JP5244335B2 - Self-propelled endoscope - Google Patents

Description

  The present invention relates to a self-propelled endoscope having an insertion portion that is automatically inserted into a duct.

  In recent years, endoscopes are widely used in the medical field and the industrial field. An endoscope used in the medical field observes an organ in a body cavity by inserting an elongated insertion portion into a body cavity, or inserts into an insertion channel of a treatment instrument provided in the endoscope as necessary. Various treatments can be performed using the treatment tool.

  A bending portion configured to be able to be bent in at least four directions of up and down and left and right is provided on the distal end side of the insertion portion of the endoscope. The bending portion is bent in a predetermined direction by operation of a bending operation member provided in the operation portion on the proximal side of the endoscope.

  When inserting an insertion portion of a medical endoscope into a large intestine via a duct in a body cavity, for example, an anus, an operator must perform a twisting operation and a feeding operation on a portion outside the body cavity of the insertion portion. Thus, the insertion portion is advanced in the large intestine, and the bending portion is bent in the large intestine by bending the bending operation member provided in the operation portion to advance the insertion portion. A technique is generally known in which the insertion portion is inserted up to a test site in the large intestine by such a twisting operation and feeding operation of the insertion portion and a bending operation of the bending portion. The above method is the same even when the industrial endoscope is inserted into a pipe having refraction.

  By the way, for example, in a medical endoscope, when the insertion portion is advanced in a duct in a body cavity, for example, when the duct in the body cavity is the large intestine, the inside of the large intestine is crushed and the inner diameter of the duct is reduced. For example, when the subject is a child, if the diameter in the large intestine is small, there is a problem that it is difficult to advance the insertion portion and it is difficult to bend the curved portion in the bent portion of the large intestine.

In view of such a problem, in Patent Document 1, a balloon that can be inflated and contracted is provided on the proximal end side of the bending portion, and the balloon is inflated to expand the duct in the body cavity so that the insertion portion can easily advance. A technique is also disclosed in which the proximal end side of the bending portion is fixed to the duct in the body cavity with the inflated balloon so that the bending portion can be easily bent. Patent Document 2 discloses a technique for fixing the distal end side of the insertion portion with respect to the duct in the body cavity by using a plurality of balloons provided on the distal end side of the insertion portion.
JP 2000-262487 A JP-A-10-127564

  Here, the insertion operation to the insertion portion of the endoscope as described above is skillful until it can be smoothly performed in a short time to the deep portion of the large intestine, particularly in the large intestine having a complicated and complicated shape. Cost.

  Therefore, an inexperienced surgeon may take time for the operation or change the running state of the intestine, for example, by losing sight of the insertion direction of the insertion portion when performing the insertion operation.

  Therefore, even an inexperienced operator needs an endoscope that can easily insert an insertion portion of an endoscope into a duct in a body cavity and can advance the insertion portion to a site to be examined. Various proposals have been made to improve the insertability of the insertion portion.

  For example, in Patent Document 2 described above, two bending portions are provided on the distal end side of the insertion portion, and the two bending portions are alternately bent so that the insertion portion can be easily advanced in the duct in the body cavity. Techniques that can be used are disclosed.

  In addition, the insertion portion is provided with an insertion propulsion member in the flexible portion located on the proximal side with respect to the bending portion, and the insertion portion is a self-propelled type that can be automatically advanced in the duct in the body cavity. Endoscopes are also well known. A self-propelled endoscope applied to an industrial endoscope is also well known.

  As a self-propelled endoscope, for example, the flexible portion is composed of an inner cylinder tube and a rotating cylinder body rotatably provided on the outer periphery of the inner cylinder tube. By forming the outer surface in a spiral shape, if the spiral-shaped portion is for medical use, the rotation self-propelled that causes rotation in contact with the inner wall of the duct in the body cavity with rotation A type endoscope is well known. In the case of a rotary self-propelled endoscope, the bending portion can be bent while the flexible portion is advanced.

  However, in a self-propelled endoscope, since the insertion portion is automatically advanced, when bending the bending portion in a bend in the body cavity, for example, a bending portion in the large intestine, at the distal end of the bending portion in the insertion direction. When the provided tip part is subjected to resistance by the collapsed intestinal wall, the bending part is bent with the tip part as a fulcrum, that is, the visual field direction of the objective lens provided at the tip part remains unchanged, There is a problem in that the proximal end side of the bending portion is bent, the distal end side of the insertion portion cannot be bent in a desired direction, and it is difficult to automatically advance the insertion portion.

  In addition, such a problem is that the operator can accurately adjust the position of the distal end of the insertion portion or twist the insertion portion when the operator inserts the insertion portion into a body channel and advances the insertion portion. If the bending is performed after adjusting the distal end of the insertion portion to a position where the resistance received by the distal end is reduced by moving the intestine to change the state of the intestine, the distal end side of the insertion portion is curved. It does not occur from being able to.

  In the case of a self-propelled endoscope, for example, in the case of a rotary self-propelled endoscope, the flexible portion rotates as described above to advance the insertion portion, but the distal end side of the flexible portion. The tip and bend located in the straight line go straight in the insertion direction without rotation, in order to facilitate the bending operation and to make the inside of the body passage inside the body cavity easier to see by the objective lens provided in the tip. And can be moved.

  However, for example, when the insertion part is inserted into the large intestine, the outer periphery of the curved part that goes straight in the insertion direction comes into contact with the intestinal wall of the large intestine, resulting in resistance to the insertion, and as a result, the rotation of the flexible part is loaded. Therefore, there is a problem that it becomes difficult to insert.

  Such a problem can be solved by using a motor having a large output as a rotating member that rotates the flexible portion, for example, a motor. However, the apparatus equipped with the motor is increased in size and the transportability of the apparatus is lowered. In addition, the installation space of the apparatus becomes large, which is not preferable. The above-described problem is not limited to a rotary self-propelled endoscope, but is similar to a self-propelled endoscope in which an insertion propelling member is provided in a flexible portion. Furthermore, the above problems are not limited to medical self-propelled endoscopes, and the same applies to industrial self-propelled endoscopes when inserted into flexible conduits.

  The object of the present invention has been made in view of the above-mentioned problems, and can bend the bending portion in a desired direction, and can be inserted into the conduit without applying a load to the insertion propelling member of the flexible portion. It is an object of the present invention to provide a self-propelled endoscope capable of automatically inserting an insertion portion stably.

In order to achieve the above object, a self-propelled endoscope according to an aspect of the present invention is a self-propelled endoscope including an insertion portion that is automatically inserted into a duct. A bending portion, and a flexible portion provided with a propulsion member for self-propelling the insertion portion located on the proximal side in the insertion direction of the insertion portion with respect to the bending portion. Projecting in the radial direction of the insertion portion radially from the bending portion, at a proximal end portion of the bending portion or a proximal end portion of the bending portion, more proximally than the bending portion. A contact member that is in contact with the inner wall in the duct and is capable of expanding and contracting in the radial direction is provided, and the contact member includes a proximal end portion of the bending portion and a proximal end portion of the bending portion. At least one is provided in plural along the insertion direction .

  According to the present invention, the bending portion can be bent in a desired direction, and the insertion portion can be automatically and stably inserted into the pipeline without applying a load to the insertion propulsion member of the flexible portion. It is possible to provide a self-propelled endoscope capable of performing the above.

  Embodiments of the present invention will be described below with reference to the drawings. In the present embodiment, the self-propelled endoscope will be described taking a medical self-propelled endoscope as an example. The self-propelled endoscope will be described by taking a rotating self-propelled endoscope as an example.

  FIG. 1 is a diagram schematically illustrating the configuration of an endoscope system including a self-propelled endoscope according to the present embodiment, and FIG. 2 is a self-propelled endoscope in the endoscope system of FIG. It is a fragmentary sectional view of the front end side of the insertion part.

  As shown in FIG. 1, an endoscope system 1 includes a rotary self-propelled endoscope (hereinafter simply referred to as an endoscope) 2, a first control device 3, a monitor 3a, and a second The main part is comprised by the control apparatus 54, the 3rd control apparatus 55, the suction device 5, and the pressure control apparatus 90 in a balloon.

  The first control device 3, the monitor 3a, the second control device 54, and the third control device 55 are placed on a trolley 59 with a caster.

  The endoscope 2 includes an insertion portion 6, and the insertion portion 6 in order from the distal end side in the insertion direction S is a distal end portion 8, a bending portion 9, a balloon fixing portion 48 (see FIG. 2), a rotating portion. The movable flexible portion 151 (see FIG. 2), the insertion assisting tool 11, the tip guide tube 13, the insertion portion storage case 12, the operation portion guide tube 14, and the connector cover 15 constitute the main part. ing.

  The insertion section 6 has either a disposable one that is discarded every time it is used or a structure that can be reused by performing sufficient sterilization after use.

  Further, the insertion assisting tool 11, the tip guide tube 13, the insertion portion storage case 12, the operation portion guide tube 14, and the connector cover 15 cover the flexible portion 151 in order from the tip side in the insertion direction S. Further, the tip guide tube 13 and the operation unit guide tube 14 are constituted by corrugated tubes.

  The insertion assisting tool 11 is inserted into the body cavity, and after the insertion tube 11b is inserted, the insertion assisting tool 11 is brought into contact with the buttocks near the anus of the subject so that the entire insertion assisting tool 11 is inserted into the body cavity. The main part is comprised by the contact part 11a which prevents that.

  In the connector cover 15, a motor or the like (not shown) that rotates the flexible portion 151 is provided. Further, the other end of an arm 58 having, for example, three joints, which is fixed to the trolley 59, is fixed to the connector cover 15.

  In the arm 58, an air supply tube, a water supply tube, a suction tube 23, a balloon tube 102, a bending tube 89, which will be described later, provided in the endoscope 2 (the air supply tube and the water supply tube are illustrated). In addition, various tubes such as FIG. 2), signal cables 33 (see FIG. 2) described later, and various communication cables connected to the motor in the connector cover 15 are inserted.

  The various cables and various tubes described above may be provided along the outer surface of the arm 58. The various cables and tubes described above are connected to the corresponding first control device 3, second control device 54, and third control device 55, respectively.

  The first control device 3 controls driving of motors in the imaging system unit, the illumination system unit, and the connector cover 15 included in the endoscope 2.

  Specifically, the first control device 3 performs image processing of the endoscopic image captured by the endoscope 2, power supply to the LED 34, power supply to the motor in the connector cover 15, and the like, which will be described later from the operator. This is performed based on an input operation through a remote control unit 67 (hereinafter referred to as a remote controller).

  The first control device 3 is electrically connected to the second control device 54 and the third control device 55 on the back side in FIG. Therefore, a signal based on an input operation from the operator via the remote controller 67 is also input to the second control device 54 and the third control device 55.

  In addition to a power switch (not shown), various operation members such as a rotation speed operation dial that changes the rotation speed of the flexible portion 151 of the endoscope 2 are disposed on the front surface of the first control device 3. . The first control device 3 is electrically connected to the monitor 3a. The monitor 3 a displays an endoscopic image captured by the endoscope 2.

  The second control device 54 performs expansion and contraction of the balloon 100 described later, air supply via the air supply tube in the endoscope 2, and bending control of the bending portion 9 by an input operation from the remote controller 67. It is.

  In addition, a carbon dioxide (CO 2) cylinder 57 is connected to the second control device 54, and the pressure of CO 2 gas that is a fluid supplied from the cylinder 57 in the balloon 100 to the second control device 54. The pressure control device 90 in the balloon for controlling the expansion, that is, adjusting the expansion and contraction of the balloon 100 is connected.

  The second control device 54 is provided with a compressor (not shown) for sending CO2 gas from the cylinder 57, a supply / exhaust valve for exhausting CO2 gas from the balloon 100, and the like.

  The third control device 55 performs water supply control via the water supply tube and suction control via the suction tube 23 in the endoscope 2 by an operation input from the remote controller 67. The third control device 55 is provided with a pump, a valve, etc. (not shown). Further, the water supply tank 24 is connected to the third control device 55. In the water supply tank 24, distilled water, physiological saline, and the like are stored.

  Specifically, the third control device 55 operates a pump, valves, and the like (not shown) when an operation input is made from the remote control 67, and supplies distilled water or physiological saline from the water supply tank 24 to the endoscope 2. Control to supply to the water supply tube.

  Further, the aspirator 5 is connected to the third control device 55 via the tube 5a. The third control device 55 operates a pump, valves, and the like when an operation input is made from the remote control 67, and the channel 2 through the channel opening 38, the suction tube 37, and the suction tube 23 of the endoscope 2, Control for sucking body fluid or the like in the body cavity into the suction device 5 is performed.

  Note that the third control device 55 is not limited to the suction device 5 and may be connected to a suction system provided in, for example, a hospital or facility.

  A remote controller 67 capable of collectively operating various functions in the endoscope 2 is connected to the first control device 3. The remote control 67 includes an operation switch 68 for operating air supply, water supply, suction, and expansion / contraction of the balloon 100 in the endoscope 2 and a joystick for bending the bending portion 9 of the endoscope 2, for example. A type of operation lever 69 is provided. In other words, the remote control 67 can give operation instructions to the first control device 3, the second control device 54, and the third control device 55.

Next, the configuration of the distal end side of the insertion portion 6 of the endoscope 2 will be described with reference to FIG.
The distal end portion 8 includes a main body ring 26 formed in a substantially cylindrical shape by a resin member having biocompatibility or a metal. An imaging unit 27 is provided inside the main body ring 26.

  The imaging unit 27 covers the substantially short tubular holding tube 28a along the insertion direction S, the base end (hereinafter simply referred to as the base end) surface of the holding tube 28a in the insertion direction S, and the outer periphery on the base end side. And the cover body 29 provided so as to cover the outer periphery and the distal end surface of the holding tube 28a in the insertion direction S in the insertion direction S (hereinafter simply referred to as the distal end). Is configured.

  The holding tube 28a and the cover tube 28b are formed of a metal having biocompatibility. The cover body 29 is formed of a transparent synthetic resin having biocompatibility.

  The holding tube 28 a is provided inside the main body ring 26. The cover tube 28b is fitted to the proximal end side of the holding tube 28a, and a through hole through which the signal cable 33 is inserted is formed on the proximal end surface of the holding tube 28a. Furthermore, the cover body 29 is fitted on the distal end side of the holding tube 28a so as to hermetically seal the opening on the distal end side of the holding tube 28a.

  In the imaging unit 27, an objective lens group 30 and a CCD (Charge Coupled Device) disposed on the optical axis of the objective lens group 30 are formed in a space formed by the holding tube 28 a, the cover tube 28 b, the cover body 29, and the like. ), An imaging element 31 which is a photoelectric conversion element such as a CMOS (Complementary Metal Oxide Semiconductor), a flexible printed circuit board (hereinafter referred to as FPC) 32, and the like.

  The FPC 32 is mounted with a circuit that receives an image signal generated by photoelectric conversion processing by the image sensor 31 and performs various signal processing such as amplification. A signal cable 33 is electrically connected to the FPC 32.

  The signal cable 33 extends from a through hole formed in the base end surface of the cover tube 28b, and extends from the distal end portion 8 to the bending portion 9 and the inner tube 49a, the connector cover 15, and the arm 58 of the flexible portion 151, which will be described later. It is inserted and electrically connected to the first control device 3.

  The objective lens group 30 is held by the objective lens frame 30a in a space formed by the holding tube 28a, the cover tube 28b, the cover body 29, and the like. The objective lens frame 30a is fixed to the holding body 35 in a space formed by the holding pipe 28a, the cover pipe 28b, the cover body 29, and the like. In addition, in a space formed by the holding tube 28a, the cover tube 28b, the cover body 29, and the like, an imaging frame 31a that holds the imaging element 31 is fitted to the proximal end side of the objective lens frame 30a.

  In a space formed by the holding tube 28a, the cover tube 28b, the cover body 29, and the like, a circuit board 31b is attached to the surface on the proximal end side of the image sensor 31. The circuit board 31b is electrically connected to the FPC 32.

  The holding body 35 is formed in a substantially circular shape in a plan view, and its peripheral edge is fixed to the inner peripheral surface on the proximal end side of the cover body 29. Specifically, the holding body 35 is fixed to the cover body 29 so that the center axis of the cover body 29 and the optical axis of the objective lens group 30 substantially coincide with each other.

  In addition, a plurality of LEDs 34 are provided on the front end surface of the holding body 35 so as to surround the objective lens group 30 in a plan view.

  When the imaging unit 27 is disposed at a predetermined position that is eccentric with respect to the central axis in the insertion direction S of the main body ring 26, the imaging unit 27 has a main body by a tip cap 36 that is disposed at the opening on the front end side of the main body ring 26. It is fixed to the ring 26.

  In the gap formed between the holding tube 28 a of the imaging unit 27 and the main body ring 26, a distal end portion of the suction tube 23 and a suction tube 37 connected to the distal end side of the suction tube 23 are arranged. Yes. The distal end portion of the suction tube 37 is fixed to the distal end cap 36.

  A channel opening 38 that opens toward the distal end side is formed on the distal end surface of the distal end cap 36. In the gap formed between the holding pipe 28a and the main body ring 26, pipes communicating with an air supply tube and a water supply tube (not shown) are also arranged. Therefore, channel openings (not shown) of these pipe lines are formed on the distal end surface of the distal end cap 36.

  In the bending portion 9, a tube holding ring 86 fitted and fixed to the inner periphery of the base end side of the main body ring 26, and a lumen 82 having a distal end fitted to the tube holding ring 86 along the insertion direction S. A plurality of, for example, four multi-lumen tubes 81 arranged in four directions, top, bottom, left, and right in a plan view in the bending portion 9, and an inner diameter fixed to the inner periphery of each multi-lumen tube 81 A holding tube 84, an outer diameter holding tube 85 fixed to the outer periphery of each multi-lumen tube 81, and a sealing ring 87 fitted to the base end of each multi-lumen tube 81 are provided.

  The tube holding ring 86 is made of metal or hard resin, and covers the distal end surface of each multi-lumen tube 81 to seal the distal end of each lumen 82.

  Each multi-lumen tube 81 has a sealing material 83 that seals the distal end portion of each lumen 82, and is formed from an elastic material (synthetic resin) such as silicon rubber. That is, the distal end portion of the lumen 82 of each multi-lumen tube 81 is airtightly held by the sealing material 83 and the tube holding ring 86.

  The inner diameter holding tube 84 is formed of a coil tube, a corrugated tube or the like and has flexibility. The outer diameter holding tube 85 is formed of a flexible member such as a thin flat coil tube, a blade tube which is a mesh tube, or a corrugated tube. Further, the outer periphery of the outer diameter holding tube 85 is covered with a curved outer skin 41 formed from an elastic member such as fluoro rubber having biocompatibility. The distal end portion of the curved outer skin 41 is fixed to the outer periphery of the base end portion of the main body ring 26 by an outer periphery-side thread-bonding portion 42.

  The sealing ring 87 seals the base end portion of the lumen 82 of each multi-lumen tube 81, and the connection pipe 88 communicating with each lumen 82 is respectively connected to the base end side of each multi-lumen tube 81. Each tip is connected.

  Each proximal end of the connection pipe 88 is connected to the distal end of a bending tube 89 to which CO 2 gas is supplied from the cylinder 57 under the control of the second control device 54. Note that the base end of each bending tube 89 is connected to the second control device 54 through the arm 58 described above or along the outer surface.

  The proximal end portion of the bending portion 9 is fixed to the distal end of a balloon fixing portion 48 made of a metal member formed in a short tubular shape along the insertion direction S. Specifically, the proximal end portion of the curved outer skin 41 is fixed to the outer periphery on the distal end side of the balloon fixing portion 48 by the outer periphery-side thread-bonding portion 42.

  On the proximal end side of the balloon fixing portion 48, a projection portion 48a is provided that engages with the engaging portion 50a of the distal end side base 50 fixed to the outer periphery on the distal end side of the flexible portion 151 so as to be rotatable. Further, the first inner layer tube base 47 is fixed to the inner periphery of the balloon fixing portion 48, and the second inner layer tube base 46 is fixed to the inner periphery of the first inner layer tube base 47.

  A balloon 100, which is a contact member formed of a material having high elasticity such as latex rubber or elastomer, is provided on the outer periphery of the balloon fixing portion 48 in a state where the airtightness is maintained by adhesion, heat welding, bobbin winding, or the like. Yes.

  The balloon 100 is provided so as to protrude radially in the radial direction of the insertion portion 6 with respect to the outer periphery of the balloon fixing portion 48 rather than the outer periphery of the bending portion 9, and when the insertion portion 6 is inserted into the body cavity, CO 2 is provided. It expands as the gas is supplied and comes into contact with the inner wall of the body cavity. Further, the outer surface 100g of the balloon 100 is subjected to a hydrophilic lubrication process which is a friction reducing process for reducing contact friction with the inner wall in the body cavity.

  The balloon fixing portion 48, the first inner layer tube base 47, and the second inner layer tube base 46 are formed with through holes penetrating in the radial direction, and the L-shaped pipe 101 is attached to the through holes. At the base end of the L-shaped pipe 101, the cylinder 57 is controlled by the control of the second control device 54, which is made of a fluorine-based resin material having a predetermined rigidity and a certain degree of flexibility. A balloon tube 102 to which CO2 gas is supplied is connected.

  That is, the inside of the balloon tube 102 and the L-shaped pipe 101 are communicated with the inside of the balloon 100. The proximal end of the balloon tube 102 is connected to the second control device 54 through the arm 58 described above or along the outer surface.

  Therefore, the balloon 100 is supplied with CO2 gas from the cylinder 57 by the control of the second control device 54 and the internal pressure control by the balloon internal pressure control device 90, and the gas is exhausted by the exhaust valve of the second control device 54. As a result, the expansion / contraction member can be formed. The inflation of the balloon 100 can be adjusted by the internal pressure control by the balloon internal pressure control device 90.

  The flexible portion 151 includes a main portion that includes the inner tube 49 a and the rotating tube 51. Specifically, an inner tube 49 a is disposed in the flexible portion 151. The inner tube 49a is formed of a tube body or the like in which a thin wire or the like is knitted into a tubular shape to give flexibility. The distal end of the inner tube 49 a is fixed to the outer periphery on the proximal end side of the first inner layer tube base 47.

  Further, various cables such as the signal cable 33, the balloon tube 102, the air supply tube, the water supply tube, the suction tube 23, the bending tube 89, and the like are inserted into the inner tube 49a. The inner tube 49a protects various cables and tubes.

  The rotating cylinder 51 is provided on the outer periphery of the inner cylinder tube 49a so as to be rotatable by a motor in the connector cover 15 about the inner cylinder tube 49a as an axis, and is a coil 91 formed by being sparsely wound. And a resin thin film 92 that continuously connects the filaments of the coil 91.

  As the material of the coil 91, for example, a metal member such as a Ni (nickel) free coil or a resin member is applied. Further, the cross-sectional shape of the wire of the coil 91 is, for example, substantially circular, and the wire diameter is set to, for example, about 1.0 mm in consideration of good torque followability. The lead angle of the coil 91 is set to be in the range of, for example, an angle of 9 ° (degrees) to 15 ° (degrees) so that the propulsion speed is suitable for endoscopy.

  The resin thin film 92 is arranged in a form covering the outer peripheral side of the coil 91 so as to connect the filaments of the coil 91. Thereby, it will be in the state which connected between the filaments of the coil 91 continuously.

  The resin thin film 92 is formed of a material having a resin hardness of 50 to 90 degrees and a film thickness of 0.03 to 0.2 mm, for example, in consideration of the balance between flexibility and durability. As a resin for forming the resin thin film 92, a resin member having good sliding property, flexibility, moldability, and biocompatibility, such as urethane, thermoplastic resin, polyester, etc., is used. It is formed in a transparent or dark color.

  Since the rotating cylinder 51 covers the outer peripheral side of the coil 91 while connecting the strips of the coil 91 with the resin thin film 92, the crest of the rotating cylinder 51 is formed high. Can do. In other words, the outer surface of the rotating cylinder 51 forms a spiral portion by the contact portion of the coil 91 with the resin thin film 92 extruding the resin thin film 92 in the radial direction to form a mountain portion.

  Therefore, the rotating cylinder 51 can be easily hooked with the body cavity wall, and the propulsive force obtained thereby can be enhanced.

  In addition, when the rotating cylinder 51 is curved to the maximum extent, there is a possibility that the resin thin film 92 protrudes inward from between the lines of the coil 91. In such a case, the resin thin film 92 does not interfere with the inner arrangement members such as the inner cylinder tube 49a, press them, or the inner cylinder tube 49a does not rotate together due to the interference. A sufficient clearance (gap) is provided between the rotating cylinder 51 and the inner cylinder tube 49a.

  Further, since the rotating cylinder 51 is formed using the metal coil 91, it has elasticity. For this reason, when the distal end of the insertion portion hits the intestinal wall, the force that the distal end pushes the intestine is gradually changed, so that the load on the intestine is reduced.

  A distal end base 50 serving as a coupling engaging portion with the bending portion 9 made of synthetic resin is fixed to the distal end of the rotating cylinder 51 with an adhesive 52.

  The distal end base 50 is formed with a protrusion 48a of the balloon fixing portion 48 and an engaging portion 50a that engages with a so-called snap fit at the distal end. In a state where the engaging portion 50a of the distal end side base 50 and the protrusion 48a of the balloon fixing portion 48 are engaged, when the rotating cylinder 51 rotates, the distal end side base 50 moves relative to the balloon fixing portion 48. It is rotatable around the insertion direction S. At this time, the balloon fixing portion 48, the bending portion 9, and the distal end portion 8 do not rotate. Further, the balloon 100 does not rotate. The reason why the balloon 100 is provided at a position where it does not rotate in the insertion portion 6 is to prevent the intestine from twisting and closing the lumen due to the rotation of the balloon 100 that expands and contacts the intestinal wall. is there.

  The rotating cylinder 51 is provided with a length set so that the length of the insertion portion 6 is at least 600 mm from the distal end portion 8. This is due to the fact that when the insertion portion 6 is inserted into the large intestine, it is generally said that the length from the anus to the boundary between the sigmoid colon and the descending colon is about 600 mm.

  The rotating cylinder 51 is provided with turning power by a motor (not shown) disposed in the connector cover 15. When the rotating cylinder 51 is rotated by a rotational force applied by a motor, a propulsive force is generated by a spiral-shaped portion formed on the outer surface of the rotating cylinder 51 coming into contact with, for example, a body cavity wall of the large intestine. Thus, the rotating cylinder 51 advances in the insertion direction S.

  At this time, the distal end side cap 50 fixed to the distal end portion of the rotating cylinder 51 abuts on the balloon fixing portion 48 and presses the bending portion 9. Thereby, the front-end | tip part 8 and the curved part 9 advance in the insertion direction S without rotation. Therefore, the spiral-shaped portion on the outer surface of the rotating cylinder 51 constitutes a propulsion member that generates propulsive force by contacting the body cavity wall with rotation and causes the insertion portion 6 to self-run.

  Next, the operation of the endoscope configured as described above will be described with reference to FIGS. 1, 2, and 3 described above. FIG. 3 is a view showing a state where the insertion portion of the endoscope of FIG. 1 is inserted from the anus of the subject into the rectum and the distal end portion is inserted up to the sigmoid colon.

  The operation of the present embodiment described below will be described by taking as an example the case where the insertion portion 6 of the endoscope 2 is inserted into the large intestine.

  When the endoscope 2 is not used, the entire insertion portion 6 is accommodated in the insertion portion storage case 12 in a state of drawing a loop, for example, as shown in FIG.

  In this state, the surgeon first inserts the insertion assisting tool 11 of the insertion portion 6 from, for example, the anus 501 of the subject lying on the bed.

  Since the insertion assisting tool 11 has an outward flange-shaped contact portion 11a, the contact portion 11a contacts the buttocks near the anus 501 of the subject after insertion. As a result, in the insertion assisting tool 11, only the insertion tube 11b is inserted from the anus 501 into the rectum 502. That is, the insertion assisting tool 11 is configured to be prevented from being entirely inserted into the rectum 502 by the contact portion 11a. At this time, the operator may fix the contact portion 11a to the patient's buttocks with a tape or the like.

  In this state, the surgeon holds the remote control 67 and operates an operation switch 68 provided on the remote control 67 to input an operation signal to the first control device 3. By drive control, the motor in the connector cover 15 is driven, and the rotating cylinder 51 of the flexible part 151 is rotated in the direction in which the insertion part 6 advances.

  As a result, the rotating cylinder 51 presses the balloon fixing portion 48 while rotating in one direction, so that the balloon fixing portion 48, the bending portion 9, and the distal end portion 8 are not rotated in the large intestine. Advance deeper. At this time, the balloon 100 does not rotate.

  At this time, the operator only needs to grasp the portion of the insertion portion 6 outside the body cavity and lightly grasp the proximal end side of the insertion assisting tool 11 without twisting or feeding it out.

  In addition, the insertion part 6 advances by rotation of the rotation cylinder 51 because the contact state between the above-described spiral-shaped part formed on the outer surface of the rotation cylinder 51 inserted in the intestine and the intestinal wall. Depends on the relationship between male screw and female screw.

  That is, the rotating cylinder 51 moves forward smoothly by the propulsive force generated by the contact with the rotation with the intestinal wall, and as a result, the entire insertion portion 6 moves forward. The insertion portion 6 moves from the rectum 502 to the sigmoid colon 503. It goes to the deep part.

  Further, when the insertion unit 6 is advanced in the large intestine, the operator operates the operation switch 68 provided on the remote controller 67 and inputs an operation signal to the second control unit 54, thereby performing the second control. The apparatus 54 supplies CO2 gas from the cylinder 57 to the balloon 100 via the balloon tube 102 and the L-shaped pipe 101, inflates the balloon 100, and contacts the intestinal wall.

  Accordingly, the bending portion 9 that is located in the vicinity of the balloon 100 and is not rotating in the insertion direction S with the rotation of the rotating cylinder 51 does not come into contact with the intestinal wall in the large intestine. Alternatively, since the contact is minimized, it is prevented that the bending portion 9 comes into contact with the intestinal wall, so that a load is applied to the rotation of the rotating cylinder 51 and the insertion becomes difficult.

  Further, since the outer surface 100g of the balloon 100 is subjected to hydrophilic lubrication treatment, even if the insertion portion 6 is advanced while the balloon 100 is inflated and in contact with the intestinal wall, the insertion portion can be smoothly moved. 6 can be advanced.

  Here, if the balloon 100 is inflated too much, even if the outer surface 100g of the balloon 100 is subjected to hydrophilic lubrication treatment, the contact between the balloon 100 and the intestinal wall becomes strong, and the insertion portion 6 proceeds. Hinder.

  However, at this time, the operator operates the operation switch 68 of the remote control 67 to drive and control the balloon pressure control device 90 to open the exhaust valve in the second control device 54. The balloon 100 may be deflated by discharging CO 2 gas from the balloon through the balloon tube 102 and the L-shaped pipe 101. In this case, the balloon 100 is not completely deflated in order to avoid contact between the curved portion 9 and the intestinal wall as much as possible. That is, the balloon 100 is deflated so that the balloon 100 remains in contact with the intestinal wall.

  Next, when the distal end portion 8 and the bending portion 9 in the insertion portion 6 reach the sigmoid colon 503 having a large bend, the operator switches the operation switch of the remote control 67 while viewing the endoscopic image displayed on the monitor 3a. By operating 68, the bending portion 9 is bent in accordance with the bending state of the sigmoid colon 503 by the drive control of the second control device 54.

  Specifically, the second control device 54 includes the lumen 82 of the multi-lumen tube 81 located in the direction opposite to the direction in which the bending portion 9 is to be bent among the four multi-lumen tubes 81 shown in FIG. The inside of the lumen 82 is pressurized by supplying CO 2 gas from the cylinder 57.

  As a result, the lumen 82 to which the CO 2 gas is supplied is restricted from expanding by the holding tubes 84 and 85 located on the inner periphery and the outer periphery of the lumen 82, so that the multi-lumen tube 81 has the CO 2 gas. As a result, the bending portion 9 bends toward the lumen 82 located on the opposite side of the lumen 82 supplied with CO 2 gas.

  That is, when it is desired to bend the bending portion 9 to the left side, CO2 gas is supplied into the lumen 82 located on the right side, and when it is desired to bend to the right side, CO2 gas is supplied into the lumen 82 located on the left side. When it is desired to bend upward, CO2 gas is supplied into the lumen 82 located on the lower side, and when it is desired to bend downward, CO2 gas may be supplied into the lumen 82 located on the upper side.

  In this way, the multi-lumen tube 81 is curved in four directions, up, down, left, and right, when any lumen 82 is pressurized by the supply of carbon dioxide gas. Using this, the bending portion 9 is bent in accordance with the bending state of the sigmoid colon 503.

  At this time, since the balloon 100 is inflated and is in contact with the intestinal wall, the bending portion 9 is bent in a desired direction with the balloon 100 as a fulcrum. Therefore, the distal end portion 8 is crushed and fixed to the intestinal wall, and the bending portion 9 is prevented from being bent toward the proximal end with the distal end portion 8 as a fulcrum.

  If the bending portion 9 does not bend in a desired direction even when the balloon 100 is inflated, the surgeon operates the operation switch 68 of the remote control 67 to drive and control the balloon internal pressure control device 90. Then, the CO 2 gas is again supplied from the cylinder 57 to the balloon 100 via the second control device 54, and the balloon 100 is further inflated. As a result, the contact pressure between the balloon 100 and the intestinal wall is increased, and the balloon 100 is securely fixed to the intestinal wall, so that the bending portion 9 is easily bent and the bending portion 9 is bent in a desired direction. .

  After the bending portion 9 is bent, the surgeon again operates the operation switch 68 of the remote controller 67 to rotate the rotating cylinder 51 forward in one direction that is the traveling direction. As a result, the insertion portion 6 advances in the descending colon 504 by contact with rotation between the intestinal wall of the sigmoid colon 503 and the rotating cylinder 51, that is, by the action of the male screw and the female screw.

  By repeating the forward rotation of the rotating cylinder 51 and the bending operation of the bending portion 9 as described above, the insertion portion 6 is further passed through the splenic curvature 505, the transverse colon 506, the liver curvature 507, and the ascending colon 508. Advance to cecum 509.

  Thus, in the present embodiment, in the insertion portion 6 in the self-propelled endoscope 2, the balloon fixing portion 48 located on the proximal end side with respect to the bending portion 9 and on the distal end side with respect to the flexible portion 151. It was shown that the balloon 100 which can be inflated and contracted is provided on the outer periphery.

  In addition, after inserting the insertion portion 6 into the body cavity, the insertion portion 6 is advanced in a state where the balloon 100 is inflated and brought into contact with the inner wall of the body cavity, for example, the intestinal wall of the large intestine.

  According to this, when the insertion portion 6 is advanced along with the rotation of the rotating cylinder 51 of the flexible portion 151, the balloon 100 is inflated and is in contact with the intestinal wall of the large intestine. Since the bending portion 9 located in the vicinity of the balloon 100 that moves without movement does not contact the intestinal wall or only minimal contact, the bending portion 9 comes into contact with the intestinal wall. It is prevented that a load is applied to the rotation of the moving cylinder 51 and the insertion becomes difficult.

  Therefore, it is not necessary to use a motor with a large output as a motor for rotating the rotating cylinder 51. Therefore, the connector cover 15 is increased in size and the transportability of the endoscope system 1 itself is reduced. It is possible to prevent the installation space of the mirror system 1 from becoming large.

  Further, when the bending portion 9 is bent by inflating the balloon 100 and fixing the balloon 100 to the intestinal wall, the distal end portion 8 receives resistance from the collapsed intestinal wall. In other words, it is possible to prevent the bending in the desired direction. That is, the bending operability is improved, and it becomes easy to capture the lumen and approach the lesioned part.

  As described above, the bending portion 9 can be bent in a desired direction, and the insertion portion 6 can be automatically and stably placed in the pipeline without applying a load to the rotation of the rotating cylinder 51 of the flexible portion 151. The self-propelled endoscope 2 that can be inserted automatically can be provided.

Hereinafter, modifications will be described.
In the present embodiment, the balloon 100 is described as being provided on the outer periphery of the balloon fixing portion 48. However, the present invention is not limited to this, and the bending portion 9 is curved on the distal end side with respect to the flexible portion 151. If the position is not obstructed, the insertion portion 6 is provided with a projection 48a that engages with the engagement portion 50a of the distal end side cap 50 of the flexible portion 151 in a rotatable manner without providing the balloon fixing portion 48. The balloon 100 may be provided on the base on the base end side of the bending portion 9.

  Hereinafter, another modification will be described with reference to FIGS. 4 and 5. FIG. 4 is a view showing a modified example in which a jelly discharge hole is provided in the balloon together with the distal end side of the insertion portion, and FIG. 5 is a diagram showing the jelly discharge hole in FIG. It is a figure which shows the provided modification with the front end side of an insertion part.

  In the present embodiment, it has been shown that the balloon 100 is inflated by supplying CO2 gas, but the fluid that inflates the balloon 100 is not limited to CO2 gas. That is, it may be another gas that does not affect the supply to the living body, or may be a jelly that is a water-soluble lubricant constituting a biocompatible friction reducing material. For example, “Null Jelly” sold by Teikoku Medix Co., Ltd. is well known as a medical lubricant. In this case, a jelly supply source may be connected to the second control device 54. The jelly is supplied into the balloon 100 by the supply control of the second control device 54 via the balloon tube 102 and the L-shaped pipe 101 as in the case of CO2 described above.

  In the case where jelly is used for inflating the balloon 100, as shown in FIG. 4, if the balloon 100 is formed with one or a plurality of holes 110 as a friction reducing material discharging portion, the balloon is made of jelly. When 100 is inflated, jelly is discharged from the hole 110 into the body cavity, so that contact friction between the outer surface 100g of the balloon 100 and the intestinal wall of the large intestine is further reduced.

  In addition, when the hole 110 is provided in the balloon 100, the hole 110 also expands with the expansion of the balloon 100, and the balloon 100 may tear from the expanded hole 110. To prevent tearing of the balloon 100 due to expansion by sticking a tear-preventing seal or the like, or forming the balloon 100 itself by using a material that is harder than the usual material and rich in elasticity. Can do.

  In order to more reliably prevent the balloon 100 from tearing, as shown in FIG. 5, one or more holes 110 for discharging the jelly into the body cavity are formed in the vicinity of the balloon 100 in the bending portion 9. It doesn't matter.

  In this case, the L-shaped pipe 101 may be connected to the hole 110 formed in the bending portion 9.

  Furthermore, still another modification will be described below with reference to FIG. FIG. 6 is a view showing a modification in which a plurality of balloons are provided along the insertion direction together with the distal end side of the insertion portion.

  As shown in FIG. 6, a plurality of balloons 100 may be provided with a set interval L along the insertion direction S on the proximal end side of the balloon fixing portion 48 or the bending portion 9 described above. .

  According to this, for example, when the bending portion 9 is bent, for example, in the case of the large intestine, stability in fixing the inflated balloon 100 to the intestinal wall is improved. Can be curved.

  Even if a plurality of balloons 100 are provided at a predetermined position, it is not always necessary to inflate all the balloons 100, and only one of the balloons 100 may be inflated.

  Furthermore, still another modification will be described below with reference to FIG. FIG. 7 is a view showing a modification in which a suction hole is provided between one balloon and the other balloon in FIG. 6 together with the distal end side of the insertion portion.

  As shown in FIG. 7, when a plurality of balloons 100 are provided along the insertion direction S at the above-described position on the distal end side of the insertion portion 6, one balloon 100a having the set interval L and the other balloon 100b are provided. A suction hole 120 may be formed on the outer surface of the proximal end side of the balloon fixing portion 48 or the bending portion 9 located between the two. At this time, the suction hole 120 is connected to the suction tube 23 inserted into the insertion portion 6 by a tube (not shown), and the suction operation is performed from the suction hole 120 by the suction control of the third control device 55. Done.

  Thus, if the suction hole 120 is formed at the position described above, for example, the intestinal wall of the large intestine is sucked through the suction hole 120 to obtain a more stable contact between the balloon 100 and the intestinal wall. Can do.

  Hereinafter, still another modification will be described with reference to FIG. FIG. 8 is a view showing a modified example in which convex portions protruding in the radial direction are provided on the outer surface of the balloon along the insertion direction together with the distal end side of the insertion portion.

  As shown in FIG. 8, one or a plurality of convex portions 130 that are elongated along the insertion direction S and project in the radial direction may be formed on the outer surface 100 g of the balloon 100. In this case, the convex portion 130 may be formed integrally with the balloon 100 or may be fixed separately. Moreover, it is preferable that the surface of the convex part 130 is also subjected to hydrophilic lubrication treatment.

  If the convex portion 130 having such a shape is provided on the outer surface 100g of the balloon 100, when the balloon 100 comes into contact with, for example, the intestinal wall of the large intestine, the convex portion 130 rotates with respect to the intestinal wall. By increasing the resistance in the direction in which the balloon 100 moves, the balloon 100 can be more reliably prevented from rotating. This also stabilizes the fixation of the balloon to the intestinal wall.

  Furthermore, in the present embodiment, the self-propelled endoscope 2 has the spiral-shaped portion inserted into the insertion portion 6 by forming the outer surface of the rotating cylinder 51 of the flexible portion 151 into the spiral-shaped portion. Although a rotary self-propelled endoscope serving as a propulsive force is shown as an example, this embodiment is also applied to a self-propelled endoscope in which a propulsive force generating unit such as a caterpillar is provided in the flexible portion 151. The present embodiment can be applied, and the present embodiment can also be applied to a self-propelled endoscope other than the rotation self-propelled type.

  Further, in the present embodiment, an example in which the insertion portion 6 is inserted into the large intestine has been described. However, the present embodiment can be applied to a tissue in a body cavity even when inserted into other than the large intestine. Of course, there is.

  Further, in the present embodiment, the self-propelled endoscope has been shown by taking a medical endoscope as an example, but the present embodiment is not limited to this, and the present embodiment is applied to an industrial endoscope. Needless to say, it may be applied. In this case, when the self-propelled endoscope is inserted into a pipe line, particularly into a soft pipe line, the same effect as in the present embodiment is produced.

  FIG. 9 is a partial cross-sectional view showing an example in which a balloon protruding in the insertion direction is provided at the distal end portion of the insertion portion of the endoscope.

  As shown in FIG. 9, a balloon 70 having a shape protruding from the distal end surface of the distal end portion 8 in the insertion direction S may be provided on the outer periphery of the distal end portion 8 of the insertion portion 6. The balloon 70 is also made of a material having high elasticity such as latex rubber and elastomer, like the balloon 100 of the present embodiment. The balloon 70 is freely expandable and contractable in the insertion direction S.

  In the distal end ring 26 of the distal end portion 8, an L-shaped pipe 71 communicating with the interior of the balloon 70 is inserted into a through hole formed at a position where the balloon 70 is provided, and at the proximal end of the L-shaped pipe 71, A tube 72 is connected. The tube 72 is inserted through the insertion portion 6 and the arm 58 and connected to the second control device 54.

  Therefore, when the balloon 70 is inflated and contracted, CO2 gas is supplied to the balloon 70 from the cylinder 57 via the tube 72 and the L-shaped pipe 71 by the supply control of the second control device 54, or the second By opening the exhaust valve of the control device 54, the CO 2 gas in the balloon 70 is discharged via the L-shaped pipe 71 and the tube 72.

  Thus, if the balloon 70 is provided on the outer periphery of the distal end portion 8, when observing the test site with the objective lens group 30 (see FIG. 2) provided on the distal end portion 8, the balloon 70 is The tip 8 is inflated so as to protrude from the tip surface of the portion 8 in the insertion direction S, and the tip of the balloon 70 is brought into contact with the periphery of the test site. Therefore, the objective lens group 30 facilitates observation of the region to be examined.

  FIG. 10 is a partial cross-sectional view showing a modification of FIG. 9 in which the tip cover protrudes to the tip in the insertion direction by inflation of a balloon provided in the tip.

  In order to facilitate the observation of the test site, the configuration in which the tip 8 is fixed at a predetermined distance from the test site may be the configuration shown in FIG.

  Specifically, as shown in FIG. 10, a ring-shaped space 226 i is provided in the distal end ring 226 of the distal end portion 8. In the space 226 i, the balloon 200 and a flange portion 202 f positioned on the distal end side of the balloon 200 are provided. And a coil spring 201 positioned between the inner peripheral surface of the distal end surface of the distal end portion 8 and the flange portion 202f.

  Therefore, the flange portion 202f of the tip cover 202 is always urged toward the balloon 200 by the coil spring 201. Further, the L-shaped pipe 71 described above communicates with the balloon 200.

  Since the tip 8 has such a configuration, the tip cover 202 housed in the space 226i is normally biased by the coil spring 201 as shown below the one-dot chain line in FIG. 10, when CO 2 gas is supplied into the balloon 200 via the tube 72 and the L-shaped pipe 71, the balloon 200 is inflated and resists the biasing force of the coil spring 201 as compared with the one-dot chain line in FIG. As shown on the upper side, it protrudes further toward the distal end side in the insertion direction S than the distal end surface of the distal end portion 8.

  Thereafter, by bringing the tip of the tip cover 202 into contact with the periphery of the test site, the tip 8 is stably fixed to the test site by the balloon 200 at a predetermined distance. The objective lens group 30 makes it easy to observe the region to be examined.

  After the fixation, when the balloon 200 is deflated by opening the exhaust valve of the second control device 54, the tip cover 202 is urged by the coil spring 201 and is lower than the one-dot chain line in FIG. As shown in FIG.

The figure which shows the outline of a structure of the endoscope system which comprises the self-propelled endoscope of this Embodiment. The fragmentary sectional view of the front end side of the insertion part of the self-propelled endoscope in the endoscope system of FIG. The figure which shows the state which inserted the insertion part of the endoscope of FIG. 1 from a subject's anus to a rectum, and inserted the front-end | tip part to the sigmoid colon. The figure which shows the modification which provided the hole for jelly discharge in a balloon with the front end side of an insertion part. The figure which shows the modification which provided the hole for the jelly discharge of FIG. 4 in the outer surface near the balloon in a curved part with the front end side of an insertion part. The figure which shows the modification provided with two or more balloons along the insertion direction with the front end side of an insertion part. The figure which shows the modification with which the suction hole was provided between the one balloon of FIG. 6, and the other balloon with the front end side of an insertion part. The figure which shows the modification which provided the convex part which protrudes to radial direction on the outer surface of the balloon along the insertion direction with the front end side of an insertion part. The fragmentary sectional view which shows the example which provided the balloon which protrudes in an insertion direction in the front-end | tip part of the insertion part of an endoscope. The fragmentary sectional view which shows the modification of FIG. 9 which makes a front-end | tip cover protrude in the insertion direction front-end | tip by expansion | swelling of the balloon provided in the front-end | tip part.

Explanation of symbols

DESCRIPTION OF SYMBOLS 2 ... Self-propelled endoscope 6 ... Insertion part 9 ... Bending part 48 ... Balloon fixing part 49a ... Inner tube 51 ... Rotating cylinder 100 ... Balloon 100g ... Outer surface 110 ... Hole 120 ... Suction hole 151 ... Flexible Part L ... Setting interval S ... Insertion direction

Claims (7)

A self-propelled endoscope having an insertion portion that is automatically inserted into a pipeline,
The insertion portion includes a bending portion, and a flexible portion provided with a propelling member that self-propels the insertion portion that is located on the proximal side in the insertion direction of the insertion portion with respect to the bending portion,
The insertion portion has a distal end side in the insertion direction with respect to the flexible portion and a proximal end portion of the bending portion or a proximal end side of the bending portion. A contact member that protrudes in the radial direction and contacts the inner wall in the pipe line and that can expand and contract in the radial direction is provided .
A plurality of the contact members are provided along the insertion direction in at least one of a proximal end portion of the bending portion and a portion closer to the proximal end than the bending portion. mirror. The self-propelled endoscope according to claim 1 , wherein the contact member is a balloon that can expand and contract as the fluid is supplied and discharged. The plurality of contact members are provided with a set interval along the insertion direction,
The self-propelled endoscope according to claim 1 or 2 , wherein a suction hole is provided in a portion between the one contact member and the other contact member. The self-propelled according to any one of claims 1 to 3 , wherein the outer surface of the contact member is subjected to friction reduction processing for reducing contact friction with the inner wall in the pipe line. Expression endoscope. The friction reducing material discharge part which reduces the contact friction with the said contact member and the said inner wall in the said pipe line is formed in the said insertion part, The any one of Claims 1-4 characterized by the above-mentioned. Self-propelled endoscope. The outer surface of the contact member, the self-propelled endoscope according to any one of claims 1 to 5, the convex portion protruding in the radial direction and being provided along the insertion direction mirror. The flexible portion is composed of an inner cylinder tube and a rotating cylinder body rotatably provided on the outer periphery of the inner cylinder tube,
The propulsion member is a spiral-shaped portion formed on an outer surface of the rotating cylinder that generates a propulsive force by contacting the inner wall in the pipe with rotation. The self-propelled endoscope according to any one of claims 1 to 6 .

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