WO2009153843A1 - Large intestine endoscope - Google Patents

Abstract

[PROBLEMS] To safely, quickly and easily perform large intestine endoscopy by a medical staff without requiring long training time by smoothly and safely inserting a large intestine endoscope toward the deepest part of the ascending colon from the sigmoid colon acting as the free intestine via the transverse colon also acting as the free intestine. [MEANS FOR SOLVING PROBLEMS] A negative pressure-supplying unit, which is in a tapered shape opening toward the back end of the large intestine endoscope body as described above and formed in a swollen state outward from the side of the large intestine endoscope body as described above, has a negative pressure-supplying hole part having an opening toward the back end of the large intestine endoscope and a negative pressure-supplying channel part for supplying negative pressure into the large intestine via the negative pressure-supplying hole part as described above. When the large intestine endoscope is inserted into the large intestine, negative pressure is supplied from the above-described negative pressure-supplying channel part toward the back end of the large intestine endoscope as described above via the above-described negative pressure-supplying hole part so that the inside of the large intestine is evacuated. Thus, the large intestine wall is closely adhered to the outer side of the large intestine endoscope body as described above.

Description

大腸内視鏡Colonoscopy

　本発明は、大腸内視鏡に係り、特に、長期間の訓練を要することなく容易かつ安全に検査を行うことができる大腸内視鏡に関する。 The present invention relates to a large intestine endoscope, and more particularly to a large intestine endoscope that can be easily and safely examined without requiring long-term training.

　従来より、大腸内視鏡検査に使用される内視鏡は、上記内視鏡の先端前面部に吸引口部及び観察レンズが設けられた前方視鏡型内視鏡が使用されている。
　ところで、図１１に示すように、人間の大腸３７は腹膜等周辺筋繊維や臓器により固定されている直腸部４２、下行結腸部４６、上行結腸部５４（以下、固定腸という）と、上記腹膜等周辺筋繊維や臓器により固定されていない、Ｓ状結腸部３８、横行結腸部４９（以下、自由腸という）とにより形成されている。
　この場合、上記固定腸と自由腸の間には、肝彎曲部５５、脾彎曲部５０、Ｓ状結腸下行結腸移行部４７と呼ばれる大きな屈曲部が存在する。 2. Description of the Related Art Conventionally, an endoscope used for a colonoscopy is a front-end endoscope in which a suction port and an observation lens are provided on a front end portion of the endoscope.
By the way, as shown in FIG. 11, a human large intestine 37 includes a rectal part 42, a descending colon part 46, an ascending colon part 54 (hereinafter referred to as a fixed intestine) fixed by peripheral muscle fibers and organs such as the peritoneum, and the peritoneum. It is formed by a sigmoid colon part 38 and a transverse colon part 49 (hereinafter referred to as a free intestine) that are not fixed by an isosceles muscle fiber or an organ.
In this case, there are large bent portions called a liver fold portion 55, a spleen fold portion 50, and a sigmoid descending colon transition portion 47 between the fixed intestine and the free intestine.

　被験者を腹臥位にさせた場合、上記固定腸は背中側に腹膜により貼り付いており、これらを後腹膜臓器という。一方、上記自由腸は腸間膜により前腹壁部に垂れ下がることとなる。この状態で、大腸内視鏡を肛門から押し込んだ場合には、自由腸から固定腸へ移行する部位において大腸内視鏡が垂れ下がった上記自由腸を押し伸ばすこととなり、結果的に、Ｓ状結腸部３８は肛門３６方向に対して鋭角に屈曲するヘアピンカーブ状になってしまうこととなる。 When the subject is placed in the prone position, the fixed intestine is attached to the back side with the peritoneum, and these are called retroperitoneal organs. On the other hand, the free intestine hangs down to the front abdominal wall by the mesentery. In this state, when the large intestine endoscope is pushed in from the anus, the free intestine where the large intestine endoscope hangs down is stretched at a site where the free intestine transitions to the fixed intestine. The part 38 will be in the shape of a hairpin curve that bends at an acute angle with respect to the anus 36 direction.

　その結果、特に、Ｓ状結腸部３８においては、単に大腸内視鏡を押し入れるのみでは、上記大腸内視鏡の挿入方向にＳ状結腸部３８の腸壁が伸長されるのみであり、上記内視鏡の挿入が困難であるとともに、場合によっては上記内視鏡操作に伴い、腸壁からの出血、腸壁の損傷、腸壁穿孔事故が発生する可能性もあった。
　内視鏡は、食道、胃、十二指腸の検査にも使用されるが、食道、胃、十二指腸はいずれも臓器の形状や構造そのものが単純であることから、食道、胃、十二指腸に用いられる内視鏡に関しては、医師は内視鏡を被験者の口から挿入することにより、大腸内視鏡の場合に比して容易に検査作業を行うことができる。 As a result, in particular, in the sigmoid colon portion 38, simply pushing the large intestine endoscope only extends the intestinal wall of the sigmoid colon portion 38 in the insertion direction of the large intestine endoscope. It was difficult to insert an endoscope, and in some cases, bleeding from the intestinal wall, damage to the intestinal wall, and an accident of perforation of the intestinal wall could occur as a result of the endoscope operation.
Endoscopes are also used for examination of the esophagus, stomach, and duodenum, but because the esophagus, stomach, and duodenum all have simple organ shapes and structures, the endoscopes used for the esophagus, stomach, and duodenum are used. Regarding the mirror, the doctor can easily perform the inspection work by inserting the endoscope through the mouth of the subject as compared with the case of the large intestine endoscope.

　しかしながら、大腸内視鏡検査においては、上記のような胃内視鏡等の検査とは異なり、上述のように、上記固定腸である直腸部４２等、固定されていない上記自由腸であるＳ状結腸部３８等の内部に大腸内視鏡を挿通させる必要があり、自由腸から固定腸への移行部においては、Ｓ状結腸下行結腸移行部４７等においては大腸内視鏡が押入されることによりヘアピンカーブ状になってしまう非常に微妙かつ複雑な構造であって、さらに、大腸内視鏡の肉厚は非常に薄いことから、大腸内視鏡の大腸内への挿入作業の困難性は胃等に挿入される内視鏡よりもはるかに高い。 However, in the colonoscopy, unlike the gastroscopy as described above, as described above, the rectal portion 42 that is the fixed intestine, etc. The colonoscope needs to be inserted into the sigmoid colon 38 or the like, and the colonoscope is pushed into the sigmoid descending colon transition part 47 or the like at the transitional part from the free intestine to the fixed intestine. It is a very delicate and complicated structure that becomes a hairpin curve due to the fact that the thickness of the colonoscope is very thin, so it is difficult to insert the colonoscope into the colon Is much higher than an endoscope inserted into the stomach or the like.

　従って、従来より、大腸内視鏡により大腸の内視鏡検査を行う場合には、検査を行う医師は長期間に亘って大腸内視鏡を大腸内へ安全かつ円滑に挿入するための訓練を行う必要があり、大腸内視鏡検査が国内で年間約２００万件行われているにも拘わらず、大腸外科医の誰しもが大腸内視鏡の検査を容易に行うことができる訳ではなく、上記大腸内視鏡検査を行うための教育施設も不足しており、また、最悪の場合には、検査中に腸壁を傷つけ、出血、腸壁損傷の事故や、重大な穿孔事故が発生する可能性もある、という問題点が存していた。 Therefore, conventionally, when performing an endoscopic examination of the large intestine with a large intestine endoscope, the doctor performing the examination has been trained to insert the large intestine endoscope into the large intestine safely and smoothly over a long period of time. Despite the fact that approximately 2 million colonoscopy are performed annually in Japan, not all colonosurgeons can easily perform colonoscopy. In addition, there is a lack of educational facilities for performing the above colonoscopy, and in the worst case, the intestinal wall is damaged during the inspection, causing an accident of bleeding, intestinal wall damage, and a serious perforation accident. There was a problem that it might be.

　従って、内視鏡外科学会においては、上記大腸内視鏡の挿入作業の困難性を解消する観点から、内視鏡の先端前面部に設けられた吸引部において陰圧を大腸内に供給して、上記自由腸壁部を吸引して大腸内視鏡に吸着させ、大腸内視鏡を大腸内へ押し込むのではなく、自由腸部分を大腸内視鏡と共に肛門方向へ繰り返し引き戻して折り畳み、自由腸部分を畳み込んで固定化し、固定腸へ直線的に連続させた状態で、大腸内視鏡を固定腸へ挿入する挿入方法が提案されていた。 Accordingly, the Endoscopic Surgery Society supplies negative pressure into the large intestine at the suction part provided at the front end of the endoscope from the viewpoint of eliminating the difficulty in inserting the large intestine endoscope. Instead of sucking the free intestinal wall and adsorbing it to the large intestine endoscope and pushing the large intestine endoscope into the large intestine, the free intestine part is repeatedly pulled back in the anus direction together with the large intestine endoscope and folded. There has been proposed an insertion method in which a large intestine endoscope is inserted into a fixed intestine in a state where the portion is folded and fixed and linearly connected to the fixed intestine.

　このような観点から、従来より、上記内視鏡前方に設けられた鉗子口を兼ねた吸引口から腸管内の空気を吸引して大腸内に陰圧を形成し、自由腸内壁を内視鏡に密着させて内視鏡を引き戻し、自由腸であるＳ状結腸部、横行結腸部の折り畳んで手前（肛門側）へ牽引し、自由腸を蛇腹状に折畳するようにして大腸内視鏡を挿入する検査方法が提案され、このような検査方法に使用できるように構成された大腸内視鏡が提案されている（特許文献１及び特許文献２）。
国際公開番号 ＷＯ９４／ １０８９６ 特開２００２－１２５９２１ From such a viewpoint, conventionally, air in the intestinal tract is sucked from the suction port also serving as a forceps port provided in front of the endoscope to form negative pressure in the large intestine, and the inner wall of the free intestine is endoscope. The colonoscopy is pulled back, the sigmoid colon, which is the free intestine, and the transverse colon are folded and pulled toward the front (anus), and the free intestine is folded into a bellows. An inspection method for inserting a large intestine is proposed, and a colonoscope configured to be used for such an inspection method has been proposed (Patent Documents 1 and 2).
International Publication Number WO94 / 10896 JP 2002-125921 A

　この場合、上記特許文献１に開示された発明にあっては、大腸内視鏡の先端前面部に形成された折曲可能部位よりも内方に吸引部が設けられていることから、上記折曲操作可能部位には大腸壁部を吸着することができず、大腸の折り畳み作業に支障を及ぼすという不具合があった。
　また、上記特許文献２に開示された発明にあっては、特許文献１に関する不具合は解消されるが、上記大腸内視鏡の先端前面部において大腸内視鏡の側方へ向かって開口した吸引口部から大腸内部の空気を吸引させて、大腸内壁を大腸内視鏡先端部に吸着させて折り畳むことにより短縮牽引を行うように構成されていることから、上記大腸内視鏡の先端前方面部に設けられた吸引口に隣接する観察レンズ部が腸管粘膜により覆われるため大腸内視鏡検査に必要な視野が確保できず、内視鏡をさらに挿入させることが困難である、という問題点が存していた。 In this case, in the invention disclosed in Patent Document 1, since the suction part is provided inward from the bendable part formed in the front end portion of the colon endoscope, the folding is performed. There was a problem in that the large intestine wall portion could not be adsorbed to the bendable region, which hindered the large intestine folding operation.
Further, in the invention disclosed in Patent Document 2, the problem related to Patent Document 1 is solved, but suction that opens toward the side of the colonoscope at the front end portion of the colonoscope is performed. Since the air inside the large intestine is sucked from the mouth, the inner wall of the large intestine is adsorbed on the distal end of the large intestine endoscope, and is folded and retracted, the front surface of the distal end of the large intestine endoscope Since the observation lens part adjacent to the suction port provided in the part is covered with the intestinal mucosa, the field of view necessary for colonoscopy cannot be secured, and it is difficult to insert the endoscope further. Existed.

　また、視界を確保するために吸引口部からの吸引状態を停止し、陰圧を解除した場合には、内視鏡と、大腸内壁との密着が不十分となり、大腸の折畳みが不可能となる。その結果、大腸内視鏡検査における上記のような自由腸の折り畳みによる短縮牽引を行う場合にも、長時間の訓練が必要である、という不具合が存していた。 In addition, when the suction state from the suction port is stopped and the negative pressure is released to ensure visibility, the adhesion between the endoscope and the inner wall of the large intestine is insufficient, and the large intestine cannot be folded. Become. As a result, there has been a problem in that long-time training is required even when performing a shortened traction by folding the free intestine as described above in colonoscopy.

　そこで、本願発明の課題は、大腸内への挿入時における内視鏡の視界を確保しつつ、大腸壁部を大腸内視鏡に確実に吸着させて、自由腸を折り畳んで自由腸から固定腸を直線化し、検査医師が長期間の訓練を要することなく、自由腸であるＳ状結腸部から、同様に自由腸である横行結腸部を介して上行結腸部の最奥部に至るまで、大腸内視鏡を円滑かつ安全に挿入することにより、大腸内視鏡検査を安全かつ迅速、容易に行うことにある。 Therefore, an object of the present invention is to secure the endoscope's field of view when inserted into the large intestine, while firmly adsorbing the large intestine wall to the large intestine endoscope, and folding the free intestine to fix the free intestine to the fixed intestine. From the sigmoid colon, which is the free intestine, to the deepest part of the ascending colon through the transverse colon, which is also the free intestine, without requiring long-term training by the examining doctor. By inserting an endoscope smoothly and safely, it is to perform colonoscopy safely, quickly and easily.

　このような技術的課題解決のため、請求項1記載の発明にあっては、大腸内視鏡本体の先端部に設けられ、大腸内へ挿入された場合に大腸内へ陰圧を供給しうる陰圧供給部を有する大腸内視鏡であって、上記陰圧供給部は、上記大腸内視鏡本体の後端部方向に向かってテーパ状に拡開して上記大腸内視鏡本体の側面部よりも外方へ膨出して形成され、大腸内視鏡後端部方向へ開口する陰圧供給孔部と、上記陰圧供給孔部を介して大腸内部に陰圧を供給する陰圧供給路部とを有し、大腸内部に挿入された場合には、上記陰圧供給路部から上記陰圧供給孔部を介して上記大腸内視鏡後端部方向に向かって陰圧を供給して大腸内部を減圧し、上記大腸内視鏡本体外側面部に大腸壁部を密着させうることを特徴とする。　 In order to solve such a technical problem, the invention according to claim 1 is provided at the distal end portion of the large intestine endoscope body, and can supply negative pressure into the large intestine when inserted into the large intestine. A large intestine endoscope having a negative pressure supply unit, wherein the negative pressure supply unit expands in a tapered shape toward the rear end of the large intestine endoscope main body, and the side surface of the large intestine endoscope main body A negative pressure supply hole that is formed to bulge outward from the section and opens toward the rear end of the colon endoscope, and a negative pressure supply that supplies negative pressure into the large intestine via the negative pressure supply hole And a negative pressure is supplied from the negative pressure supply path toward the rear end of the large intestine endoscope through the negative pressure supply hole. The inside of the large intestine can be decompressed, and the large intestine wall can be brought into close contact with the outer surface of the large intestine endoscope main body. *

　従って、請求項１記載の発明にあっては、大腸内視鏡が大腸内に挿入され、上記陰圧供給路部を介して陰圧が供給され、上記陰圧供給孔部から大腸内視鏡本体の後方に向かって、大腸内視鏡本体外方に陰圧が形成される。
　その結果、挿入された大腸内視鏡の先端部から後端部方向にかけて陰圧が発生することから、大腸内壁は、大腸内視鏡の先端前部を除き、大腸内視鏡本体の外側部に吸着される。従って、検査者は大腸壁部が吸着された大腸内視鏡を手前に手繰り寄せることにより大腸の自由腸部を折り畳むことができる。 Therefore, according to the first aspect of the present invention, a large intestine endoscope is inserted into the large intestine, a negative pressure is supplied through the negative pressure supply passage, and the large intestine endoscope is supplied from the negative pressure supply hole. A negative pressure is formed outside the main body of the large intestine endoscope toward the rear of the main body.
As a result, negative pressure is generated from the distal end of the inserted large intestine endoscope toward the rear end, so that the inner wall of the large intestine is the outer part of the main body of the large intestine endoscope except for the front end of the large intestine endoscope. To be adsorbed. Therefore, the examiner can fold the large intestine of the large intestine by pulling the large intestine endoscope with the large intestine wall adsorbed to the front.

　請求項２記載の発明にあっては、上記陰圧供給部の後端部には、大腸内視鏡本体部よりも径方向外方へ突出し、上記密着した大腸壁部に係合しうる係合部が形成されていることを特徴とする。
　従って、請求項２記載の発明にあっては、上記陰圧供給部から上記陰圧供給孔部を介して陰圧が供給され大腸壁部が大腸内視鏡本体の外側面部に密着し、検査者が大腸内視鏡を手繰り寄せ大腸内壁を折りたたむ際には、上記係合部を大腸内壁に係合させた状態で折り畳むことができる。 According to a second aspect of the present invention, the rear end portion of the negative pressure supply portion protrudes radially outward from the large intestine endoscope main body and can be engaged with the tightly adhered large intestine wall. A joint is formed.
Therefore, in the invention according to claim 2, a negative pressure is supplied from the negative pressure supply portion through the negative pressure supply hole portion, and the colon wall portion is in close contact with the outer side surface portion of the large intestine endoscope body. When the person pulls the large intestine endoscope and folds the inner wall of the large intestine, the engagement portion can be folded in a state of being engaged with the inner wall of the large intestine.

　請求項３記載の発明にあっては、上記陰圧供給部は、全体略截頭円錐台形状に形成されていることを特徴とする。
　請求項４記載の発明にあっては、上記陰圧供給孔部は複数設けられる一方、上記陰圧供給部には、上記陰圧供給路部が連通すると共に上記複数の陰圧供給孔部に連通する陰圧供給室が設けられ、上記陰圧供給路部からの陰圧は上記陰圧供給室を介して上記陰圧供給孔へ供給されることを特徴とする。 The invention according to claim 3 is characterized in that the negative pressure supply part is formed in a substantially truncated frustoconical shape as a whole.
In the invention described in claim 4, the negative pressure supply hole is provided in a plurality, while the negative pressure supply passage communicates with the negative pressure supply in the plurality of negative pressure supply holes. A negative pressure supply chamber that communicates is provided, and the negative pressure from the negative pressure supply passage is supplied to the negative pressure supply hole through the negative pressure supply chamber.

　請求項５記載の発明にあっては、上記陰圧供給孔部は、上記陰圧供給部の後端部に、所定間隔をおいて全周に亘って開設されていることを特徴とする。
　請求項６記載の発明にあっては、上記陰圧供給路部は、上記大腸内視鏡内部に挿通されていることを特徴とする。 According to a fifth aspect of the present invention, the negative pressure supply hole is formed at the rear end portion of the negative pressure supply part over the entire circumference at a predetermined interval.
The invention according to claim 6 is characterized in that the negative pressure supply passage is inserted into the large intestine endoscope.

　請求項７記載の発明にあっては、上記陰圧供給部は、上記大腸内視鏡本体とは別体であって、上記大腸内視鏡本体に対して着脱可能に形成されていると共に上記陰圧供給路部は大腸内視鏡本体部の外部に装着されていることを特徴とする。
　請求項８記載の発明にあっては、上記陰圧供給部は、上記大腸内視鏡本体と一体に形成されていると共に上記陰圧供給路部は大腸内視鏡本体部の内部に配設されていることを特徴とする。 In the invention according to claim 7, the negative pressure supply unit is separate from the large intestine endoscope main body, and is detachably formed with respect to the large intestine endoscope main body. The negative pressure supply path is mounted outside the main body of the large intestine endoscope.
In the invention according to claim 8, the negative pressure supply part is formed integrally with the large intestine endoscope main body, and the negative pressure supply path part is disposed inside the large intestine endoscope main body part. It is characterized by being.

　請求項１の記載の発明にあっては、大腸内部に挿入された場合には、上記陰圧供給路部から上記陰圧供給孔部を介して上記大腸内視鏡後端部方向に向かって陰圧を供給して大腸内部を減圧し、上記大腸内視鏡本体外側面部に大腸壁部を密着させるように構成されている。 In the first aspect of the present invention, when inserted into the large intestine, the negative pressure supply path is directed toward the rear end of the large intestine through the negative pressure supply hole. The inside of the large intestine is depressurized by supplying a negative pressure, and the large intestine wall is in close contact with the outer side surface of the large intestine endoscope main body.

　その結果、大腸内壁は大腸内視鏡本体の内、観察レンズ部が設けられた先端面部においては大腸内視鏡に密着することはないため、大腸内視鏡の挿入時に観察レンズ部が吸着した大腸壁部により覆われて視界を失ってしまう、という事態を解消することができる。
　即ち、本発明にあっては、大腸内視鏡の操作時に陰圧を大腸内へ供給した場合には、大腸壁部は大腸内視鏡本体以後の部位に密着することから、従来のように、柔らかい腸管粘膜のうち、粘膜層及び粘膜下層が上記吸引口部により引き込まれ、上記内視鏡の先端前面部に設けられた観察レンズ部が覆われるため大腸内視鏡検査に必要な視野が確保できず、上記内視鏡を大腸内腔部に進行させることが困難となる、という不具合を有効に回避することができる。 As a result, the inner wall of the large intestine does not adhere to the large intestine endoscope at the distal end surface portion where the observation lens unit is provided in the large intestine endoscope body, so that the observation lens unit is adsorbed when the large intestine endoscope is inserted. It is possible to eliminate the situation of losing visibility due to being covered by the large intestine wall.
That is, in the present invention, when a negative pressure is supplied into the large intestine during the operation of the large intestine endoscope, the large intestine wall is in close contact with the part after the large intestine endoscope body. Of the soft intestinal mucosa, the mucous membrane layer and the submucosal layer are drawn by the suction port, and the observation lens provided at the front end of the endoscope is covered, so that the field of view necessary for colonoscopy is increased. It is possible to effectively avoid the problem that the endoscope cannot be secured and it is difficult to advance the endoscope to the colon cavity.

　また、視界を確保するために、吸着した大腸壁部を観察レンズ部から除去するために、一時的に吸引口部からの吸引状態を停止し、陰圧を解除する必要がなくなり、この一時的な陰圧の解除により、内視鏡と、大腸内壁との密着が不十分となり、結果的に、大腸の折畳みが不可能となる、もしくは折り畳み作業に非常に時間を要する、という不具合を解消することができる。
　従って、大腸内壁を大腸内視鏡に吸着させて、自由腸の折り畳みを確実に行うことにより、検査医師が長期間の訓練を要することなく、大腸内視鏡を自由腸であるＳ状結腸部から、同様に自由腸である横行結腸部を介して上行結腸部の最奥部に至るまで円滑かつ安全、迅速に挿入することができ、大腸内視鏡検査を安全かつ容易に行うことができる。 In addition, in order to remove the adsorbed large intestine wall from the observation lens unit in order to secure the field of view, it is not necessary to temporarily stop the suction state from the suction port and release the negative pressure. By releasing the negative pressure, there is insufficient adhesion between the endoscope and the inner wall of the large intestine. As a result, it is impossible to fold the large intestine. be able to.
Therefore, by adsorbing the inner wall of the large intestine to the large intestine endoscope and securely folding the free intestine, the sigmoid colon portion that is the free intestine can be used without requiring a long-term training by the examining doctor. To the deepest part of the ascending colon through the transverse colon, which is also the free intestine, can be inserted smoothly, safely and quickly, and colonoscopy can be performed safely and easily .

　請求項２記載の発明にあっては、上記陰圧供給部から上記陰圧供給孔部を介して陰圧が供給され大腸壁部が大腸内視鏡本体の外側面部に密着し、検査者が大腸内視鏡を手繰り寄せ大腸内壁を折りたたもうとした場合には、上記係合部が大腸壁部に係合した状態で折り畳むことができる。
　その結果、大腸壁部が大腸内視鏡本体の外側面部に密着すると共に上記係合部が大腸壁部に係合していることから、大腸内視鏡本体から大腸壁部が脱落することなく、確実に大腸内視鏡を肛門側に手繰り寄せて折り畳みながら、大腸内視鏡を大腸内へ挿入することができる。 In the invention of claim 2, a negative pressure is supplied from the negative pressure supply portion through the negative pressure supply hole portion, the colon wall portion is in close contact with the outer side surface portion of the colon endoscope body, and the examiner When the colonoscope is hand-drawn and the colon wall is about to be folded, the colon can be folded in a state where the engagement portion is engaged with the wall of the colon.
As a result, since the large intestine wall is in close contact with the outer surface of the large intestine endoscope body and the engaging portion is engaged with the large intestine wall, the large intestine wall does not fall out of the large intestine endoscope main body. The large intestine endoscope can be inserted into the large intestine while reliably pulling the large intestine endoscope toward the anus and folding it.

　請求項３記載の発明にあっては、請求項２記載の効果に加えて、上記陰圧供給部は、全体略截頭円錐台形状に形成されていることから、大腸内部への挿入時には、大腸内壁との間の摩擦抵抗が小さいことから、自由腸であっても挿入しやすく、また、大腸壁部を折り畳む際には、上記請求項２記載の発明におけるように係合部が大腸壁部に係合するため、自由腸の折り畳み時に大腸を手繰り寄せやすく、大腸内視鏡検査を容易に行うことができる。 In the invention of claim 3, in addition to the effect of claim 2, the negative pressure supply part is formed in a substantially truncated truncated cone shape as a whole, so when inserted into the large intestine, Since the frictional resistance with the inner wall of the large intestine is small, it is easy to insert even in the free intestine, and when the large intestine wall is folded, the engaging portion is the large intestine wall as in the invention of claim 2 above. Since the large intestine is engaged, the large intestine can be easily pulled around when the free intestine is folded, and the colonoscopy can be easily performed.

　請求項４及び５記載の発明にあっては、上記陰圧供給孔部は複数設けられる一方、上記陰圧供給部には、上記陰圧供給路部が連通すると共に上記複数の陰圧供給孔部に連通する陰圧供給室が設けられ、上記陰圧供給路部からの陰圧は上記陰圧供給室を介して上記陰圧供給孔へ供給されることから、陰圧供給路部から陰圧が供給された場合には、陰圧供給室を介して複数の陰圧供給孔部へ陰圧が供給されることから、各陰圧供給孔部へ供給する陰圧を平均化することができ、大腸内視鏡本体の周面部全域に略均一化された陰圧を供給することができる。従って、大腸壁部を均等に大腸内視鏡本体の外側面部に吸着させることができる。 In the inventions according to claims 4 and 5, a plurality of the negative pressure supply holes are provided, while the negative pressure supply passage communicates with the negative pressure supply part and the plurality of negative pressure supply holes. A negative pressure supply chamber communicating with the negative pressure supply passage is provided, and the negative pressure from the negative pressure supply passage is supplied to the negative pressure supply hole through the negative pressure supply chamber. When the pressure is supplied, the negative pressure is supplied to the plurality of negative pressure supply holes through the negative pressure supply chamber. Therefore, the negative pressure supplied to each negative pressure supply hole can be averaged. In addition, a substantially uniform negative pressure can be supplied to the entire peripheral surface portion of the large intestine endoscope main body. Therefore, the large intestine wall can be evenly adsorbed to the outer side surface of the large intestine endoscope body.

　その結果、大腸壁部は大腸内視鏡本体の周面部に均等に吸着されることから、大腸内視鏡周面部方向において吸着のムラがなくなり、大腸内視鏡を手元に引き寄せ折り畳む際に、周面方向において部分的に大腸壁部が離脱し、その結果、大腸部が大腸内視鏡本体から脱落してしまうという事態を防止することができる。
　請求項６記載の発明にあっては、上記陰圧供給路部は、上記大腸内視鏡内部に挿通されていることから、大腸内視鏡挿入時にも違和感なく挿入作業を行うことができる。 As a result, the large intestine wall is uniformly adsorbed to the peripheral surface of the large intestine endoscope body, so there is no unevenness of adsorption in the peripheral surface of the large intestine endoscope, when pulling and folding the large intestine endoscope at hand, It is possible to prevent a situation in which the large intestine wall part is partially detached in the circumferential direction, and as a result, the large intestine part is dropped from the large intestine endoscope main body.
In the invention described in claim 6, since the negative pressure supply passage is inserted into the large intestine endoscope, the insertion operation can be performed without a sense of incongruity even when the large intestine endoscope is inserted.

　請求項７記載の発明にあっては、上記陰圧供給部は、上記大腸内視鏡本体とは別体であって、上記大腸内視鏡本体に対して着脱可能に形成されていると共に上記陰圧供給路部は大腸内視鏡本体部の外部に装着されていることから既存の大腸内視鏡に対して容易に装着することができ、誰しもが容易かつ迅速に大腸内視鏡の被験者４０４０への挿入を行うことができる。
　請求項８記載の発明にあっては、上記陰圧供給部は、上記大腸内視鏡本体と一体に形成されていると共に上記陰圧供給路部は大腸内視鏡本体部の内部に配設されていることから、より取り扱いやすく、大腸検査を容易に行うことができる大腸内視鏡を提供することができる。　 In the invention according to claim 7, the negative pressure supply unit is separate from the large intestine endoscope main body, and is detachably formed with respect to the large intestine endoscope main body. Since the negative pressure supply path is mounted outside the colonoscope main body, it can be easily mounted on an existing colonoscope, making it easy and fast for everyone. Can be inserted into the subject 4040.
In the invention according to claim 8, the negative pressure supply part is formed integrally with the large intestine endoscope main body, and the negative pressure supply path part is disposed inside the large intestine endoscope main body part. Therefore, it is possible to provide a colonoscope that is easier to handle and can easily perform a colon examination.

　以下、添付図面に示す実施の形態に基づき、本発明にかかる大腸内視鏡１０を詳細に説明する。
　本実施の形態に係る大腸内視鏡１０は、図１～図４に示すように、大腸内視鏡本体１１の先端部に設けられ、上記大腸内視鏡本体１１の径方向に沿って膨出する陰圧供給部１２を備え、上記陰圧供給部１２は、大腸内視鏡本体１１後方へ開口する複数の陰圧供給孔部１３と、上記陰圧供給孔部１３へ陰圧を供給する陰圧供給路部１４とを有し、大腸内部に挿入された場合には、上記陰圧供給路部１４から上記陰圧供給孔部１３を介して上記大腸内視鏡本体１１後方に向かって、大腸内部を減圧して上記大腸内視鏡本体１１の外側面部に大腸壁部１５を密着させうる陰圧を供給するように構成されている。
　本実施の形態にあっては、上記陰圧供給部１２は、上記大腸内視鏡本体１１とは別体の着脱可能な合成樹脂製の吸引キャップ１６により形成されており、一般に入手可能な大腸内視鏡の大腸内視鏡本体１１に装着されている。 Hereinafter, a colonoscope 10 according to the present invention will be described in detail based on an embodiment shown in the accompanying drawings.
As shown in FIGS. 1 to 4, the large intestine endoscope 10 according to the present embodiment is provided at the distal end portion of the large intestine endoscope main body 11 and swells along the radial direction of the large intestine endoscope main body 11. The negative pressure supply unit 12 includes a plurality of negative pressure supply holes 13 that open to the rear of the colon endoscope main body 11 and the negative pressure supply hole 13. And a negative pressure supply passage portion 14 that is inserted into the large intestine, and is directed from the negative pressure supply passage portion 14 to the back of the large intestine endoscope body 11 through the negative pressure supply hole portion 13. Thus, the inside of the large intestine is decompressed to supply a negative pressure that can bring the large intestine wall 15 into close contact with the outer surface of the large intestine endoscope main body 11.
In the present embodiment, the negative pressure supply unit 12 is formed by a removable synthetic resin suction cap 16 separate from the large intestine endoscope main body 11, and is generally available in the large intestine. The endoscope is attached to the large intestine endoscope main body 11.

　上記吸引キャップ１６は、全体略截頭円錐台形状であって、先端部１７から後端部１８にかけて拡開するテーパ状に形成されており、上記陰圧供給部１２の後端部には、全周に亘って大腸内視鏡本体部１１よりも径方向外方へ突出し、大腸３７の折り畳み時に、大腸内視鏡１０を後方へ引き戻した場合には、密着した大腸壁部１５に係合する係合部３２が形成されている。 The suction cap 16 has a substantially truncated frustoconical shape as a whole and is formed in a tapered shape that expands from the front end portion 17 to the rear end portion 18. When the large intestine endoscope 10 is pulled back backward when the large intestine 37 is folded, it is engaged with the intimate large intestine wall 15. An engaging portion 32 is formed.

　また、上記吸引キャップ１６の先端部１７側から後端部１８側にかけて、大腸内視鏡本体１１への固定部１９と、上記固定部１９の後端部寄りに設けられた陰圧供給室２０と、上記陰圧供給室２０に直交して後端部１８方向へ連設された複数の長孔状の陰圧供給孔部１３とを備えている。 Further, the suction cap 16 has a fixing portion 19 to the large intestine endoscope body 11 from the front end portion 17 side to the rear end portion 18 side, and a negative pressure supply chamber 20 provided near the rear end portion of the fixing portion 19. And a plurality of long-hole negative pressure supply holes 13 that are arranged perpendicular to the negative pressure supply chamber 20 in the direction of the rear end 18.

　上記吸引キャップ１６は、中空状に一体形成され、図３に示すように、上記固定部１９は、前端内周面部に刻設されたネジ溝２１により形成され、図４に示すように、一般に市販されている既存の大腸内視鏡本体１１の先端外周面部に形成されたネジ溝２２に螺合して装着しうるように構成されている。
　図３に示すように、上記陰圧供給室２０は、吸引キャップ本体部２３内に全周に亘って円環状に形成され、上記陰圧供給室２０には、上記長孔からなる陰圧供給孔部１３が後端部１８に向かって直交した状態で複数連設されている。 The suction cap 16 is integrally formed in a hollow shape, and as shown in FIG. 3, the fixing portion 19 is formed by a thread groove 21 formed on the inner peripheral surface portion of the front end. As shown in FIG. It is configured to be screwed into a thread groove 22 formed on the outer peripheral surface of the distal end of an existing large intestine endoscope main body 11 that is commercially available.
As shown in FIG. 3, the negative pressure supply chamber 20 is formed in an annular shape over the entire circumference in the suction cap main body 23, and the negative pressure supply chamber 20 has a negative pressure supply comprising the long holes. A plurality of holes 13 are continuously provided in a state of being orthogonal to the rear end 18.

　上記陰圧供給孔部１３は、細径であって、一端部は上記陰圧供給室２０に開口して設けられると共に、他端部は吸引キャップ１６の後端部１８において開口しており、本実施の形態にあっては、全周に亘って等間隔に１７個設けられている。 The negative pressure supply hole 13 has a small diameter, and one end is provided to open to the negative pressure supply chamber 20, and the other end is open to the rear end 18 of the suction cap 16. In the present embodiment, 17 are provided at equal intervals over the entire circumference.

　また、本実施の形態にあっては、図１に示すように、上記陰圧供給路部１４は、細径の合成樹脂製であって可撓性を有する所定の長さのチューブにより形成され、医療用固定テープ等の適宜の固定手段により大腸内視鏡本体１１の外周面部に固定されている。
　上記チューブからなる陰圧供給路部１４の先端部は、剛性を有する管体部５９を介して上記吸引キャップ１６の上記陰圧供給孔部１３の内の一個に固定されていると共に、他端部は大腸挿入時には肛門外方に配置され、所定の陰圧供給装置（図示せず）に接続し得るように構成されている。 Further, in the present embodiment, as shown in FIG. 1, the negative pressure supply path portion 14 is made of a thin tube made of a synthetic resin having a predetermined length having flexibility. It is fixed to the outer peripheral surface portion of the large intestine endoscope main body 11 by appropriate fixing means such as a medical fixing tape.
The distal end portion of the negative pressure supply passage portion 14 made of the tube is fixed to one of the negative pressure supply hole portions 13 of the suction cap 16 via a rigid tube body portion 59 and the other end. When the large intestine is inserted, the part is arranged outside the anus and is configured to be connected to a predetermined negative pressure supply device (not shown).

　本実施の形態にあっては、上記陰圧供給装置として、一般に医療用に使用されている吸引ポンプが使用されている。この場合、このような吸引ポンプの吸引力は６０ｃｍｈｇであり、この吸引力により充分に大腸壁部１５を大腸内視鏡本体部１１に対して、密着させ、かつ、密着状態で手前に牽引して折りたたんだ場合でも、大腸内視鏡本体部１１から大腸壁部１５が脱落しない程度の陰圧を供給することができることが確認されている。 In this embodiment, a suction pump generally used for medical purposes is used as the negative pressure supply device. In this case, the suction force of such a suction pump is 60 cmhg, and the large intestine wall 15 is sufficiently brought into close contact with the large intestine endoscope main body 11 by this suction force, and is pulled toward the front in the close contact state. Even when folded, it has been confirmed that a negative pressure can be supplied to such an extent that the large intestine wall 15 does not fall off from the large intestine endoscope main body 11.

　図３に示すように、上記吸引キャップ部１６の先端部および後端部には開口部２５，２６が開設され、後端部側の開口部２６を介して大腸内視鏡本体１１の先端部２７に挿通され、上記ネジ溝２１，２２が螺合して固定された場合には、図１に示すように、先端部側の開口部２５を介して大腸内視鏡本体１１の先端前面部８１に設けられた観察レンズ３１，ライトガイド３０，吸引孔２９および送気孔２８は大腸内視鏡本体１１前方に向かって露出するように構成されている。 As shown in FIG. 3, openings 25 and 26 are formed at the distal end and the rear end of the suction cap portion 16, and the distal end of the large intestine endoscope main body 11 is opened through the opening 26 on the rear end side. 27, when the screw grooves 21 and 22 are screwed and fixed, as shown in FIG. 1, the front end portion of the large-intestine endoscope main body 11 is opened through the opening 25 on the distal end side. The observation lens 31, the light guide 30, the suction hole 29, and the air supply hole 28 provided in 81 are configured to be exposed toward the front of the colon endoscope body 11.

　以下、添付図面に示す実施例に基づき、本発明に係る大腸内視鏡１０を使用して大腸内視鏡検査を行う場合について詳細に説明する。
　本実施の形態に係る大腸内視鏡１０を使用する場合には、予め、上記の吸引ポンプに上記陰圧供給路部１４の後端部を適宜のアダプタを介して接続し、陰圧供給可能な状態にしておく。 Hereinafter, based on the Example shown to an accompanying drawing, the case where a colonoscopy is performed using the colonoscope 10 which concerns on this invention is demonstrated in detail.
When using the large intestine endoscope 10 according to the present embodiment, negative pressure can be supplied by connecting the rear end portion of the negative pressure supply path portion 14 to the suction pump via an appropriate adapter in advance. Keep it in a proper state.

　図６（Ａ）～（Ｇ）及び図８（Ｈ）～（Ｌ）は、内視鏡テーブル４１上において被験者４０を腹ばいにさせた状態を側方から見た断面図（腹臥位側方縦断面図）であり、図７（Ａ）～（Ｇ）及び図９（Ｈ）～（Ｌ）は、同様に被験者４０を腹ばいにさせた状態を背中側から見た縦断面図（腹臥位上方縦断面図）である。 6 (A) to 6 (G) and FIGS. 8 (H) to (L) are cross-sectional views of the state in which the subject 40 is placed on the endoscope table 41 from the side (side view of the prone position). 7 (A) to (G) and FIGS. 9 (H) to (L) are longitudinal sectional views showing the state in which the subject 40 is placed in the stomach in the same manner (back prone). FIG.

　本実施の形態に係る大腸内視鏡１０を使用して大腸内視鏡検査を行う場合には、図６（Ａ）及び図７（Ａ）に示すように、被験者４０を腹臥位（腹ばい）の状態にして、下腹部（恥骨５８及び前腸骨棘の下方）に平面馬蹄形又は平面略V字形に形成された枕状の挿入物３５を差込み、下腹部（恥骨５８及び前腸骨棘の下方）を持ち上げさせ、被験者４０の前腹壁部３３が自然下垂する状態を形成する。 When performing a colonoscopy using the colonoscope 10 according to the present embodiment, as shown in FIGS. 6 (A) and 7 (A), the subject 40 is placed in the prone position (prone). ), A pillow-like insert 35 formed in a flat horseshoe shape or a plane V-shape is inserted into the lower abdomen (below the pubic bone 58 and anterior iliac spine), and the lower abdomen (pubic bone 58 and anterior iliac spine) is inserted. The lower part of the front abdominal wall 33 of the subject 40 is naturally suspended.

　この状態で本実施の形態に係る大腸内視鏡１０を、図６に示すように、被験者４０の肛門３６から大腸３７内へ挿入する。この場合、図６（Ａ）及び図７（Ａ）に示すように、大腸内視鏡１０は仙骨３９の抵抗により、前腹壁部３３方向へ略直角に方向転換して滑落する。 In this state, the large intestine endoscope 10 according to the present embodiment is inserted into the large intestine 37 from the anus 36 of the subject 40 as shown in FIG. In this case, as shown in FIGS. 6 (A) and 7 (A), the large intestine endoscope 10 changes its direction substantially perpendicular to the anterior abdominal wall 33 due to the resistance of the sacrum 39 and slides down.

　この場合、図６（Ａ）及び図７（Ａ）に示すように、大腸内視鏡１０は直腸部４２からＳ状結腸部３８の折り返し部５１に至っており、大腸内視鏡１０の先端部は肛門３６から約２５ｃｍ内方の位置にあるが、本実施の形態に係る大腸内視鏡１０は、図１に示すように、大腸内視鏡本体１１の系方向外方へ膨出する截頭円錐台形状の吸引キャップ１６を有していることから、大腸３７内部に挿入する場合にあたっても、大腸壁部１５に対する挿入抵抗が小さく、図４及び図５に示すように、大腸３７内に挿入するというよりも大腸壁部１５を押しのけるようにして、大腸３７内を大腸内視鏡１０の自重及びＳ状結腸部３８の重さの双方で自然落下状態で進行するものであり、被検査者にとり全くの無痛状態での挿入が可能となる。 In this case, as shown in FIGS. 6 (A) and 7 (A), the large intestine endoscope 10 extends from the rectal portion 42 to the folded portion 51 of the sigmoid colon portion 38, and the distal end portion of the large intestine endoscope 10. Is approximately 25 cm inward from the anus 36, but the large intestine endoscope 10 according to the present embodiment is swelled outward in the system direction of the large intestine endoscope main body 11, as shown in FIG. Since the truncated conical suction cap 16 is provided, even when inserted into the large intestine 37, the insertion resistance with respect to the large intestine wall 15 is small, and as shown in FIG. 4 and FIG. The large intestine wall 15 is pushed away rather than inserted, and the inside of the large intestine 37 progresses in a state of natural fall with both the weight of the large intestine endoscope 10 and the weight of the sigmoid colon 38. Insertion in a completely painless state is possible for the person.

　上記のように大腸内視鏡１０が直腸部４２を通過してＳ状結腸部３８内を下降し、前腹壁部３３近傍の折り返し部５１に至った場合には、上記吸引ポンプ（図示せず）を作動させて陰圧を陰圧供給路部１４を介して大腸内部へ供給する。
　供給された陰圧は、上記のように陰圧供給室２０を介して大腸内視鏡本体部１１の周縁部全域に沿って吸引キャップ１６の後端部１８に、大腸内視鏡本体１１の後端方向へ向かって開設された１７個の各陰圧供給孔部１３から大腸３７内部に供給される。その結果、各陰圧供給孔部１３から大腸内視鏡本体１１の後端部へ向かって陰圧が供給される。 As described above, when the large intestine endoscope 10 passes through the rectal portion 42 and descends in the sigmoid colon portion 38 and reaches the folded portion 51 in the vicinity of the anterior abdominal wall portion 33, the suction pump (not shown) ) To supply negative pressure to the inside of the large intestine via the negative pressure supply passage 14.
The negative pressure supplied is applied to the rear end 18 of the suction cap 16 along the entire peripheral edge of the large-intestine endoscope main body 11 via the negative pressure supply chamber 20 as described above. It is supplied into the large intestine 37 from each of the 17 negative pressure supply holes 13 opened toward the rear end direction. As a result, negative pressure is supplied from each negative pressure supply hole 13 toward the rear end of the large intestine endoscope body 11.

　図４及び図５に示すように、陰圧は、上記陰圧供給室２０を介して各陰圧供給孔部１３に供給されることから、各陰圧供給孔部１３から供給される陰圧は略同一のものとなり、大腸内視鏡本体部１１の周面方向に沿って略均一の陰圧が供給される。
　その結果、大腸壁部１５は、上記吸引キャップ１６の後端部１８から大腸内視鏡本体１１の後端方向にかけて密着すると共に、上記のように陰圧供給孔部１３から後方へ向けて陰圧が供給されることにより大腸壁部１５は大腸内視鏡本体１１の先端部の後方側から吸引されて大腸内視鏡本体１１に吸着するため、大腸内視鏡本体１１及び吸引キャップ１６の外側面部８２に密着するが、上記大腸内視鏡１０の先端前面部８１には密着しない。 As shown in FIGS. 4 and 5, since the negative pressure is supplied to each negative pressure supply hole 13 through the negative pressure supply chamber 20, the negative pressure supplied from each negative pressure supply hole 13. Are substantially the same, and a substantially uniform negative pressure is supplied along the circumferential direction of the large-intestine endoscope main body 11.
As a result, the large intestine wall 15 is in close contact from the rear end 18 of the suction cap 16 to the rear end of the large intestine endoscope body 11, and as described above, is negatively directed backward from the negative pressure supply hole 13. When the pressure is supplied, the large intestine wall 15 is sucked from the rear side of the distal end of the large intestine endoscope main body 11 and is adsorbed by the large intestine endoscope main body 11. It is in close contact with the outer side surface portion 82 but is not in close contact with the front end front portion 81 of the large intestine endoscope 10.

　その結果、従来のように、大腸内視鏡本体１１の先端面部８１に設けられている観察レンズ３１が、密着した大腸壁部１５により被覆されてしまい検査者が大腸内部を視認することができないという事態の発生は阻止される。なお、図中符合５２は腸液である。 As a result, the observation lens 31 provided on the distal end surface portion 81 of the large-intestine endoscope main body 11 is covered with the closely-attached large intestine wall portion 15 so that the examiner cannot visually recognize the inside of the large intestine. This situation is prevented. In the figure, reference numeral 52 denotes intestinal fluid.

　この状態で、検査者は、図５に示すように、大腸内視鏡１０を手前（肛門側）に引き戻し、大腸３７を折り畳む作業を行う。この場合、本実施の形態に係る大腸内視鏡１０にあっては、上記吸引キャップ１６は截頭円錐台形状に形成され、かつ、大腸内視鏡本体１１の径方向外方へ突出して大腸壁部１５に係合しうる係合部３２が形成されていることから、上記係合部３２を大腸壁部１５に係合させた状態で大腸内視鏡１０を引き戻し、大腸３７の「引き戻し、折り畳み牽引作業」を容易かつ迅速に行うことができる。 In this state, as shown in FIG. 5, the examiner pulls the large intestine endoscope 10 back (anus) and folds the large intestine 37. In this case, in the large intestine endoscope 10 according to the present embodiment, the suction cap 16 is formed in a truncated truncated cone shape, and projects outward in the radial direction of the large intestine endoscope main body 11. Since the engaging portion 32 that can be engaged with the wall portion 15 is formed, the large intestine endoscope 10 is pulled back in a state where the engaging portion 32 is engaged with the large intestine wall portion 15, and the “retracting back” of the large intestine 37 is performed. The “folding towing operation” can be performed easily and quickly.

　その結果、上記係合部３２により、大腸壁部１５を確実に大腸内視鏡本体１１に固定した状態で上記引き戻し作業を行うことができ、引き戻し作業の途中で、一度密着した大腸壁部１５が大腸内視鏡本体１１から離脱してしまう、という事態を防止することができ、効率的かつ迅速に大腸３７の折り畳み作業を行うことができる。 As a result, the pulling operation can be performed in a state where the large intestine wall portion 15 is securely fixed to the large intestine endoscope body 11 by the engaging portion 32, and the large intestine wall portion 15 that has been in close contact with the midway of the pull back operation. Can be prevented from being detached from the large intestine endoscope main body 11, and the large intestine 37 can be folded efficiently and quickly.

　上記引き戻し作業の場合には、図６（Ｂ）に示すように、大腸内視鏡１０を直腸部４２の上部まで、肛門３６から１２～１３ｃｍの位置にまで引き戻す。この引き戻し作業により、大腸内視鏡１０の先端前面部８１に設けられた観察レンズ３１からの視界が、再度開け、大腸内視鏡１０のアングル操作を自然開放することにより、図６（Ｃ）及び図７（Ｃ）に示すように、大腸内視鏡１０の先端部は、全腹壁部３３の剛性抵抗により、自然にＳ状結腸部３８と下行結腸部４６との接合部にある下行結腸移行部４７へ向く。 In the case of the above pull-back operation, as shown in FIG. 6 (B), the large intestine endoscope 10 is pulled back to the upper part of the rectal portion 42 to a position of 12 to 13 cm from the anus 36. By this pull-back operation, the field of view from the observation lens 31 provided on the front end portion 81 of the large-intestine endoscope 10 is reopened, and the angle operation of the large-intestine endoscope 10 is naturally released, whereby FIG. 7C, the distal end portion of the large intestine endoscope 10 is naturally located at the junction of the sigmoid colon portion 38 and the descending colon portion 46 due to the rigid resistance of the entire abdominal wall portion 33. Go to the transition section 47.

　この間の大腸内視鏡１０の進入による大腸３７の蠕動運動が発生するが、被験者４０の口側に存在する空気が胃を介して腸内へ上昇し、腸内を膨張させることにより再度視界が確保されることとなる。また、観察レンズ３１からの視界が充分ではなく、大腸内視鏡１０の進行方向の確認が不可能な場合には、鉗子孔３４から青色に着色した水を排出して大腸壁部４３内に流し進行方向（上下方向）の確認を行うようにする。 During this period, peristaltic movement of the large intestine 37 occurs due to the entrance of the large intestine endoscope 10, but the air existing on the mouth side of the subject 40 rises into the intestine through the stomach and expands in the intestine, so that the field of view is again displayed. Will be secured. In addition, when the field of view from the observation lens 31 is not sufficient and confirmation of the traveling direction of the large intestine endoscope 10 is impossible, the blue colored water is discharged from the forceps hole 34 into the large intestine wall 43. Check the direction of flow (up and down).

　その後、図６（ｃ）、（Ｄ）及び図７（ｃ）、（Ｄ）に示すように、さらに、大腸内視鏡１０をＳ状結腸部３８内へ挿入して、上記同様の要領により、３～４回繰り返しＳ状結腸部３８を蛇腹状に折り畳み、Ｓ状結腸部３８を短縮化する。 Thereafter, as shown in FIGS. 6 (c), (D) and FIGS. 7 (c), (D), the large intestine endoscope 10 is further inserted into the sigmoid colon 38 and the same procedure as described above is performed. The sigmoid colon 38 is folded in a bellows shape three to four times, and the sigmoid colon 38 is shortened.

　この折りたたみ作業を繰り返すことにより、下行結腸移行部４７は肛門３６側へ牽引されることにより、ヘアピンカーブ状のＳ状結腸部３８が直線化し、下行結腸部４６内に進入することができる。下行結腸部４６は固定腸であることから、容易な挿入が可能であり、その後、図６（Ｅ）～（Ｇ）及び図７（Ｅ）～（Ｇ）に示すように、上記内視鏡テーブル４１の被験者４０の頭部側（Ｔ）を下降させて肛門３６側を上昇させることにより、大腸内視鏡１０を脾湾曲部５０に滑り落として引き戻すことによりＳ状結腸部３８から下行結腸部４６を直線化することができる。 By repeating this folding operation, the descending colon transition portion 47 is pulled toward the anus 36, whereby the sigmoid colon portion 38 having a hairpin curve shape is linearized and can enter the descending colon portion 46. Since the descending colon portion 46 is a fixed intestine, it can be easily inserted. Thereafter, as shown in FIGS. 6 (E) to (G) and FIGS. 7 (E) to (G), the endoscope By lowering the head side (T) of the subject 40 of the table 41 and raising the anus 36 side, the colonoscope 10 is slid down and pulled back to the splenic curved portion 50 to pull the descending colon from the sigmoid colon 38. The portion 46 can be straightened.

　次に、横行結腸部４９への挿入を行う。この場合、図８（Ｈ）に示すように、前腹壁部３３は依然として自然下垂した状態である。従って、横行結腸部４９は自由腸であることから、前腹壁部３３へ下垂した状態となっている。また、この場合、肛門３６は大腸各部位よりも高位置にある。 Next, insertion into the transverse colon 49 is performed. In this case, as shown in FIG. 8 (H), the front abdominal wall 33 is still in a state of being drooped naturally. Accordingly, since the transverse colon portion 49 is a free intestine, the transverse colon portion 49 is suspended from the front abdominal wall portion 33. In this case, the anus 36 is located higher than each part of the large intestine.

　従って、図８（Ｈ）及び図９（Ｈ）に示すように、上記脾湾曲部５０の比較的広い空間内で方向転換を行うことにより、検査者は横行結腸部４９の内腔が視認できることから、大腸内視鏡１０を横行結腸部４９内へ滑り落とすように落下挿入させる。
　そして、上記と同様の要領で吸引キャップ部１６から陰圧を横行結腸部４９内へ供給して、図８（Ｉ）及び図９（Ｉ）に示すように、横行結腸部４９を大腸内視鏡本体１１の外周面部に密着させ、大腸内視鏡１０を肛門３６側へ牽引して横行結腸部４９を折りたたむ。 Therefore, as shown in FIGS. 8 (H) and 9 (H), the examiner can visually recognize the lumen of the transverse colon portion 49 by changing the direction in a relatively wide space of the splenic curved portion 50. Then, the large intestine endoscope 10 is dropped and inserted so as to slide into the transverse colon portion 49.
Then, negative pressure is supplied from the suction cap 16 into the transverse colon 49 in the same manner as described above, and as shown in FIGS. 8 (I) and 9 (I), the transverse colon 49 is viewed in the large intestine. The intestine endoscope 10 is brought into close contact with the outer peripheral surface portion of the mirror body 11, and the large intestine endoscope 10 is pulled toward the anus 36 to fold the transverse colon portion 49.

　さらに、この作業を繰り返し、さらに横行結腸部４９を折りたたみ、図８（Ｊ）及び図９（Ｊ）に示すように、内視鏡テーブル４１を操作して被験者４０の後腹膜臓器及び肝臓４４がある右側を低くして、横行結腸部４９の右側寄りの腸液を吸収する。
　その後、図９（Ｋ）に示すように、検査者は大腸内視鏡１０を反時計方向へ反転（Ｒ）させることにより大腸内視鏡１０の先端部を肝臓部４４の内側の抵抗にこすりつけるようにして横行結腸部４９の牽引作業を行うことにより肝湾曲部５５へ到達することができる。 Further, this operation is repeated, the transverse colon portion 49 is further folded, and as shown in FIGS. 8 (J) and 9 (J), the retroperitoneal organ and liver 44 of the subject 40 are operated by operating the endoscope table 41. One right side is lowered to absorb the intestinal fluid on the right side of the transverse colon 49.
Thereafter, as shown in FIG. 9K, the examiner rubs the distal end portion of the large intestine endoscope 10 against the resistance inside the liver portion 44 by turning the large intestine endoscope 10 counterclockwise (R). Thus, the liver bending portion 55 can be reached by pulling the transverse colon portion 49.

　その後、図９（Ｌ）に示すように、大腸内視鏡１０の先端部を脊椎５６側へ向けて、大腸内視鏡１０を脊椎５６方向へ一度上昇させるようにして肝湾曲部５５を乗り越え、上行結腸部５４へ進入する。
　その後、固定腸である上行結腸部５４を進行することにより大腸内視鏡１０は盲腸５７へ到達することができる。盲腸５７へ到達した場合には、骨盤の腸骨の抵抗で撓み、回盲弁を観察レンズを介して大腸内視鏡１０の正面に視認することができる。
　その後、吸引ポンプを停止し、大腸内視鏡１０が抜けることのないように保持しつつ、挿入物３５を取り除き、被験者４０を左側臥位にして内視鏡テーブル４１を水平にする。　 Thereafter, as shown in FIG. 9 (L), the distal end portion of the large intestine endoscope 10 is directed to the spine 56 side, and the large intestine endoscope 10 is once lifted in the direction of the spine 56 so as to get over the liver bending portion 55. The ascending colon part 54 is entered.
Thereafter, the large intestine endoscope 10 can reach the cecum 57 by proceeding through the ascending colon portion 54 which is a fixed intestine. When the cecum 57 is reached, it is bent by the resistance of the pelvic iliac bone, and the ileocecal valve can be viewed in front of the colonoscope 10 through the observation lens.
Thereafter, the suction pump is stopped and the large-intestine endoscope 10 is held so as not to come out, while the insert 35 is removed, and the endoscope table 41 is leveled with the subject 40 in the left-side position.

　本実施の形態に係る大腸内視鏡１０にあっては、上記陰圧供給部１２は、全体略截頭円錐台形状に形成されていることから、大腸内視鏡１０への挿入時に大腸内壁との摩擦抵抗が小さいことから挿入しやすく、また、大腸壁部１５を折り畳むために引き戻す際には後端部が径方向外方へ突出する係合部となっていることから大腸壁部１５に引っかかりやすく、確実に大腸壁部を折り畳むことができる。 In the large intestine endoscope 10 according to the present embodiment, since the negative pressure supply unit 12 is formed in a substantially truncated truncated cone shape as a whole, the inner wall of the large intestine is inserted into the large intestine endoscope 10. Since the frictional resistance is small, it can be easily inserted, and when the colon wall 15 is pulled back to be folded, the rear wall is an engaging portion that projects radially outward. It is easy to get caught in, and the wall of the large intestine can be reliably folded.

　従って、本実施の形態に係る大腸内視鏡１０にあっては、「挿入時には大腸内壁との間の極力摩擦抵抗を小さくし、引く戻し時には可能な限り大腸内壁との間の摩擦抵抗を大きくする」という大腸内視鏡検査時における大腸折り畳み作業の原則に適合した検査を成立させることができる。
　また、本実施の形態に係る大腸内視鏡１０は、挿入時に容易に挿入が可能であることから、大腸内視鏡１０の挿入時に、検査者である医師は余裕を持って大腸内部を視認しながら挿入することができるため、挿入時に大腸内壁に形成された病変を発見することができる。 Therefore, in the large intestine endoscope 10 according to the present embodiment, “the frictional resistance between the inner wall of the large intestine is reduced as much as possible during insertion, and the frictional resistance between the inner wall of the large intestine is increased as much as possible when pulled back. It is possible to establish a test that conforms to the principle of large intestine folding work at the time of large intestine endoscopy.
In addition, since the large intestine endoscope 10 according to the present embodiment can be easily inserted at the time of insertion, the doctor who is an examiner visually recognizes the inside of the large intestine with a margin when the large intestine endoscope 10 is inserted. Therefore, the lesion formed on the inner wall of the large intestine at the time of insertion can be found.

　即ち、一般に、現状の大腸内視鏡検査においては引き抜き時に病変を発見することとしているが、引き抜き時には大きな病変しか発見できず、重大な病変であっても小さな病変は見逃す場合がある、という問題点がある。本実施の形態に係る大腸内視鏡１０にあっては、このような従来の大腸内視鏡検査の欠陥を克服することが可能となる。 That is, in general, the current colonoscopy is to detect a lesion at the time of extraction, but only a large lesion can be detected at the time of extraction, and a small lesion may be missed even if it is a serious lesion There is a point. In the large intestine endoscope 10 according to the present embodiment, it is possible to overcome such a defect of the conventional large intestine endoscopy.

　なお、本件発明者は、既に、特許３７７０９０２号（特願２００５―２６３０７１号）において、肛門部３６に装着して肛門３６から大腸３７内に陰圧を供給し、上記陰圧を利用して挿入した大腸内視鏡１０の周面部に大腸壁部１５を吸着させ、上記同様に自由腸であるＳ状結腸部３８及び横行結腸部４９を牽引して直線化させうる大腸内視鏡補助具を提案している。 In addition, in the patent No. 3770902 (Japanese Patent Application No. 2005-263071), the present inventor has already attached the anal part 36 to supply a negative pressure from the anus 36 into the large intestine 37 and inserts it using the negative pressure. A large intestine endoscope assisting tool that adsorbs the large intestine wall 15 to the peripheral surface of the large intestine endoscope 10 and pulls the sigmoid colon 38 and the transverse colon 49 that are free intestines in the same manner as described above. is suggesting.

　図１０に示すように、このような大腸内視鏡補助具８０は、大腸内視鏡と共に使用され、直腸肛門部内に配置され、大腸内視鏡が内部に挿通される管本体部６０と、上記管本体部６０に設けられ、上記直腸肛門部から大腸内を減圧して、大腸内視鏡の上記内視鏡筒部外側面部に大腸内壁を密着させうる吸引減圧部６１とを備えている。 As shown in FIG. 10, such a large intestine endoscope auxiliary tool 80 is used together with a large intestine endoscope, is disposed in the rectal anus, and a tube main body 60 through which the large intestine endoscope is inserted; A suction pressure reducing unit 61 is provided in the tube main body 60, and can decompress the inside of the large intestine from the rectal anus and adhere the inner wall of the large intestine to the outer surface of the endoscope tube part of the large intestine endoscope. .

　また、上記吸引減圧部６１は、上記管本体部６０に設けられた複数の孔部６２と、上記複数の孔部６２を介して、上記孔部６２から大腸内部の空気を吸引して大腸内部に陰圧を形成しうる減圧機構６３とを有し、上記減圧機構６３は、上記複数の孔部６２へ連通する陰圧供給通路６４と、上記陰圧供給通路６４を介して陰圧を供給しうる陰圧供給部６５とを有する。 The suction pressure reducing unit 61 sucks air inside the large intestine from the hole 62 through the plurality of holes 62 provided in the tube main body 60 and the plurality of holes 62, The pressure reducing mechanism 63 is capable of forming a negative pressure, and the pressure reducing mechanism 63 supplies a negative pressure via the negative pressure supply passage 64 communicating with the plurality of holes 62 and the negative pressure supply passage 64. And a negative pressure supply unit 65 that can be used.

　また、上記管本体部６０には、大腸内視鏡が上記管本体部６０内に円滑に挿通されるように管本体部６０内部に潤滑剤を供給しうる潤滑剤供給部６６が設けられている。
　また、上記管本体部６０の基部６７側には、挿通される大腸内視鏡と圧接して、外部から上記管本体部６０への空気の流入を防ぐことができる空気流入遮断部６８が設けられている。また、上記管本体部６０を上記直腸肛門部内に固定しうる固定部６９を有している。 The tube main body 60 is provided with a lubricant supply unit 66 that can supply a lubricant into the tube main body 60 so that the large intestine endoscope can be smoothly inserted into the tube main body 60. Yes.
In addition, an air inflow blocking unit 68 that can prevent the inflow of air from the outside to the tube main body 60 is provided on the base 67 side of the tube main body 60 in pressure contact with the inserted large intestine endoscope. It has been. Moreover, it has the fixing | fixed part 69 which can fix the said pipe | tube main-body part 60 in the said rectal anal part.

　また、上記固定部６９は、上記管本体部６０の外部に設けられ、流体が供給されることにより上記管本体部１１外方へ膨出しうる膨出部７０と、この膨出部７０へ流体を供給しうる流体供給部７１を有する。
　上記膨出部７０は、上記管本体部６０の先端部７１に設けられ、内部に流体が供給されることにより膨出するバルーン体７２により構成されている。また、上記バルーン体７２は、上記管本体部６０の全周に亘って設けられている。また、上記管本体部６０の基部側には、上記管本体部６０を肛門部外方において支持しうる保持片７３が設けられている。　 Further, the fixing portion 69 is provided outside the tube main body portion 60, and a bulging portion 70 that can bulge outward from the tube main body portion 11 when a fluid is supplied thereto, and a fluid to the bulging portion 70. The fluid supply part 71 which can supply is supplied.
The bulging portion 70 is provided at a distal end portion 71 of the tube main body portion 60, and is configured by a balloon body 72 that bulges when fluid is supplied to the inside. The balloon body 72 is provided over the entire circumference of the tube main body 60. In addition, a holding piece 73 that can support the tube main body 60 outside the anus is provided on the base side of the tube main body 60.

　本件発明者は、上記特許発明に係る大腸内視鏡補助具８０の完成後、さらに研究を進めた結果、本実施の形態に係る大腸内視鏡１０の完成に至ったものである。この場合、上記特許第３７７０９０２号に係る大腸内視鏡補充具８０に対する本実施の形態に係る大腸内視鏡１０の優位点は以下の点にある。 As a result of further research after the completion of the large intestine endoscope auxiliary tool 80 according to the above-mentioned patented invention, the present inventor has completed the large intestine endoscope 10 according to the present embodiment. In this case, the advantage of the large intestine endoscope 10 according to the present embodiment over the large intestine endoscope replenishment tool 80 according to the above-mentioned Japanese Patent No. 3770902 is as follows.

　第一に、肛門側のみから吸引しても陰圧が内視鏡先端部まで完全に届かない場合がある。即ち、肛門３６から大腸内部へ大腸内視鏡を挿入し、図８（Ｈ）に示すように、Ｓ状結腸部３８及び下行結腸部４６を直線化させ、大腸内視鏡が横行結腸部４９に到達した場合であっても、図１１に示すように、脾湾曲部５０が鋭角状に屈曲していることから、肛門３６から供給される陰圧が脾湾曲部５０を回りこみにくく、大腸内視鏡の先端部まで陰圧が届きにくくなる事態がある。その結果、挿入された大腸内視鏡への吸着が充分に行われない場合がある。 First, negative pressure may not reach the tip of the endoscope completely even if suctioned only from the anal side. That is, a large intestine endoscope is inserted from the anus 36 into the large intestine, and the sigmoid colon 38 and the descending colon 46 are linearized as shown in FIG. 11, since the splenic curved portion 50 is bent at an acute angle as shown in FIG. There is a situation in which the negative pressure is difficult to reach to the distal end of the endoscope. As a result, there are cases where the adsorption to the inserted large intestine endoscope is not sufficiently performed.

　第二に、本来、大腸３７は上行結腸部５４の先端部において小腸につながっており、小腸は食道を介して口から大気に開放されている。従って、大腸３７はその両端部において大気に開放された「開放空間」として形成されている。従って、肛門側のみからの陰圧の供給では大腸内部に充分な陰圧を形成することができない場合がある。
　従って、大腸内視鏡の先端部において陰圧を供給することにより、大腸内視鏡へ大腸壁部を吸着させうるのに必要な陰圧空間を内視鏡に沿って形成することができる。 Secondly, the large intestine 37 is originally connected to the small intestine at the tip of the ascending colon 54, and the small intestine is opened from the mouth to the atmosphere via the esophagus. Accordingly, the large intestine 37 is formed as an “open space” that is open to the atmosphere at both ends thereof. Therefore, supply of negative pressure only from the anal side may not be able to form a sufficient negative pressure inside the large intestine.
Therefore, by supplying negative pressure at the distal end portion of the large intestine endoscope, a negative pressure space necessary for adsorbing the large intestine wall portion to the large intestine endoscope can be formed along the endoscope.

　第三に、腸は自然に小腸から大腸へと蠕動運動を行う。その結果、大腸内部へ小腸側から空気が常時供給されてしまい、充分な陰圧空間を形成することができない場合がある。　従って、肛門側からのう陰圧の供給では全体として充分に大腸壁部を大腸内視鏡に吸着させられない場合が生ずる。 ③ Third, the intestine naturally peristates from the small intestine to the large intestine. As a result, air is constantly supplied from the small intestine side into the large intestine, and a sufficient negative pressure space may not be formed. Therefore, when the negative pressure is supplied from the anal side, the large intestine wall may not be sufficiently adsorbed to the large intestine endoscope as a whole.

　第四に、肛門に「痔ろう」がある場合等には、肛門側を密閉することができず、大腸内に充分な陰圧を形成することができない場合がある。
　以上のような、本願発明者による実際に大腸内視鏡を使用しての臨床検査における事情に基づき、本実施の形態に係る大腸内視鏡１０が開発されたものである。 Fourthly, when there is an “anxiety” in the anus, the anus cannot be sealed, and a sufficient negative pressure may not be formed in the large intestine.
The colonoscope 10 according to the present embodiment has been developed on the basis of the circumstances in the clinical examination using the colonoscope actually by the inventor as described above.

しかしながら、本実施の形態に係る大腸内視鏡１０を使用する際に、上記特許３７７０９０２号に係る大腸内視鏡補助具８０を同時に利用してもよい。
　本実施の形態に係る大腸内視鏡１０と特許３７７０９０２号に係る大腸内視鏡補助具８０とを併用することにより、大腸内視鏡１０の先端部側及び肛門３６側の双方から陰圧を大腸３７内部へ供給することができ、大腸内視鏡の挿入時に、大腸３７内部においてより均等な陰圧状態を形成できることから、さらに確実に大腸壁部１５を大腸内視鏡１０に対して吸着させ、確実な大腸３７の牽引作業を行うことが可能となる。 However, when using the large intestine endoscope 10 according to the present embodiment, the large intestine endoscope auxiliary tool 80 according to Japanese Patent No. 3770902 may be used at the same time.
By using the large intestine endoscope 10 according to the present embodiment and the large intestine endoscope auxiliary tool 80 according to Japanese Patent No. 3770902 together, negative pressure is applied from both the distal end side and the anus 36 side of the large intestine endoscope 10. Since it can be supplied into the large intestine 37 and a more uniform negative pressure state can be formed in the large intestine 37 when the large intestine endoscope is inserted, the large intestine wall 15 is more reliably adsorbed to the large intestine endoscope 10. Thus, it is possible to perform reliable pulling work of the large intestine 37.

　なお、本実施の形態に係る大腸内視鏡１０にあっては、上記陰圧供給部１２は、上記大腸内視鏡本体１１とは別体であって、上記大腸内視鏡本体１１に対して着脱可能に形成されていると共に上記陰圧供給路部１４は大腸内視鏡本体部１１の外部に配設されている場合を例に説明したが、上記実施の形態に限定されず、上記陰圧供給部１２は、上記大腸内視鏡本体１１と一体に形成されていると共に大腸内視鏡本体１１の内部に配設されるように構成されていてもよい。
　また、上記陰圧供給部１２の具体的構成に関しては、上記実施の形態に限定されない。 In the large intestine endoscope 10 according to the present embodiment, the negative pressure supply unit 12 is separate from the large intestine endoscope main body 11 and is separate from the large intestine endoscope main body 11. In the above description, the negative pressure supply path 14 is disposed outside the large intestine endoscope main body 11 as an example. However, the present invention is not limited to the above embodiment, and The negative pressure supply unit 12 may be formed integrally with the large intestine endoscope main body 11 and arranged inside the large intestine endoscope main body 11.
The specific configuration of the negative pressure supply unit 12 is not limited to the above embodiment.

　本発明に係る大腸内視鏡は、広く、大腸内視鏡を大腸内へ挿入して大腸壁部を大腸内視鏡へ吸着させて自由腸を折り畳み、自由腸と固定腸とを直線化して大腸内視鏡を挿入して大腸内視鏡検査を行う技術に広く適用することができる。 The large intestine endoscope according to the present invention broadly inserts the large intestine endoscope into the large intestine, adsorbs the large intestine wall to the large intestine endoscope, folds the free intestine, and linearizes the free intestine and the fixed intestine. The present invention can be widely applied to a technique for performing a colonoscopy by inserting a colonoscope.

本発明に係る大腸内視鏡の一実施の形態を示す斜視図であって、既存の大腸内視鏡に対して、吸引キャップ及び陰圧供給路部を取り付けた状態を示す図である。It is a perspective view which shows one Embodiment of the large intestine endoscope which concerns on this invention, Comprising: It is a figure which shows the state which attached the suction cap and the negative pressure supply path part with respect to the existing large intestine endoscope. 本発明に係る大腸内視鏡の一実施の形態を示す斜視図であって、先端部に取り付けられた吸引キャップおよび陰圧供給路部を後方から見た状態を示す斜視図である。It is a perspective view showing one embodiment of a large intestine endoscope concerning the present invention, and is a perspective view showing the state where the suction cap and negative pressure supply channel part attached to the tip part were seen from back. 本発明に係る大腸内視鏡に使用される吸引キャップの一実施の形態を示す縦断面図である。It is a longitudinal cross-sectional view which shows one Embodiment of the suction cap used for the large intestine endoscope which concerns on this invention. 本発明に係る大腸内視鏡を大腸内に挿入している状態を示す概略図である。It is the schematic which shows the state which has inserted the large intestine endoscope which concerns on this invention in the large intestine. 本発明に係る大腸内視鏡に装着された陰圧供給路部及び吸引キャップを介して大腸内へ陰圧を供給して大腸壁部を大腸内視鏡本体の周面部に吸着させた状態で肛門側へ引き、Ｓ状結腸等の自由腸を折り畳んでいる状態を示す概念図である。In a state where negative pressure is supplied into the large intestine through the negative pressure supply path and suction cap attached to the large intestine endoscope according to the present invention and the large intestine wall is adsorbed on the peripheral surface of the large intestine endoscope main body. It is a conceptual diagram which shows the state which pulled to the anus side and folded free intestines, such as a sigmoid colon. 本発明に係る大腸内視鏡を大腸内に挿入して、陰圧を供給して大腸壁部を大腸内視鏡本体の周面部に吸着させた状態で肛門側へ引き、Ｓ状結腸を折り畳む作業を繰り返し、Ｓ状結腸から下行結腸までを直線化させる過程を、被験者の側方側から示す概念図である。The colonoscope according to the present invention is inserted into the large intestine, a negative pressure is supplied, and the colon wall is attracted to the peripheral surface of the colon endoscope main body and pulled to the anus side to fold the sigmoid colon. It is a conceptual diagram which shows the process which repeats an operation | work and linearizes from the sigmoid colon to the descending colon from the side of a test subject. 本発明に係る大腸内視鏡を大腸内に挿入して、陰圧を供給して大腸壁部を大腸内視鏡本体の周面部に吸着させた状態で肛門側へ引き、Ｓ状結腸を折り畳む作業を繰り返し、Ｓ状結腸から下行結腸までを直線化させる過程を、被験者の上方側から示す概念図である。The colonoscope according to the present invention is inserted into the large intestine, a negative pressure is supplied, and the colon wall is attracted to the peripheral surface of the colon endoscope main body and pulled to the anus side, and the sigmoid colon is folded. It is a conceptual diagram which shows the process which repeats an operation | work and linearizes from a sigmoid colon to a descending colon from the test subject's upper side. 本発明に係る大腸内視鏡を大腸内に挿入して、陰圧を供給して大腸壁部を大腸内視鏡本体の周面部に吸着させた状態で肛門側へ引き、Ｓ状結腸を折り畳む作業を繰り返すことにより、Ｓ状結腸から下行結腸までを直線化させた後、横行結腸を同様に折り畳み、上行結腸から盲腸部に至るまで大腸内視鏡を挿入する過程を、被験者の側方側から示す概念図である。The colonoscope according to the present invention is inserted into the large intestine, a negative pressure is supplied, and the colon wall is attracted to the peripheral surface of the colon endoscope main body and pulled to the anus side to fold the sigmoid colon. Repeat the process to linearize from the sigmoid colon to the descending colon, then fold the transverse colon in the same way and insert the colonoscope from the ascending colon to the cecum. It is a conceptual diagram shown from. 本発明に係る大腸内視鏡を大腸内に挿入して、陰圧を供給して大腸壁部を大腸内視鏡本体の周面部に吸着させた状態で肛門側へ引き、Ｓ状結腸を折り畳む作業を繰り返すことにより、Ｓ状結腸から下行結腸までを直線化させた後、横行結腸を同様に折り畳み、上行結腸から盲腸部に至るまで大腸内視鏡を挿入する過程を、被験者の上方側から示す概念図である。The colonoscope according to the present invention is inserted into the large intestine, a negative pressure is supplied, and the colon wall is attracted to the peripheral surface of the colon endoscope main body and pulled to the anus side to fold the sigmoid colon. After repeating the operation to linearize from the sigmoid colon to the descending colon, the process of folding the transverse colon in the same manner and inserting the colonoscope from the ascending colon to the cecum is performed from above the subject. FIG. 同一の発明者の発明に係る特許第３７７０９０２号の大腸内視鏡補助具を示す縦断面図である。It is a longitudinal cross-sectional view which shows the large intestine endoscope auxiliary tool of the patent 3770902 based on the invention of the same inventor. 大腸を一般的、模式的に示す概略図である。It is the schematic which shows a large intestine generally and typically.

符号の説明Explanation of symbols

１０　大腸内視鏡
１１　大腸内視鏡本体　　　　　　　　　　　　　　　　　　　　　　　　　　　　　
１２　膨出部
１３　陰圧供給孔部
１４　陰圧供給路部
１５　大腸壁部
１６　吸引キャップ
１７　先端部
１８　後端部
１９　固定部
２０　陰圧供給室
２１　ネジ溝
２２　ネジ溝
２３　吸引キャップ本体部
２４　外側面部
２５　開口部
２６　開口部
２７　先端部
２８　送気孔
２９　吸気孔
３０　ライトガイド
３１　観察レンズ
３２　係合部
３３　前腹壁部
３４　鉗子孔
３５　挿入物
３６　肛門
３７　大腸
３８　Ｓ状結腸部
３９　仙骨
４０　被験者
４１　内視鏡テーブル
４２　直腸部
４３　左側壁部
４４　肝臓部
４５　腸管
４６　下行結腸部
４７　下行結腸移行部　
４８　腸骨アーチ
４９　横行結腸部
５０　脾湾曲部
５１　折り返し部
５２　腸液
５４　上行結腸部
５５　肝湾曲部
５６　脊椎
５７　盲腸
５８　恥骨
５９　管体部
６０　管本体部
６１　吸引減圧部
６２　孔部
６３　減圧機構
６４　陰圧供給通路
６５　潤滑剤供給部　
６７　基部
６８　空気流入遮断部
６９　固定部
７０　膨出部
７１　先端部
７２　バルーン体
７３　保持片
８０　大腸内視鏡補助具
８１　先端前面部
８２　外側面部 10 Colonoscope 11 Colonoscope body
12 bulging portion 13 negative pressure supply hole portion 14 negative pressure supply passage portion 15 large intestine wall portion 16 suction cap 17 front end portion 18 rear end portion 19 fixing portion 20 negative pressure supply chamber 21 screw groove 22 screw groove 23 suction cap body portion 24 Outer side surface portion 25 Opening portion 26 Opening portion 27 Tip portion 28 Air supply hole 29 Intake hole 30 Light guide 31 Observation lens 32 Engaging portion 33 Front abdominal wall portion 34 Forceps hole 35 Insert 36 Anus 37 Large intestine 38 Sigmoid colon portion 39 Sacrum 40 Subject 41 Endoscopic table 42 Rectal part 43 Left side wall part 44 Liver part 45 Intestine 46 Lower colon part 47 Lower colon transition part
48 iliac arch 49 transverse colon part 50 spleen curved part 51 fold part 52 intestinal fluid 54 ascending colon part 55 liver curved part 56 spine 57 cecum 58 pubic bone 59 tubular body part 60 pipe body part 61 suction decompression part 62 hole part 63 decompression mechanism 64 Negative pressure supply passage 65 Lubricant supply section
67 Base portion 68 Air inflow blocking portion 69 Fixing portion 70 Swelling portion 71 Tip portion 72 Balloon body 73 Holding piece 80 Large intestine endoscope auxiliary tool 81 Tip front surface portion 82 Outer side surface portion

Claims (8)

1. 　大腸内視鏡本体の先端部に設けられ、大腸内へ挿入された場合に大腸内へ陰圧を供給しうる陰圧供給部を有する大腸内視鏡であって、
   　上記陰圧供給部は、上記大腸内視鏡本体の後端部方向に向かって拡開するテーパ状であって上記大腸内視鏡本体の側面部よりも外方へ膨出して形成され、大腸内視鏡後端部方向へ開口する陰圧供給孔部と、上記陰圧供給孔部を介して大腸内部に陰圧を供給する陰圧供給路部とを有し、
   　大腸内部に挿入された場合には、上記陰圧供給路部から上記陰圧供給孔部を介して上記大腸内視鏡後端部方向に向かって陰圧を供給して大腸内部を減圧し、上記大腸内視鏡本体外側面部に大腸壁部を密着させうることを特徴とする大腸内視鏡。 A colonoscope having a negative pressure supply unit that is provided at the distal end of the large intestine endoscope body and can supply negative pressure into the large intestine when inserted into the large intestine,
   The negative pressure supply portion is a taper shape that expands toward the rear end of the large intestine endoscope body, and is formed to bulge outward from the side surface portion of the large intestine endoscope body. A negative pressure supply hole that opens in the direction of the rear end of the endoscope, and a negative pressure supply passage that supplies negative pressure into the large intestine through the negative pressure supply hole,
   When inserted into the large intestine, the negative pressure is supplied from the negative pressure supply path to the rear end of the large intestine through the negative pressure supply hole to reduce the inside of the large intestine, A large intestine endoscope characterized in that a large intestine wall can be brought into close contact with the outer side surface of the large intestine endoscope main body.
2. 　上記陰圧供給部の後端部には、大腸内視鏡本体部よりも径方向外方へ突出し、上記密着した大腸壁部に係合しうる係合部が形成されていることを特徴とする請求項１記載の大腸内視鏡。 The negative pressure supply portion has a rear end formed with an engaging portion that protrudes radially outward from the large intestine endoscope main body and engages with the closely attached large intestine wall. The large intestine endoscope according to claim 1.
3. 　上記陰圧供給部は、全体略截頭円錐台形状に形成されていることを特徴とする請求項２記載の大腸内視鏡。 The large intestine endoscope according to claim 2, wherein the negative pressure supply part is formed in a substantially truncated truncated cone shape as a whole.
4. 　上記陰圧供給孔部は複数設けられる一方、上記陰圧供給部には、上記陰圧供給路部が連通すると共に上記複数の陰圧供給孔部に連通する陰圧供給室が設けられ、上記陰圧供給路部からの陰圧は上記陰圧供給室を介して上記陰圧供給孔へ供給されることを特徴とする請求項１記載の大腸内視鏡。 A plurality of the negative pressure supply holes are provided, and the negative pressure supply part is provided with a negative pressure supply chamber that communicates with the negative pressure supply passages and communicates with the plurality of negative pressure supply holes. The large intestine endoscope according to claim 1, wherein the negative pressure from the negative pressure supply passage is supplied to the negative pressure supply hole through the negative pressure supply chamber.
5. 　上記陰圧供給孔部は、上記陰圧供給部の後端部に、所定間隔をおいて全周に亘って開設されていることを特徴とする請求項２記載の大腸内視鏡。 3. The large intestine endoscope according to claim 2, wherein the negative pressure supply hole portion is provided at a rear end portion of the negative pressure supply portion over the entire circumference at a predetermined interval.
6. 　上記陰圧供給路部は、上記大腸内視鏡本体内部に配設されていることを特徴とする請求項１記載の大腸内視鏡。 The large intestine endoscope according to claim 1, wherein the negative pressure supply path is disposed inside the large intestine endoscope main body.
7. 　上記陰圧供給部は、上記大腸内視鏡本体とは別体であって、上記大腸内視鏡本体に対して着脱可能に形成されていると共に上記陰圧供給路部は大腸内視鏡本体部の外部に配設されていることを特徴とする請求項１記載の大腸内視鏡。 The negative pressure supply unit is separate from the large intestine endoscope main body, and is formed to be detachable from the large intestine endoscope main body, and the negative pressure supply path is formed in the large intestine endoscope main body. The large intestine endoscope according to claim 1, wherein the large intestine endoscope is disposed outside the unit.
8. 　上記陰圧供給部は、上記大腸内視鏡本体と一体に形成されていると共に上記陰圧供給路部は大腸内視鏡本体部の内部に配設されていることを特徴とする請求項１記載の大腸内視鏡。 2. The negative pressure supply part is formed integrally with the large intestine endoscope main body, and the negative pressure supply path part is disposed inside the large intestine endoscope main body part. The colonoscope described.

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