JP3791902B2

JP3791902B2 - Endoscope

Info

Publication number: JP3791902B2
Application number: JP2001221910A
Authority: JP
Inventors: 高嗣山谷
Original assignee: Olympus Corp
Current assignee: Olympus Corp
Priority date: 2001-07-23
Filing date: 2001-07-23
Publication date: 2006-06-28
Anticipated expiration: 2021-07-23
Also published as: JP2003033316A

Description

【０００１】
【発明の属する技術分野】
本発明は、処置具挿通用チャンネルを複数備え、それぞれの処置具挿通用チャンネルのチャンネル開口より突出される処置具を揺動させて各種処置を行える内視鏡に関する。
【０００２】
【従来の技術】
従来より、細長の挿入部を体腔内に挿入することにより、体腔内臓器などを観察したり、必要に応じて処置具チャンネル内に挿通した処置具を用いて各種治療処置の行える医療用の内視鏡が広く利用されている。
【０００３】
近年、内視鏡に複数の処置具挿通用チャンネルを設け、それぞれの処置具挿通用チャンネルに異なる処置具を挿通して体腔内の病変部位を内視鏡的に切除する等の手技が有用であると広く認知されている。
【０００４】
例えば特開２０００−３７３４８号公報の処置用内視鏡には、２つの処置具挿通用チャンネルを備えた内視鏡を用い、各処置具挿通用チャンネルに各種処置具を挿通して処置を行う方式が示されている。
【０００５】
前記処置用内視鏡では、一方の処置具挿通用チャンネルの先端開口部に、他方の処置具挿通用チャンネルの先端開口部から離れていく方向に作動する鉗子起上装置を設け、この鉗子起上装置が備えられた処置具挿通用チャンネルに挿通される把持用処置具（以下把持鉗子と呼ぶ）と、他方の処置具挿通用チャンネルに挿通された針状電気メスなどの切開用処置具（以下切開具と呼ぶ）とを組み合わせて処置を行う。
【０００６】
具体的には病変粘膜部、若しくはその近傍を把持鉗子で把持した後、切開具が挿通される処置具挿通用チャンネルから離れる方向に把持鉗子を移動させ、引っ張っられた状態の粘膜部分を切開具で切除することが記載されている。
【０００７】
【発明が解決しようとする課題】
しかしながら、前記特開２０００−３７３４８号公報の処置用内視鏡では、把持鉗子で引っ張った粘膜部分を切開具の先端で横方向に切除する誘導手段について何ら言及されていない。このため、前記処置用内視鏡の構成では、切開具の先端位置の誘導を、内視鏡の湾曲操作などで行うしか方法がなく、そのように行う場合には、把持鉗子や内視鏡視野までもが湾曲操作に伴って一緒に動いてしまうという不具合が生じる。
【０００８】
また、切開具先端の微妙な操作を、湾曲操作で行うことは難しく、切開作業が非常に難しくなるばかりでなく、１回の操作で切除できる範囲が限られてしまうという不具合があった。
【０００９】
本発明は上記事情に鑑みてなされたものであり、複数の処置具挿通用チャンネルの先端開口から処置具を突出させて内視鏡的処置を行う際の作業性に優れた内視鏡を提供することを目的にしている。
【００１０】
【課題を解決するための手段】
本発明の内視鏡は、内視鏡挿入部の先端部に配設された、複数の処置具を体腔内に導く複数の処置具挿通用チャンネルと、前記複数の処置具挿通用チャンネルのうち第２の処置具挿通用チャンネルの開口部先端側において、前記複数の処置具のうち第２の処置具の先端部を内視鏡画像の左右方向中心線を境界にして左右両方向に移動可能に配設された第２の処置具揺動台と、前記複数の処置具挿通用チャンネルのうち第１の処置具挿通用チャンネルの開口部先端側において、前記複数の処置具のうち第１の処置具の先端部を前記第２の処置具揺動台が移動する面から遠ざかる方向に移動可能に配設された第１の処置具揺動台と、を具備したことを特徴とする。
【００１１】
この構成によれば、処置具先端部を内視鏡画像の中心部を含めて左右方向に広範囲に移動させられる。
【００１２】
【発明の実施の形態】
以下、図面を参照して本発明の実施の形態を説明する。
図１ないし図１０は本発明の一実施形態に係り、図１は内視鏡挿入部の先端部の構成を説明する長手方向断面図、図２は先端部を正面から見たときの図、図３は図１の矢印Ｐ側から第２処置具揺動台を見たときの図、図４は図１のＸ−Ｙ線断面図、図５は第２処置具揺動台の外観形状を説明する図、図６は第２処置具揺動台によって揺動される処置具位置と観察視野範囲との関係を説明する図、図７はＴＶモニタに映し出される処置具の画像を説明する図、図８は第２処置具揺動台の作用を示す図、図９は第１処置具揺動台及び第２処置具揺動台の作用を示す図、図１０は第１処置具揺動台及び第２処置具揺動台の作用を示す図である。
【００１３】
本実施形態の内視鏡は観察画像を表示装置の画面上に表示させるタイプのものであり、内視鏡挿入部は通常の内視鏡と同様、先端側から順に、先端部１、湾曲部（不図示）、可撓管部（不図示）を連設し、内視鏡挿入部全体として軟性に構成してある。
【００１４】
図１及び図２に示すように前記先端部１には内視鏡先端面を傾斜面２ａにした硬質な先端硬性部材２が設けられている。この先端硬性部材２の傾斜面２ａには観察光学系１１を構成する観察窓３と、照明光学系１３を構成する例えば２つの照明窓４と、前記観察窓３に開口を対向させた送気送水ノズル５と、前方側送水口６と、第１処置具挿通用チャンネル７に連通する第１チャンネル開口部８の第１チャンネル開口８ａと、第２処置具挿通用チャンネル９に連通する第２チャンネル開口部１０の第２チャンネル開口１０ａとが設けられている。つまり、本実施形態の内視鏡は斜視型の内視鏡である。
【００１５】
前記先端硬性部材２の第１チャンネル開口部８近傍には第１チャンネル開口８ａから導出される図示しない処置具の体腔内突出方向を調整する処置具載置面１４ａを形成した略平板状で図中上下方向に揺動する第１処置具揺動台１４を配置する第１処置具揺動台配置部１４Ａが形成されている。
【００１６】
また、前記第２チャンネル開口部１０近傍には第２チャンネル開口１０ａから導出される図示しない処置具の体腔内突出方向を調整する処置具挿通孔１９を形成した略ブロック形状で図中左右方向に揺動する第２処置具揺動台１５を配置する第２処置具揺動台配置部１５Ａが形成されている。
【００１７】
そして、前記第１処置具揺動台１４の配置位置を、前記第２処置具揺動台１５の配置位置よりも基端側で、かつ上方側に設定するとともに、前記第１処置具揺動台１４及び第２処置具揺動台１５の配置位置を、前記観察窓３の上辺３ｕより上方側に設定している。本実施形態においては、内視鏡が斜視型であるので、傾斜面２ａの先端側から順に、観察窓３、第２処置具揺動台１５、第１処置具揺動台１４が軸方向に配置されている。
【００１８】
前記第２処置具揺動台配置部１５Ａは、内視鏡先端部外径寸法の大径化を図ることなく、前記第２処置具揺動台１５の揺動範囲を大きくとることができるように、先端部１の最大径部分である直径近傍に設けてある。
【００１９】
なお、前記観察光学系１１は斜視型に限定されるものではなく、直視、或いは側視であってもよく、前記観察窓３も辺を持たない丸型でもよい。また、前記観察光学系１１の結像位置には撮像素子１２が配設されている。さらに、前記照明窓４の基端面には照明光を導光する図示しないライトガイドファイバーの先端面が臨まれている。又、前記送気送水ノズル５は、前記観察窓３の表面に洗滌水を噴き付けて洗滌する送水ノズルと、体腔内に空気等の気体を送り込むノズルとを兼用している。さらに、前記先端硬性部材２の基端部には湾曲部を構成する第１湾曲駒３７が連結され、この第１湾曲駒３７の外側には湾曲ゴム３８が被覆されている。この湾曲ゴム３８の先端部は、糸巻き接着によって前記先端硬性部材２に水密に固定されている。そして、内視鏡挿入部の基端側に設けられた操作部（不図示）の図示しない操作ノブを適宜操作することによって湾曲部を湾曲させて、先端硬性部材２を上下左右に移動させることができるようになっている。
【００２０】
図１ないし図７を参照して第１処置具揺動台１４及び第２処置具揺動台１５の構成及びその配置位置関係を説明する。なお、図１中の矢印Ｑ方向は、術者が観察するＴＶモニタの画面上方向である。
まず、図１ないし図３を参照して第１処置具揺動台１４について説明する。
【００２１】
前記第１処置具揺動台１４は、この第１処置具揺動台１４の基端側に配置される第１の軸１６により、前記先端硬性部材２に対して上下方向に回動自在な状態にしている。また、この第１処置具揺動台１４の先端側には第１ワイヤ端末部材１７が回動自在に設けられており、この第１ワイヤ端末部材１７に第１操作ワイヤ１８の先端部が連結固定されている。この第１操作ワイヤ１８の基端部は、内視鏡挿入部内を挿通して図示しない第１の揺動台操作機構に連結固定されている。
【００２２】
したがって、第１の揺動台操作機構によって前記第１操作ワイヤ１８を進退させることによって、第１処置具揺動台１４が第１の軸１６を中心に実線に示す倒置位置と二点鎖線で示す最大起上位置との間を回動する。
【００２３】
なお、前記第１処置具揺動台１４の回転規制は、先端硬性部材２に設けられている当接面２ｂと、第１処置具揺動台１４の倒置面１４ｂ、起上面１４ｃとの突き当てで行う。すなわち、倒置位置で先端硬性部材２の当接面２ｂと第１処置具揺動台１４の倒置面１４ｂ面とが突き当たり、最大起上位置で先端硬性部材２の当接面２ｂと第１処置具揺動台１４の起上面１４ｃとが突き当たる構成になっている。
【００２４】
次に、図１ないし図７を参照して第２処置具揺動台１５の構成及びその配置位置を説明する。
前記第２処置具揺動台１５は、図１及び図４に示すようにこの第２処置具揺動台１５から突設する第２の軸２２及び第３の軸２３を前記先端硬性部材２の延出部３０及び先端硬性部材２の所定位置に配置して、この軸２２，２３を中心に第２処置具揺動台１５が先端硬性部材２の左右方向に回動自在な状態にしている。
【００２５】
前記第２処置具揺動台１５は、処置具挿通孔１９の開口１９ａが形成された傾斜面２０ａを有する台本体部２０と、前記第２処置具挿通用チャンネル９を介して導入される第２処置具を前記処置具挿通孔１９に導く一対の処置具誘導壁部２６と、第２処置具揺動台１５を左右に揺動させるための操作ワイヤ２４，２５が接続される前記傾斜面２０ａから両側部に突出した一対の凸部２０ｂ、２０ｃとで構成されている。
【００２６】
前記台本体部２０の上面中央部には第２の軸２２を配設する第１回転軸配置穴２１ａが形成され、この回転軸用孔２１と同軸上の下面中央部には第３の軸２３を配設する第２回転軸配置穴２１ｂが形成されている。
【００２７】
前記凸部２０ｂに回動自在に設けられたワイヤ端末部材３２には第２操作ワイヤ２４の先端部が連結固定され、前記凸部２０ｃに回動自在に設けられたワイヤ端末部材３３には第３操作ワイヤ２５の先端部が連結固定されている。これら第２の操作ワイヤ２４及び第３の操作ワイヤ２５の基端部は、挿入部内を挿通して図示しない第２の揺動台操作機構に連結固定されている。
【００２８】
したがって、この第２の揺動台操作機構によって前記操作ワイヤ２４，２５を適宜進退させることによって、第２処置具揺動台１５が第２の軸２２及び第３の軸２３を中心に左右方向に回動する。
【００２９】
図２に示すように前記処置具挿通孔１９の開口１９ａの左右方向に対する開口中心線２８と、前記第２チャンネル開口部１０の左右方向に対するチャンネル中心線２９と、前記観察窓３の左右方向に対する視野中心線２７とを略同一面に位置するように設けている。また更に、開口中心線２８、視野中心線２７、チャンネル中心線２９を、先端部の左右方向中心線の近傍の略同一面に位置するように設定してもよい。
【００３０】
なお、前記第２処置具揺動台１５の回転規制は、先端硬性部材２に周状に形成した少なくとも１つ以上のストッパー凹部３１の端部３１ａ、３１ｂとワイヤ端末部材３２、３３との突き当てで行う。すなわち、ストッパー凹部３１の所定位置に形成した端部３１ａとワイヤ端末部材３２とを突き当てるとともに、ストッパー凹部３１の所定位置に形成した端部３１ｂとワイヤ端末部材３３とを突き当てる構成にして所定の回転角を設定している。
【００３１】
このように回転角を設定することより、図６に示すように先端硬性部材２の先端面である傾斜面２ａから処置具４４を例えば約１５ｍｍ突出させた状態にして、前記第２の操作ワイヤ２４及び第３の操作ワイヤ２５を操作して第２処置具揺動台１５を回動操作すると、処置具４４は２点鎖線で示す軌跡を描く。この際、処置具４４の先端部が観察窓３の左右観察視野範囲を越えることがなく（図７参照）、視野中心線２７を挟んで左右両方向に略等距離回動移動する。なお、前記処置具４４が視野中心線２７上に位置したとき、この処置具４４の先端が内視鏡の先端面である傾斜面２ａから最も遠い位置になる。
【００３２】
図７に示すように表示装置である例えばＴＶモニタの画面４１には略上方側から突出したように処置具の画像４４ａが映し出される。このとき、処置具挿通孔１９の開口１９ａの開口中心線２８と、観察窓３の視野中心線２７とを上述したように設定したことにより、処置具４４が視野中心線２７上に配置されたとき、処置具の画像４４ａは画面の左右方向中心線である画面中心線４５上に表示される。また、ストッパー凹部３１の端部３１ａ、３１ｂとワイヤ端末部材３２、３３とが突き当たったとき、それぞれの処置具の画像４４ａが画面の左端及び右端に表示される。このため、術者は、処置具先端部を内視鏡画像の中心部を含めて左右方向に広範囲に移動させることができる。
【００３３】
なお、前記処置具の画像４４ａが画面の略上方側から突出したように映し出されるのは上述したように第２処置具揺動台１５の配置位置を観察窓３の上辺３ｕより上方側に設定したためである。
【００３４】
また、前記処置具誘導壁２６の内面には、少なくとも前記第２処置具揺動台１５の左右方向最大回動時、処置具４４を回転方向とは反対方向に押圧する作用点又は作用稜線３９が形成してある。このため、処置具４４を左右に大きく振ったとき、この処置具４４が開口１９ａ内周面と作用稜線３９との２点で支持されるので、処置具４４を確実にホールドして作業を行える。
【００３５】
さらに、前記処置具挿通孔１９の開口１９ａは、左右方向に対して上下方向に長い長円形で形成している。このとき、図１に示すように、処置具挿通孔１９の開口１９ａから突出する処置具４４と開口１９ａとの間の左右方向及び上下方向のクリアランスは、揺動方向である左右方向クリアランスの和（Ｘ1＋Ｘ2）よりも、上下方向クリアランス（Ｙ）を、大きく、若しくは同寸法になるように設定している。つまり、ＹとＸ１，Ｘ２との間に、Ｙ≧Ｘ1＋Ｘ2 の関係を設定して、この第２処置具揺動台１５によって揺動操作される処置具４４の振れ量を少なくして微妙な作業を可能にしている。
【００３６】
なお、図４に示すように第２の操作ワイヤ２４は、第１処置具揺動台１４のすぐ真下を通って挿入部内に導かれている。
【００３７】
また、図５では台本体部２０の傾斜面２０ａ内で外周が連続する開口１９ａを示しているが、この開口１９ａを大きめに形成して傾斜面２０ａ内で開口１９ａの外周の一部が不連続になる形状であってもよい。つまり、開口１９ａの形状について特に限定はしない。
【００３８】
さらに、第１処置具揺動台１４が配置される第１処置具揺動台配置部１４Ａに、この第１処置具揺動台１４を起上させたとき、第２処置具揺動台配置部１５Ａに連通する開口部を形成して、内視鏡の洗滌・消毒性を向上させている。
【００３９】
又、前記第２処置具揺動台１５を回動させたとき、操作ワイヤ２４，２５が処置具誘導壁２６に接触することを防止するように前記処置具誘導壁２６の高さ寸法が設定されている。
【００４０】
また、前記第１の揺動台操作機構及び第２の揺動台操作機構の位置関係及び機構、或いは前記第１処置具挿通用チャンネル７と前記第２処置具挿通用チャンネル９のチャンネル内径寸法及びチャンネルの材質、硬さ等についても特に限定されるものではない。
【００４１】
上述のように構成した内視鏡の作用を説明する。
まず、図８に示すように内視鏡挿入部４０の先端部１に設けられている観察窓３を病変粘膜に対向させる。そして、病変粘膜に対して内視鏡的観察を行うとともに、例えば第２処置具挿通用チャンネル９を介して処置具である注射針４２を体腔内に導入する。ここで、注射針４２を病変粘膜に対向させるために第２処置具揺動台１５を揺動させて注射針４２を病変粘膜の所定部位に対向させ、注射針４２を矢印ａに示すように目的部位に進め、病変粘膜の下層に生理食塩水などの薬液を注入する。すると、病変粘膜を含む粘膜層を***する。
【００４２】
次に、図９に示すように第１処置具挿通用チャンネル７を介して処置具である把持鉗子４３を体腔内に導入する。ここで、この把持鉗子４３を、***した粘膜層に対向させるため、第１処置具揺動台１４を揺動する。そして、把持鉗子４３を粘膜層の所定部位に対向させたなら、この把持鉗子４３を押し進めて***した病変粘膜を含む粘膜層を把持する。一方、前記第２処置具挿通用チャンネル９に注射針４２の代わりに処置具である切開具４４を挿入し、この切開具４４を病変粘膜近傍に配置する。
【００４３】
次いで、第１処置具揺動台１４を揺動させて把持鉗子４３を矢印ｂ方向に起上させていく。すると、把持鉗子４３によって把持されていた病変粘膜を含む粘膜層が引っ張り上げられた状態になる。
【００４４】
ここで、図１０に示すように第２処置具揺動台１５を矢印ｃ、ｄ方向に揺動させて、***した粘膜下層部を切開具４４で切除していく。このとき、第１処置具揺動台１４が第２処置具揺動台１５の上方側に配置されているので、病変粘膜を吊り上げた状態で、観察窓３を通して切開面側の状況、例えば切開具４４先端の深さに注意を払いながら、病変粘膜の根元部を切除する切除作業を速やかに行える。このとき処置具先端は、内視鏡画像の中心部を含めて左右方向に広範囲に移動することができる。
【００４５】
また、画面上に表示される切開具４４の画像が画面中心線４５近傍に位置しているとき、切開具４４の先端の位置が内視鏡の先端面から最も遠い位置になる。つまり、切開具４４の画像が画面の端側に位置しているときには、たとえ切開具４４が揺動していても、刃先位置が深くならないので、術者もその点を考慮して、切開作業を行える。
【００４６】
このことによって、この内視鏡とそれに組み合わせられる処置具を用いれば、広範囲な病変部位に対して確実かつ容易に一括切除等の手技をを行えるとともに、操作性が容易であることから、確実かつ迅速な手術が可能になって、術者及び患者の負担が低減される。
【００４７】
なお、第１処置具挿通用チャンネル７を介して切開具４４を体腔内に導入し、第２処置具挿通用チャンネル９を介して把持鉗子４３を体腔内に導入して、内視鏡の先端に対する体腔内の粘膜位置を調整することで、上述と同様な切除作業を行うことが可能である。
【００４８】
図１１ないし図１３は本発明の変形例に係り、図１１は第２処置具揺動台の他の構成を説明する図、図１２は図１１の第２処置具揺動台を含む先端部の構成を説明する一部断面図、図１３はＴＶモニタに映し出される処置具の画像を説明する図である。
【００４９】
図１１に示すように本実施形態においては前記実施形態で説明したように第２処置具揺動台１５を回転軸を中心に回動させる代わりに、先端硬性部材２の所定位置に、前記観察窓３に対して平行な直線溝からなるストッパー凹部５１を設けて第２処置具揺動台１５ａを観察窓３の視野中心線２７を挟んで左右両方向に平行移動するようにしている。
【００５０】
つまり、図１１及び図１２に示すように前記ストッパー凹部５１内に、前記第２の操作ワイヤ２４の先端に設けられた第２のワイヤ端末部材３２の下端部及び前記第３の操作ワイヤ２５の先端に設けられた第３のワイヤ端末部材３３の下端部とを配置している。
【００５１】
このことにより、第２の操作ワイヤ２４及び第３の操作ワイヤ２５が適宜操作されることによって、第２処置具揺動台１５が視野中心線２７を挟んで、左右両方向に前記先端面３６に対して平行に揺動する。このとき、第２処置具揺動台１５で揺動される処置具４４の先端から内視鏡の先端面３６までの距離は揺動範囲内において常に一定になる。このため、図１３に示すように表示装置の画面４１に映し出される処置具４４の画像４４ａも画面中心線４５を挟んで左右方向に、画面上面に対して平行に移動する。
【００５２】
このように、処置具の先端を、表示装置の画面上で左右方向に平行に移動するように第２処置具揺動台を構成したことによって、上述した実施形態の効果に加えて、処置具の先端の位置を内視鏡の先端面から常に一定な位置に配置して手技を行うことができる。このことにより、第２処置具揺動台で例えば切開具を揺動させたとき、切り口の一部が深くなることがなくなる。
【００５３】
図１４及び図１５は本発明の他の変形例に係り、図１４は第２処置具揺動台の別の構成を説明する図、図１５はＴＶモニタに映し出される処置具の画像を説明する図である。
【００５４】
図１４に示すように本実施形態においては、第２処置具揺動台１５の回転軸の位置を軸２２ａに変えている。具体的に、回転軸２２ａの位置を、第２チャンネル開口部１０のチャンネル中心線２９に対して位置ずれさせるとともに、第２処置具揺動台１５の中心線に対して位置ずれさせて、第２処置具揺動台１５の揺動範囲を視野中心線２７を挟んで左側方向と右側方向との移動距離を変化させている。そして、前記処置具４４が揺動されて視野中心線２７近傍に位置したとき、この処置具４４の先端の先端面３６からの突出距離が最大になる。
【００５５】
また、図１５に示すように表示装置の画面４１に映し出される処置具４４の画像４４ａの画面中心線４５を挟んでの移動距離も左側方向と右側方向とで変化する。
【００５６】
このように、第２処置具揺動台の回転軸の位置を変えることによって、上述した実施形態の効果に加えて、第２処置具揺動台で揺動される処置具の揺動範囲を手技に対応させて変化させることができる。
【００５７】
図１６及び図１７は本発明の別の変形例に係り、図１６は内視鏡挿入部の先端部の他の構成を説明する長手方向断面図、図１７はＴＶモニタに映し出される処置具の画像を説明する図である。
【００５８】
図１６に示すように本実施形態においては、第２処置具揺動台１５の位置を観察窓３の下側に配置している。また、前記第２処置具揺動台１５の回転軸を第２の軸２２、１本にしている。さらに、前記第２処置具揺動台１５に、この第２処置具揺動台１５の揺動状態によって付勢力が変化する例えばばね等の弾性部材４８が設けている。又、第１処置具揺動台１４ｄの先端部に、前記第２処置具揺動台１５と同様、開口部４７を設けて、この第１処置具揺動台１４ｄで揺動される処置具の振れ量を少なくして微妙な作業を可能にしている。
【００５９】
この構成により、両操作ワイヤ２４，２５にテンションがかかっていない状態になると、前記弾性部材４８の復元力によって第２処置具揺動台１５が揺動位置から所定位置に戻る。また、図１７に示すように処置具の画像４４ａは、画面４１の略下方側から突出するように映し出される。
【００６０】
なお、図１７に示すように前記第２処置具揺動台１５の揺動範囲は、少なくとも処置具の先端が画面の左右方向の画面中心線４５を挟んで左右方向に移動するように設定されており、画面中心線４５近傍に画像４４ａがあるとき、この処置具４４の先端の先端面３６からの突出距離が最大である。その他の構成は上述した実施形態と同様である。
【００６１】
このように、操作ワイヤにテンションがかかっていない状態のとき、第２処置具揺動台１５を所定の位置に復帰させる付勢力を有する弾性部材４８を設けたことによって、上述した実施形態の効果に加えて、弾性部材４８によって第２処置具揺動台１５を所望の位置に復帰させる構成にすることができる。
【００６２】
つまり、弾性部材４８によって、チャンネル開口１０に対して処置具誘導壁２６を所定の状態に対向させて、処置具の第２処置具揺動台１５へ誘導性を向上させられる。
【００６３】
なお、本発明は、以上述べた実施形態のみに限定されるものではなく、発明の要旨を逸脱しない範囲で種々変形実施可能である。例えば、先端面３６が傾斜していない直視型の内視鏡もその一例である。
【００６４】
［付記］
以上詳述したような本発明の上記実施形態によれば、以下の如き構成を得ることができる。
【００６５】
（１）内視鏡挿入部の先端部に、内視鏡画像を撮らえる対物光学系と、処置具を体腔内に導く複数の処置具挿通用チャンネルとを設けた内視鏡において、
前記複数の処置具挿通用チャンネルの少なくとも１つに、処置具の先端を内視鏡画像の左右方向中心線を境界にして左右両方向に移動可能にする、処置具揺動台を設けた内視鏡。
【００６６】
（２）前記処置具挿通用チャンネルから突出する処置具を前記対物光学系が撮らえたとき、
前記表示装置の画面略上側、又は画面略下側から前記処置具の画像が映し出されるように、処置具揺動台と前記対物光学系との位置関係を設定した付記１記載の内視鏡。
【００６７】
（３）前記表示装置の画面の左右方向中心線近傍に処置具の画像が映し出されるとき、前記処置具先端が内視鏡挿入部の先端部先端面から最遠点に位置する付記２記載の内視鏡。
【００６８】
【発明の効果】
以上説明したように本発明によれば、複数の処置具挿通用チャンネルの先端開口から処置具を突出させて内視鏡的処置を行う際の作業性に優れた内視鏡を提供することができる。
【図面の簡単な説明】
【図１】図１ないし図１０は本発明の一実施形態に係り、図１は内視鏡挿入部の先端部の構成を説明する長手方向断面図
【図２】先端部を正面から見たときの図
【図３】図１の矢印Ｐ側から第２処置具揺動台を見たときの図
【図４】図１のＸ−Ｙ線断面図
【図５】第２処置具揺動台の外観形状を説明する図
【図６】第２処置具揺動台によって揺動される処置具位置と観察視野範囲との関係を説明する図
【図７】ＴＶモニタに映し出される処置具の画像を説明する図
【図８】第２処置具揺動台の作用を示す図
【図９】第１処置具揺動台及び第２処置具揺動台の作用を示す図
【図１０】第１処置具揺動台及び第２処置具揺動台の作用を示す図
【図１１】図１１ないし図１３は本発明の変形例に係り、図１１は第２処置具揺動台の他の構成を説明する図
【図１２】図１１の第２処置具揺動台を含む先端部の構成を説明する一部断面図
【図１３】ＴＶモニタに映し出される処置具の画像を説明する図
【図１４】図１４及び図１５は本発明の他の変形例に係り、図１４は第２処置具揺動台の別の構成を説明する図
【図１５】ＴＶモニタに映し出される処置具の画像を説明する図
【図１６】図１６及び図１７は本発明の別の変形例に係り、図１６は内視鏡挿入部の先端部の他の構成を説明する長手方向断面図
【図１７】ＴＶモニタに映し出される処置具の画像を説明する図
【符号の説明】
１…先端部
２…先端硬性部材
２ａ…傾斜面
３…観察窓
１５…第２処置具揺動台
２７…視野中心線[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an endoscope that includes a plurality of treatment instrument insertion channels and can perform various treatments by swinging a treatment instrument protruding from a channel opening of each treatment instrument insertion channel.
[0002]
[Prior art]
Conventionally, by inserting a long and thin insertion portion into a body cavity, the inside of a body cavity can be observed, and various medical treatments can be performed using a treatment instrument inserted into a treatment instrument channel as necessary. Endoscopes are widely used.
[0003]
In recent years, a technique has been useful in which a plurality of treatment instrument insertion channels are provided in an endoscope, and a different treatment instrument is inserted into each treatment instrument insertion channel to endoscopically remove a lesion site in a body cavity. Widely recognized.
[0004]
For example, the treatment endoscope disclosed in Japanese Patent Laid-Open No. 2000-37348 uses an endoscope having two treatment instrument insertion channels, and performs treatment by inserting various treatment instruments into each treatment instrument insertion channel. The scheme is shown.
[0005]
In the treatment endoscope, a forceps raising device that operates in a direction away from the distal end opening of the other treatment instrument insertion channel is provided at the distal end opening of one treatment instrument insertion channel. A treatment instrument for grasping (hereinafter referred to as grasping forceps) inserted into a treatment instrument insertion channel provided with the upper device, and an incision treatment instrument such as a needle-shaped electric knife inserted into the other treatment instrument insertion channel ( The treatment is performed in combination with an incision tool).
[0006]
Specifically, after grasping the lesion mucosa or the vicinity thereof with grasping forceps, the grasping forceps are moved away from the treatment instrument insertion channel through which the incision tool is inserted, and the pulled mucosa is incised. It is described that excision.
[0007]
[Problems to be solved by the invention]
However, in the treatment endoscope disclosed in Japanese Patent Laid-Open No. 2000-37348, there is no mention of a guiding means for excising the mucosal portion pulled by the grasping forceps in the lateral direction at the distal end of the cutting tool. For this reason, in the configuration of the treatment endoscope, there is only a method for guiding the distal end position of the incision tool by a bending operation of the endoscope. In such a case, a grasping forceps or an endoscope is used. There is a problem that even the visual field moves together with the bending operation.
[0008]
In addition, it is difficult to perform delicate operations on the distal end of the incision tool by a bending operation, so that not only the incision operation becomes very difficult, but also the range that can be excised by a single operation is limited.
[0009]
The present invention has been made in view of the above circumstances, and provides an endoscope excellent in workability when performing a endoscopic treatment by projecting a treatment tool from the distal end openings of a plurality of treatment tool insertion channels. The purpose is to do.
[0010]
[Means for Solving the Problems]
An endoscope according to the present invention includes a plurality of treatment instrument insertion channels arranged at a distal end portion of an endoscope insertion portion and guiding a plurality of treatment instruments into a body cavity, and the plurality of treatment instrument insertion channels. On the distal end side of the opening of the second treatment instrument insertion channel, the distal end portion of the second treatment instrument among the plurality of treatment instruments can be moved in both the left and right directions with the horizontal center line of the endoscopic image as a boundary. The first treatment tool of the plurality of treatment tools is disposed on the distal end side of the first treatment tool insertion channel of the plurality of treatment tool insertion channels and the second treatment tool swinging base disposed. And a first treatment instrument oscillating base arranged to be movable in a direction away from a surface on which the second treatment instrument oscillating base moves.
[0011]
According to this configuration, the distal end portion of the treatment instrument can be moved in a wide range in the left-right direction including the center portion of the endoscopic image.
[0012]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
1 to 10 relate to an embodiment of the present invention, FIG. 1 is a longitudinal sectional view for explaining a configuration of a distal end portion of an endoscope insertion portion, and FIG. 2 is a view when the distal end portion is viewed from the front. 3 is a view when the second treatment instrument swinging table is viewed from the arrow P side in FIG. 1, FIG. 4 is a cross-sectional view taken along line XY of FIG. 1, and FIG. FIG. 6 is a diagram for explaining the relationship between the position of the treatment tool swung by the second treatment tool rocking table and the observation visual field range, and FIG. 7 is for explaining the image of the treatment tool displayed on the TV monitor. 8 is a diagram showing the operation of the second treatment instrument swinging table, FIG. 9 is a diagram showing the operation of the first treatment instrument swinging table and the second treatment instrument swinging table, and FIG. 10 is the first treatment instrument swinging table. It is a figure which shows the effect | action of a moving table and a 2nd treatment tool rocking | fluctuation table.
[0013]
The endoscope of the present embodiment is of a type that displays an observation image on the screen of a display device, and the endoscope insertion portion is the distal end portion 1 and the bending portion in order from the distal end side in the same manner as a normal endoscope. (Not shown), a flexible tube portion (not shown) is provided continuously, and the entire endoscope insertion portion is configured to be flexible.
[0014]
As shown in FIGS. 1 and 2, the distal end portion 1 is provided with a rigid distal end rigid member 2 having an endoscope distal end surface having an inclined surface 2a. On the inclined surface 2 a of the distal end rigid member 2, an observation window 3 that constitutes the observation optical system 11, for example, two illumination windows 4 that constitute the illumination optical system 13, and an air supply that faces the observation window 3. The water supply nozzle 5, the front water supply port 6, the first channel opening 8 a of the first channel opening 8 that communicates with the first treatment instrument insertion channel 7, and the second treatment instrument insertion channel 9 that communicates with the second channel 9. A second channel opening 10 a of the channel opening 10 is provided. That is, the endoscope of the present embodiment is a perspective type endoscope.
[0015]
In the vicinity of the first channel opening 8 of the distal end rigid member 2, a treatment instrument mounting surface 14a for adjusting a protruding direction in a body cavity of a treatment instrument (not shown) derived from the first channel opening 8a is formed in a substantially flat plate shape. A first treatment instrument oscillating base arrangement portion 14A for arranging a first treatment instrument oscillating base 14 that swings in the middle and up and down directions is formed.
[0016]
Further, in the vicinity of the second channel opening 10, a treatment tool insertion hole 19 for adjusting a protruding direction in a body cavity of a treatment tool (not shown) derived from the second channel opening 10a is formed in a substantially block shape in the horizontal direction in the figure. A second treatment instrument oscillating base arrangement portion 15A for arranging the oscillating second treatment instrument oscillating base 15 is formed.
[0017]
Then, the arrangement position of the first treatment instrument rocking table 14 is set on the proximal side and above the arrangement position of the second treatment tool rocking table 15, and the first treatment tool rocking table 14 is swung. The arrangement positions of the table 14 and the second treatment instrument swing table 15 are set above the upper side 3u of the observation window 3. In the present embodiment, since the endoscope is a perspective type, the observation window 3, the second treatment instrument swing base 15, and the first treatment instrument swing base 14 are arranged in the axial direction sequentially from the distal end side of the inclined surface 2a. Is arranged.
[0018]
The second treatment instrument oscillating base arrangement portion 15A can increase the oscillating range of the second treatment instrument oscillating base 15 without increasing the outer diameter of the distal end portion of the endoscope. In the vicinity of the diameter, which is the maximum diameter portion of the tip 1.
[0019]
The observation optical system 11 is not limited to a perspective type, and may be a direct view or a side view, and the observation window 3 may be a round shape having no side. An imaging element 12 is disposed at the imaging position of the observation optical system 11. Furthermore, the proximal end surface of the illumination window 4 faces the distal end surface of a light guide fiber (not shown) that guides illumination light. The air / water supply nozzle 5 serves both as a water supply nozzle for spraying washing water onto the surface of the observation window 3 and a nozzle for sending a gas such as air into the body cavity. Furthermore, a first bending piece 37 constituting a bending portion is connected to the proximal end portion of the distal end rigid member 2, and a bending rubber 38 is covered on the outside of the first bending piece 37. The distal end portion of the curved rubber 38 is watertightly fixed to the distal end rigid member 2 by thread winding adhesion. Then, by appropriately operating an operation knob (not shown) of an operation section (not shown) provided on the proximal end side of the endoscope insertion section, the bending section is bent, and the distal end rigid member 2 is moved up, down, left and right. Can be done.
[0020]
With reference to FIG. 1 thru | or FIG. 7, the structure of the 1st treatment instrument rocking | fluctuation base 14 and the 2nd treatment tool rocking | fluctuation base 15 and its arrangement positional relationship are demonstrated. In addition, the arrow Q direction in FIG. 1 is the screen upper direction of the TV monitor observed by the operator.
First, the first treatment instrument swing base 14 will be described with reference to FIGS. 1 to 3.
[0021]
The first treatment instrument swinging table 14 is rotatable up and down with respect to the distal end rigid member 2 by a first shaft 16 disposed on the proximal end side of the first treatment instrument swinging table 14. It is in a state. In addition, a first wire terminal member 17 is rotatably provided at the distal end side of the first treatment instrument swing base 14, and the distal end portion of the first operation wire 18 is connected to the first wire terminal member 17. It is fixed. The proximal end portion of the first operation wire 18 is inserted into the endoscope insertion portion and connected and fixed to a first swinging table operation mechanism (not shown).
[0022]
Therefore, by moving the first operating wire 18 forward and backward by the first swinging table operating mechanism, the first treatment instrument swinging table 14 is moved in the inverted position indicated by the solid line around the first shaft 16 and the two-dot chain line. It rotates between the maximum raised positions shown.
[0023]
It should be noted that the rotation restriction of the first treatment instrument swinging table 14 is that the abutment surface 2b provided on the distal end rigid member 2, the inversion surface 14b of the first treatment instrument swinging table 14, and the rising surface 14c. Do it with a guess. That is, the abutting surface 2b of the distal end rigid member 2 and the inverted surface 14b of the first treatment instrument swing base 14 abut each other at the inverted position, and the abutting surface 2b of the distal rigid member 2 and the first treatment at the maximum raised position. The rising surface 14c of the tool swinging table 14 is in contact with the rising surface 14c.
[0024]
Next, the configuration and arrangement position of the second treatment instrument swing base 15 will be described with reference to FIGS.
As shown in FIGS. 1 and 4, the second treatment instrument swinging table 15 is provided with a second shaft 22 and a third shaft 23 protruding from the second treatment tool swinging table 15, and the distal end rigid member 2. The extension portion 30 and the distal end rigid member 2 are arranged at predetermined positions so that the second treatment instrument swinging table 15 is rotatable in the left-right direction of the distal end rigid member 2 around the shafts 22 and 23. Yes.
[0025]
The second treatment instrument swinging table 15 is introduced through a table main body 20 having an inclined surface 20a in which an opening 19a of a treatment instrument insertion hole 19 is formed, and the second treatment instrument insertion channel 9. 2 The inclined surface to which a pair of treatment instrument guide wall portions 26 for guiding the treatment instrument to the treatment instrument insertion hole 19 and operation wires 24 and 25 for swinging the second treatment instrument swinging table 15 to the left and right are connected. It is comprised by a pair of convex part 20b, 20c which protruded in the both sides from 20a.
[0026]
A first rotating shaft disposing hole 21a for disposing a second shaft 22 is formed in the central portion of the upper surface of the base body portion 20, and a third shaft is formed in the central portion of the lower surface coaxial with the rotating shaft hole 21. A second rotation shaft disposing hole 21b for disposing 23 is formed.
[0027]
The distal end portion of the second operation wire 24 is connected and fixed to the wire terminal member 32 provided rotatably on the convex portion 20b, and the wire terminal member 33 provided rotatably on the convex portion 20c. 3 The tip of the operation wire 25 is connected and fixed. The base end portions of the second operation wire 24 and the third operation wire 25 are inserted into the insertion portion and connected and fixed to a second swinging table operation mechanism (not shown).
[0028]
Therefore, the second treatment instrument swinging table 15 is moved in the left-right direction around the second shaft 22 and the third shaft 23 by appropriately moving the operating wires 24 and 25 forward and backward by the second swinging table operating mechanism. To turn.
[0029]
As shown in FIG. 2, the opening center line 28 with respect to the left-right direction of the opening 19 a of the treatment instrument insertion hole 19, the channel center line 29 with respect to the left-right direction of the second channel opening 10, and the left-right direction of the observation window 3. The visual field center line 27 is provided so as to be located on substantially the same plane. Furthermore, the aperture center line 28, the visual field center line 27, and the channel center line 29 may be set so as to be located on substantially the same plane in the vicinity of the center line in the left-right direction of the tip portion.
[0030]
It should be noted that the rotation restriction of the second treatment instrument swing base 15 is such that the end portions 31a, 31b of the at least one stopper recess 31 formed circumferentially on the distal end rigid member 2 and the wire terminal members 32, 33 are pushed. Do it with a guess. That is, the end 31a formed at a predetermined position of the stopper recess 31 and the wire terminal member 32 are abutted, and the end 31b formed at a predetermined position of the stopper recess 31 and the wire terminal member 33 are abutted. The rotation angle is set.
[0031]
By setting the rotation angle in this manner, as shown in FIG. 6, the treatment tool 44 is projected from the inclined surface 2a, which is the distal end surface of the distal end rigid member 2, for example by about 15 mm, and the second operation wire When the second treatment instrument swing base 15 is rotated by operating the 24 and the third operation wire 25, the treatment instrument 44 draws a locus indicated by a two-dot chain line. At this time, the distal end portion of the treatment instrument 44 does not exceed the left and right observation visual field range of the observation window 3 (see FIG. 7), and is pivotally moved in both left and right directions across the visual field center line 27. When the treatment instrument 44 is positioned on the visual field center line 27, the distal end of the treatment instrument 44 is the farthest from the inclined surface 2a that is the distal end face of the endoscope.
[0032]
As shown in FIG. 7, an image 44a of the treatment tool is projected on the screen 41 of a display device such as a TV monitor so as to protrude substantially from the upper side. At this time, the treatment tool 44 is disposed on the visual field center line 27 by setting the opening center line 28 of the opening 19a of the treatment tool insertion hole 19 and the visual field center line 27 of the observation window 3 as described above. At this time, the treatment tool image 44a is displayed on the screen center line 45 which is the center line in the horizontal direction of the screen. Further, when the end portions 31a, 31b of the stopper recess 31 and the wire terminal members 32, 33 abut each other, the images 44a of the respective treatment tools are displayed on the left end and the right end of the screen. For this reason, the surgeon can move the distal end portion of the treatment instrument in a wide range in the left-right direction including the center portion of the endoscopic image.
[0033]
Note that the treatment instrument image 44a is projected so as to protrude from substantially the upper side of the screen, as described above, the arrangement position of the second treatment instrument swing base 15 is set above the upper side 3u of the observation window 3. Because.
[0034]
Further, on the inner surface of the treatment instrument guide wall 26, at least when the second treatment instrument swinging table 15 is rotated to the maximum in the left-right direction, an action point or action ridge line 39 that presses the treatment instrument 44 in a direction opposite to the rotation direction. Is formed. For this reason, when the treatment instrument 44 is shaken greatly to the left and right, the treatment instrument 44 is supported at two points of the inner peripheral surface of the opening 19a and the action ridge line 39, so that the operation can be performed with the treatment instrument 44 held securely. .
[0035]
Furthermore, the opening 19a of the treatment instrument insertion hole 19 is formed in an oval shape that is long in the vertical direction with respect to the horizontal direction. At this time, as shown in FIG. 1, the horizontal and vertical clearances between the treatment tool 44 protruding from the opening 19 a of the treatment tool insertion hole 19 and the opening 19 a are the sum of the left and right clearances which are the swinging directions. The vertical clearance (Y) is set larger or equal to (X1 + X2). That is, a relationship of Y ≧ X1 + X2 is set between Y and X1, X2, and the amount of swing of the treatment instrument 44 that is swung by the second treatment instrument swinging table 15 is reduced to perform delicate work. Is possible.
[0036]
As shown in FIG. 4, the second operation wire 24 is guided directly under the first treatment instrument swing base 14 into the insertion portion.
[0037]
Further, FIG. 5 shows the opening 19a whose outer periphery is continuous in the inclined surface 20a of the base body portion 20, but this opening 19a is formed larger so that a part of the outer periphery of the opening 19a is not in the inclined surface 20a. It may be a continuous shape. That is, the shape of the opening 19a is not particularly limited.
[0038]
Further, when the first treatment instrument swinging table 14 is raised in the first treatment instrument swinging base arrangement portion 14A where the first treatment instrument swinging base 14 is disposed, the second treatment instrument swinging base arrangement is arranged. An opening communicating with the portion 15A is formed to improve the cleaning and disinfection of the endoscope.
[0039]
Further, the height dimension of the treatment instrument guide wall 26 is set so as to prevent the operation wires 24 and 25 from coming into contact with the treatment instrument guide wall 26 when the second treatment instrument swing base 15 is rotated. Has been.
[0040]
Further, the positional relationship and mechanism of the first swing table operating mechanism and the second swing table operating mechanism, or the channel inner diameter dimensions of the first treatment instrument insertion channel 7 and the second treatment instrument insertion channel 9. Further, the material and hardness of the channel are not particularly limited.
[0041]
The operation of the endoscope configured as described above will be described.
First, as shown in FIG. 8, the observation window 3 provided at the distal end portion 1 of the endoscope insertion portion 40 is opposed to the lesioned mucosa. Then, the lesioned mucosa is observed endoscopically, and the injection needle 42 as a treatment tool is introduced into the body cavity through the second treatment tool insertion channel 9, for example. Here, in order to make the injection needle 42 face the lesioned mucosa, the second treatment instrument swinging table 15 is swung so that the injection needle 42 faces the predetermined part of the lesioned mucosa, and the injection needle 42 is shown by an arrow a. Proceed to the target site and inject a medical solution such as physiological saline into the lower layer of the lesioned mucosa. Then, the mucosal layer including the diseased mucosa is raised.
[0042]
Next, as shown in FIG. 9, the grasping forceps 43 as the treatment tool is introduced into the body cavity through the first treatment tool insertion channel 7. Here, in order to make this grasping forceps 43 oppose the raised mucosa layer, the first treatment instrument swinging table 14 is swung. Then, when the grasping forceps 43 is opposed to a predetermined part of the mucosal layer, the grasping forceps 43 is pushed forward to grasp the mucosa layer including the lesioned mucosa raised. On the other hand, an incision instrument 44 as a treatment instrument is inserted into the second treatment instrument insertion channel 9 instead of the injection needle 42, and the incision instrument 44 is disposed in the vicinity of the lesion mucosa.
[0043]
Next, the first treatment instrument swing base 14 is swung to raise the grasping forceps 43 in the direction of arrow b. Then, the mucosa layer including the lesioned mucosa held by the grasping forceps 43 is pulled up.
[0044]
Here, as shown in FIG. 10, the second treatment instrument oscillating base 15 is oscillated in the directions of arrows c and d, and the raised submucosa is excised with the incision instrument 44. At this time, since the first treatment instrument rocking table 14 is disposed above the second treatment tool rocking table 15, the state on the incision surface side, for example, incision, is passed through the observation window 3 in a state where the lesion mucosa is lifted. While paying attention to the depth of the tip of the tool 44, the excision work for excising the root of the mucosa of the lesion can be performed quickly. At this time, the distal end of the treatment instrument can be moved in a wide range in the left-right direction including the central portion of the endoscopic image.
[0045]
Further, when the image of the cutting tool 44 displayed on the screen is located in the vicinity of the screen center line 45, the position of the distal end of the cutting tool 44 is the farthest from the distal end surface of the endoscope. In other words, when the image of the incision tool 44 is positioned on the end side of the screen, even if the incision tool 44 is swung, the blade tip position does not become deep. Can be done.
[0046]
By using this endoscope and the treatment tool combined therewith, it is possible to perform a procedure such as collective resection reliably and easily on a wide range of lesions, and since operability is easy, Rapid surgery is possible, and the burden on the operator and patient is reduced.
[0047]
The incision tool 44 is introduced into the body cavity via the first treatment instrument insertion channel 7, and the grasping forceps 43 is introduced into the body cavity via the second treatment instrument insertion channel 9, and the distal end of the endoscope By adjusting the position of the mucous membrane in the body cavity, the excision work similar to the above can be performed.
[0048]
11 to 13 relate to a modification of the present invention, FIG. 11 is a diagram for explaining another configuration of the second treatment instrument swinging table, and FIG. 12 is a front end portion including the second treatment instrument swinging table of FIG. FIG. 13 is a diagram for explaining an image of the treatment tool displayed on the TV monitor.
[0049]
As shown in FIG. 11, in this embodiment, instead of rotating the second treatment instrument swinging table 15 around the rotation axis as described in the above embodiment, the observation is performed at a predetermined position of the distal end rigid member 2. A stopper recess 51 made of a straight groove parallel to the window 3 is provided so that the second treatment instrument swinging table 15a is translated in both the left and right directions with the visual field center line 27 of the observation window 3 interposed therebetween.
[0050]
That is, as shown in FIGS. 11 and 12, the lower end portion of the second wire terminal member 32 provided at the tip of the second operation wire 24 and the third operation wire 25 are provided in the stopper recess 51. The lower end part of the 3rd wire terminal member 33 provided in the front-end | tip is arrange | positioned.
[0051]
As a result, when the second operation wire 24 and the third operation wire 25 are appropriately operated, the second treatment instrument swinging table 15 is placed on the distal end surface 36 in both the left and right directions with the visual field center line 27 interposed therebetween. Oscillates in parallel. At this time, the distance from the distal end of the treatment instrument 44 oscillated by the second treatment instrument oscillating table 15 to the distal end surface 36 of the endoscope is always constant within the oscillation range. For this reason, as shown in FIG. 13, the image 44 a of the treatment tool 44 displayed on the screen 41 of the display device also moves in parallel to the upper surface of the screen in the left-right direction across the screen center line 45.
[0052]
In this way, in addition to the effects of the above-described embodiment, the treatment tool is configured by configuring the second treatment tool swinging base so that the distal end of the treatment tool is moved in parallel in the left-right direction on the screen of the display device. It is possible to perform the procedure by always arranging the position of the distal end at a constant position from the distal end surface of the endoscope. Thus, for example, when the incision instrument is swung on the second treatment instrument swinging table, a part of the cut end is not deepened.
[0053]
14 and 15 relate to another modified example of the present invention, FIG. 14 is a diagram for explaining another configuration of the second treatment instrument swinging table, and FIG. 15 is a diagram for explaining the image of the treatment instrument displayed on the TV monitor. FIG.
[0054]
As shown in FIG. 14, in the present embodiment, the position of the rotation shaft of the second treatment instrument swinging table 15 is changed to the shaft 22a. Specifically, the position of the rotary shaft 22a is displaced with respect to the channel center line 29 of the second channel opening 10, and is displaced with respect to the center line of the second treatment instrument swinging table 15, 2 The movement range of the treatment instrument rocking table 15 is changed in the leftward direction and the rightward direction with the visual field center line 27 interposed therebetween. When the treatment instrument 44 is swung and positioned in the vicinity of the visual field center line 27, the protrusion distance from the distal end surface 36 of the distal end of the treatment instrument 44 is maximized.
[0055]
Further, as shown in FIG. 15, the moving distance of the image 44a of the treatment instrument 44 displayed on the screen 41 of the display device across the screen center line 45 also changes between the left side and the right side.
[0056]
In this way, by changing the position of the rotation axis of the second treatment instrument swinging table, in addition to the effect of the above-described embodiment, the swing range of the treatment tool swung by the second treatment tool swinging table is increased. It can be changed according to the procedure.
[0057]
16 and 17 relate to another modified example of the present invention, FIG. 16 is a longitudinal sectional view for explaining another configuration of the distal end portion of the endoscope insertion portion, and FIG. 17 is a treatment instrument displayed on a TV monitor. It is a figure explaining an image.
[0058]
As shown in FIG. 16, in the present embodiment, the position of the second treatment instrument swinging table 15 is arranged below the observation window 3. Further, the second treatment instrument swinging table 15 has a single rotating shaft 22 and a single rotating shaft. Furthermore, an elastic member 48 such as a spring whose urging force changes according to the swinging state of the second treatment instrument swing base 15 is provided on the second treatment instrument swing base 15. Similarly to the second treatment instrument rocking table 15, an opening 47 is provided at the tip of the first treatment tool rocking table 14d, and the treatment tool is rocked by the first treatment tool rocking table 14d. The amount of runout is reduced to enable delicate work.
[0059]
With this configuration, when the operation wires 24 and 25 are not in tension, the second treatment instrument swinging table 15 returns from the swinging position to a predetermined position by the restoring force of the elastic member 48. In addition, as shown in FIG. 17, the treatment instrument image 44 a is projected so as to protrude from a substantially lower side of the screen 41.
[0060]
As shown in FIG. 17, the swing range of the second treatment instrument swing base 15 is set such that at least the distal end of the treatment instrument moves in the left-right direction across the screen center line 45 in the left-right direction of the screen. When the image 44a is in the vicinity of the screen center line 45, the protrusion distance from the distal end surface 36 of the distal end of the treatment instrument 44 is maximum. Other configurations are the same as those of the above-described embodiment.
[0061]
As described above, by providing the elastic member 48 having an urging force for returning the second treatment instrument swinging table 15 to a predetermined position when the operation wire is not tensioned, the effects of the above-described embodiment are provided. In addition, the second treatment instrument swinging table 15 can be returned to a desired position by the elastic member 48.
[0062]
That is, by the elastic member 48, the treatment instrument guide wall 26 is opposed to the channel opening 10 in a predetermined state, and the inductivity can be improved to the second treatment instrument swing base 15 of the treatment instrument.
[0063]
It should be noted that the present invention is not limited to the embodiments described above, and various modifications can be made without departing from the spirit of the invention. For example, a direct-view endoscope in which the distal end surface 36 is not inclined is an example.
[0064]
[Appendix]
According to the embodiment of the present invention as described above in detail, the following configuration can be obtained.
[0065]
(1) In an endoscope provided with an objective optical system that captures an endoscope image and a plurality of treatment instrument insertion channels that guide the treatment instrument into a body cavity at the distal end portion of the endoscope insertion part.
An endoscope provided with a treatment instrument oscillating base that allows the distal end of the treatment instrument to move in both the left and right directions with the horizontal center line of the endoscopic image as a boundary at least one of the plurality of treatment instrument insertion channels mirror.
[0066]
(2) When the objective optical system captures a treatment tool protruding from the treatment tool insertion channel,
The endoscope according to supplementary note 1, wherein a positional relationship between the treatment instrument swinging table and the objective optical system is set so that an image of the treatment instrument is projected from substantially the upper side of the screen or the lower side of the screen.
[0067]
(3) When the image of the treatment instrument is displayed near the center line in the left-right direction on the screen of the display device, the distal end of the treatment instrument is located at the farthest point from the distal end surface of the endoscope insertion portion. Endoscope.
[0068]
【The invention's effect】
As described above, according to the present invention, it is possible to provide an endoscope excellent in workability when performing an endoscopic treatment by projecting a treatment tool from the distal end openings of a plurality of treatment tool insertion channels. it can.
[Brief description of the drawings]
FIG. 1 to FIG. 10 relate to an embodiment of the present invention, and FIG. 1 is a longitudinal sectional view for explaining the configuration of a distal end portion of an endoscope insertion portion. FIG. FIG. 3 is a view when the second treatment instrument swinging table is viewed from the arrow P side in FIG. 1. FIG. 4 is a cross-sectional view taken along the line XY of FIG. FIG. 6 is a diagram for explaining the external shape of the table. FIG. 6 is a diagram for explaining the relationship between the position of the treatment tool swung by the second treatment tool rocking table and the observation visual field range. FIG. 8 is a diagram illustrating the operation of the second treatment instrument swinging table. FIG. 9 is a diagram illustrating the operation of the first treatment instrument swinging table and the second treatment instrument swinging table. FIGS. 11 to 13 show a modification of the present invention, and FIG. 11 shows another example of the second treatment instrument swinging table. Explain the configuration FIG. 12 is a partial cross-sectional view for explaining the configuration of the distal end portion including the second treatment instrument swing base in FIG. 11. FIG. 13 is a diagram for explaining an image of the treatment instrument displayed on the TV monitor. 14 and FIG. 15 relate to another modified example of the present invention, and FIG. 14 is a diagram for explaining another configuration of the second treatment instrument swinging table. FIG. 15 is a diagram for explaining an image of the treatment instrument displayed on the TV monitor. 16 and 17 relate to another modified example of the present invention, and FIG. 16 is a longitudinal sectional view for explaining another configuration of the distal end portion of the endoscope insertion portion. FIG. 17 is shown on a TV monitor. Figure explaining the image of the treatment tool
DESCRIPTION OF SYMBOLS 1 ... Tip part 2 ... Tip rigid member 2a ... Inclined surface 3 ... Observation window 15 ... 2nd treatment instrument rocking | fluctuation stand 27 ... Visual field centerline

Claims

内視鏡挿入部の先端部に配設された、複数の処置具を体腔内に導く複数の処置具挿通用チャンネルと、
前記複数の処置具挿通用チャンネルのうち第２の処置具挿通用チャンネルの開口部先端側において、前記複数の処置具のうち第２の処置具の先端部を内視鏡画像の左右方向中心線を境界にして左右両方向に移動可能に配設された第２の処置具揺動台と、
前記複数の処置具挿通用チャンネルのうち第１の処置具挿通用チャンネルの開口部先端側において、前記複数の処置具のうち第１の処置具の先端部を前記第２の処置具揺動台が移動する面から遠ざかる方向に移動可能に配設された第１の処置具揺動台と、
を具備したことを特徴とする内視鏡。A plurality of treatment instrument insertion channels arranged at the distal end portion of the endoscope insertion section , for guiding a plurality of treatment instruments into a body cavity;
The distal end portion of the second treatment instrument among the plurality of treatment instruments on the distal end side of the second treatment instrument insertion channel among the plurality of treatment instrument insertion channels, the center line in the left-right direction of the endoscopic image A second treatment instrument oscillating base disposed so as to be movable in both the left and right directions with a boundary therebetween;
Among the plurality of treatment instrument insertion channels, on the distal end side of the opening of the first treatment instrument insertion channel, the distal end portion of the first treatment instrument out of the plurality of treatment instruments is placed on the second treatment instrument swing base. A first treatment instrument oscillating base arranged to be movable in a direction away from the surface on which the
An endoscope characterized by comprising: