at the tip of the guide tube .

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