JP7474993B2 - Medical Inner Tubes - Google Patents

Medical Inner Tubes Download PDF

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JP7474993B2
JP7474993B2 JP2021507282A JP2021507282A JP7474993B2 JP 7474993 B2 JP7474993 B2 JP 7474993B2 JP 2021507282 A JP2021507282 A JP 2021507282A JP 2021507282 A JP2021507282 A JP 2021507282A JP 7474993 B2 JP7474993 B2 JP 7474993B2
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則仁 和田
卓也 宮崎
義彦 日村
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Description

本発明は、医療用の処置具等を挿入して体腔内に導入するための医療用のインナーチューブに関する。The present invention relates to a medical inner tube for inserting a medical treatment tool or the like into a body cavity.

従来、可撓性を有する内視鏡及びその観察下で使用される処置具がそれぞれ挿入される複数の可撓性を有するインナーチューブと、インナーチューブが挿入されてその先端部が先端から突出するアウターチューブとを備える内視鏡治療装置が知られている（例えば、特許文献１参照）。Conventionally, an endoscopic treatment device has been known which includes a flexible endoscope, multiple flexible inner tubes into which treatment tools to be used under observation therethrough are respectively inserted, and an outer tube into which the inner tubes are inserted and whose tips protrude from the tip (see, for example, Patent Document 1).

この内視鏡治療装置では、インナーチューブの先端部に屈曲可能な首振りパイプが取り付けられる。首振りパイプの先端側には２本のワイヤ部材の先端部が固定される。首振りパイプは、一方のワイヤ部材を牽引することによりアウターチューブの径方向外側に屈曲させ、他方のワイヤ部材を牽引することにより、直線状に戻すことができるようになっている。In this endoscopic treatment device, a bendable oscillating pipe is attached to the distal end of the inner tube. The distal ends of two wire members are fixed to the distal side of the oscillating pipe. The oscillating pipe can be bent radially outward from the outer tube by pulling one of the wire members, and can be returned to a straight state by pulling the other wire member.

この内視鏡治療装置を用いて腹腔鏡手術を行う際には、アウターチューブに複数のインナーチューブを挿入して取り付け、各インナーチューブに内視鏡及び処置具を挿入した状態の内視鏡治療装置が、開創部に装着した開創器に取り付けた開創器用バルブキャップを介して体腔内に挿入される。When performing laparoscopic surgery using this endoscopic treatment device, multiple inner tubes are inserted and attached to the outer tube, and the endoscopic treatment device with an endoscope and treatment tools inserted into each inner tube is inserted into the body cavity via a retractor valve cap attached to a retractor attached to the retraction portion.

そして、各インナーチューブの先端屈曲部をアウターチューブの先端から突出させ、ワイヤ部材を牽引して首振りパイプを屈曲させる。さらに、内視鏡及び処置具の先端部を各インナーチューブの先端から突出させ、該先端部を屈曲させて手技が行われる。The distal bending portions of the inner tubes are then caused to protrude from the distal end of the outer tube, the wire members are pulled to bend the oscillating pipe, and the distal ends of the endoscope and treatment tool are caused to protrude from the distal ends of the inner tubes and bent to perform the procedure.

これによれば、各インナーチューブの先端屈曲部を外側に屈曲させ、内視鏡及び処置具の先端部を内側に屈曲させて手技を行うことができる。このため、十分な内視鏡の視野と処置具による作業空間を確保することができるとともに、各処置具間の距離を把握し易いので、腹腔鏡手術を容易に行うことができる。According to this, the distal bending portion of each inner tube can be bent outward, and the distal ends of the endoscope and treatment tool can be bent inward to perform the procedure. This makes it possible to ensure a sufficient field of view for the endoscope and a working space for the treatment tools, and also makes it easy to grasp the distance between each treatment tool, making laparoscopic surgery easy to perform.

国際公開第２０１７／１１９１０８International Publication No. 2017/119108

しかしながら、特許文献１に記載の内視鏡治療装置では、内視鏡及び処置具は、インナーチューブの先端屈曲部によって、外側に向かって突出されるため、被処置部に対向させるためには、内側に大きく屈曲させなければならないという不都合があった。However, in the endoscopic treatment device described in Patent Document 1, the endoscope and treatment tool are protruded outward by the bending tip portion of the inner tube, and therefore have the disadvantage that they must be bent significantly inward in order to face the area to be treated.

本発明の目的は、かかる従来技術の課題に鑑み、内視鏡や処置具を大きく屈曲させる必要なく被処置部に対向させることを可能にする医療用のインナーチューブを提供することにある。In view of the problems with the conventional technology, an object of the present invention is to provide an inner tube for medical use that allows an endoscope or treatment tool to be opposed to a part to be treated without the need to bend the endoscope or treatment tool significantly.

本発明の医療用のインナーチューブは、
アウターチューブに対してその内壁と中心軸線との間に位置するように挿入されてその先端から先端部が突出し、可撓性の処置具又は可撓性の内視鏡が挿入されてその先端部が先端から突出する医療用のインナーチューブであって、
インナーチューブにおいて、アウターチューブの軸線から遠い側を外側、アウターチューブの軸線に近い側を内側、先端及び基端を結ぶ方向と前記外側及び前記内側を結ぶ方向とに直交する方向を上下方向と規定すると、
基端部がインナーチューブに沿って基端方向に牽引される第１ワイヤを備え、
インナーチューブの先端部には、第１屈曲部と、該第１屈曲部よりも基端側に位置する第２屈曲部とを有する先端屈曲部が設けられ、
前記第１屈曲部は、その先端部を、その基端部に対して直線状をなしている状態から、該先端部と該基端部との間において前記上下方向に沿って延びる第１回動軸線を中心として前記内側方向に回動可能に接続されることでインナーチューブの先端部を該内側方向に屈曲可能に構成され、
前記第２屈曲部は、その先端部を、その基端部に対して直線状をなしている状態から、該先端部と該基端部との間において前記上下方向に沿って延びる第２回動軸線を中心として前記外側方向に回動可能に接続されることでインナーチューブの先端部を該外側方向に屈曲可能に構成される。
前記先端屈曲部は、
前記第１ワイヤの先端部を、前記第１屈曲部よりも先端側の前記内側に固定する第１固定部と、
前記第１屈曲部と前記第２屈曲部との間に設けられ、前記第１ワイヤが前記第１回動軸線よりも前記内側、かつ、前記第２回動軸線よりも前記外側を通るように該第１ワイヤの通過位置を拘束する第１拘束部と、
前記第２屈曲部よりも基端側に設けられ、前記第１ワイヤが前記第２回動軸線の前記外側を通るように該第１ワイヤの通過位置を拘束する第２拘束部とを備えてもよい。 The medical inner tube of the present invention is
A medical inner tube into which a flexible treatment tool or a flexible endoscope is inserted so that the distal end of the inner tube protrudes from the distal end of the outer tube, the inner tube being inserted between an inner wall of the outer tube and a central axis of the outer tube, the distal end of the inner tube protruding from the distal end of the outer tube,
In the inner tube, the side farther from the axis of the outer tube is defined as the outside, the side closer to the axis of the outer tube is defined as the inside, and the direction perpendicular to the direction connecting the tip and base ends and the direction connecting the outside and the inside is defined as the up-down direction.
a first wire having a proximal end adapted to be pulled proximally along the inner tube;
The inner tube has a distal end bent portion having a first bent portion and a second bent portion located closer to the base end than the first bent portion,
the first bending portion is configured to be rotatable in the inward direction from a state in which a tip end is linear with respect to a base end about a first rotation axis extending in the up-down direction between the tip end and the base end, thereby allowing the tip end of the inner tube to be bent in the inward direction,
The second bending portion is configured so that its tip end can be bent in the outward direction from a state in which it is straight with respect to its base end, by being connected so as to be rotatable in the outward direction about a second rotation axis extending along the up-down direction between the tip end and the base end.
The tip bending portion is
a first fixing portion that fixes a tip end portion of the first wire to the inside on a tip side of the first bent portion;
a first restraining portion provided between the first bent portion and the second bent portion and restraining a passing position of the first wire so that the first wire passes on the inner side of the first rotation axis and on the outer side of the second rotation axis;
The wire may further include a second restraining portion provided on the base end side of the second bent portion and restraining a passing position of the first wire so that the first wire passes outside the second rotation axis.

この構成において、先端屈曲部が直線状をなしている状態において第１ワイヤが牽引されると、インナーチューブの内側に位置する第１固定部が外側に位置する第２拘束部の方向に引き付けられる。そして、第１、第２屈曲部は、それぞれインナーチューブの内側、外側に回動可能であり、第１ワイヤは第１回動軸線の内側、及び第２回動軸線の外側を通っているので、この第１ワイヤの牽引により第１、第２屈曲部が屈曲する。In this configuration, when the first wire is pulled while the tip bending portion is straight, the first fixing portion located inside the inner tube is pulled toward the second restraining portion located outside. The first and second bending portions are rotatable inside and outside the inner tube, respectively, and the first wire passes inside the first rotation axis and outside the second rotation axis, so that the first and second bending portions are bent by pulling the first wire.

これにより、先端屈曲部は、全体としてＳ字状に屈曲し、その先端部が外側にシフトした状態となる。したがって、この状態のインナーチューブから突出した内視鏡や処置具の先端部を、大きく屈曲させる必要なく被処置部に対向させることが可能となる。As a result, the distal bending portion is bent into an S-shape as a whole, with the distal end shifted outward, making it possible for the distal end of the endoscope or treatment tool protruding from the inner tube in this state to face the treatment site without the need for significant bending.

本発明において、
基端部がインナーチューブに沿って基端方向に牽引される第２ワイヤを備え、
前記先端屈曲部は、
前記第２ワイヤの先端部を、前記第１屈曲部よりも先端側の前記外側に固定する第２固定部と、
前記第１屈曲部と前記第２屈曲部との間に設けられ、前記第２ワイヤが前記第１回動軸線よりも前記外側、かつ、前記第２回動軸線よりも前記内側を通るように該第２ワイヤの通過位置を拘束する第３拘束部と、
前記第２屈曲部よりも基端側に設けられ、前記第２ワイヤが前記第２回動軸線の前記内側を通るように該第２ワイヤの通過位置を拘束する第４拘束部とを備えるのが好ましい。 In the present invention,
a second wire having a proximal end adapted to be pulled proximally along the inner tube;
The tip bending portion is
a second fixing portion that fixes a tip end portion of the second wire to the outer side on a tip side of the first bent portion;
a third restraining portion provided between the first bent portion and the second bent portion and restraining a passing position of the second wire so that the second wire passes outside the first rotation axis and inside the second rotation axis;
It is preferable to include a fourth restraining portion provided on the base end side of the second bent portion and restraining the passing position of the second wire so that the second wire passes inside the second rotation axis.

これによれば、上記のようにＳ字状に屈曲した状態のインナーチューブの先端屈曲部を、第２ワイヤを基端方向に牽引することにより、直線状の状態に戻すことができる。With this, the distal bent portion of the inner tube bent in an S-shape as described above can be returned to a straight state by pulling the second wire in the proximal direction.

本発明において、
前記第１、第２屈曲部は、それぞれ連続して接続された２又は３以上の中空の円筒状部材で構成され、
前記円筒状部材のうち、相互に隣接する一方の円筒状部材は、他方の円筒状部材の側に、該円筒状部材の中心軸線を含み、前記上下方向に垂直な対称面について対称な位置に半円より中心角が大きい部分円状の２つの円状凸部を有し、他方の円筒状部材は該２つの円状凸部に嵌合した半円より中心角が大きい部分円状の２つの円状凹部を有し、
前記相互に隣接する一方及び他方の円筒状部材は、前記円状凸部及び前記円状凹部を介して前記対称面に垂直な回動軸線の周りで相互に回動し得るように接続されており、
前記一方及び他方の円筒状部材は、相互間の回動範囲を、相互に直線状に配置される状態と、相互に所定角度で屈曲した状態で配置される状態との間に制限するとともに相互に分離するのを阻止すべく相互に当接し又は摺動する当接摺動面をそれぞれ有し、
インナーチューブは、前記処置具又は内視鏡のインナーチューブへの挿入が、前記一方及び他方の円筒状部材が相互に直線状に配置される状態において前記処置具又は内視鏡の先端部を直線状に弾性変形させた状態で行われるとともに、前記処置具又は内視鏡の先端部のインナーチューブからの突出が、前記一方及び他方の円筒状部材が相互に所定角度で屈曲した状態で配置される状態において該先端部が元の屈曲した形状に復帰しつつ行われるものである。
また、本発明において、インナーチューブとして、前記処置具がそれぞれ挿入される第１インナーチューブ及び第２インナーチューブと、前記内視鏡が挿入される第３インナーチューブとを備え、
前記第１～第３インナーチューブは、アウターチューブに挿入されて先端部が該アウターチューブから突出するものであり、
前記第１～第３インナーチューブ及び前記アウターチューブは、該アウターチューブから先端部が突出した前記第１～第３インナーチューブについて前記処置具及び内視鏡の挿入及び突出が行われた場合に、各処置具の先端部が相互に近接し、かつ該内視鏡の先端部が、各処置具の先端部の方向を向いた状態となるように構成されるのが好ましい。 In the present invention,
the first and second bent portions are each formed of two or more hollow cylindrical members connected in series,
Among the cylindrical members, one of the cylindrical members adjacent to each other has, on the side of the other cylindrical member, two partially circular convex portions having a larger central angle than a semicircle at symmetrical positions with respect to a symmetry plane that includes the central axis of the cylindrical member and is perpendicular to the up-down direction, and the other cylindrical member has two partially circular concave portions having a larger central angle than a semicircle and fitted into the two circular convex portions,
the one and the other cylindrical members adjacent to each other are connected to each other so as to be mutually rotatable about a rotation axis perpendicular to the plane of symmetry via the circular convex portion and the circular concave portion,
the one and the other cylindrical members each have a contact sliding surface that contacts or slides against each other to limit a rotation range between a state in which the cylindrical members are disposed linearly relative to each other and a state in which the cylindrical members are disposed bent at a predetermined angle relative to each other and to prevent the cylindrical members from being separated from each other ;
The inner tube is configured so that the treatment tool or endoscope is inserted into the inner tube with the tip of the treatment tool or endoscope elastically deformed in a straight line with the one and other cylindrical members arranged in a straight line relative to each other, and the tip of the treatment tool or endoscope protrudes from the inner tube with the tip returning to its original bent shape with the one and other cylindrical members arranged in a straight line with respect to each other at a predetermined angle.
In the present invention, the surgical instrument includes a first inner tube and a second inner tube into which the treatment tools are respectively inserted, and a third inner tube into which the endoscope is inserted,
the first to third inner tubes are inserted into an outer tube such that their tip portions protrude from the outer tube;
It is preferable that the first to third inner tubes and the outer tube are configured so that when the treatment tools and endoscope are inserted and ejected into the first to third inner tubes with their tip portions protruding from the outer tubes, the tip portions of the treatment tools are close to each other and the tip portion of the endoscope is pointed toward the tip portions of the treatment tools.

これによれば、先端屈曲部を形成するための円筒状の部材を円筒状部材の形状にレーザ加工するだけで、２又は３以上の円筒状部材が連続して接続された状態の第１、第２屈曲部を形成している先端屈曲部を容易に製造することができる。According to this, by simply laser processing the cylindrical member for forming the tip bending portion into the shape of the cylindrical member, a tip bending portion forming first and second bending portions in which two or more cylindrical members are connected in series can be easily manufactured.

本発明の一実施形態に係る医療用のインナーチューブを備える内視鏡治療装置を示す平面図である。1 is a plan view showing an endoscopic treatment apparatus including a medical inner tube according to an embodiment of the present invention. 図１の内視鏡治療装置の側面図である。FIG. 2 is a side view of the endoscopic treatment apparatus of FIG. 1 . 図３Ａは、図１のインナーチューブにおける方向性を定義するための模式図である。FIG. 3A is a schematic diagram for defining the directionality of the inner tube of FIG. 図３Ｂは、図１のインナーチューブにおける方向性を定義するための模式図である。FIG. 3B is a schematic diagram for defining the directionality of the inner tube of FIG. 図４Ａは、図１のインナーチューブの先端屈曲部が直線状になっているときの様子を示す平面図である。FIG. 4A is a plan view showing a state in which the tip bent portion of the inner tube in FIG. 1 is straightened. 図４Ｂは、該先端屈曲部が屈曲しているときの様子を示す平面図である。FIG. 4B is a plan view showing the tip bending portion when bent. 図５Ａは、図１のインナーチューブの先端屈曲部における２つの円筒状部材が直線状になっているときの様子を示す平面図である。5A is a plan view showing a state in which two cylindrical members at the tip bent portion of the inner tube in FIG. 1 are straightened. FIG. 図５Ｂは、図５Ａの側面図である。FIG. 5B is a side view of FIG. 5A. 図５Ｃは、該２つの円筒状部材が屈曲しているときの様子を示す平面図である。FIG. 5C is a plan view showing the two cylindrical members when bent.

以下、図面を用いて本発明の実施形態を説明する。図１及び図２は、本発明の一実施形態に係るインナーチューブを備える内視鏡治療装置を示す。DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the present invention will now be described with reference to the accompanying drawings. Figures 1 and 2 show an endoscopic treatment apparatus including an inner tube according to an embodiment of the present invention.

図１及び図２に示すように、この内視鏡治療装置１は、可撓性の内視鏡３が挿入されてその先端部が先端から突出するインナーチューブ２と、可撓性の処置具が挿入されて先端から突出する複数のインナーチューブ４と、各インナーチューブ２、４が挿入されてインナーチューブ２、４の先端部が先端から突出するアウターチューブ５とを備える。各インナーチューブ２、４は、アウターチューブ５の内壁とその中心軸線Ａとの間に配置される。1 and 2, this endoscopic treatment device 1 includes an inner tube 2 into which a flexible endoscope 3 is inserted and whose tip protrudes therefrom, a plurality of inner tubes 4 into which flexible treatment tools are inserted and whose tips protrude therefrom, and an outer tube 5 into which the inner tubes 2, 4 are inserted and whose tip protrudes therefrom. Each of the inner tubes 2, 4 is disposed between the inner wall of the outer tube 5 and its central axis A.

各インナーチューブ４は、それぞれ基端部が該インナーチューブ４に沿って基端方向に牽引される第１、第２ワイヤ６、７を備える。Each inner tube 4 includes first and second wires 6, 7 at the proximal end thereof which are pulled proximally along the inner tube 4.

ここで、図３Ａ及び図３Ｂに示すように、各インナーチューブ２、４において、アウターチューブ５の中心軸線Ａから遠い側を外側ｓ１、近い側を内側ｓ２、先端及び基端を結ぶ方向と該外側ｓ１及び内側ｓ２を結ぶ方向とに直交する方向を上下方向Ｄと規定する。Here, as shown in Figures 3A and 3B, in each inner tube 2, 4, the side farther from the central axis A of the outer tube 5 is defined as the outer side s1, the side closer to the central axis A of the outer tube 5 is defined as the inner side s2, and the direction perpendicular to the direction connecting the tip and base ends and the direction connecting the outer side s1 and the inner side s2 is defined as the up-down direction D.

インナーチューブ４の先端部には、第１屈曲部８と、第１屈曲部８よりも基端側に位置する第２屈曲部９とを有する先端屈曲部１０が設けられる。The inner tube 4 has at its distal end a distal bent portion 10 having a first bent portion 8 and a second bent portion 9 located closer to the proximal end than the first bent portion 8 .

図４Ａ及び図４Ｂは、先端屈曲部１０が直線状になっているとき及び屈曲しているときの様子を示す。図４Ａ及び図４Ｂに示すように、第１屈曲部８は、その先端部を、その基端部に対して直線状をなしている状態から、該先端部と該基端部との間において上下方向Ｄに沿って延びる第１回動軸線ａ１を中心として内側ｓ２方向に回動可能に接続されることでインナーチューブ４の先端部を内側ｓ２方向に屈曲可能に構成される。4A and 4B show the state when the tip bending portion 10 is straight and when it is bent. As shown in Fig. 4A and 4B, the first bending portion 8 is connected so that its tip portion can be turned inwardly in the s2 direction from a state in which it is straight with respect to its base end portion about a first turning axis a1 extending in the up-down direction D between the tip portion and the base end portion, thereby enabling the tip portion of the inner tube 4 to be bent in the inward direction s2.

第２屈曲部９は、その先端部を、その基端部に対して直線状をなしている状態から、該先端部と該基端部との間において上下方向Ｄに沿って延びる第２回動軸線ａ２を中心として外側ｓ１方向に回動可能に接続されることでインナーチューブ４の先端部を外側ｓ１方向に屈曲可能に構成される。The second bending portion 9 is configured so that its tip end can be bent in the outward direction s1 from a state in which it is straight with respect to its base end, by being connected so as to be rotatable in the outward direction s1 around a second rotation axis a2 extending along the vertical direction D between the tip end and the base end.

先端屈曲部１０は、第１、第２ワイヤ６、７の先端部を、第１屈曲部８よりも先端側の内側ｓ２、外側ｓ１にそれぞれ固定する第１、第２固定部１１、１２を備える。また、先端屈曲部１０は、第１屈曲部８と第２屈曲部９との間に設けられ、第１、第２ワイヤ６、７の通過位置をそれぞれ拘束する第１、第３拘束部１３、１４を備える。The tip bending portion 10 includes first and second fixing portions 11 and 12 that respectively fix the tip portions of the first and second wires 6 and 7 to the inner side s2 and the outer side s1 on the distal side of the first bending portion 8. The tip bending portion 10 also includes first and third restraining portions 13 and 14 that are provided between the first bending portion 8 and the second bending portion 9 and restrain the passing positions of the first and second wires 6 and 7, respectively.

第１拘束部１３は、第１ワイヤ６が第１回動軸線ａ１よりも内側ｓ２、かつ、第２回動軸線ａ２よりも外側ｓ１を通るように構成される。第３拘束部１４は、第２ワイヤ７が第１回動軸線ａ１よりも外側ｓ１、かつ、第２回動軸線ａ２よりも内側ｓ２を通るように第２ワイヤ７の通過位置を拘束する。The first restraining unit 13 is configured so that the first wire 6 passes through a position s2 inside the first rotation axis a1 and outside s1 of the second rotation axis a2. The third restraining unit 14 restrains the passing position of the second wire 7 so that the second wire 7 passes through a position s1 outside the first rotation axis a1 and inside s2 of the second rotation axis a2.

また、先端屈曲部１０は、第２屈曲部９よりも基端側に設けられ、第１、第２ワイヤ６、７が第２回動軸線ａ２の外側ｓ１、内側ｓ２をそれぞれ通るように第１、第２ワイヤ６、７の通過位置をそれぞれ拘束する第２、第４拘束部１５、１６を備える。したがって、第１、第２ワイヤ６、７は、先端屈曲部１０の周りを、その先端側から基端側にかけて相互に反対側に１８０°旋回する螺旋を形成している。The distal bending portion 10 is provided on the proximal side of the second bending portion 9 and includes second and fourth restraining portions 15 and 16 that restrain the passing positions of the first and second wires 6 and 7 so that the first and second wires 6 and 7 pass on the outer side s1 and the inner side s2 of the second rotation axis a2, respectively. Therefore, the first and second wires 6 and 7 form spirals that rotate 180° in opposite directions around the distal bending portion 10 from the distal side to the proximal side.

第１、第２屈曲部８、９は、連続して接続された２又は３以上の円筒状部材１７、１８で構成される。円筒状部材１８は、先端屈曲部１０において、第１、第２屈曲部８、９それぞれの両側に配置された円筒状部材である。円筒状部材１７は、先端屈曲部１０において、該両側の円筒状部材１８の間に配置された円筒状部材である。なお、円筒状部材１７を省略し、円筒状部材１８同士が隣接するように構成してもよい。The first and second bent portions 8, 9 are composed of two or more continuously connected cylindrical members 17, 18. The cylindrical members 18 are cylindrical members disposed on both sides of the first and second bent portions 8, 9 in the distal bent portion 10. The cylindrical member 17 is a cylindrical member disposed between the cylindrical members 18 on both sides in the distal bent portion 10. Note that the cylindrical member 17 may be omitted and the cylindrical members 18 may be configured to be adjacent to each other.

図５Ａ～図５Ｃは、それぞれ第１屈曲部８又は第２屈曲部９において相互に隣接し、直線状態にある円筒状部材１７を上方から見た様子、該円筒状部材１７を側面から見た様子、及び屈曲状態にある該円筒状部材１７を上方から見た様子をそれぞれ示す。Figures 5A to 5C respectively show a cylindrical member 17 adjacent to each other at the first bend 8 or the second bend 9 in a straight state, viewed from above, the cylindrical member 17 viewed from the side, and the cylindrical member 17 in a bent state, viewed from above.

ただし、この場合、第１、第２屈曲部８、９のそれぞれにおいて円筒状部材１７が１つのみ用いられている図４Ａ及び図４Ｂの場合と異なり、図５Ａ～図５Ｃに示されている接続された２つの円筒状部材１７の両側に円筒状部材１８が接続され、第１屈曲部８又は第２屈曲部９が構成される。However, in this case, unlike the cases of Figures 4A and 4B in which only one cylindrical member 17 is used in each of the first and second bends 8, 9, cylindrical members 18 are connected to both sides of the two connected cylindrical members 17 shown in Figures 5A to 5C to form the first bend 8 or the second bend 9.

図５Ａ及び図５Ｂに示すように、相互に隣接する一方の円筒状部材１７は、他方の円筒状部材１７の側に、部分円状の２つの円状凸部１９をそれぞれ上下方向Ｄにおいて反対側に有する。２つの円状凸部１９は、円筒状部材１７の中心軸線を含み、上下方向Ｄに垂直な対称面について対称な位置に位置する。5A and 5B , one of the mutually adjacent cylindrical members 17 has two partially circular convex portions 19 on opposite sides in the vertical direction D toward the other cylindrical member 17. The two circular convex portions 19 include the central axis of the cylindrical member 17 and are located at symmetrical positions with respect to a plane of symmetry perpendicular to the vertical direction D.

他方の円筒状部材１７は、一方の円筒状部材１７の側に２つの部分円状の円状凹部２０を前記対称面について対称な位置に有する。そして、一方の円筒状部材１７の２つの円状凸部１９と、他方の円筒状部材１７の２つの円状凹部２０とが篏合して、各円筒状部材１７は、前記対称面に垂直な回動軸線の周りで相互に回動し得るように接続されている。The other cylindrical member 17 has two partially circular recessed portions 20 on the side of the one cylindrical member 17 at positions symmetrical with respect to the plane of symmetry. The two circular protrusions 19 of one cylindrical member 17 and the two circular recessed portions 20 of the other cylindrical member 17 are engaged with each other, so that the cylindrical members 17 are connected so as to be mutually rotatable about a rotation axis perpendicular to the plane of symmetry.

また、一方及び他方の円筒状部材１７は、相互間の回動範囲を、相互に直線状に配置される図５Ａの状態と、相互に所定角度αで屈曲した状態で配置される図５Ｃの状態との間に制限するとともに相互に分離するのを阻止すべく相互に当接し又は摺動する当接摺動面２１をそれぞれ有する。In addition, the one and the other cylindrical members 17 each have abutting or sliding surfaces 21 that abut or slide against each other to limit the rotational range between the state in Figure 5A in which they are arranged in a straight line with respect to each other, and the state in Figure 5C in which they are arranged in a bent state with respect to each other at a predetermined angle α, and to prevent them from separating from each other.

また、上記の一方及び他方の円筒状部材１７と、それぞれに隣接する円筒状部材１８との間も、同様にして円状凸部１９と円状凹部２０との嵌合により接続し、当接摺動面２１により相互間の回動範囲が制限され、かつ相互に分離することが阻止される。In addition, the above-mentioned one and the other cylindrical members 17 and the adjacent cylindrical members 18 are similarly connected by the engagement of circular convex portions 19 and circular concave portions 20, and the abutting sliding surfaces 21 limit the rotational range between them and prevent them from separating from each other.

図１及び図２に示すように、各インナーチューブ４の基端部には、スライドパイプ２３、スライドノブ２４、２５、及び脱気防止弁２６が設けられる。スライドパイプ２３は、先端屈曲部１０に対して、案内管２７により接続される。各インナーチューブ４の脱気防止弁２６は、バルブコネクタ２８を介してスライドパイプ２３に接続され、処置具２９が挿入されていないインナーチューブ４から空気漏れが生じることを防ぐ機能を有する。1 and 2, a slide pipe 23, slide knobs 24, 25, and an anti-leak valve 26 are provided at the base end of each inner tube 4. The slide pipe 23 is connected to the distal bending portion 10 by a guide tube 27. The anti-leak valve 26 of each inner tube 4 is connected to the slide pipe 23 via a valve connector 28, and has the function of preventing air leakage from an inner tube 4 in which a treatment tool 29 is not inserted.

第１、第２ワイヤ６、７は、それぞれ、第２、第４拘束部１５、１６を経た後、案内管２７の軸線方向に沿って案内管２７に埋設され、基端部がスライドノブ２４、２５に固定される。The first and second wires 6 and 7 pass through the second and fourth restraint portions 15 and 16, respectively, and are then embedded in the guide tube 27 along the axial direction of the guide tube 27, with their base ends fixed to the slide knobs 24 and 25.

スライドノブ２４、２５は、スライドパイプ２３に対して摺動自在に構成される。このため、インナーチューブ４の先端屈曲部１０がアウターチューブ５の先端から突出しているときに、スライドノブ２４を基端側に牽引することによって、図４Ａのように直線状態にある先端屈曲部１０を、図４Ｂのように屈曲させることができる。逆に、スライドノブ２５を基端側に牽引することによって先端屈曲部１０を、図４Ａのように、屈曲していない直線状に戻すことができる。The slide knobs 24, 25 are configured to be slidable relative to the slide pipe 23. Therefore, when the distal bent portion 10 of the inner tube 4 protrudes from the distal end of the outer tube 5, the distal bent portion 10, which is in a straight state as shown in Fig. 4A, can be bent as shown in Fig. 4B by pulling the slide knob 24 toward the proximal end. Conversely, the distal bent portion 10 can be returned to its unbent, straight state as shown in Fig. 4A by pulling the slide knob 25 toward the proximal end.

スライドノブ２４には、ストッパリング３０が回動し得るように設けられる。ストッパリング３０は、スライドパイプ２３の径方向外方に立てられた回動位置と、倒された回動位置との間で回動し得るようになっている。スライドノブ２４を基端側に牽引した状態で、ストッパリング３０を倒してバルブコネクタ２８に掛けることにより、該牽引状態が固定される。A stopper ring 30 is rotatably provided on the slide knob 24. The stopper ring 30 is rotatable between a rotation position in which it is erected radially outward from the slide pipe 23 and a rotation position in which it is tilted. With the slide knob 24 pulled toward the base end, the stopper ring 30 is tilted and hooked onto the valve connector 28, thereby fixing the pulled state.

この構成において、内視鏡治療装置１を使用する際には、まず、図１に示すように、肛門部３１の開口状態を維持するとともに肛門部３１を保護するための開口器３２が肛門部３１に装着される。そして、開口器３２に対して、開口器３２用のバルブキャップ３３を取り付ける。バルブキャップ３３は、開口器３２により形成された開口部から内視鏡治療装置１を導入可能にするとともに腹腔の気密性を維持する。In this configuration, when the endoscopic treatment device 1 is used, first, as shown in Fig. 1, the opening device 32 for maintaining the anal area 31 in an open state and protecting the anal area 31 is attached to the anal area 31. Then, a valve cap 33 for the opening device 32 is attached to the opening device 32. The valve cap 33 enables the endoscopic treatment device 1 to be introduced through the opening formed by the opening device 32 and maintains the airtightness of the abdominal cavity.

次に、アウターチューブ５にインナーチューブ２、４を挿入して取り付ける。本実施形態では、図１に示すように、処置具２９用の２つのインナーチューブ４と、内視鏡３用の１つのインナーチューブ２が周方向に６０度ずつ離れるように取り付けられる。また、このとき、２つのインナーチューブ４の先端屈曲部１０の先端側が、後述の屈曲時に相互に離間するような該周方向の回転角度で取り付けられる。Next, the inner tubes 2, 4 are inserted into and attached to the outer tube 5. In this embodiment, as shown in Fig. 1, two inner tubes 4 for the treatment tools 29 and one inner tube 2 for the endoscope 3 are attached so as to be spaced apart from each other by 60 degrees in the circumferential direction. At this time, the distal ends of the distal bending portions 10 of the two inner tubes 4 are attached at such a rotation angle in the circumferential direction that they will be spaced apart from each other when bent as described below.

なお、この時点では、インナーチューブ２、４は、アウターチューブ５の先端から突出せず埋没した状態となっている。At this point, the inner tubes 2 and 4 are buried in the outer tube 5 without protruding from the tip thereof.

次に、インナーチューブ２に内視鏡３を挿入し、各インナーチューブ４に処置具２９を挿入する。このとき、内視鏡３及び処置具２９は、インナーチューブ２、４の先端から突出せず埋没した状態となっている。Next, the endoscope 3 is inserted into the inner tube 2, and the treatment tool 29 is inserted into each inner tube 4. At this time, the endoscope 3 and the treatment tool 29 are buried in the distal ends of the inner tubes 2, 4 without protruding therefrom.

次に、内視鏡治療装置１を、開口器用のバルブキャップ３３を介して、直腸３４内に挿入する。そして、インナーチューブ２、４を前進させてアウターチューブ５の先端からそれぞれの先端部を突出させる。さらに、各インナーチューブ４のスライドノブ２４を牽引することによって、インナーチューブ４の先端屈曲部１０を屈曲させる。これにより、各先端屈曲部１０の先端側は、相互に左右方向に離間して、ほぼ平行な状態で対峙した状態となる。Next, the endoscopic treatment device 1 is inserted into the rectum 34 via the valve cap 33 for the mouth opening device. Then, the inner tubes 2, 4 are advanced so that their respective distal ends protrude from the distal end of the outer tube 5. Furthermore, the slide knobs 24 of the inner tubes 4 are pulled to bend the distal bending portions 10 of the inner tubes 4. As a result, the distal ends of the distal bending portions 10 are spaced apart from each other in the left-right direction and face each other in a substantially parallel state.

次に、図１及び図２に示すように、内視鏡３及び処置具２９を前進させ、インナーチューブ２、４の先端から突出させる。このとき、各処置具２９の先端部は直線状に弾性変形されていた状態が元に復帰することにより、相互に近接した状態となる。また、内視鏡３の先端部は、直線状に弾性変形されていた状態が元に復帰することにより、相互に近接した各処置具２９の先端部の方向を向いた状態となる。1 and 2, the endoscope 3 and the treatment tool 29 are advanced and projected from the distal ends of the inner tubes 2, 4. At this time, the distal ends of the treatment tools 29 return to their original state from the state in which they were elastically deformed linearly, and are brought into close proximity to each other. In addition, the distal end of the endoscope 3 returns to its original state from the state in which it was elastically deformed linearly, and is brought into a state in which it faces the direction of the distal ends of the treatment tools 29 that are close to each other.

したがって、この後、内視鏡３により直腸３４内の被処置部及び処置具２９を観察しながら、処置具２９を被処置部に近接させて、手技を行うことができる。Therefore, thereafter, while observing the treatment area in the rectum 34 and the treatment tool 29 through the endoscope 3, the treatment tool 29 can be brought close to the treatment area to perform the procedure.

本実施形態によれば、各インナーチューブ２の先端屈曲部１０をほぼＳ字状に屈曲させ、各先端屈曲部１０の先端部が相互に離れてかつほぼ平行な状態として処置具２９が先端屈曲部１０から突出される。このため、処置具２９を被処置部に向ける際の処置具２９の屈曲量を少なくすることができる。したがって、直腸手術のような比較的狭い体腔内の手術も容易に行うことができる。According to this embodiment, the distal bending portion 10 of each inner tube 2 is bent into a substantially S-shape, and the treatment tool 29 is projected from the distal bending portion 10 with the distal ends of the distal bending portions 10 spaced apart from each other and substantially parallel to each other. This reduces the amount of bending of the treatment tool 29 when the treatment tool 29 is directed toward the part to be treated. This makes it easy to perform surgery in a relatively narrow body cavity, such as rectal surgery.

また、処置具２９の屈曲量を少なくすることができるので、各先端屈曲部１０の先端部が相互に離れてかつほぼ平行な状態となるので、処置具２９を予め屈曲した形状に形成しつつ、直線状に屈曲可能に構成することができる。In addition, since the amount of bending of the treatment tool 29 can be reduced, the tip portions of each tip bending portion 10 are spaced apart from each other and are approximately parallel to each other, so that the treatment tool 29 can be formed into a pre-bent shape while being configured to be bent in a straight line.

つまり、処置具２９を屈曲している状態から直線状に伸ばした状態でインナーチューブ２に挿入し、処置具２９の先端部をインナーチューブ２から突出させると、処置具２９を元の屈曲した状態に戻るようにすることができる。これにより、処置具２９に操作部を設けることなく、処置具２９を図１のように相互に内側に屈曲させることができる。In other words, the treatment tool 29 can be returned to its original bent state by inserting the treatment tool 29 into the inner tube 2 in a state where it is straightened from a bent state and protruding the tip of the treatment tool 29 from the inner tube 2. This allows the treatment tools 29 to be bent inwardly relative to each other as shown in FIG.

また、先端屈曲部１０の第１、第２屈曲部８、９は、それを形成するための円筒状の部材を円筒状部材１７、１８の形状にレーザ加工するだけで、２又は３以上の円筒状部材１７、１８が連続して接続された状態のものとして、容易に製造することができる。In addition, the first and second bends 8, 9 of the tip bend portion 10 can be easily manufactured as two or more cylindrical members 17, 18 connected in series, simply by laser processing the cylindrical members used to form them into the shape of the cylindrical members 17, 18.

以上、本発明の実施形態について説明したが、本発明は、これに限定されることなく変形して実施することができる。例えば、インナーチューブ２の先端屈曲部１０は、断面形状が真円状に限らず、円状（円筒状）であればよく、多少楕円状や多角形状であってもよい。Although the embodiment of the present invention has been described above, the present invention is not limited to this and can be modified and embodied. For example, the cross-sectional shape of the tip bent portion 10 of the inner tube 2 is not limited to a perfect circle, but may be any circle (cylindrical), or may be slightly elliptical or polygonal.

また、内視鏡３用のインナーチューブ２の先端部に、処置具２９用のインナーチューブ４の先端屈曲部１０と同様の屈曲部を設けてもよい。In addition, a bent portion similar to the distal bent portion 10 of the inner tube 4 for the treatment tool 29 may be provided at the distal end of the inner tube 2 for the endoscope 3 .

また、処置具２９は、その先端部に関節部を有し、ワイヤを介して屈曲できるものであってもよい。The treatment tool 29 may also have a joint at its tip and be bendable via a wire.

１…内視鏡治療装置、２、４…インナーチューブ、３…内視鏡、５…アウターチューブ、６…第１ワイヤ、７…第２ワイヤ、８…第１屈曲部、９…第２屈曲部、１０…先端屈曲部、１１…第１固定部、１２…第２固定部、１３…第１拘束部、１４…第３拘束部、１５…第２拘束部、１６…第４拘束部、１７、１８…円筒状部材、１９…円状凸部、２０…円状凹部、２１…当接摺動面、２３…スライドパイプ、２４、２５…スライドノブ、２６…脱気防止弁、２７…案内管、２８…バルブコネクタ、２９…処置具、３０…ストッパリング、３１…肛門部、３２…開口器、３３…バルブキャップ、３４…直腸。1...endoscopic treatment device, 2, 4...inner tube, 3...endoscope, 5...outer tube, 6...first wire, 7...second wire, 8...first bent portion, 9...second bent portion, 10...tip bent portion, 11...first fixed portion, 12...second fixed portion, 13...first restraining portion, 14...third restraining portion, 15...second restraining portion, 16...fourth restraining portion, 17, 18...cylindrical member, 19...circular convex portion, 20...circular concave portion, 21...contact sliding surface, 23...slide pipe, 24, 25...slide knob, 26...anti-deaeration valve, 27...guide tube, 28...valve connector, 29...treatment tool, 30...stoppering ring, 31...anal portion, 32...opening device, 33...valve cap, 34...rectum.

Claims (3)

アウターチューブに対してその内壁と中心軸線との間に位置するように挿入されてその先端から先端部が突出し、可撓性の処置具又は可撓性の内視鏡が挿入されてその先端部が先端から突出する医療用のインナーチューブであって、
インナーチューブにおいて、アウターチューブの軸線から遠い側を外側、アウターチューブの軸線に近い側を内側、先端及び基端を結ぶ方向と前記外側及び前記内側を結ぶ方向とに直交する方向を上下方向と規定すると、
基端部がインナーチューブに沿って基端方向に牽引される第１ワイヤ及び第２ワイヤを備え、
インナーチューブの先端部には、第１屈曲部と、該第１屈曲部よりも基端側に位置する第２屈曲部とを有する先端屈曲部が設けられ、
前記第１屈曲部は、その先端部を、その基端部に対して直線状をなしている状態から、該先端部と該基端部との間において前記上下方向に沿って延びる第１回動軸線を中心として前記内側方向に回動可能に接続されることでインナーチューブの先端部を該内側方向に屈曲可能に構成され、
前記第２屈曲部は、その先端部を、その基端部に対して直線状をなしている状態から、該先端部と該基端部との間において前記上下方向に沿って延びる第２回動軸線を中心として前記外側方向に回動可能に接続されることでインナーチューブの先端部を該外側方向に屈曲可能に構成され、
前記先端屈曲部は、
前記第１ワイヤの先端部を、前記第１屈曲部よりも先端側の前記内側に固定する第１固定部と、
前記第１屈曲部と前記第２屈曲部との間に設けられ、前記第１ワイヤが前記第１回動軸線よりも前記内側、かつ、前記第２回動軸線よりも前記外側を通るように該第１ワイヤの通過位置を拘束する第１拘束部と、
前記第２屈曲部よりも基端側に設けられ、前記第１ワイヤが前記第２回動軸線の前記外側を通るように該第１ワイヤの通過位置を拘束する第２拘束部と、
前記第２ワイヤの先端部を、前記第１屈曲部よりも先端側の前記外側に固定する第２固定部と、
前記第１屈曲部と前記第２屈曲部との間に設けられ、前記第２ワイヤが前記第１回動軸線よりも前記外側、かつ、前記第２回動軸線よりも前記内側を通るように該第２ワイヤの通過位置を拘束する第３拘束部と、
前記第２屈曲部よりも基端側に設けられ、前記第２ワイヤが前記第２回動軸線の前記内側を通るように該第２ワイヤの通過位置を拘束する第４拘束部とを備え、
前記第１、第２屈曲部は、それぞれ連続して接続された２又は３以上の中空の円筒状部材で構成され、
前記円筒状部材のうち、相互に隣接する一方の円筒状部材は、他方の円筒状部材の側に、該円筒状部材の中心軸線を含み、前記上下方向に垂直な対称面について対称な位置に半円より中心角が大きい部分円状の２つの円状凸部を有し、他方の円筒状部材は該２つの円状凸部に嵌合した半円より中心角が大きい部分円状の２つの円状凹部を有し、
前記相互に隣接する一方及び他方の円筒状部材は、前記円状凸部及び前記円状凹部を介して前記対称面に垂直な回動軸線の周りで相互に回動し得るように接続されており、
前記一方及び他方の円筒状部材は、相互間の回動範囲を、相互に直線状に配置される状態と、相互に所定角度で屈曲した状態で配置される状態との間に制限するとともに相互に分離するのを阻止すべく相互に当接し又は摺動する当接摺動面をそれぞれ有し、
インナーチューブは、前記処置具又は内視鏡のインナーチューブへの挿入が、前記一方及び他方の円筒状部材が相互に直線状に配置される状態において前記処置具又は内視鏡の先端部を直線状に弾性変形させた状態で行われるとともに、前記処置具又は内視鏡の先端部のインナーチューブからの突出が、前記一方及び他方の円筒状部材が相互に所定角度で屈曲した状態で配置される状態において該先端部が元の屈曲した形状に復帰しつつ行われるものであることを特徴とするインナーチューブ。 A medical inner tube into which a flexible treatment tool or a flexible endoscope is inserted so that the distal end of the inner tube protrudes from the distal end of the outer tube, the inner tube being inserted between an inner wall of the outer tube and a central axis of the outer tube, the distal end of the inner tube protruding from the distal end of the outer tube,
In the inner tube, the side farther from the axis of the outer tube is defined as the outside, the side closer to the axis of the outer tube is defined as the inside, and the direction perpendicular to the direction connecting the tip and base ends and the direction connecting the outside and the inside is defined as the up-down direction.
a first wire and a second wire, the proximal ends of which are pulled in a proximal direction along the inner tube;
The inner tube has a distal end bent portion having a first bent portion and a second bent portion located closer to the base end than the first bent portion,
the first bending portion is configured to be rotatable in the inward direction from a state in which a tip end is linear with respect to a base end about a first rotation axis extending in the up-down direction between the tip end and the base end, thereby allowing the tip end of the inner tube to be bent in the inward direction,
the second bending portion is configured to be rotatable in the outward direction from a state in which the tip end is linear with respect to the base end about a second rotation axis extending along the up-down direction between the tip end and the base end, thereby allowing the tip end of the inner tube to be bent in the outward direction,
The tip bending portion is
a first fixing portion that fixes a tip end portion of the first wire to the inside on a tip side of the first bent portion;
a first restraining portion provided between the first bent portion and the second bent portion and restraining a passing position of the first wire so that the first wire passes on the inner side of the first rotation axis and on the outer side of the second rotation axis;
a second restraining portion provided on a proximal end side of the second bent portion and restraining a passing position of the first wire so that the first wire passes outside the second rotation axis;
a second fixing portion that fixes a tip end portion of the second wire to the outer side on a tip side of the first bent portion;
a third restraining portion provided between the first bent portion and the second bent portion and restraining a passing position of the second wire so that the second wire passes outside the first rotation axis and inside the second rotation axis;
a fourth restraining portion that is provided on a proximal side of the second bent portion and that restrains a passing position of the second wire so that the second wire passes on the inside of the second rotation axis;
the first and second bent portions are each formed of two or more hollow cylindrical members connected in series,
Among the cylindrical members, one of the cylindrical members adjacent to each other has, on the side of the other cylindrical member, two partially circular convex portions having a larger central angle than a semicircle at symmetrical positions with respect to a symmetry plane that includes the central axis of the cylindrical member and is perpendicular to the up-down direction, and the other cylindrical member has two partially circular concave portions having a larger central angle than a semicircle and fitted into the two circular convex portions,
the one and the other cylindrical members adjacent to each other are connected to each other so as to be mutually rotatable about a rotation axis perpendicular to the plane of symmetry via the circular convex portion and the circular concave portion,
the one and the other cylindrical members each have a contact sliding surface that contacts or slides against each other to limit a rotation range between a state in which the cylindrical members are disposed linearly relative to each other and a state in which the cylindrical members are disposed bent at a predetermined angle relative to each other and to prevent the cylindrical members from being separated from each other ;
The inner tube is characterized in that the treatment tool or endoscope is inserted into the inner tube with the tip of the treatment tool or endoscope elastically deformed in a straight line with the one and other cylindrical members arranged in a straight line relative to each other, and the tip of the treatment tool or endoscope protrudes from the inner tube with the tip returning to its original bent shape with the one and other cylindrical members arranged in a straight line with each other . アウターチューブに対してその内壁と中心軸線との間に位置するように挿入されてその先端から先端部が突出し、可撓性の処置具又は可撓性の内視鏡が挿入されてその先端部が先端から突出する医療用のインナーチューブであって、
インナーチューブにおいて、アウターチューブの軸線から遠い側を外側、アウターチューブの軸線に近い側を内側、先端及び基端を結ぶ方向と前記外側及び前記内側を結ぶ方向とに直交する方向を上下方向と規定すると、
基端部がインナーチューブに沿って基端方向に牽引される第１ワイヤを備え、
インナーチューブの先端部には、第１屈曲部と、該第１屈曲部よりも基端側に位置する第２屈曲部とを有する先端屈曲部が設けられ、
前記第１屈曲部は、その先端部を、その基端部に対して直線状をなしている状態から、該先端部と該基端部との間において前記上下方向に沿って延びる第１回動軸線を中心として前記内側方向に回動可能に接続されることでインナーチューブの先端部を該内側方向に屈曲可能に構成され、
前記第２屈曲部は、その先端部を、その基端部に対して直線状をなしている状態から、該先端部と該基端部との間において前記上下方向に沿って延びる第２回動軸線を中心として前記外側方向に回動可能に接続されることでインナーチューブの先端部を該外側方向に屈曲可能に構成され、
前記先端屈曲部は、
前記第１ワイヤの先端部を、前記第１屈曲部よりも先端側の前記内側に固定する第１固定部と、
前記第１屈曲部と前記第２屈曲部との間に設けられ、前記第１ワイヤが前記第１回動軸線よりも前記内側、かつ、前記第２回動軸線よりも前記外側を通るように該第１ワイヤの通過位置を拘束する第１拘束部と、
前記第２屈曲部よりも基端側に設けられ、前記第１ワイヤが前記第２回動軸線の前記外側を通るように該第１ワイヤの通過位置を拘束する第２拘束部とを備え、
前記第１、第２屈曲部は、それぞれ連続して接続された２又は３以上の中空の円筒状部材で構成され、
前記円筒状部材のうち、相互に隣接する一方の円筒状部材は、他方の円筒状部材の側に、該円筒状部材の中心軸線を含み、前記上下方向に垂直な対称面について対称な位置に半円より中心角が大きい部分円状の２つの円状凸部を有し、他方の円筒状部材は該２つの円状凸部に嵌合した半円より中心角が大きい部分円状の２つの円状凹部を有し、
前記相互に隣接する一方及び他方の円筒状部材は、前記円状凸部及び前記円状凹部を介して前記対称面に垂直な回動軸線の周りで相互に回動し得るように接続されており、
前記一方及び他方の円筒状部材は、相互間の回動範囲を、相互に直線状に配置される状態と、相互に所定角度で屈曲した状態で配置される状態との間に制限するとともに相互に分離するのを阻止すべく相互に当接し又は摺動する当接摺動面をそれぞれ有し、
インナーチューブは、前記処置具又は内視鏡のインナーチューブへの挿入が、前記一方及び他方の円筒状部材が相互に直線状に配置される状態において前記処置具又は内視鏡の先端部を直線状に弾性変形させた状態で行われるとともに、前記処置具又は内視鏡の先端部のインナーチューブからの突出が、前記一方及び他方の円筒状部材が相互に所定角度で屈曲した状態で配置される状態において該先端部が元の屈曲した形状に復帰しつつ行われるものであることを特徴とするインナーチューブ。 A medical inner tube into which a flexible treatment tool or a flexible endoscope is inserted so that the distal end of the inner tube protrudes from the distal end of the outer tube, the inner tube being inserted between an inner wall of the outer tube and a central axis of the outer tube, the distal end of the inner tube protruding from the distal end of the outer tube,
In the inner tube, the side farther from the axis of the outer tube is defined as the outside, the side closer to the axis of the outer tube is defined as the inside, and the direction perpendicular to the direction connecting the tip and base ends and the direction connecting the outside and the inside is defined as the up-down direction.
a first wire having a proximal end adapted to be pulled proximally along the inner tube;
The inner tube has a distal end bent portion having a first bent portion and a second bent portion located closer to the base end than the first bent portion,
the first bending portion is configured to be rotatable in the inward direction from a state in which a tip end portion is linear with respect to a base end portion about a first rotation axis extending in the up-down direction between the tip end portion and the base end portion, thereby allowing the tip end portion of the inner tube to be bent in the inward direction,
the second bending portion is configured to be rotatable in the outward direction from a state in which the tip end is linear with respect to the base end about a second rotation axis extending along the up-down direction between the tip end and the base end, thereby allowing the tip end of the inner tube to be bent in the outward direction,
The tip bending portion is
a first fixing portion that fixes a tip end portion of the first wire to the inside on a tip side of the first bent portion;
a first restraining portion provided between the first bent portion and the second bent portion and restraining a passing position of the first wire so that the first wire passes on the inner side of the first rotation axis and on the outer side of the second rotation axis;
a second restraining portion provided on a proximal side of the second bent portion and configured to restrain a passing position of the first wire so that the first wire passes outside the second rotation axis;
the first and second bent portions are each formed of two or more hollow cylindrical members connected in series,
Among the cylindrical members, one of the cylindrical members adjacent to each other has, on the side of the other cylindrical member, two partially circular convex portions having a larger central angle than a semicircle at symmetrical positions with respect to a symmetry plane that includes the central axis of the cylindrical member and is perpendicular to the up-down direction, and the other cylindrical member has two partially circular concave portions having a larger central angle than a semicircle and fitted into the two circular convex portions,
the one and the other cylindrical members adjacent to each other are connected to each other so as to be mutually rotatable about a rotation axis perpendicular to the plane of symmetry via the circular convex portion and the circular concave portion,
the one and the other cylindrical members each have a contact sliding surface that contacts or slides against each other to limit a rotation range between a state in which the cylindrical members are disposed linearly relative to each other and a state in which the cylindrical members are disposed bent at a predetermined angle relative to each other and to prevent the cylindrical members from being separated from each other ;
The inner tube is characterized in that the treatment tool or endoscope is inserted into the inner tube with the tip of the treatment tool or endoscope elastically deformed in a straight line with the one and other cylindrical members arranged in a straight line relative to each other, and the tip of the treatment tool or endoscope protrudes from the inner tube with the tip returning to its original bent shape with the one and other cylindrical members arranged in a straight line with each other . インナーチューブとして、前記処置具がそれぞれ挿入される第１インナーチューブ及び第２インナーチューブと、前記内視鏡が挿入される第３インナーチューブとを備え、The surgical instrument includes a first inner tube and a second inner tube into which the treatment tools are respectively inserted, and a third inner tube into which the endoscope is inserted,
前記第１～第３インナーチューブは、アウターチューブに挿入されて先端部が該アウターチューブから突出するものであり、the first to third inner tubes are inserted into an outer tube such that their distal ends protrude from the outer tube;
前記第１～第３インナーチューブ及び前記アウターチューブは、該アウターチューブから先端部が突出した前記第１～第３インナーチューブについて前記処置具及び内視鏡の挿入及び突出が行われた場合に、各処置具の先端部が相互に近接し、かつ該内視鏡の先端部が、各処置具の先端部の方向を向いた状態となるように構成されることを特徴とする請求項１又は２に記載のインナーチューブ。The inner tube according to claim 1 or 2, characterized in that the first to third inner tubes and the outer tube are configured such that when the treatment tools and the endoscope are inserted and ejected into the first to third inner tubes whose tip portions protrude from the outer tubes, the tip portions of the treatment tools are close to each other and the tip portion of the endoscope is directed toward the tip portions of the treatment tools.
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