JP6472078B2 - Endoscope system - Google Patents

Description

In the present invention, the first fluid pipe into which carbon dioxide is introduced and the second fluid pipe into which air is introduced are connected to the third fluid pipe, and either carbon dioxide or air is used as the third fluid pipe. The present invention relates to an endoscope system having a configuration that flows into the system .

  In recent years, an insertion device inserted into a subject, for example, an endoscope, has been widely used in the medical field and the industrial field.

  Endoscopes used in the medical field include observing organs in body cavities by inserting an elongated insertion part into a body cavity as a subject, and using an optical system included in the insertion part, and endoscopes as necessary. Various treatments can be performed using the treatment tool inserted into the channel of the treatment tool included in the device.

  In addition, endoscopes used in the industrial field include a subject that is inserted into a subject such as a jet engine or a pipe of a factory by inserting an elongated insertion portion of the endoscope into the subject. It is possible to observe and inspect the wound and corrosion of the test site inside.

  Here, in an endoscope used in the medical field, when an insertion portion is inserted into a body cavity and observation or various treatments are performed, the longitudinal direction of the insertion portion (hereinafter, simply referred to as the “insertion portion”) is improved. In general, a method of inflating the body cavity by supplying air, which is a second fluid, into the body cavity from the distal end (referred to as the longitudinal direction).

  Specifically, the surgeon closes the air supply hole provided in the endoscope of the air / water supply button provided in the operation section of the endoscope, thereby closing the fluid supply line. On the other hand, air is supplied from an air pump that is a second fluid supply source connected to the endoscope, and is provided at the distal end of the fluid supply conduit at the distal end in the longitudinal direction of the insertion portion (hereinafter simply referred to as the distal end). In general, a method of expanding the inside of a body cavity by supplying air from the fluid supply nozzle into the body cavity is generally performed.

  Further, in a state where the insertion portion is inserted into the body cavity and the treatment target tissue in the body cavity is observed by the optical system, the treatment tool inserted into the channel is forward in the longitudinal direction from the distal end of the insertion portion (hereinafter simply referred to as the front). A technique for peeling and excising a tissue to be treated using a treatment tool by causing the insertion portion to move in the longitudinal direction is then known.

  For example, in the state where the insertion part is inserted into the body cavity and the cancer tissue in the body cavity is observed by the optical system, the high-frequency electric knife inserted into the channel is projected forward from the distal end of the insertion part, and then inserted. A known endoscopic submucosal layer that removes cancer tissue previously floated by injection of a dedicated liquid using a high-frequency electric knife by moving the part back and forth in the longitudinal direction (hereinafter simply referred to as front and back) Exfoliation (hereinafter referred to as ESD (Endoscopic Sub mucosal Dissection)) is well known.

  As another example, in a state where the insertion portion is inserted into the body cavity and the cancer tissue in the body cavity is observed by the optical system, the snare inserted through the channel is projected forward from the tip of the insertion portion, and the snare is previously A known endoscopic mucosal resection (hereinafter referred to as EMR (Endoscopic)) is performed by removing the cancer tissue by being hooked on the floating cancer tissue by injection of a dedicated liquid and then constricting the snare while applying a high-frequency current to the snare. (Mucosal Resection)) is well known.

  By the way, for example, procedures such as ESD and EMR in the large intestine often have a procedure time exceeding 1 hour.

  Therefore, as described above, if air is continuously supplied from the fluid supply nozzle into the body cavity for a long time, there is a problem that the subject feels fullness or pain in the large intestine, for example.

  In addition, air is difficult to be absorbed into the body cavity after the procedure, and it is also painful for the subject. In addition, since air contains oxygen, blood is easy to coagulate when air is fed to the bleeding site, causing accidents. In the treatment using high-frequency current such as ESD and EMR, there is a problem that the technique must be carefully performed so that oxygen contained in the air does not react to the high-frequency current, and the operability is poor.

  In view of these problems, Patent Document 1 discloses that by connecting a carbon dioxide cylinder, which is a first fluid supply source, to a fluid supply conduit that is provided in the endoscope and opens at the distal end of the insertion portion. A configuration and technique of an insertion system for inflating a body cavity by supplying carbon dioxide as a first fluid into the body cavity from an opening of a fluid supply line is disclosed.

  Further, in Patent Document 2, in addition to the fluid supply conduit, a gas supply conduit that opens as a gas outlet at the distal end of the insertion portion is provided in the endoscope, and the first fluid supply source is provided in the gas supply conduit. The structure and method of the insertion system which expands the inside of a body cavity by supplying the carbon dioxide which is the 1st fluid from a gas jet nozzle by connecting the gas supply apparatus which is is disclosed.

  Even if carbon dioxide is supplied into the body cavity, it has good biological suction and is absorbed into the body cavity in about one hour after the procedure. There is no worry of causing accidents even when airing to the site, it is not flammable. For this reason, there is an advantage that the operability is improved because it is easy for the operator to handle.

JP 2004-290682 A JP 2014-50533 A

  However, since the insertion system described in Patent Document 1 has a configuration in which only carbon dioxide is supplied to the fluid supply conduit of the endoscope, air is supplied to the fluid supply conduit of the endoscope. There is a problem that it is necessary to change from a general insertion system and cannot be easily applied to an existing insertion system. Furthermore, since only carbon dioxide is used, there is a problem that the amount of carbon dioxide used increases.

  Further, in the insertion system described in Patent Document 2, in addition to the gas supply conduit for supplying carbon dioxide into the body cavity as described above, air is generally supplied to the objective lens of the optical system in the insertion portion. Since a typical fluid supply conduit is also provided, there is a problem that the diameter becomes larger than the insertion portion of a normal endoscope.

  In view of such a problem, a configuration in which the fluid supply line and the gas supply line are made common and air and carbon dioxide are switched and supplied to the common line is also conceivable.

  Specifically, a third pipeline of the fluid switching device is connected to a fluid supply pipeline provided in the endoscope, and the first pipeline and the second pipeline are connected to the third pipeline. The carbon dioxide supplied from the gas supply device which is the first fluid supply source connected to the first pipe is supplied to the third pipe or connected to the second pipe. By switching whether to supply air from the air pump as the second fluid supply source, carbon dioxide is supplied into the body cavity using one fluid supply line, and air is supplied to the objective lens. The structure which can implement | achieve is conceivable.

  More specifically, when air is supplied to the objective lens, the operator closes the air hole of the air / water supply button as described above, so that the air supplied from the air pump that is always driven is , And supplied to the objective lens via the second conduit, the third conduit, and the fluid supply conduit.

  On the other hand, when supplying carbon dioxide into the body cavity, the operator stops driving the air pump and drives the gas supply device to close the vent hole of the air supply button, so that the operator is supplied from the gas supply device. It can be considered that the carbon dioxide is supplied into the body cavity via the first conduit, the third conduit, and the fluid supply conduit.

  However, if the surgeon forgets to stop driving the air pump and drives the gas supply device to close the vent hole of the air supply button, the third conduit and the fluid supply conduit will contain carbon dioxide. Since not only air but also air is supplied, an excessive amount of gas is supplied into the body cavity, and there is a concern that the subject may feel pain.

  In view of such a problem, when the gas supply device is driven, a control in which the driving of the air pump is stopped is also conceivable. In this case, a new control program must be reconstructed in the insertion system. There was a problem that it could not be applied easily.

  From the above, there has been a demand for a configuration of a fluid switching device and an insertion system that can supply only carbon dioxide into a body cavity even if the operator forgets to stop driving the air pump with a simple configuration.

  The above problem is not limited to the endoscope, and the same applies to an insertion device inserted into another subject.

  In addition, the switching of the fluid using the fluid switching device is not limited to the switching of the supply of air and carbon dioxide. In the configuration in which the first fluid and the second fluid are switched and supplied into the subject, the first The same applies to other configurations in which only the fluid is supplied into the subject.

The present invention has been made in view of the above circumstances, and an endoscope having a configuration capable of preventing an excessive supply of fluid by reliably supplying carbon dioxide into a subject with a simple configuration. An object is to provide a mirror system .

In order to achieve the above object, an endoscope system according to an aspect of the present invention includes a first fluid pipe through which a first fluid flows from the outside, and a second fluid pipe through which a second fluid flows from the outside. One end side of which is connected to the first fluid pipe and the second fluid pipe, and one of the first fluid and the second fluid flowing in from the one end side is provided on the other end side. A third fluid pipe that flows out to the outside from the supplied supply port, one end into which the first fluid flows, and the other in which the first fluid flows out are provided in the middle of the first fluid pipe A cylinder having an end, and a reciprocating movement between the one end and the other end of the cylinder, the first fluid flowing in from the one end of the cylinder and receiving the first fluid. The first fluid passes through one fluid pipe. A first piston portion formed with a first through hole having a diameter that increases the pipe resistance, and when the first piston portion moves to the other end side of the cylinder from the inside of the cylinder The second fluid pipe moves into the third fluid pipe and the communication between the second fluid pipe and the third fluid pipe is blocked by the outer peripheral surface, and communicates with the first through hole and more than the first fluid pipe. A moving part having a second piston part formed with a second through hole having a diameter that increases the pipe resistance when the first fluid passes, and the first fluid is in the cylinder. When the pressure passing from the one end to the other end of the cylinder is lower than a set value, the first piston portion is moved from the other end side to the one end side by extension, and the second piston Move the part into the cylinder The second fluid pipe and the third fluid pipe are disconnected from each other by the second piston portion, and in response to the pressure being equal to or higher than the set value in the cylinder, the cylinder is compressed by compression. A fluid switching device comprising: an urging portion that moves the moving portion from the one end side to the other end side, and that can be expanded and contracted in an extending direction connecting the one end and the other end of the cylinder; An endoscope inserted into the subject and having a fluid supply line, the fluid switching device connected to the fluid supply line via the third fluid line, and the fluid switching A first fluid supply source for supplying the first fluid to the first fluid pipe of the device; and a second fluid source for supplying the second fluid to the second fluid pipe of the fluid switching device. Two fluid supply sources, the first fluid and the second fluid source. The fluid is a different type of fluid, the first fluid is carbon dioxide and the second fluid is air.

According to the present invention, it is possible to provide an endoscope system having a configuration capable of preventing excessive supply of fluid by reliably supplying only carbon dioxide into a subject with a simple configuration. .

The figure which shows schematically the endoscope system which comprises the endoscope to which the fluid switching apparatus of 1st Embodiment is connected. The perspective view which expands and shows the air / water tank unit of FIG. The fragmentary sectional view which shows schematically the pipe line structure in the connector of the endoscope of FIG. The fragmentary sectional view which shows schematically the structure of the fluid switching apparatus of 1st Embodiment with the connector of the endoscope of FIG. 4 is a partial cross-sectional view schematically showing a state in which the second piston portion of the moving unit in FIG. 4 has moved into the air supply conduit of the endoscope and the communication between the air supply conduit and the air conduit has been blocked. In the fluid switching apparatus of 2nd Embodiment, the fragmentary sectional view which shows schematically a part of structure of the 2nd piston part in a moving part. 6 is a partial cross-sectional view schematically showing a state in which the second piston portion of FIG. 6 moves to a position where the air pipe line is shut off with the supply of carbon dioxide and the exclusion member expands. The fragmentary sectional view which shows roughly the modification of the fluid switching apparatus which provided the notch in the air supply base side of the attachment connector connected with respect to the liquid supply base and the air supply base of the connector of the endoscope of FIG. FIG. 8 is a partial cross-sectional view schematically showing a state in which the extruding member of FIG. 8 has moved so as to jump out into the air supply duct together with the second piston portion. FIG. 9 is an external view schematically showing the configuration of a slider that moves the piston portion of FIG. An example of the incision operation of the lesion mucosa site in ESD using the incision tool protruding from the endoscope channel and the high frequency knife while inserting the endoscope system of the first and second embodiments into the subject. Schematic perspective view The perspective view explaining roughly the peeling operation | movement of the lesion mucosa site | part in ESD using the peeling tool protruded from the channel of the endoscope

  Embodiments of the present invention will be described below with reference to the drawings. Hereinafter, the insertion device will be described using an endoscope as an example. Therefore, the insertion system will be described by taking an endoscope system using a fluid switching device and an endoscope as an example.

(First embodiment)
FIG. 1 is a diagram schematically showing an endoscope system including an endoscope to which a fluid switching device according to the present embodiment is connected, and FIG. 2 is an enlarged view of the air / water tank unit of FIG. FIG. 3 is a partial cross-sectional view schematically showing a pipe line configuration in the connector of the endoscope of FIG.

  As shown in FIG. 1, an endoscope system 1 that is an insertion system includes an endoscope 2 that is an insertion device to which a fluid switching device 200 (see FIG. 4) described later is connected, and a peripheral device 100. Yes.

  The endoscope 2 includes an insertion portion 4 to be inserted into a subject, an operation portion 3 connected to a proximal end in the longitudinal direction N of the insertion portion 4 (hereinafter simply referred to as a proximal end), and the operation The main part is comprised including the universal cord 5 extended from the part 3 and the connector 10 provided at the extended end of the universal cord 5.

  The insertion portion 4 includes a distal end portion 6 positioned on the distal end side in the longitudinal direction N of the insertion portion 4 (hereinafter simply referred to as the distal end side), a bending portion 7 provided continuously to the proximal end of the distal end portion 6, The flexible tube portion 8 is connected to the base end of the curved portion 7.

  A distal end opening 17 of a treatment instrument insertion conduit (hereinafter referred to as a channel) that also serves as a suction conduit (not shown) is provided on the distal end surface 6s of the distal end portion 6 on the illumination window 13, the objective lens 15, the air / water feeding nozzle 16. Etc. are provided.

  The illumination window 13 supplies illumination light into the subject. Instead of the illumination window 13, a light emitting element such as an LED may be provided on the front end surface 6s.

  The objective lens 15 constitutes an objective optical system (not shown) provided in the distal end portion 6 and is used when observing the inside of the subject.

  Further, the air / water supply nozzle 16 is inserted into the objective lens 15 or the subject via the fluid supply conduit R (see FIG. 3) provided in the connector 10, the universal cord 5, the operation unit 3, and the insertion unit 4. A fluid is supplied.

  Specifically, as shown in FIG. 3, the fluid supply line R includes a liquid supply line 70 communicating with the liquid supply base 10b provided on the side face 10s of the connector 10, and an air supply base 10c provided on the side face 10s. And an air supply pipe line 23 communicating with the air supply line 23.

  Although not shown, the liquid supply conduit 70 and the air supply conduit 23 communicate with each other so as to become one fluid supply conduit on the distal end side of the insertion portion 4, and are connected to the distal end of the fluid supply conduit R after communication. An air / water supply nozzle 16 is connected.

  Therefore, the liquid supplied via the liquid supply line 70 and the gas supplied via the air supply line 23 are selectively discharged from the supply port 16 k of the air / water supply nozzle 16.

  In the present embodiment, the case where the air supply line 23 which is the fluid supply line R provided in the endoscope 2 also serves as a third line of the fluid switching device 200 described later is taken as an example. List and show. Therefore, of course, the configuration may be such that the air supply conduit 23 and the third conduit of the fluid switching device 200 are separately provided and connected. That is, the third conduit of the fluid supply device 200 may be provided outside the endoscope 2.

  The tip opening 17 constitutes an opening at the tip of a channel (not shown) provided in the insertion portion 4, the operation portion 3, the universal cord 5, and the connector 10. The channel is branched at the operation unit 3, and a part of the channel is opened as a treatment instrument insertion port 3 s at the operation unit 3.

  The tip opening 17 is used when a suction device is connected to a channel in the connector 10 and sucks body fluid or the like in the subject through the channel, and various treatments inserted into the channel through the treatment instrument insertion port 3s. An opening for projecting the tool into the subject is formed.

  The bending portion 7 is operated to bend in four directions, for example, up, down, left, and right by a bending operation knob 9 provided in the operation unit 3.

  The peripheral device 100 includes a keyboard 31 placed on the gantry 30 and an air A which is a second fluid (air) A (a second fluid pipe constituting a fluid switching device 200 described later). 4) and a connection cable 35 for electrically connecting the video processor 34, the connector 10 and the video processor 34 to each other, the light source device 33 having an air pump U as a second fluid supply source (not shown). And a monitor 36.

  As shown in FIG. 3, the connector 10 is detachable from the light source device 33 via a light source connection connector 10 a provided at the end of the connector 10.

  As shown in FIG. 3, an air duct 22, which will be described later, branches from the air feed duct 23 toward the light source connection connector 10 a.

  In the present embodiment, the case where the air conduit 22 that is the second fluid pipe is provided in the endoscope 2 is shown as an example, but the second fluid pipe is provided outside the endoscope 2. It does not matter. That is, the second fluid pipe of the fluid switching device 200 may not be provided in the endoscope 2.

  Further, an air / water tank unit 40 shown in FIG. 2 constituting a part of a fluid switching device 200 (see FIG. 4) described later is detachable from the connector 10.

  As shown in FIG. 2, the air / water tank unit 40 stores a liquid such as sterilized water therein, and is detachably attached to the tank 41 via a hook 43. The tank 41 is made of polysulfone, for example. In the connector 10 provided on the other end of the tube 44, for example, a cap 42 made of polymethylbenden, a tube 44 made of, for example, silicone rubber, one end of which is connected to the cap 42. The main part is composed of an attachment connector 45 made of, for example, stainless steel, which can be connected to the liquid supply base 10b and the air supply base 10c on the side surface 10s, and a gas base 46 provided on the cap 42.

  Further, as shown in FIG. 4 to be described later, in the mounting connector 45 and the tube 44, when the mounting connector 45 is connected to the liquid feeding base 10b and the air feeding base 10c, a later-described first communicating with the air feeding conduit 23 is provided. 1 is provided with a CO2 pipe 21 which is a fluid pipe and a liquid feed pipe 71 which will be described later and communicated with the liquid feed pipe 70 (FIG. 4 shows a CO2 pipe provided in the attachment connector 45. 21 and the liquid supply pipe 71 only are shown).

  In the present embodiment, when the attachment connector 45 is connected to the liquid supply base 10b and the air supply base 10c, the CO2 pipe 21 communicates with the air supply pipe 23 and the liquid supply pipe with respect to the liquid supply pipe 70. A configuration in which the communication of the path 71 is performed simultaneously is shown as an example. That is, a configuration in which the attachment connector of the CO2 pipe 21 and the attachment connector of the liquid supply pipe 71 with respect to the connector 10 are made common is shown as an example. However, the present invention is not limited to this, and the attachment connector of the CO2 pipe 21 and the attachment connector of the liquid supply pipe 71 with respect to the connector 10 may be provided separately.

  In addition, as shown in FIG. 1, one end of a CO 2 supply tube 51 is connected to the gas base 46. A CO2 gas regulator 52 is connected to the other end of the CO2 supply tube 51.

  A first fluid that supplies the CO2 gas regulator 52 with carbon dioxide (CO2) C (see FIG. 5) that is a different type of fluid from the second fluid and that is the first fluid to the CO2 pipeline 21. A CO2 gas cylinder 53 as a supply source is connected.

  Therefore, when the attachment connector 45 is connected to the liquid supply base 10b and the air supply base 10c, the carbon dioxide C (see FIG. 5) in the CO2 gas cylinder 53 is provided in the operation unit 3 by driving the CO2 gas regulator 52. When the air / water supply button 3b (see FIG. 1) is pressed, the carbon dioxide C enters the tank 41 from the gas base 46 via the CO2 supply tube 51, and the carbon dioxide C is used as a pressure source in the tank 41. The liquid is supplied to the liquid supply line 70 via the liquid supply line 71 in the tube 44 and discharged toward the objective lens 15 from the supply port 16k of the air / water supply nozzle 16.

Next, the configuration of the fluid switching device 200 will be described with reference to FIGS. 4 and 5.
4 is a partial cross-sectional view schematically showing the configuration of the fluid switching device according to the present embodiment together with the connector of the endoscope shown in FIG. 1, and FIG. 5 shows that the second piston portion of the moving portion shown in FIG. It is the fragmentary sectional view which shows roughly the state which moved into the air supply line of an endoscope, and interrupted | blocked communication with an air supply line and an air line.

  As shown in FIG. 4, the fluid switching device 200 includes a CO2 pipe 21, an air pipe 22, an air supply pipe 23, a cylinder 60, and a moving part 65, and a main part is configured. .

  The air conduit 22 is provided in the connector 10 as described above, and is connected to one end side of the air supply conduit 23, and when the light source connection connector 10a of the connector 10 is connected to the light source device 33. Air A is introduced from the outside. Specifically, air A flows in as the air pump U in the light source device 33 is driven.

  The CO2 conduit 21 is provided in the tube 44 and the attachment connector 45 as described above, and is connected to one end of the air supply conduit 23 when the attachment connector 45 is connected to the air supply cap 10c. Carbon dioxide C is introduced from the outside.

  Specifically, as the CO2 gas regulator 52 is driven, the carbon dioxide C (see FIG. 5) in the CO2 gas cylinder 53 flows into the CO2 pipeline 21 through the CO2 supply tube 51, the gas cap 46, and the tank 41. It is what is done.

  As described above, the air supply line 23 is provided in the endoscope 2, and when the air line 22 is connected at one end side and the attachment connector 45 is connected to the air supply base 10c, A CO2 pipe line 21 is connected to one end side.

  In addition, either the air A or the carbon dioxide C that flows in from one end side of the air supply conduit 23 flows out from the supply port 16k of the above-described air supply / water supply nozzle 16 provided on the other end side of the air supply conduit 23. Is done.

  Although not shown, the air supply conduit 23 communicates with a vent hole (not shown) of the above-described air / water feed button 3b, and when the vent hole is not blocked by the operator, the air A and the dioxide dioxide are communicated. Any of the carbon C is configured to leak out of the endoscope 2 from the vent hole. That is, only when the air hole of the air / water supply button 3 b is closed by the operator, either the air A or the carbon dioxide C flows out from the supply port 16 k of the air / water supply nozzle 16.

  Further, the air pump U always supplies air A to the air pipe 22 after being driven. Therefore, after the air pump U is driven, the air A continuously flows into not only the air supply conduit 23 but also the CO2 conduit 21. However, as described above, the air hole of the air supply / water supply button 3b is formed by the operator. As long as it is not blocked by the leak, it leaks out of the endoscope 2 from the vent hole.

  The cylinder 60 is provided in the middle position of the CO2 pipe line 21 in the attachment connector 45, and has one end 60i into which carbon dioxide C flows and the other end 60t from which carbon dioxide C flows out.

  The moving part 65 is provided in the cylinder 60 and is composed of a first piston part 61 and a second piston part 62. The moving unit 65 is made of stainless steel, for example.

  As shown in FIGS. 4 and 5, the first piston portion 61 is a member that reciprocates between one end 60 i and the other end 60 t of the cylinder 60 and receives carbon dioxide introduced from the one end 60 i. A through hole 61 h is formed along the extending direction E of the cylinder 60.

  When the first piston portion 61 moves to the other end 60t side, the first moving portion 65 is locked to the cylinder 60, thereby preventing the entire moving portion 65 from jumping out from the cylinder 60 to the air supply line 23 side. It also functions as a retaining stopper.

  The second piston portion 62 is formed to have a smaller diameter than the first piston portion 61 and is elongated along the extending direction E, and the attachment connector 45 is connected to the air supply base 10c. When one piston portion 61 moves from one end 60 i side shown in FIG. 4 to the other end 60 t side shown in FIG. 5, it moves so as to jump out from the cylinder 60 into the air supply line 23 via the CO 2 pipe line 21. A second through-hole 62 h that is a member that blocks communication between the air duct 22 and the air-feed duct 23 and communicates with the first through-hole 61 h is formed along the extending direction E.

  The first piston part 61 may be formed integrally with the second piston part 62, or may be formed separately and connected to each other.

  Further, when the attachment connector 45 is connected to the air supply base 10c, the CO2 conduit 21 is always in communication with the air supply conduit 23 via the first through hole 61h and the second through hole 62h.

  Furthermore, the first through hole 61h and the second through hole 62h are formed to have a diameter K that increases the pipe resistance when the carbon dioxide C passes through the CO2 pipe 21. In other words, the first through hole 61h and the second through hole 62h are formed to have a smaller diameter than the CO2 conduit 21.

  As a result, the first piston 61 receives a pressure when the carbon dioxide C flows from the one end 60 i to the other end 60 t in the cylinder 60, and extends in the extending direction E from the one end 60 i side to the other end 60 t side of the cylinder 60. Move along.

  That is, as the CO 2 gas regulator 52 is driven, carbon dioxide C flows into the CO 2 pipe 21, and the first piston 61 is moved along the extending direction E from the one end 60 i side of the cylinder 60. Move to the other end 60t side.

  Only when the first piston 61 is moved to the other end 60t side in accordance with the supply of the carbon dioxide C to the first through hole 61h of the first piston 61, the pressure becomes equal to or higher than the set pressure. An opening / closing valve may be provided.

  Further, in the cylinder 60, when the pressure at which the carbon dioxide C passes from the one end 60i to the other end 60t falls below the set value, the first piston 61 is moved from the other end 60t shown in FIG. A biasing portion 68 that moves the second piston portion 62 into the cylinder 60 and releases the blockage between the air conduit 22 and the air supply conduit 23 by the second piston portion 62 while moving to the one end 60i side shown. The biasing portion 68 is provided with one end locked to the first piston portion 61 and the other end locked to the other end 60 t of the cylinder 60. An example of the biasing portion 68 is an extension spring.

  Here, as described above, the air A supplied from the air pump U via the air conduit 22 is also supplied to the CO2 conduit 21 communicating with the air supply conduit 23. Therefore, the set value of the pressure for supplying the carbon dioxide C needs to be set larger than the value obtained by adding the urging force of the urging unit 68 to the supply pressure of the air A.

  That is, the pressure at which the carbon dioxide C is supplied from the CO2 pipe 21 to the air supply pipe 23 needs to be set higher than the pressure at which the air A is supplied from the air pipe 22 to the air supply pipe 23.

  As described above, in the fluid switching device 200 according to the present embodiment, when the CO2 gas regulator 52 is not driven and only the air pump U is driven, the operator sets the air hole of the air / water supply button 3b. When closed, air A is discharged toward the objective lens 15 from the supply port 16k of the air / water supply nozzle 16 via the air line 22 and the air supply line 23.

  On the other hand, even if the surgeon forgets to stop driving the air pump U and drives the CO2 gas regulator 52 while driving the air pump U, as described above, the supply of carbon dioxide C to the CO2 pipeline 21 is performed. Accordingly, as shown in FIG. 5, the first piston portion 61 in the cylinder 60 moves from the one end 60 i to the other end 60 t so that the second piston portion 62 jumps out into the air supply conduit 23. Then, the communication between the air line 22 and the air supply line 23 is blocked. Therefore, when the surgeon closes the air hole of the air / water supply button 3b, the air / water supply nozzle 16 passes through the CO2 conduit 21, the first through hole 61h, the second through hole 62h, and the air supply conduit 23. Only carbon dioxide C is discharged from the supply port 16k and supplied into the subject.

  Even if the communication between the air line 22 and the air supply line 23 is interrupted by the second piston 62, the air pump U normally stops or releases the pressure when the supply pressure becomes an abnormal value. Therefore, the air pump U will not break down.

  Further, when the supply of carbon dioxide C to the CO2 conduit 21 is stopped, as shown in FIG. 4, the first piston portion 61 is moved toward the one end 60 i by the urging portion 68, whereby the second When the piston part 62 moves into the cylinder 60, the disconnection of the communication between the air line 22 and the air supply line 23 by the second piston part 62 is released.

  As described above, in the present embodiment, the carbon dioxide C is not supplied to the CO2 conduit 21, the air A is supplied to the air conduit 22, and the air hole of the air / water supply button 3 b is blocked. In this case, when only the air A is discharged from the supply port 16k of the air / water supply nozzle 16 communicating with the air supply line 23 and the carbon dioxide C is supplied to the CO2 line 21, the second piston 62 With the movement of the air line 22, the communication between the air line 22 and the air supply line 23 is cut off. Therefore, even if the air pump U is driven when the air hole of the air / water supply button 3 b is blocked, the air supply line It is shown that only carbon dioxide C is discharged from the supply port 16k of the air / water supply nozzle 16 communicating with the air supply / water supply nozzle 23.

  According to this, when only the carbon dioxide C is supplied from the supply port 16k of the air / water supply nozzle 16 into the subject, even if the operator forgets to stop driving the air pump U, the operator does not supply the carbon dioxide C. Accordingly, since the second piston portion 62 blocks the air conduit 22, only CO2 is discharged from the supply port 16k of the air / water supply nozzle 16, so that even the air A is supplied to the supply port 16k of the air / water supply nozzle 16. It will not be discharged from.

  Even if the carbon dioxide C in the CO2 gas cylinder 53 disappears, when the supply of the carbon dioxide C is stopped, the urging portion 68 releases the block of the air pipeline 22 by the second piston portion 62. Therefore, air A can be supplied into the subject instead of carbon dioxide C.

  As described above, the fluid switching device 200 and the endoscope system 1 having a configuration capable of preventing excessive supply of fluid by reliably supplying only carbon dioxide C into the subject with a simple configuration are provided. can do.

(Second Embodiment)
FIG. 6 is a partial cross-sectional view schematically showing a part of the configuration of the second piston part in the moving part in the fluid switching device of the present embodiment. FIG. 7 is a diagram showing the second piston part of FIG. It is a fragmentary sectional view which shows schematically the state which moved to the position which interrupts | blocks an air line with supply of carbon, and the exclusion member expanded.

  The configuration of the fluid switching device and the endoscope system according to the second embodiment is configured so that the second piston portion has an exclusion member as compared with the configurations of the fluid switching device and the endoscope system shown in FIGS. Is different. Therefore, the same components as those in the first embodiment are denoted by the same reference numerals, and the description thereof is omitted.

  As shown in FIG. 6, the supply of carbon dioxide C to the outer periphery of the end of the second piston 62 of the moving unit 65 opposite to the first piston 61 in the fluid switching device 200 of the present embodiment. An exclusion member 69 is provided that can expand and contract in accordance with the interruption.

  An example of the exclusion member 69 is a balloon. Moreover, as a member which comprises the other exclusion member 69, the rubber tube etc. which are coat | covered by the outer periphery of the 2nd piston part 62 are mentioned. Further, the member constituting the exclusion member 69 does not hinder the movement of the second piston portion 62 after the expansion, and moves so as to jump out to the air supply line 23, and then sends the air A from the air line 22. Any member may be used as long as it can prevent, for example, about 90% from entering the tracheal passage 23 within a gas supply amount that does not affect the surgical procedure.

  The evacuation member 69 communicates with the second through hole 62h through a communication hole 62j formed in the second piston portion 62, and the carbon dioxide C through the second through hole 62h and the communication hole 62j. Expand with supply.

  Further, as shown in FIG. 7, the exclusion member 69 expands its diameter when the second piston portion 62 moves so as to jump out into the air supply conduit 23 with the supply of carbon dioxide C to the CO2 conduit 21. In close contact with the inner wall of the air supply line 23, the opening of the air line 22 is closed to block communication between the air line 22 and the air supply line 23. Other configurations and operations are the same as those in the first embodiment described above.

  According to such a configuration, in the above-described first embodiment, the second piston portion 62 is formed of a hard member such as stainless steel, and therefore, as shown in FIG. Even if it moves so as to jump out, a gap is formed between the inner wall of the air supply duct 23 and the outer periphery of the second piston portion 62, so that the air duct 22 cannot be completely blocked.

  However, according to the configuration of the present embodiment, when the second piston 62 moves out to the air supply pipe 23 with the supply of the carbon dioxide C to the CO2 pipe 21, the exclusion member 69 is moved to the first position. From the first embodiment, since the diameter of the carbon dioxide C introduced from the two through holes 62h through the communication hole 62j is increased, the diameter of the carbon dioxide C is in close contact with the inner wall of the air supply duct 23 and the opening of the air duct 22 is blocked. However, the air duct 22 can be reliably closed. Other effects are the same as those of the first embodiment described above.

  Hereinafter, modified examples will be described with reference to FIGS. FIG. 8 schematically shows a modification of the fluid switching device in which a notch is provided on the air supply base side of the attachment connector connected to the liquid supply base and the air supply base of the connector of the endoscope of FIG. FIG. 9 is a partial cross-sectional view, FIG. 9 is a partial cross-sectional view schematically showing a state in which the exclusion member of FIG. 8 moves together with the second piston portion so as to jump out into the air supply conduit, and FIG. It is an external view which shows schematically the structure of the slider to move.

  As shown in FIG. 8, a notch 45k is formed in a portion of the mounting connector 45 that faces the air feeding base 10c, and the CO2 pipe 21 is connected to the air feeding pipe 23 only by connecting the mounting connector 45 to the liquid feeding base 10b. The fluid switching device 200 may have a configuration that does not communicate with the fluid.

  According to such a configuration, even when the attachment connector 45 is connected to the liquid supply base 10b and the air hole of the air / water supply button 3b is blocked, the air supply base 10c is leaked, so Even if A is supplied, the air A leaks from the air supply cap 10c, and even if the carbon dioxide C is supplied to the CO2 conduit 21, the carbon dioxide C leaks from the second through hole 62h.

  Therefore, in order to make the air supply line 23 and the CO2 line 21 communicate with each other, the operator manually moves the slider 47 as shown in FIG. 10 to move the slider 47 to the slider 47 as shown in FIG. It is necessary to cause the connected second piston portion 62 to jump out into the air supply duct 23.

  In this state, when carbon dioxide C is supplied to the CO2 conduit 21, the exhaust member 69 is expanded in diameter as shown in FIG. 7 as in the above-described embodiment, so that the air supply conduit from the CO2 conduit 21 is expanded. Carbon dioxide C can be reliably supplied to 23. In this configuration, since the biasing portion 68 is not provided, the operator manually moves the slider 47 when returning the second piston portion 62 into the cylinder 60.

  According to such a configuration, the air A and the carbon dioxide C cannot be supplied to the air feeding pipe 23 simply by connecting the mounting connector 45 to the liquid feeding base 10b. If the slider 47 is manually moved, the carbon dioxide C Since it is possible to reliably supply only the gas to the air supply conduit 23, it is possible to reliably prevent erroneous delivery of carbon dioxide C.

  Further, in order to move the second piston portion 62 by supplying carbon dioxide C, a large supply pressure is required. However, in the present modification, the second piston 62 can be manually moved. It can be made smaller than the form.

  In this modification as well, the second piston 62 may jump out to the air supply pipe 23 using the supply pressure of carbon dioxide C. In this case, the air A does not need to leak in the air supply base 10c.

  The fluid switching device 200 and the endoscope system 1 according to the first and second embodiments described above are particularly effective when supplying carbon dioxide C into the subject in the ESD procedure described above.

  Hereinafter, an example of the ESD procedure described above will be briefly described with reference to FIGS. 11 and 12.

  FIG. 11 shows an incision of a lesion mucosa site in ESD using an incision tool protruding from an endoscope channel and a high-frequency knife while inserting the endoscope system of the first and second embodiments into a subject. FIG. 11A is a perspective view schematically illustrating an example of the operation. FIG. 11A is a perspective view illustrating a procedure for making a hole using an incision tool in the mucosa around the lesioned mucosa, and FIG. FIG. 11C is a perspective view showing a state in which the high-frequency knife is protruded into the subject through the channel of the endoscope, and FIG. 11C is a cutting tool in which the tip of the high-frequency knife in FIG. FIG. 11D is a perspective view illustrating an incision operation of a lesion mucosa portion by a high-frequency knife.

  FIG. 12 is a perspective view schematically illustrating the peeling operation of the lesion mucosa site in ESD using the peeling tool protruding from the channel of the endoscope, and FIG. 12 (A) is the tip of the peeling tool. FIG. 12B is a perspective view showing the orientation adjustment operation of the bending portion of the peeling tool in FIG. 12A.

  First, the surgeon introduces the endoscope system 1 into the subject, and then uses a syringe needle (not shown) that protrudes from the distal end opening 17 into the subject through the treatment tool insertion port 3s through the channel. As shown in FIG. 12 (A), physiological saline is injected into the submucosal layer of the lesioned mucosa portion S, which is the tissue to be treated, so that the lesioned mucosa portion S is raised.

  Next, as shown in FIG. 12A, the surgeon drills a hole H in a part of the mucosa around the lesion mucosa portion S using the incision tool 112 projected into the subject from the distal end opening 17. I will.

  Thereafter, the operator removes the incision tool 112 from the channel as shown in FIG. 8B, and the knife of the high-frequency knife 113 that protrudes from the distal end opening 17 into the subject through the treatment tool insertion port 3s through the channel. The tip is inserted into the hole H as shown in FIG.

  In this state, while supplying a high-frequency current to the knife tip, as shown in FIG. 11 (D), the tip side of the insertion portion 4 is moved back and forth by about 20 mm to 50 mm while using the curvature of the bending portion 7. The distal end side of the high-frequency knife 113 is also moved about 20 mm to about 50 mm, and the periphery of the lesion mucosa portion S is incised to form a cut end P.

  Next, the operator incises the lesioned mucosa portion S over the entire circumference, and then removes the high-frequency knife 113 from the channel, and as shown in FIG. 12 (A), the distal end from the treatment instrument insertion port 3s through the channel. A peeling tool 114 protruding from the opening 17 into the subject is introduced into the subject, the knife portion 114n is brought into contact with the cut P, the bent portion 114k is hooked, and the lower layer of the lesion mucosa portion S is incised and peeled off. Go. At this time, it is desirable that the bent portion 114k be parallel to the intrinsic muscle layer or face the lumen.

  If the direction of the bent portion 114k is not desirable, the direction of the bent portion 114k is adjusted. Specifically, as shown in FIG. 12B, in a state where the operation slider 114b of the operation unit 114a is slightly moved backward, the sheath 114s is grasped and the operation unit 114a is rotated. Subsequently, after the direction of the bent portion 114k is changed, the rotation of the knife portion 114n is restricted by a known mechanism by moving the operation slider 114b forward. Thereby, the bending part 114k is fixed in the state which maintained the direction during mucous membrane excision and peeling.

  Finally, the operator removes and removes all of the mucosa portion S from the lesion, and then removes the peeling tool 114 from the channel, and protrudes from the distal end opening 17 into the subject through the channel from the treatment tool insertion port 3s. Using a grasping forceps or the like, the lesioned mucosa portion S is taken out through the channel.

  Since such an ESD procedure is a long-term procedure that exceeds one hour, the fluid switching device according to the present embodiment can reliably supply only carbon dioxide C to the subject in order to expand the subject. 200, the configuration of the endoscope system 1 is particularly effective for reducing the pain of the subject. Note that the present invention is not limited to an ESD technique, and is particularly effective for a technique that requires a long time such as the above-described EMR.

  In the first and second embodiments described above, the insertion device has been described by taking the medical endoscope 2 as an example. In addition, the present invention can also be applied to an insertion device such as a treatment tool other than the endoscope 2.

  Therefore, the fluid switching device 200 can also be applied to an insertion device such as a treatment tool other than the endoscope 2, and can also be applied to an insertion system using an insertion device such as a treatment tool other than the endoscope 2. .

  Further, in the first and second embodiments, the carbon dioxide C is taken as an example of the first fluid and the air A is taken as an example as the second fluid. Needless to say, this is applicable.

1. Endoscope system (insertion system)
2. Endoscope (insertion device)
16k ... supply port 21 ... CO2 pipe (first fluid pipe)
22 ... Air line (second fluid line)
23 ... Air supply line (third fluid line) (fluid supply line)
53 ... CO2 gas cylinder (first fluid supply source)
60 ... Cylinder 60i ... One end of cylinder 60t ... Other end of cylinder 61 ... First piston portion 61h ... First through hole 62 ... Second piston portion 62h ... Second through hole 65 ... Moving portion 68 ... Biasing Portion 69 ... Exhaust member 200 ... Fluid switching device A ... Air (second fluid)
C ... Carbon dioxide (first fluid)
K: Diameter of first through hole and second through hole R: Fluid supply line U: Air pump (second fluid supply source)

Claims (6)

A first fluid pipe through which the first fluid flows from the outside;
A second fluid pipe into which the second fluid flows from the outside;
One end side is connected to the first fluid pipe and the second fluid pipe, and either the first fluid or the second fluid introduced from the one end side is provided on the other end side. A third fluid pipe flowing out from the supply port;
A cylinder provided at an intermediate position of the first fluid pipe and having one end into which the first fluid flows in and the other end from which the first fluid flows out;
It is provided in the cylinder and reciprocates between the one end and the other end of the cylinder, receives the first fluid flowing in from the one end of the cylinder, and more than the first fluid pipe. A first piston portion having a first through-hole having a diameter that increases a pipe resistance when the first fluid passes; and the first piston portion is located on the other end side of the cylinder. When moved, the cylinder moves from the cylinder into the third fluid pipe, and the outer peripheral surface blocks communication between the second fluid pipe and the third fluid pipe, and communicates with the first through hole. A moving part having a second piston part formed with a second through hole having a diameter with which a pipe resistance when the first fluid passes is larger than that of the first fluid pipe;
In the cylinder, when the pressure at which the first fluid passes from the one end of the cylinder to the other end falls below a set value, the first piston portion is extended from the other end side to the one end by extension. And moving the second piston part into the cylinder to release the second fluid pipe and the third fluid pipe from being blocked by the second piston part, In response to the pressure being equal to or higher than the set value, the one end of the cylinder and the other end are moved by compression from the one end side of the cylinder to the other end side. An urging portion that can freely expand and contract in the extending direction connecting
A fluid switching device comprising:
An endoscope inserted into the subject and having a fluid supply line;
The fluid switching device connected to the fluid supply line via the third fluid pipe;
A first fluid supply source for supplying the first fluid to the first fluid pipe of the fluid switching device;
A second fluid supply source for supplying the second fluid to the second fluid pipe of the fluid switching device;
Comprising
The first fluid and the second fluid are different types of fluids;
The endoscope system according to claim 1, wherein the first fluid is carbon dioxide, and the second fluid is air. The biasing portion is an extension spring in which one end of the biasing portion is locked to the first piston portion and the other end of the biasing portion is locked to the other end of the cylinder. The endoscope system according to claim 1. 2. The internal view according to claim 1, wherein the first fluid pipe and the third fluid pipe are always in communication with each other through the first through hole and the second through hole. Mirror system . When the second piston portion communicates with the second through hole, expands with the supply of the first fluid through the second through hole, and moves into the third fluid pipe The endoscope system according to claim 3, further comprising: an exclusion member that blocks communication between the second fluid pipe and the third fluid pipe. The endoscope system according to claim 1, wherein the first piston part is formed integrally with or connected to the second piston part. The second fluid continuously flows into the first fluid pipe and the third fluid pipe;
The pressure at which the first fluid is supplied to the third fluid pipe is higher than the pressure at which the second fluid flows into the first fluid pipe and the third fluid pipe. The endoscope system according to claim 1.

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