WO2012043034A1 - Medical device and endoscope device - Google Patents

Medical device and endoscope device Download PDF

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Publication number
WO2012043034A1
WO2012043034A1 PCT/JP2011/066856 JP2011066856W WO2012043034A1 WO 2012043034 A1 WO2012043034 A1 WO 2012043034A1 JP 2011066856 W JP2011066856 W JP 2011066856W WO 2012043034 A1 WO2012043034 A1 WO 2012043034A1
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WO
WIPO (PCT)
Prior art keywords
tube
fluid
state
strength
insertion portion
Prior art date
Application number
PCT/JP2011/066856
Other languages
French (fr)
Japanese (ja)
Inventor
勇太 杉山
Original Assignee
オリンパスメディカルシステムズ株式会社
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Filing date
Publication date
Application filed by オリンパスメディカルシステムズ株式会社 filed Critical オリンパスメディカルシステムズ株式会社
Publication of WO2012043034A1 publication Critical patent/WO2012043034A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00154—Holding or positioning arrangements using guiding arrangements for insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00071—Insertion part of the endoscope body
    • A61B1/00078—Insertion part of the endoscope body with stiffening means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00112—Connection or coupling means
    • A61B1/00121—Connectors, fasteners and adapters, e.g. on the endoscope handle
    • A61B1/00128—Connectors, fasteners and adapters, e.g. on the endoscope handle mechanical, e.g. for tubes or pipes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131—Accessories for endoscopes
    • A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/12—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements
    • A61B1/128—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements provided with means for regulating temperature

Definitions

  • the present invention relates to a medical device capable of changing the strength of an insertion portion to be inserted into a lumen such as an intestine, and an endoscope apparatus including the medical device.
  • Endoscopes have been put to practical use in which an elongated insertion part can be inserted into a lumen such as the intestine for observation, and various treatments and treatments can be performed by inserting the treatment tool into the treatment tool channel as necessary.
  • a distal end side of an elongated insertion portion of an endoscope is provided with a bending portion configured to bend in the vertical direction and the horizontal direction.
  • the bending portion is configured to bend in accordance with operation of an operation member provided in the operation portion on the hand side.
  • the insertion part of the endoscope configured as described above is inserted toward the deep part of the large intestine through the anus, for example. At that time, the surgeon performs a twisting operation or a feeding operation for advancing the insertion portion positioned outside the body, and operates an operation member provided in the operation portion to appropriately bend the bending portion.
  • a flexible tubular overtube is placed in the sigmoid colon in advance, and then the insertion portion is inserted into the through-hole of the overtube, and this insertion portion is directed to the deep portion of the large intestine. Insert.
  • the guide wire is inserted in advance to a target site in the large intestine, and then the guide wire in the large intestine is observed through the observation window of the endoscope while the insertion portion is directed to the deep portion of the large intestine insert.
  • the overtube in the procedure of placing the overtube at the bent portion such as the sigmoid colon, the following problems occur when the flexibility of the overtube is softer than the flexibility of the insertion portion. That is, when the surgeon inserts the insertion portion into the through-hole of the overtube and pushes the insertion portion toward the deep portion of the large intestine, the overtube that has been curved along the sigmoid colon is pushed in. There arises a problem of being straightened by the insertion portion. In order to eliminate this problem, it is desirable to set the flexibility of the overtube harder than the flexibility of the insertion portion.
  • Patent Document 1 Japanese National Patent Publication No. 2007-500037 shows a catheter whose strength can be manipulated. Since this catheter is usually soft and flexible, it solves the problem that it is difficult to transmit the pressing force.
  • the catheter has an inner shaft with rigidity that can be changed by cooling and heating a desired location at one or more locations.
  • one or more fluid transport lumens for supplying heated or cooled fluid for changing the strength of the inner shaft are provided inside or outside the outer layer constituting the inner shaft. It is a configuration. For this reason, when there is one fluid transport lumen, there is a problem that it takes time until the strength of the inner shaft changes after the fluid is supplied to the fluid transport lumen. On the other hand, in order to improve responsiveness, when a fluid transport lumen is provided on the entire inner periphery or outer periphery of the outer layer, the number of fluid transport lumens increases, so that the configuration becomes complicated and the flexibility of the catheter is increased. There is a risk of damage.
  • the present invention has been made in view of the above circumstances, and a medical device including an insertion portion with excellent responsiveness, in which the hardness of the insertion portion changes by rapidly supplying a heated fluid or a cooled fluid.
  • the purpose is to provide.
  • the medical device of one embodiment of the present invention is a medical device having an insertion portion that is provided so as to be relatively movable with respect to the longitudinal axis direction of the endoscope insertion portion, and the insertion portion has a predetermined temperature.
  • a tubular strength variable member whose strength changes between the first state and the second state at the boundary; and a fluid having a temperature higher than the predetermined temperature that changes the strength variable member to the first state; or
  • An endoscope apparatus includes an endoscope having an endoscope insertion portion, and a longitudinal insertion hole through which the endoscope insertion portion is inserted into an insertion portion to be inserted into the body.
  • An overtube having a tubular strength variable member whose strength changes between a first state and a second state at a predetermined temperature, and the strength change member of the overtube in the first state.
  • a fluid supply device for supplying a fluid having a temperature higher than the predetermined temperature to be changed or a fluid having a temperature lower than the predetermined temperature for changing the strength variable member to the second state
  • the insertion portion of the overtube is provided on the tube inner surface side of the strength varying member, and has a tube outer surface that constitutes the fluid supply path and a through hole that constitutes the insertion hole between the tube inner surface and the tube.
  • Member and said strength variable member It provided outside the tube surface, and comprises a second tube member having a luminal surface constituting the fluid return path between the tube outer surface.
  • An endoscope apparatus includes an endoscope having a treatment instrument channel in an endoscope insertion portion, and an insertion portion that can be inserted into and removed from the treatment instrument channel of the endoscope insertion portion.
  • a guide member having a tubular strength variable member whose strength changes between the first state and the second state at the boundary of the determined temperature, and the predetermined member for changing the strength variable member of the guide member to the first state.
  • a fluid supply device that supplies a fluid having a temperature higher than a predetermined temperature or a fluid having a temperature lower than the predetermined temperature that changes the strength variable member to the second state, and the insertion portion of the guide member Is provided on the tube inner surface side of the strength variable member, and includes a tube member having a tube outer surface constituting the fluid supply path and a through hole constituting the fluid recovery path between the strength varying member and the tube inner surface. ing.
  • An endoscope apparatus includes an endoscope having a treatment instrument channel in an endoscope insertion portion, and a longitudinal axis through which the endoscope insertion portion is inserted into an insertion portion to be inserted into the body.
  • An overtube having a tubular strength variable member having a direction insertion hole, the strength of which changes between a first state and a second state at a predetermined temperature, and a strength variable member of the overtube.
  • a first fluid supply for supplying a fluid having a temperature higher than the predetermined temperature to be changed to the first state or a fluid having a temperature lower than the predetermined temperature for changing the strength variable member to the second state.
  • An apparatus an intensity variable member that is inserted and disposed in the treatment instrument channel and changes in strength between a first state and a second state with a predetermined temperature as a boundary, and predetermined in the treatment instrument channel Strength variable part inserted and arranged in the state A fluid having a temperature higher than the predetermined temperature that changes the first state to the first state or a fluid having a temperature lower than the predetermined temperature that changes the strength variable member to the second state. And a fluid having a temperature higher than the predetermined temperature or a fluid having a temperature lower than the predetermined temperature supplied from the second fluid supply device. It is supplied through a gap between the endoscope insertion portion or a gap between the strength varying member inserted and disposed in the treatment instrument channel and the treatment instrument channel.
  • FIG. 1 is a diagram for explaining an endoscope apparatus including an endoscope and an overtube as a medical device.
  • Longitudinal sectional view for explaining the configuration of the overtube Y3-Y3 line cross-sectional view of FIG. Y4-Y4 line cross-sectional view of FIG.
  • the figure explaining the procedure etc. which arrange the tube body of an overtube in the transverse colon The figure explaining the procedure etc.
  • FIGS. 9 to 14 relate to the second embodiment
  • FIG. 9 is a diagram illustrating an endoscope apparatus including an endoscope and a guide member that is a medical device.
  • Longitudinal sectional view for explaining the structure of the guide member The figure explaining the procedure after inserting the guide part of a guide member from an anus and passing through the sigmoid colon and arrange
  • FIG. 15 is a diagram for explaining an endoscope apparatus including an endoscope, an overtube, and a shape holding member.
  • the figure explaining the procedure etc. which lead out an endoscope insertion part in the descending colon via the tube body of an overtube The figure explaining the procedure etc. which arrange
  • position an endoscope insertion part to a liver curve via the tube body of an overtube The figure explaining the procedure etc.
  • the endoscope apparatus 1 of this embodiment is mainly configured by including an endoscope 10 and an overtube 20 that is a medical device.
  • the endoscope 10 mainly includes an endoscope insertion portion 11, an endoscope operation portion 12, and a universal cable 13.
  • the endoscope insertion portion 11 is configured by connecting a distal end portion 14, a bending portion 15, and a flexible tube portion 16 sequentially from the distal end side.
  • an image pickup unit including an image pickup element such as a CCD or a C-MOS for picking up an image of the test part is built.
  • the bending portion 15 is configured to bend in the vertical direction and the horizontal direction, for example.
  • the flexible tube portion 16 has a predetermined flexibility.
  • the endoscope operation section 12 is provided with a bending knob 17 for bending the bending section 15, a treatment instrument channel inlet 18 for guiding the treatment instrument to a treatment instrument channel (not shown), and the like.
  • the universal cable 13 extends from the side of the proximal end side of the endoscope operation unit 12.
  • An endoscope connector 19 is provided at the proximal end portion of the universal cable 13.
  • the endoscope connector 19 is detachably connected to an external device such as the light source device 2.
  • the overtube 20 has an insertion hole 20H in the longitudinal axis direction through which the endoscope insertion portion 11 can be inserted.
  • the overtube 20 includes a tube body 21 that is an insertion portion capable of changing flexibility, and an overtube operation portion 22 having rigidity that is a gripping portion.
  • the overtube operation section 22 is provided with a first tube base 23a and a second tube base 23b.
  • the first fluid tube 3 extending from the fluid supply device 30 is connected to the first tube base 23a.
  • a second fluid tube 4 extending from the fluid supply device 30 is connected to the second tube base 23b.
  • the tube body 21 includes a tubular strength variable member 25, a tubular insertion portion insertion tube 26, a tubular tube exterior member 27, and an annular tip component member 28.
  • the insertion portion insertion tube 26 and the tube exterior member 27 are tube members having predetermined flexibility.
  • the strength varying member 25 is a tubular member whose strength such as hardness or elastic modulus changes between a first state and a second state at a predetermined temperature.
  • the strength-variable member 25 is, for example, a shape memory polymer having a glass transition temperature set between, for example, 10 degrees Celsius and 55 degrees Celsius, or a thermoplastic having a melting point set between, for example, 10 degrees Celsius and 55 degrees Celsius. It is formed in a tubular shape with a resin and a low melting point alloy.
  • the strength varying member 25 is a shape memory polymer whose glass transition temperature is lower than the body temperature, for example, set to 25 degrees Celsius, and is formed with an inner diameter dimension ⁇ d, a wall thickness t, and an outer diameter dimension ⁇ D.
  • the strength of the strength variable member 25 changes from the soft state of the first state to the hard state of the second state by changing the temperature of the strength variable member 25 from a state higher than the glass transition temperature to a lower state. To do.
  • the strength of the variable strength member 25 changes from the second state to the first state when the temperature of the variable strength member 25 changes from a lower state to a higher state than the glass transition temperature.
  • the first state and the second state of the strength variable member 25 are differences in the magnitude of deformation when an external force having a predetermined magnitude is applied to the strength variable member 25 from a predetermined direction. .
  • the strength varying member 25 is easily deformable in the first state.
  • the strength variable member 25 has, for example, higher hardness in the second state than in the first state.
  • the deformation amount of the strength varying member 25 is smaller than the deformation amount set in the first state, in other words, it is difficult to deform compared to the first state.
  • the tube body 21 including the strength varying member 25 is in the first state when the tube body 21 is inserted into the large intestine, for example, the tube body 21 is passive when the tip abuts against the wall of the large intestine.
  • the contact state is then released, it has the flexibility to return to its original shape again.
  • the flexibility that returns to the original shape after the contact is released as described above is referred to as a predetermined flexibility.
  • the tube body 21 retains the shape holding force that holds the curved shape of the tube body 21 in the soft state.
  • the shape holding force in the second state of the strength variable member 25 in the present embodiment is when the endoscope insertion portion 11 is inserted into the insertion hole 20H of the tube body 21 in which the curved shape is held.
  • the distal end portion 14 comes into contact with the curved inner peripheral surface of the insertion hole 20H, the curved shape of the tube body 21 is set without being deformed.
  • the insertion portion insertion tube 26 is a first tube member.
  • the insertion portion insertion tube 26 has a through hole that constitutes an insertion hole 20H into which the endoscope insertion portion 11 of the endoscope 10 can be inserted and removed.
  • the outer diameter of the insertion portion insertion tube 26 is smaller than the inner diameter of the strength variable member 25.
  • the insertion portion insertion tube 26 is disposed on the tube inner surface side of the strength variable member 25.
  • a first gap 29 a is formed between the inner surface of the variable strength member 25 and the outer surface of the insertion tube 26.
  • the first gap 29 a is a fluid supply path through which the fluid supplied from the fluid supply device 30 is sent.
  • the tube exterior member 27 is a second tube member.
  • the tube exterior member 27 constitutes the exterior of the tube body 21.
  • the tube exterior member 27 has a through-hole having a diameter larger than the outer diameter of the strength variable member 25 that is determined in advance.
  • the tube exterior member 27 is disposed on the tube outer surface side of the strength variable member 25.
  • a second gap 29 b is formed between the outer surface of the strength variable member 25 and the inner surface of the tube exterior member 27.
  • the first clearance 29 a is configured as a fluid recovery path for recovering the fluid supplied to the first clearance 29 a to the fluid supply device 30.
  • the tip component member 28 has a central hole 28h at the center thereof.
  • An outer surface of the distal end portion of the insertion portion insertion tube 26 is disposed in the central hole 28h.
  • the outer surface of the distal end portion of the insertion portion insertion tube 26 and the inner surface of the central hole 28h are integrally fixed, for example, by adhesion.
  • a circumferential recess 28 a is formed on the outer peripheral side of the tip constituent member 28.
  • the inner surface of the distal end portion of the tube exterior member 27 is disposed in the circumferential recess 28a.
  • the depth of the circumferential recess 28 a is set to be approximately the same as the thickness of the tube exterior member 27.
  • the distal end portion of the tube exterior member 27 is externally disposed in the circumferential recess 28a, and is fixed integrally with the distal end component member 28 by, for example, adhesion.
  • annular groove 28b is formed around the central hole 28h, which is a predetermined position on the base end face of the tip component member 28.
  • the tip end portion of the variable strength member 25 is engaged.
  • the distal end portion of the strength varying member 25 is disposed in the annular groove 28b, and is fixed integrally with the distal end component member 28 by, for example, adhesion.
  • a notch portion 25a having a predetermined width dimension and a predetermined depth dimension from the front end surface is predetermined in the circumferential direction at the distal end portion of the strength varying member 25 disposed in the annular groove 28b. It is formed at intervals.
  • the depth dimension of the notch 25a is set larger than the depth dimension of the annular groove 28b.
  • the cutout portion 25a is a communication portion that connects the fluid supply path and the fluid recovery path. According to this configuration, the fluid supplied to the first gap 29a passes through the notch 25a and is supplied to the second gap 29b side as indicated by an arrow Y2.
  • the overtube operation unit 22 includes, for example, a large diameter portion 22c and a small diameter portion 22d as shown in FIGS.
  • the overtube operation unit 22 includes a central through hole 22h along the central axis.
  • a proximal end portion of the insertion portion insertion tube 26 is disposed in the central through hole 22h, and is integrally fixed to the overtube operation portion 22 by adhesion, for example.
  • a proximal end portion of the tube exterior member 27 is fitted on the outer peripheral surface of the small-diameter portion 22d of the overtube operation portion 22 and is integrally fixed to the overtube operation portion 22 by adhesion, for example.
  • an annular groove 22j in which the proximal end portion of the strength varying member 25 is engaged is disposed at a predetermined position on the distal end surface of the small diameter portion 22d and around the central through hole 22h.
  • the base end portion of the strength varying member 25 is disposed in the annular groove 22j and is integrally fixed to the overtube operation portion 22 by, for example, adhesion.
  • Numeral 22a is a first communicating hole
  • numeral 22b is a second communicating hole
  • numeral 22e is a first space part
  • numeral 22f is a second space part.
  • the first communication hole 22a communicates the first space 22e and the first gap 29a.
  • the second communication hole 22b communicates the second space 22f and the second gap 29b.
  • the first space portion 22e is formed by closing the opening of the concave portion formed on the outer peripheral surface side of the large diameter portion 22c with the first lid member 24a.
  • the second space portion 22f is formed by closing the opening of the concave portion formed on the outer peripheral surface side of the large diameter portion 22c with the second lid member 24b.
  • the first tube base 23a is fixed to the first lid member 24a.
  • the second tube base 23b is fixed to the second lid member 24b.
  • Reference numeral 24a1 is a through hole and has openings on one side and the other side of the lid member 24a.
  • Reference numeral 24b1 is a through hole, and has openings on one side and the other side of the lid member 24b.
  • the fluid supply device 30 includes a cooling device 31, a heating device 32, a liquid feed pump 33, a suction pump 34, and a fluid control unit 35.
  • Reference numeral 5 denotes a foot switch.
  • the first fluid tube 3 is connected to a first fluid base 6 a provided in the fluid supply device 30.
  • the second fluid tube 4 is connected to the second fluid base 6b.
  • the cooling device 31 is installed at a predetermined position in a supply pipe 37 that communicates the liquid feeding tank 36 provided in the fluid supply device 30 and the first fluid base 6a.
  • the cooling device 31 cools, for example, water, which is a fluid supplied from the liquid feeding tank 36 to the supply pipe 37, for example, 10 degrees Celsius, which is lower than the glass transition temperature 25 degrees of the strength variable member 25.
  • the heating device 32 heats, for example, water, which is a fluid stored in the liquid supply tank 36, to, for example, 40 degrees Celsius, which is higher than the glass transition temperature 25 degrees of the strength variable member 25.
  • the heating device 32 is also installed at a predetermined position in the supply pipe 37.
  • the liquid feed pump 33 supplies the water stored in the liquid feed tank 36 to the supply pipe 37 in the operating state.
  • the suction pump 34 is connected to a suction tank 38 and sucks fluid through a recovery line 39 or the like having one end connected to the second fluid base 6b.
  • the foot switch 5 includes, for example, a first switch 5a and a second switch 5b.
  • a cooling signal is transmitted from the foot switch 5.
  • a heating signal is transmitted from the foot switch 5 by turning on the second switch 5b.
  • the fluid control unit 35 When the fluid control unit 35 receives the cooling signal from the foot switch 5, the fluid control unit 35 turns on the cooling device 31, the liquid feed pump 33, and the suction pump 34. Thus, the supply of water stored in the liquid supply tank 36 is started by the liquid supply pump 33 and the recovery of the water supplied by the suction pump 34 is started.
  • the water stored in the liquid supply tank 36 is supplied to the supply pipe 37 and is cooled to 10 degrees Celsius by the cooling device 31 while passing through the supply pipe 37.
  • the cooling water cooled to 10 degrees Celsius is the first fluid supply path through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space 22e, and the first communication hole 22a. It is supplied to the gap 29a.
  • the cooling water supplied to the 1st clearance gap 29a is supplied to the 2nd clearance gap 29b via the notch part 25a. Thereafter, the cooling water is the second clearance 29b, the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39, which are fluid recovery paths. It is collected in the suction tank 38 via
  • the fluid control unit 35 instantaneously switches the liquid feeding pump 33 to the off state.
  • the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. As a result, the cooling water in the overtube 20 can be reliably recovered.
  • the fluid control unit 35 When the fluid control unit 35 receives the heating signal from the foot switch 5, the fluid control unit 35 turns on the heating device 32, the liquid feeding pump 33, and the suction pump 34. As a result, supply of water stored in the liquid supply tank 36 is started by the liquid supply pump 33 and recovery of water supplied by the suction pump 34 is started.
  • the water stored in the liquid feeding tank 36 is supplied to the supply pipe 37 and heated to 40 degrees Celsius by the heating device 32 while passing through the supply pipe 37.
  • the hot water heated to 40 degrees Celsius is a first gap that is a fluid supply path through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space 22e, and the first communication hole 22a. 29a.
  • the warm water supplied to the 1st clearance gap 29a is supplied to the 2nd clearance gap 29b via the notch part 25a.
  • the hot water passes through the second gap 29b, the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery pipe line 39, which are fluid recovery paths.
  • the suction tank 38 Through the suction tank 38.
  • the fluid control unit 35 instantaneously switches the liquid feed pump 33 to the off state, similarly to the case where the first switch 5a is turned off.
  • the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. This ensures that hot water in the overtube 20 can be collected.
  • the medical staff uses the endoscope 10, the light source device 2, the overtube 20, and the fluid supply device 30 as the endoscope device 1.
  • a foot switch 5, a display device (not shown), a video processor, and the like are prepared.
  • the medical staff prepares the overtube 20 in which the hardness of the tube body 21 is changed by, for example, 25 degrees Celsius instructed by the operator.
  • the surgeon confirms whether the overtube 20 is instructed. After confirming that the instruction is given, the surgeon operates a setting switch provided on the main panel (not shown) of the fluid supply device 30 to set the temperature of water cooled by the cooling device 31 to, for example, 10 degrees Celsius.
  • the temperature of water heated by the heating device 32 is set to 40 degrees Celsius, for example.
  • the surgeon confirms the hardness of the tube body 21 of the overtube 20. That is, it is confirmed whether or not the strength varying member 25 is in a soft state.
  • the distal end portion of the tube body 21 is inserted into the large intestine from the patient's anus as shown in FIG. Then, a hand operation such as a push-in operation or a twist operation is performed to push the tube body 21 toward the deep part of the large intestine.
  • the tube body 21 inserted from the anus 71 advances from the rectum 72 to the sigmoid colon 73 by the operator's hand operation. Then, the tube body 21 reaches the sigmoid colon 73. Thereafter, the surgeon appropriately performs a pushing operation or a twisting operation to push the tube body 21 forward, and the distal end portion of the tube body 21 is distal to the sigmoid colon 73 as shown by a two-dot chain line in FIG. Place in side descending colon 74.
  • the surgeon determines that the distal end portion of the tube body 21 has passed through the sigmoid colon 73, the surgeon holds the first switch 5a of the foot switch 5 for the purpose of holding the curved shape of the tube body 21 as it is. Turn on. Then, a cooling signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
  • the fluid control unit 35 that has received the cooling signal turns on the cooling device 31, the liquid feed pump 33, and the suction pump 34 to start supplying water stored in the liquid feed tank 36. Then, the water stored in the liquid feeding tank 36 is supplied to the supply pipe 37 and is cooled to, for example, 10 degrees Celsius by the cooling device 31 while passing through the supply pipe 37 to become cooling water.
  • the cooling water passes through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space portion 22e, and the first communication hole 22a, and the first gap located on the inner surface side of the strength variable member 25. 29a. Thereafter, the cooling water supplied to the first gap 29a is supplied to the second gap 29b located on the tube outer surface side of the strength varying member 25 via the notch 25a.
  • the cooling water touches the entire inner surface of the pipe of the strength variable member 25 and the entire outer surface of the pipe, so that the temperature of the variable strength member 25 is rapidly reduced. Go. Then, when the temperature of the strength variable member 25 changes below the glass transition temperature, the hardness of the strength variable member 25 is changed from the first state to the second state, and the hardness of the tube body 21 is hard. To change. That is, the tube body 21 that has been placed in the descending colon 74, in the sigmoid colon 73, in the rectum 72, and outside the anus 71 is held in its curved shape.
  • the cooling water supplied to the second gap 29b passes through the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39. And collected in the suction tank 38. That is, the cooling water is continuously supplied from the fluid supply device 30 to the first gap 29 a and the second gap 29 b of the overtube 20.
  • the operator inserts the endoscope insertion portion 11 into the insertion hole 20H from the overtube operation portion 22 side of the overtube 20. Then, the surgeon pushes the endoscope insertion portion 11 and operates it. Then, the endoscope insertion part 11 moves smoothly in the insertion hole 20H toward the distal end side.
  • the distal end portion 14 and the bending portion 15 of the endoscope 10 are led out into the descending colon 74 from the distal end of the tube body 21 as indicated by the solid line in FIG.
  • the surgeon continuously performs the operation of moving the endoscope insertion portion 11 forward, that is, the pushing operation, the twisting operation, and the bending operation while observing the endoscope image displayed on the display device.
  • the endoscope insertion part 11 is inserted toward the back direction of the descending colon 74 with poor mobility.
  • the surgeon visually recognizes the endoscopic image displayed on the display device, and places the distal end portion 14 at the boundary between the descending colon 74 and the movable transverse colon 75 as shown by a two-dot chain line in FIG. It arrange
  • the operator turns on the first switch 5a and turns on the second switch 5b of the foot switch 5 for the purpose of releasing the hold of the curved shape of the tube body 21. Then, a heating signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
  • the fluid control unit 35 Upon receiving the heating signal, the fluid control unit 35 turns on the heating device 32, the liquid feed pump 33, and the suction pump 34. Then, the water stored in the liquid feeding tank 36 is supplied to the supply pipe 37, and is heated to, for example, 40 degrees Celsius by the heating device 32 while passing through the supply pipe 37 to become hot water.
  • the warm water passes through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space 22e, and the first communication hole 22a, and the first gap 29a located on the inner surface side of the strength variable member 25.
  • the hot water supplied to the first gap 29a is supplied to the second gap 29b located on the outer surface side of the strength variable member 25 via the notch 25a.
  • the hot water supplied to the second gap 29b passes through the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39. It is collected in the suction tank 38.
  • the hot water is continuously supplied to the first gap 29a and the second gap 29b, so that the hot water touches the inner surface and the outer surface of the strength variable member 25, so that the temperature of the strength variable member 25 is quickly increased. It rises. Then, when the temperature of the strength variable member 25 changes to the glass transition temperature or higher, the hardness of the strength variable member 25 is changed from the second state to the first state, and the hardness of the tube body 21 is determined in advance. It changes to the state which has the flexibility. That is, the tube body 21 held in the curved shape returns to a state having predetermined flexibility again.
  • the operator turns off the second switch 5b.
  • the tube body 21 is held in a desired flexibility by the body temperature.
  • the surgeon performs a hand operation to advance the predetermined flexible tube body 21 toward the deep portion along the endoscope insertion portion 11 in which the distal end portion 14 is located in the vicinity of the splenic curve 76.
  • the surgeon When the surgeon confirms the image of the distal end portion of the tube body 21 on the screen of the display device, the surgeon performs a pushing operation and a twisting operation of the tube body 21, and the distal end portion of the tube body 21 as shown by a solid line in FIG. Is placed in the transverse colon 75.
  • the first switch 5a of the foot switch 5 is again used for the purpose of maintaining the curved shape of the tube body 21 in the curved shape. Turn on the.
  • the cooling water is supplied in the order of the first gap 29a and the second gap 29b, and within the splenic curve 76, the descending colon 74, the sigmoid colon 73, the rectum 72, and the anus 71.
  • the tube body 21 in the soft state that has been arranged more externally is held in its curved shape.
  • the surgeon performs the pushing operation of the endoscope insertion portion 11 located in the insertion hole 20H. Then, the endoscope insertion portion 11 smoothly moves in the insertion hole 20H and is led out from the distal end of the tube body 21 into the transverse colon 75 as shown by a two-dot chain line in FIG.
  • the surgeon After the derivation, the surgeon performs an operation of moving the endoscope insertion portion 11 forward while observing the endoscope image, so that the endoscope insertion portion 11 is a liver that is a boundary between the transverse colon 75 and the ascending colon 78. It arrange
  • the operator turns off the first switch 5a and turns on the second switch 5b of the foot switch 5 in order to release the curved shape of the tube body 21.
  • the hot water is supplied to the first gap 29a and the second gap 29b, the temperature of the strength varying member 25 starts to rise, and the hardness of the strength varying member 25 is increased from the second state. Change to the first state. That is, the tube body 21 held in the curved shape returns to the desired flexibility again.
  • the operator turns off the second switch 5b. Thereafter, the surgeon moves the tube body 21 forward toward the deep part along the endoscope insertion part 11 in which the distal end portion 14 is positioned in the vicinity of the liver curvature 77 with the flexible tube body 21 determined in advance. I do.
  • the surgeon When the surgeon confirms the image of the distal end portion of the tube body 21 on the screen of the display device, the surgeon performs a pushing operation and a twisting operation of the tube body 21, and ascends the distal end portion of the tube body 21 as shown in FIG. Place in the colon 78.
  • the first switch 5a of the foot switch 5 is again used for the purpose of holding the curved shape of the tube body 21 as it is. Turn on the.
  • the cooling water is supplied in the order of the first gap 29a and the second gap 29b, and in the ascending colon 78, in the liver curve 77, in the transverse colon 75, in the splenic curve 76, and in the descending colon 74.
  • the tube body 21 in a soft state that is disposed inside, inside the sigmoid colon 73, inside the rectum 72, and outside the anus 71 is held in its curved shape.
  • the surgeon performs the pushing operation of the endoscope insertion portion 11 located in the insertion hole 20H. Then, the endoscope insertion portion 11 smoothly moves in the insertion hole 20H and is led out from the distal end of the tube body 21 into the ascending colon 78 as shown in FIG. After the derivation, the surgeon performs an operation of moving the endoscope insertion portion 11 forward, and makes the endoscope insertion portion 11 reach the vicinity of the cecum 79 while observing the endoscope image.
  • the operator turns off the first switch 5a and turns on the second switch 5b to bring the tube body held in the second state in a curved shape into a soft state.
  • the operator confirms that the tube body 21 has changed to the desired flexibility, the operator operates the second switch 5b to turn off the large intestine while pulling back the overtube 20 and the endoscope insertion portion 11. Transition to inspection.
  • the first gap 29a is provided on the tube center side separated from the intestinal wall
  • the second gap 29b is provided on the tube outer peripheral side, which is the intestinal wall side
  • the cooling water is continuously provided in the order of the first gap 29a and the second gap 29b. Supply.
  • the cooling water cooled by the cooling device 31 can be supplied to the strength variable member 25 without being raised due to the influence of body temperature. Accordingly, it is possible to improve the responsiveness by causing the temperature of the strength varying member 25 to be lowered more quickly and changing from the first state to the second state.
  • the cooling device By stopping 31, the strength variable member 25 can be brought to a glass transition temperature or a temperature higher than the melting point by the body temperature, and the tube body 21 can be in a soft state. This ensures that the tube body 21 is removed from the body.
  • the cooling water is collected from the overtube 20 so that the body temperature can be quickly transmitted to the outer surface side of the strength variable member 25 located on the body wall side. .
  • the temperature of the strength varying member 25 starts to rise due to body temperature at the same time as the supply of cooling water is stopped.
  • the tube body in which the endoscope insertion portion 11 is in the second state when performing an inspection in the large intestine, after the distal end portion of the tube body 21 passes through the sigmoid colon of the patient, the tube body in which the endoscope insertion portion 11 is in the second state. It is supposed to be inserted into 21. However, the endoscope insertion part 11 is previously arranged at a predetermined position in the tube body 21, and the endoscope insertion part 11 and the tube body 21 are inserted from the anus 71 in a substantially integrated state, and the rectum 72, You may make it push forward to the sigmoid colon 73.
  • the water sent from the liquid supply tank 36 to the supply pipe 37 is cooled by the cooling device 31 or heated by the heating device 32 in the pipe.
  • a cooling water tank and a hot water tank may be provided, and a cooling device 31 and a heating device 32 may be provided in each tank.
  • the cooling device 31 and the heating device 32 are turned on during the inspection, so that the cooling signal is input to the fluid control unit 35 and the cooling water is supplied at the same time. Hot water can be supplied at the same time as it is input.
  • a plurality of uneven portions may be provided on the tube outer surface and the tube inner surface of the strength variable member 25.
  • the surface area in contact with the cooling water or hot water supplied to the first gap 29a and the second gap 29b is increased.
  • the responsiveness of switching from the first state to the second state or the responsiveness of switching to the opposite state can be further improved.
  • turbulence can be generated in the fluid flowing in the gaps 29a and 29b, and the heat exchange rate between the fluid and the outer surface of the tube and the inner surface of the tube can be increased.
  • the strength variable member 25 may be configured to change temperature uniformly by mixing a filler having high thermal conductivity into the shape memory polymer constituting the variable strength member 25. And by setting the direction of the filler to be mixed in a predetermined direction in advance, the heat conduction on the outer surface side and the inner surface side is improved compared to the thickness direction of the strength variable member 25, and the strength is more efficiently and uniformly. The temperature of the variable member 25 can be changed.
  • the endoscope apparatus 1A of the present embodiment is mainly configured by including an endoscope 10 and a guide member 40 that is a medical device.
  • the endoscope apparatus 1 ⁇ / b> A includes an endoscope 10, a fluid supply device 30, and a foot switch 5 having the same configuration as that of the above-described embodiment.
  • the guide member 40 is inserted into the treatment instrument channel (not shown) from the treatment instrument channel inlet 18 provided in the endoscope operation unit 12 and led out from the distal end opening (not shown) into the body.
  • the guide member 40 includes a guide part 41 as an insertion part and a rigid guide part operation part 42 as a grip part.
  • the guide part 41 is configured to be able to change flexibility.
  • the guide portion operation unit 42 is provided with a first tube base 43a and a second tube base 43b.
  • the first fluid tube 3 extending from the fluid supply device 30 is connected to the first tube base 43a
  • the second fluid tube 4 extending from the fluid supply device 30 is connected to the second tube base 43b.
  • Reference numeral 44 denotes a proximal end cover member.
  • the guide portion 41 includes a tubular variable strength member 45 that also serves as a tube exterior member, and a tubular inner layer tube 46.
  • the inner layer tube 46 is a tube member having predetermined flexibility.
  • the strength variable member 45 changes in strength between the first state and the second state at a predetermined temperature.
  • the strength variable member 45 is a shape memory polymer that has a glass transition temperature set between, for example, 10 degrees Celsius and 55 degrees Celsius, or a thermoplastic that has a melting point that is set between, for example, 10 degrees Celsius and 55 degrees Celsius. It is formed in a cylindrical shape with a resin and a low melting point alloy. That is, in the present embodiment, the distal end side of the strength varying member 45 is closed.
  • the strength variable member 45 is a shape memory polymer whose glass transition temperature is lower than the body temperature, for example, set to 25 degrees Celsius, and is formed with an inner diameter dimension ⁇ d1, a wall thickness t1, and an outer diameter dimension ⁇ D1.
  • the inner layer tube 46 has a through hole 46a serving as a fluid recovery path.
  • the outer diameter of the inner layer tube 46 is smaller than the inner diameter of the variable strength member 45 in advance.
  • the inner layer tube 46 is disposed on the inner surface side of the strength variable member 45.
  • a gap 47 is formed between the tube inner surface of the strength varying member 45 and the tube outer surface of the inner layer tube 46.
  • the gap 47 is a fluid supply path through which the fluid supplied from the fluid supply device 30 is sent.
  • the length of the distal end surface of the inner layer tube 46 is set so as to be spaced from the bottom surface of the distal end portion of the strength variable member 45 by a predetermined dimension.
  • the separation part 48 is a communication part that communicates the fluid supply path and the fluid recovery path. That is, in the present embodiment, the fluid supplied to the gap 47 flows into the through hole 46a side through the separating portion 48 as indicated by an arrow Y10.
  • the guide portion 41 When the strength varying member 45 is in the first state, the guide portion 41 is passively deformed, for example, when it is inserted into the large intestine and its tip abuts against the large intestine wall. And after that, it has the predetermined flexibility which returns to an original shape by cancelling
  • the guide portion 41 has a shape holding force that holds the curved shape in the first state at the time of switching. Then, the shape holding force of the strength varying member 45 in the present embodiment moves the endoscope insertion portion 11 along the guide portion 41 that is derived from the distal end opening of the treatment instrument channel and is held in a curved shape. At this time, the curved shape of the guide portion 41 is not deformed by the moving endoscope insertion portion 11 and is set to hold the curved shape.
  • variable strength member 45 is cylindrical
  • the variable strength member 45 may be tubular, and in that case, one end is closed with, for example, a disc-shaped lid member. And in the structure which provides a cover member, you may make it provide the annular groove for fixing the inner layer tube 46 to a cover member integrally on the one surface side of a cover member.
  • the inner layer tube 46 is provided with a notch having substantially the same configuration as the notch 25a serving as a communication portion.
  • the guide part operation part 42 has, for example, a large diameter part 42c and a small diameter part 42d. Moreover, the guide part operation part 42 is provided with the central through-hole 42h along the central axis. The proximal end portion of the inner layer tube 46 is disposed in the central through hole 42h, and is fixed integrally to the guide portion operation portion 42 by, for example, adhesion. The proximal end side opening of the central through hole 42 h is closed by the proximal end cover member 44.
  • the base end portion of the strength varying member 45 is fitted on the outer peripheral surface of the small diameter portion 42d of the guide portion operation portion 42, and is fixed integrally to the guide portion operation portion 42 by, for example, adhesion.
  • Reference numeral 42a is a communication hole
  • reference numeral 42b is a space portion.
  • the communication hole 42 a communicates the space 42 b and the gap 47.
  • the space portion 42 b is formed by closing the opening of the concave portion formed on the outer peripheral surface side of the large diameter portion 42 c with the lid member 49.
  • the first tube base 43 a is fixed to the lid member 49.
  • the second tube base 43 b is fixed to the base end cover member 44.
  • Reference numeral 44 h is a through hole, and has openings on one side and the other side of the lid member 44.
  • Reference numeral 49h denotes a through hole, which has openings on one side and the other side of the lid member 49.
  • the fluid supply device 30 shown in FIG. 9 includes a cooling device 31, a heating device 32, a liquid feed pump 33, a suction pump 34, and a fluid control unit 35.
  • the foot switch 5 includes, for example, a first switch 5a and a second switch 5b.
  • the fluid control unit 35 Upon receiving the cooling signal, the fluid control unit 35 turns on the cooling device 31 and starts supplying the water stored in the liquid supply tank 36 by the liquid supply pump 33 and is supplied by the suction pump 34. Start collecting water. That is, the water stored in the liquid supply tank 36 is supplied to the supply pipe 37 and cooled to 10 degrees Celsius by the cooling device 31 while passing through the supply pipe 37. The cooling water cooled to 10 degrees Celsius is supplied to the gap 47, which is a fluid supply path, through the first fluid base 6a, the first fluid tube 3, the first tube base 43a, the space portion 42b, and the communication hole 42a. . Then, the cooling water supplied to the gap 47 flows into the through hole 46 a that is a fluid recovery path via the separation portion 48. Thereafter, the cooling water is recovered from the through hole 46 a into the suction tank 38 via the second tube base 43 b, the second fluid tube 4, the second fluid base 6 b, and the recovery conduit 39.
  • the fluid control unit 35 instantaneously switches the liquid feeding pump 33 to the off state.
  • the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. Thereby, the cooling water in the guide member 40 can be reliably collected.
  • the fluid control unit 35 When the fluid control unit 35 receives the heating signal, the fluid control unit 35 turns on the heating device 32 to start the supply of water stored in the liquid supply tank 36 by the liquid supply pump 33 and the supply by the suction pump 34. Start collecting water. That is, the water stored in the liquid supply tank 36 is supplied to the supply pipe 37 and is heated to 40 degrees Celsius by the heating device 32 while passing through the supply pipe 37. The hot water heated to 40 degrees Celsius is supplied to the gap 47 through the first fluid base 6a, the first fluid tube 3, the first tube base 43a, the space portion 42b, and the communication hole 42a. Then, the hot water supplied to the gap 47 flows into the through hole 46 a via the separation portion 48. Thereafter, the hot water is recovered in the suction tank 38 via the second tube base 43 b, the second fluid tube 4, the second fluid base 6 b, and the recovery conduit 39.
  • the fluid control unit 35 instantaneously switches the liquid feed pump 33 to the off state, similarly to the case where the first switch 5a is turned off.
  • the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. This ensures that hot water in the guide member 40 can be collected.
  • the medical staff uses the endoscope 10, the light source device 2, the guide member 40, and the fluid supply device 30 as the endoscope device 1A.
  • a foot switch 5, a display device (not shown), a video processor, and the like are prepared.
  • the medical staff prepares the guide member 40 whose hardness of the guide portion 41 is changed by, for example, 25 degrees Celsius instructed by the operator.
  • the surgeon confirms whether the guide member 40 has instructed. After confirming that the instruction is given, the surgeon operates a setting switch provided on the main panel (not shown) of the fluid supply device 30 to set the temperature of water cooled by the cooling device 31 to, for example, 10 degrees Celsius. The temperature of water heated by the heating device 32 is set to 40 degrees Celsius, for example.
  • the surgeon confirms the hardness of the guide portion 41 of the guide member 40. That is, it is confirmed whether or not the strength varying member 45 is in a soft state. If the surgeon confirms that the guide portion 41 has a predetermined flexibility, a channel opening (not shown) provided on the distal end surface of the distal end portion 14 from the treatment instrument channel inlet 18 to the guide portion distal end portion is provided. Insert it toward. Thereafter, the surgeon guides the guide portion 41 to the outside from the channel opening of a desired length.
  • the surgeon inserts the distal end portion of the guide portion 41 into the large intestine from the patient's anus. Then, a hand operation such as a pushing operation and a twisting operation is performed to push the guide portion 41 toward the deep part of the large intestine. Then, the operator places the distal end portion of the guide portion 41 inserted from the anus 71 in the descending colon 74 on the distal end side from the sigmoid colon 73 as shown in FIG.
  • the surgeon determines that the distal end portion of the guide portion 41 has passed through the sigmoid colon 73, the surgeon holds the first switch 5a of the foot switch 5 for the purpose of holding the curved shape of the guide portion 41 as it is. Turn on. Then, a cooling signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
  • the fluid control unit 30 Upon receiving the cooling signal, the fluid control unit 30 supplies the cooling water via the first fluid base 6a to the strength variable member 45 via the first fluid tube 3, the first tube base 43a, the space part 42b, and the communication hole 42a. It supplies to the clearance 47 located in the pipe inner surface side. Thereafter, the cooling water supplied to the gap 47 flows into the through hole 46a through the separation portion 48, and from the through hole 46a, the second tube base 43b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39. It is collected in the suction tank 38 via That is, the cooling water is continuously supplied from the fluid supply device 30 to the gap 47 of the guide member 40.
  • the cooling water continuously supplied to the gap 47 touches the inner surface of the pipe of the strength varying member 45 and quickly reduces the temperature of the strength varying member 45.
  • the temperature of the strength variable member 45 is changed to the glass transition temperature or lower, the hardness of the strength variable member 45 is changed from the first state to the second state, and the hardness of the guide portion 41 is hard.
  • the guide portion 41 in a soft state that is disposed in the descending colon 74, the sigmoid colon 73, the rectum 72, and the anus 71 is held in its curved shape.
  • the surgeon moves the endoscope insertion portion 11 along the guide portion 41 in a hard state. That is, as shown by a broken line in FIG. 11, the distal end portion 14 of the endoscope insertion portion 11 is inserted into the rectum 72 from the anus 71, and then a hand operation such as a pushing operation and a twisting operation is performed to insert the endoscope.
  • the part 11 is introduced into the descending colon 74 along the hard guide part 41 as shown by the solid line in FIG.
  • the surgeon further inserts the endoscope insertion portion 11 toward the back of the descending colon 74 having poor mobility while observing the endoscope image displayed on the display device. Then, the surgeon visually recognizes the endoscopic image displayed on the display device and arranges the distal end portion 14 at a desired position in the vicinity of the splenic curve 76 as indicated by a two-dot chain line in FIG.
  • the surgeon turns off the first switch 5a and turns on the second switch 5b of the foot switch 5 for the purpose of releasing the curved shape of the guide portion 41. Then, a heating signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
  • the fluid control unit 35 Upon receiving the heating signal, the fluid control unit 35 supplies the hot water via the first fluid base 6a to the pipe of the variable strength member 45 via the first fluid tube 3, the first tube base 43a, the space 42b, and the communication hole 42a. It supplies to the clearance gap 47 located in the surface side. Thereafter, the hot water supplied to the gap 47 flows into the through hole 46a through the separation portion 48, and passes through the second tube cap 43b, the second fluid tube 4, the second fluid cap 6b, and the recovery conduit 39 from the through hole 46a. Through the suction tank 38.
  • the hot water continuously supplied to the gap 47 touches the inner surface of the strength variable member 45 and quickly raises the temperature of the strength variable member 45. Then, when the temperature of the strength variable member 45 changes to the glass transition temperature or higher, the hardness of the strength variable member 45 is changed from the second state to the first state, and the hardness of the guide portion 41 is set in advance. It changes to the defined flexibility. That is, the guide part 41 held in the curved shape returns to the desired flexibility state again.
  • the operator turns off the second switch 5b.
  • the guide portion 41 is held in a desired flexibility by the body temperature. Thereafter, the surgeon further pushes the predetermined flexible guide portion 41 toward the opening of the treatment instrument channel.
  • the distal end portion of the guide portion 41 is led out into the transverse colon 75 from the distal end portion 14 of the endoscope. If the surgeon visually recognizes that the distal end portion of the guide portion 41 is disposed at a desired position of the transverse colon 75 in the endoscopic image, the transverse portion of the transverse colon 75 and the guide portion 41 disposed in the treatment instrument channel are displayed.
  • the first switch 5a of the foot switch 5 is turned on again for the purpose of maintaining the curved shape as it is.
  • the cooling water is supplied to the gap 47, and the guide portion 41 in the soft state that has been arranged in the transverse colon 75, the treatment instrument channel, and the treatment instrument channel inlet 18 is provided. It is held in its curved shape.
  • the surgeon performs a pushing operation or a twisting operation of the endoscope insertion portion 11 to introduce the endoscope insertion portion 11 into the transverse colon 75 along the guide portion 41 in a hard state.
  • the surgeon performs an operation of advancing the endoscope insertion portion 11 while observing the endoscope image, so that the endoscope insertion portion 11 is hepatic curved 77 as indicated by a two-dot chain line in FIG. Place it at a desired position in the vicinity.
  • the surgeon stops the insertion of the endoscope insertion portion 11. Then, the operator turns off the first switch 5a and turns on the second switch 5b of the foot switch 5 for the purpose of releasing the curved shape of the guide portion 41.
  • the hot water is supplied to the gap 47, the hardness of the strength varying member 45 changes from the second state to the first state, and the guide portion 41 can be preset again. Return to flexibility.
  • the operator turns off the second switch 5b, and further pushes the guide portion 41, which has changed to a predetermined flexibility, toward the opening of the treatment instrument channel.
  • the distal end portion of the guide portion 41 is led into the ascending colon 78 as shown by the solid line in FIG.
  • the first switch 5a of the foot switch 5 is again used for the purpose of holding the curved shape of the guide portion 41 in the curved shape.
  • the cooling water is supplied to the gap 47 and is in a soft state in which the cooling water is disposed in the ascending colon 78, the transverse colon 75, the treatment instrument channel, and the treatment instrument channel inlet 18.
  • the guide portion 41 is held in its curved shape.
  • the surgeon performs a pushing operation or a twisting operation of the endoscope insertion portion 11 to introduce the endoscope insertion portion 11 into the ascending colon 78 along the guide portion 41 in a hard state.
  • the surgeon performs an operation of moving the endoscope insertion portion 11 forward while observing the endoscope image, so that the endoscope insertion portion 11 reaches the vicinity of the cecum 79.
  • the operator turns off the first switch 5a and turns on the second switch 5b to bring the guide portion 41 held in the curved shape into a soft state.
  • the operator turns off the second switch 5b to remove the guide member 40 from the treatment instrument channel. Then, after the guide member 40 is removed, the procedure shifts to an inspection of the large intestine performed while pulling back the endoscope insertion portion 11.
  • the outer diameter dimension of the strength variable member 45 is set to the maximum outer diameter dimension permitted by the guide section 41 by arranging the strength variable member 45 on the outermost peripheral side of the guide section 41.
  • the maximum holding strength can be obtained.
  • the distal end portion of the guide portion 41 when performing an inspection in the large intestine, the distal end portion of the guide portion 41 is disposed in advance at a position where the patient's sigmoid colon 73 has passed, and then the endoscopic view is performed.
  • the mirror insertion part 11 is inserted into the large intestine along the guide part 41 which is in a hard state.
  • the guide part 41 in a soft state is disposed in the treatment instrument channel of the endoscope insertion part 11, and the endoscope insertion part 11 and the guide part 41 are inserted into the rectum 72 from the anus 71 together.
  • the guide portion 41 is led out from the distal end portion 14 and the guide portion 41 is switched to the second state or the first state so that the endoscope insertion portion 11 passes through the sigmoid colon 73. May be.
  • the hardness of the guide portion 41 is set to be hard, and the endoscope insertion portion 11 is set along the guide portion 41 in the second state. It may be inserted toward the deep part of the large intestine.
  • strength variable member 45 which comprises the guide part 41 is aimed at the improvement of the responsiveness which changes from a soft state to a hard state, or the reverse state.
  • a member having high thermal conductivity may be disposed on the surface, or a member having high thermal conductivity may be disposed on the outer surface and the inner surface of the strength variable member 25 constituting the tube body 21.
  • a high heat conductive member a silicon sheet, a graphite sheet, a PGS graphite sheet, a mesh tube knitted in a mesh shape, or grease is used.
  • the silicon sheet, the graphite sheet, or the PGS graphite sheet having a band shape is spirally wound and disposed. Thereby, the responsiveness can be improved without impairing the flexibility of the guide portion 41 and the tube body 21.
  • the endoscope insertion portion 11 is moved toward the deep portion of the large intestine along the guide portion 41.
  • the endoscope insertion portion 11 in the insertion hole 20H of the tube body 21 is moved toward the distal end of the tube body 21 while the cooling water is supplied to bring the tube body 21 into the second state.
  • the guide surface 41 is heated at the outer surface side of the strength varying member 45 by the body temperature or room temperature, and the temperature of the cooling water rises. There is a risk.
  • the distal end portion 14 of the endoscope insertion portion 11 in which the insertion portion insertion tube 26 is disposed in the insertion hole 20H there is a risk that the temperature of the cooling water may be increased by heat generated from the imaging device provided in the window or heat generated from the illumination window, and the temperature of the cooling water may be increased by heating the tube exterior member 27 at the body temperature or room temperature. May rise.
  • a heat insulating part is provided in at least one of the outer peripheral surface or inner peripheral surface of the insertion part insertion pipe 26. Accordingly, it is possible to prevent body temperature and room temperature from being transmitted to the second gap 29b side via the tube exterior member 27. In addition, it is possible to prevent the heat generated from the imaging device or the illumination window from being transmitted to the first gap 29a via the insertion portion insertion tube 26.
  • a heat insulating portion is provided on at least one of the tube outer surface and the tube inner surface of the strength varying member 45. Accordingly, it is possible to prevent body temperature and room temperature from being transmitted to the gap 47 via the strength varying member 45.
  • the heat insulation part mentioned above is a heat insulation sheet, for example, a strip
  • a heat insulating part can be provided without impairing the flexibility of the guide part 41 and the tube body 21.
  • the endoscope apparatus 1 ⁇ / b> B of the present embodiment is mainly configured by including an endoscope 10, an overtube 20 that is a medical device, and a shape holding member 50.
  • the endoscope apparatus 1B includes fluid supply apparatuses 30B1 and 30B2 and foot switches 5B1 and 5B2 having the same configuration as that of the above-described embodiment.
  • the shape holding member 50 is an elongated rod-shaped member. The shape holding member 50 is inserted into a treatment instrument channel (not shown) from a treatment instrument channel inlet 18 provided in the endoscope operation unit 12 and is disposed at a predetermined position.
  • the shape holding member 50 includes a shape holding main body 51 that is an insertion portion that can change flexibility, and a shape holding operation portion 52 having rigidity that is a gripping portion.
  • the shape holding body 51 of the present embodiment is configured by a solid strength variable member. That is, the shape-maintaining body 51 is a shape memory polymer whose glass transition temperature is lower than the body temperature, for example, 25 degrees Celsius, and has an outer diameter dimension that is smaller than the inner diameter of the treatment instrument channel. One end of the shape holding body 51 is fixed to the shape holding operation unit 52.
  • a plug body with a tube cap (hereinafter abbreviated as a plug body) 53 is attached to the treatment instrument channel inlet 18 of the present embodiment.
  • the plug 53 includes a plug base 54 to which the first fluid tube 3B extending from the second fluid supply device 30B2 is connected. For example, water supplied from the first fluid tube 3B to the plug base 54 is supplied into the treatment instrument channel.
  • a communication part with a tube cap (hereinafter abbreviated as a communication part) 55 is attached to the overtube operation part 22 of the overtube 20 of the present embodiment.
  • the communication portion 55 includes a communication portion base 56 and a side hole 57.
  • a second fluid tube 4B extending from the second fluid supply device 30B2 is connected to the base 56.
  • the configuration of the first fluid supply device 30B1 and the configuration of the second fluid supply device 30B2 are the same as the configuration of the fluid supply device 30 described above, and the configuration of the first foot switch 5B1 and the configuration of the second foot switch 5B2 are the same.
  • the configuration of the foot switch 5 is the same as that described above.
  • the first fluid tube 3 ⁇ / b> B has the same configuration as the first fluid tube 3
  • the second fluid tube 4 ⁇ / b> B has the same configuration as the second fluid tube 4.
  • Other configurations are the same as those of the above-described embodiment, and the same members are denoted by the same reference numerals and description thereof is omitted.
  • the operation of the endoscope apparatus 1B configured as described above will be described.
  • the endoscope apparatus 1B is used when the endoscope insertion portion 11 is inserted, for example, to the vicinity of the cecum to perform inspection in the large intestine.
  • the endoscope apparatus 1B includes an endoscope 10, a light source device 2, an overtube 20, a shape holding member 50, fluid supply devices 30B1, 30B2, foot switches 5B1, 5B2, a display device (not shown), a video processor, and the like.
  • the operator places the shape holding member 50 in a soft state in a desired state in the treatment instrument channel of the endoscope insertion portion 11 in advance.
  • the surgeon inserts the shape holding main body 51 into the treatment instrument channel through a plug hole (not shown) of the plug 53 and brings the end surface of the shape holding operation portion 52 into contact with the plug 53.
  • the plug hole is closely attached to the outer peripheral surface of the shape-maintaining main body 51, and the distal end of the shape-maintaining main body 51 is located, for example, on the distal end side of the bending portion 15.
  • the surgeon operates a setting switch provided on a main panel (not shown) of the fluid supply devices 30B1 and 30B2, and the temperature of water cooled by the cooling device 31 provided in each fluid supply device 30B1 and 30B2. Is set to 10 degrees Celsius, for example, and the temperature of the water heated by the heating device 32 is set to 40 degrees Celsius, for example.
  • the surgeon first confirms that the hardness of the tube body 21 of the overtube 20 is a predetermined flexibility. Thereafter, the surgeon inserts the distal end portion of the tube body 21 into the large intestine from the patient's anus and places the distal end portion of the tube body 21 on the distal side of the sigmoid colon 73 as indicated by the two-dot chain line in FIG. In the descending colon 74.
  • the first switch of the first foot switch 5B1 is used for the purpose of maintaining the curved shape of the tube body 21 as it is. Turn on 5a.
  • the cooling water cooled by the first fluid supply device 30B1 is supplied from the first fluid base 6a to the first gap 29a and the second gap 29b of the tube body 21.
  • the strength varying member 25 is quickly cooled by the cooling water, and the tube body 21 arranged in the descending colon 74, the sigmoid colon 73, the rectum 72, and the outside of the anus 71 is held in a curved shape. Is done.
  • the endoscope When the operator confirms that the tube body 21 has changed to a hard state, the endoscope is inserted in which the shape-maintaining body 51 is disposed in the treatment instrument channel from the overtube operation portion 22 side into the insertion hole 20H. Insert part 11. Then, the surgeon advances the distal end portion 14 of the endoscope insertion portion 11 toward the distal end of the tube body 21.
  • the distal end portion 14 and the bending portion 15 of the endoscope insertion portion 11 are led out into the descending colon 74 in order from the distal end of the tube body 21.
  • the surgeon performs an operation of inserting the endoscope insertion unit 11 into the deep part of the large intestine while observing the endoscope image displayed on the display device. Then, as shown by a two-dot chain line in FIG. 16, the distal end portion 14 is arranged at a desired position in the vicinity of the splenic curve 76.
  • the surgeon holds the curved shape of the endoscope insertion portion 11 as it is, that is, holds the curved shape of the shape holding body 51 in the treatment instrument channel as it is.
  • the first switch 5a of the second foot switch 5B2 is turned on. Then, a cooling signal is transmitted from the second foot switch 5B2 to the second fluid supply device 30B2.
  • the second fluid supply device 30B2 Upon receiving the cooling signal, the second fluid supply device 30B2 supplies the cooling water into the treatment instrument channel via the first fluid tube 3B and the plug base 54. In this state, since the outer peripheral surface of the shape holding body 51 is in close contact with the plug hole, the cooling water is not leaked to the outside through the plug hole, and the inner peripheral surface of the treatment instrument channel and the shape holding body. It is supplied toward the channel opening through a gap with the outer peripheral surface of 51.
  • the cooling water toward the channel opening touches the outer surface of the shape holding body 51 made of a variable strength member, whereby the shape holding body 51 is quickly cooled.
  • the hardness of the guide portion 41 arranged in the treatment instrument channel of the endoscope insertion portion 11 and outside the treatment instrument channel inlet 18 (not shown) changes to a hard state. .
  • the curved shape of the endoscope insertion portion 11 is held by the shape holding main body 51 disposed in the treatment instrument channel.
  • the surgeon turns off the first switch 5a of the first foot switch 5B1 and turns on the second switch 5b for the purpose of changing the tube body 21 from a hard state to a soft state.
  • a heating signal is transmitted from the first foot switch 5B1 to the first fluid supply device 30B1, and hot water is supplied to the first gap 29a and the second gap 29b of the tube body 21.
  • the temperature of the strength varying member 25 of the tube body 21 rises, and the tube body 21 held in the curved shape returns to the predetermined flexibility again.
  • the operator When the operator confirms the flexibility of the tube body 21, the operator performs a hand operation to advance the tube body 21 along the endoscope insertion portion 11 in which the distal end portion 14 is located in the vicinity of the splenic curve 76. At this time, the tube body 21 moves smoothly along the endoscope insertion portion 11 in which the shape holding body 51 disposed in the treatment instrument channel is in the second state and is in a hard state.
  • the surgeon When the surgeon confirms the image of the distal end portion of the tube body 21 on the screen of the display device, the surgeon performs a pushing operation and a twisting operation of the tube body 21, and the distal end portion of the tube body 21 as shown in FIG. Is placed in the transverse colon 75.
  • the cooling water that has flowed out of the channel opening into the body is collected through a gap between the outer peripheral surface of the endoscope insertion portion 11 and the inner peripheral surface of the insertion hole 20H.
  • the first foot switch 5B1 of the first foot switch 5B1 is again used for the purpose of holding the curved shape of the tube body 21 as it is.
  • the switch 5a is turned on.
  • the cooling water is supplied from the first fluid supply device 30B1 to the first gap 29a and the second gap 29b, and in the transverse colon 75, in the splenic curve 76, in the descending colon 74, and in the sigmoid colon.
  • the tube body 21 arranged outside 73, inside the rectum 72, and outside the anus 71 remains in a curved shape and changes to a hard state.
  • the surgeon also has the first switch 5a of the second foot switch 5B2 for the purpose of releasing the holding of the curved shape of the endoscope insertion portion 11, that is, for the purpose of returning the shape holding body 51 to a flexible state. Is turned off and the second switch 5b is turned on.
  • the hot water supplied from the second fluid supply device 30B2 flows toward the channel opening through the gap between the treatment instrument channel and the shape holding body 51. Then, the temperature of the shape holding body 51 rises, and the shape holding body held in the second state in the curved state returns to the predetermined flexibility again, so that the endoscope insertion portion 11 is flexible. It becomes the state which has sex.
  • the warm water does not flow into the body and the outer peripheral surface of the endoscope insertion portion 11 and the insertion hole 20 ⁇ / b> H. It is collected through a gap with the inner peripheral surface.
  • the surgeon turns off the second switch 5b after confirming that the shape-maintaining body 51 is in the first state. Then, the operator performs an operation of moving the endoscope insertion portion 11 located in the insertion hole 20H to the distal end side of the tube body 21. Then, the endoscope insertion portion 11 is moved to the distal opening side of the insertion hole 20H and is led out from the distal end of the tube body 21 into the transverse colon 75. Thereafter, the operator arranges the endoscope insertion portion 11 at a desired position in the vicinity of the liver curve 77 as shown by a two-dot chain line in FIG. 17 while observing the endoscope image.
  • the operator turns on the first switch 5a of the second foot switch 5B2 again for the purpose of holding the curved shape of the endoscope insertion portion 11 in the curved shape.
  • the cooling water flows in the treatment instrument channel toward the channel opening, thereby cooling the shape-maintaining body 51, and in the liver curvature 77, in the transverse colon 75, in the treatment instrument channel, and
  • the shape-maintaining main body 51 in the first state that is disposed outside the treatment instrument channel inlet 18 is held in the second state with its curved shape. That is, again, the curved shape of the endoscope insertion portion 11 in the large intestine is held in a hard state by the shape holding body 51.
  • the operator turns off the first switch 5a of the first foot switch 5B1 and turns on the second switch 5b for the purpose of returning the tube body 21 from the hard state to the soft state. Then, hot water is supplied from the first fluid supply device 30B1 to the first gap 29a and the second gap 29b, and the tube body 21 returns to the predetermined flexibility again.
  • the surgeon performs a hand operation to advance the flexible tube body 21 along the endoscope insertion portion 11 in which the curved shape is held in a hard state by the shape-maintaining body 51, and FIG.
  • the distal end of the tube body 21 is placed in the ascending colon 78 as shown in FIG.
  • the operator turns on the first switch 5a of the first foot switch 5B1 for the purpose of holding the curved shape of the tube body 21 in the curved shape.
  • the cooling water is supplied from the first fluid supply device 30B1 to the first gap 29a and the second gap 29b, and the strength varying member 25 is cooled, so that the inside of the ascending colon 78 and the liver curve 77 In the transverse colon 75, in the splenic curve 76, in the descending colon 74, in the sigmoid colon 73, in the rectum 72, and outside the anus 71, the tube body 21 remains in a curved shape and changes to a hard state. .
  • the surgeon releases the holding of the curved shape of the endoscope insertion portion 11. That is, for the purpose of returning the shape-maintaining body 51 to the first state, the first switch 5a of the second foot switch 5B2 is turned off and the second switch 5b is turned on. Then, the temperature of the shape-maintaining main body 51 is increased by the hot water supplied from the second fluid supply device 30B2, and the shape-maintaining main body 51 that has been held in the second state in the curved state is again predetermined flexibility. By returning to, the endoscope insertion portion 11 becomes flexible.
  • the surgeon performs an operation of pushing the endoscope insertion portion 11 located in the insertion hole 20H, and moves the endoscope insertion portion 11 from the distal end of the tube body 21 to the ascending colon 78 as shown in FIG. Let it be derived. After the derivation, the surgeon performs an operation of moving the endoscope insertion portion 11 forward while observing the endoscope image, so that the endoscope insertion portion 11 reaches the vicinity of the cecum 79.
  • the operator turns off the first switch 5a of the first foot switch 5B1 and turns on the second switch 5b to bring the tube body 21 held in the curved shape into a soft state.
  • the surgeon removes the shape holding body 51 from the treatment instrument channel. Then, the surgeon shifts to an inspection of the large intestine performed while pulling back the overtube 20 and the endoscope insertion portion 11.
  • the shape holding main body 51 is arranged in the treatment instrument channel of the endoscope 10 and the cooling water or the hot water is supplied into the treatment instrument channel.
  • the state is changed to the first state or the second state. This makes it possible to change the endoscope insertion portion 11 in which the shape-maintaining main body 51 is disposed in the treatment instrument channel between a predetermined flexible state and a hard state that maintains a curved shape.
  • the shape-maintaining main body 51 by configuring the shape-maintaining main body 51 with a solid strength variable member, it is possible to obtain higher strength than a tubular member having the same diameter. According to this configuration, the tube body 21 of the overtube 20 is moved along the endoscope insertion portion 11 by setting the shape-maintaining body 51 disposed in the treatment instrument channel to the second state in which the curved shape is maintained. Therefore, it becomes possible to insert it deeply.
  • the cooling water that has flowed into the body is collected through the gap between the outer peripheral surface of the endoscope insertion portion 11 and the inner peripheral surface of the insertion hole 20H.
  • a plurality of grooves extending in the longitudinal axis direction may be formed on the outer periphery of the shape maintaining body 51.
  • the shape holding body 51 of the shape holding member 50 is inserted and disposed in the treatment instrument channel provided in the endoscope insertion portion 11, and cooling water or hot water is supplied into the treatment instrument channel.
  • the configuration is shown.
  • the endoscope 10, the overtube 20, the guide member 40, the light source device 2, the first fluid supply device 30B1, the second fluid supply device 30B2, the first foot switch 5B1, the second An endoscope apparatus 1C including the foot switch 5B2, a display device (not shown), a video processor, and the like may be configured, and the guide portion 41 of the guide member 40 may be used as the shape maintaining body 51.
  • a gap formed by two members is used as a fluid supply path and a fluid recovery path.
  • a belt-shaped member 63 having a rectangular cross-sectional shape including two through holes 61 and 62 serving as a fluid supply path and a fluid recovery path is spirally wound to form a fluid path forming member 60.
  • the fluid path forming member 60 may be arranged on the inner surface side of the strength variable members 25 and 45 indicated by a two-dot chain line. According to this configuration, it is possible to prevent buckling by securing the strength in the longitudinal axis direction without impairing the flexibility of the tubular strength variable members 25 and 45.
  • variable strength members 25 and 45 may be provided with a plurality of fluid supply paths and fluid recovery paths. Specifically, for example, a plurality of sets of fluid supply holes 25c and fluid recovery holes 25d are provided in the meat portion 25b of the strength varying member 25 in FIG. The fluid supply holes 25c and the fluid recovery holes 25d are alternately arranged. According to this configuration, the temperature change of the strength variable member 25 can be performed more evenly.
  • the fluid supply hole 25c and the fluid recovery hole 25d communicate with each other through a communication portion (not shown) provided on the distal end side of the strength varying member 25.
  • the glass transition temperature is set to 25 degree
  • the glass transition temperature may be set within a predetermined range based on the body temperature.
  • the strength variable member is set to the first state at body temperature (for example, 36 degrees Celsius), and the second state is obtained by cooling the strength variable member with, for example, cooling water at 16 degrees Celsius, or the body temperature (for example, 36 degrees Celsius).
  • the strength variable member may be set to the second state, and the first state may be obtained by warming the strength variable member with, for example, hot water of 51 degrees Celsius. According to this configuration, it becomes possible to easily change the temperature of the shape memory polymer by reducing the difference between the environmental temperature and the glass transition temperature.

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Abstract

An insertion section in a medical device which is provided so as to be moveable relative to the length-wise axial-direction of an endoscope insertion section is equipped with: a tubular variable-strength member, the strength of which alters between a first state and a second state at a pre-determined temperature; a fluid supply path which brings fluid, at a temperature which is higher than the pre-determined temperature which changes the variable-strength member to the first state, or fluid, at a temperature which is lower than the pre-determined temperature which changes the variable-strength member to the second state, into contact with the tube-surface of the variable-strength member and supplies the fluid; a fluid collection path which collects the fluid supplied via the fluid supply path; and a connection unit which is provided in the tip-side of the variable-strength member and which connects the fluid collecting path and the fluid supply path.

Description

医療機器及び内視鏡装置Medical equipment and endoscope device
　本発明は、腸等の管腔に挿入される挿入部の強度が変化可能な医療機器、及びその医療機器を備える内視鏡装置に関する。 The present invention relates to a medical device capable of changing the strength of an insertion portion to be inserted into a lumen such as an intestine, and an endoscope apparatus including the medical device.
　腸等の管腔内に細長の挿入部を挿入して観察を行え、必要に応じて処置具チャンネル内に処置具を挿通して各種治療、処置を行える内視鏡が実用化されている。一般的に、内視鏡の細長な挿入部の先端側には、上下方向、及び左右方向に湾曲するように構成された湾曲部が備えられている。湾曲部は、手元側の操作部に設けられている操作部材の操作に伴って湾曲動作する構成になっている。 Endoscopes have been put to practical use in which an elongated insertion part can be inserted into a lumen such as the intestine for observation, and various treatments and treatments can be performed by inserting the treatment tool into the treatment tool channel as necessary. In general, a distal end side of an elongated insertion portion of an endoscope is provided with a bending portion configured to bend in the vertical direction and the horizontal direction. The bending portion is configured to bend in accordance with operation of an operation member provided in the operation portion on the hand side.
　上述のように構成された内視鏡の挿入部は、例えば肛門を介して大腸の深部に向けて挿入される。その際、術者は、体外に位置する挿入部に対して捻り操作、或いは前進させるための送り操作等を行うとともに、操作部に設けられた操作部材を操作して湾曲部を適宜湾曲させる。 The insertion part of the endoscope configured as described above is inserted toward the deep part of the large intestine through the anus, for example. At that time, the surgeon performs a twisting operation or a feeding operation for advancing the insertion portion positioned outside the body, and operates an operation member provided in the operation portion to appropriately bend the bending portion.
　しかし、挿入部の捻り操作、或いは送り操作と、操作部材の操作とを組み合わせ行って、挿入部を大腸の深部まで円滑に、且つ短時間で挿入することができるようになるまでには熟練を要する。このため、経験の浅い医師でも、挿入部を大腸の深部まで円滑に、且つ短時間で挿入することができるように様々な手技、装置が提案されており、例えばオーバーチューブを用いる手技、ガイドワイヤーを用いる手技が知られている。 However, skill is required until the insertion portion can be inserted into the deep part of the large intestine smoothly and in a short time by combining the twisting operation or feeding operation of the insertion portion and the operation of the operation member. Cost. For this reason, various procedures and devices have been proposed so that even inexperienced doctors can insert the insertion part smoothly into the deep part of the large intestine in a short time. For example, a technique using an overtube, a guide wire, etc. Techniques using are known.
　オーバーチューブを用いる手技では、可撓性を有する管状のオーバーチューブを予めＳ状結腸に配置し、その後、オーバーチューブの貫通孔内に挿入部を挿入して、この挿入部を大腸の深部に向けて挿入する。一方、ガイドワイヤーを用いる手技では、予めガイドワイヤーを大腸内の目的部位まで挿通させ、その後、内視鏡の観察窓を通して大腸内のガイドワイヤーを観察しつつ、挿入部を大腸の深部に向けて挿入する。 In the procedure using an overtube, a flexible tubular overtube is placed in the sigmoid colon in advance, and then the insertion portion is inserted into the through-hole of the overtube, and this insertion portion is directed to the deep portion of the large intestine. Insert. On the other hand, in the procedure using a guide wire, the guide wire is inserted in advance to a target site in the large intestine, and then the guide wire in the large intestine is observed through the observation window of the endoscope while the insertion portion is directed to the deep portion of the large intestine insert.
　しかし、オーバーチューブをＳ状結腸等の屈曲部に配置する手技においては、オーバーチューブの可撓性が挿入部の可撓性に比べて軟らかな場合、以下の不具合が生じる。即ち、術者が、オーバーチューブの貫通孔内に挿入部を挿入してこの挿入部を大腸深部に向けて押し込み操作した際、Ｓ状結腸に沿って湾曲していたオーバーチューブが押し込まれていく挿入部によって直線化される不具合が生じる。この不具合を解消するためには、オーバーチューブの可撓性を挿入部の可撓性に比べて硬く設定することが望ましい。そして、オーバーチューブの可撓性を硬く設定した場合、挿入部を湾曲形状のオーバーチューブの貫通孔に沿わせて挿入することが可能になるが、オーバーチューブの可撓性を硬く設定することにより、オーバーチューブを例えばＳ状結腸等の屈曲部に配置することが困難になる。 However, in the procedure of placing the overtube at the bent portion such as the sigmoid colon, the following problems occur when the flexibility of the overtube is softer than the flexibility of the insertion portion. That is, when the surgeon inserts the insertion portion into the through-hole of the overtube and pushes the insertion portion toward the deep portion of the large intestine, the overtube that has been curved along the sigmoid colon is pushed in. There arises a problem of being straightened by the insertion portion. In order to eliminate this problem, it is desirable to set the flexibility of the overtube harder than the flexibility of the insertion portion. And when the flexibility of the overtube is set hard, it becomes possible to insert the insertion portion along the through-hole of the curved overtube, but by setting the flexibility of the overtube hard It becomes difficult to arrange the overtube at a bent portion such as the sigmoid colon.
　一方、ガイドワイヤーを観察しつつ、挿入部を大腸の深部に向けて挿入する手技においては、ガイドワイヤーを観察することによって進行方向を判断することは可能になる。しかし、経験の浅い医師にとっては、挿入部をガイドワイヤーに沿わせて大腸の深部に向けて挿入することは、難しい操作である。 On the other hand, in the procedure of inserting the insertion portion toward the deep part of the large intestine while observing the guide wire, it is possible to determine the traveling direction by observing the guide wire. However, it is a difficult operation for an inexperienced doctor to insert the insertion portion along the guide wire toward the deep portion of the large intestine.
　なお、ガイドワイヤーについても硬度を硬く設定することによって、ガイドワイヤーに沿わせて挿入部を深部に向けて挿入することが可能になるが、ガイドワイヤーの硬度を硬く設定することによって、大腸内の目的部位までガイドワイヤーを予め挿通させておくことが困難になる。 In addition, by setting the hardness of the guide wire to be hard, it is possible to insert the insertion portion toward the deep portion along the guide wire. However, by setting the hardness of the guide wire to be hard, It becomes difficult to insert the guide wire in advance to the target site.
　例えば、日本国特表２００７－５０００３７号公報（以下、特許文献１と記載する）には、強度を操作可能なカテーテルが示されている。このカテーテルは、通常軟質であるとともに可撓性を有するため、押圧力の伝達に難点があるという不具合を解決するものである。前記カテーテルは、一箇所以上において、所望の箇所を冷却および加熱することにより変化させることのできる剛性を備える内側シャフトを有している。 For example, Japanese National Patent Publication No. 2007-500037 (hereinafter referred to as Patent Document 1) shows a catheter whose strength can be manipulated. Since this catheter is usually soft and flexible, it solves the problem that it is difficult to transmit the pressing force. The catheter has an inner shaft with rigidity that can be changed by cooling and heating a desired location at one or more locations.
　しかしながら、特許文献１のカテーテルでは、内側シャフトの強度を変化させるための加熱された流体または冷却された流体を供給する流体輸送ルーメンを１本以上、内側シャフトを構成する外層の内側または外側に設ける構成である。このため、流体輸送ルーメンが１本の場合、流体輸送ルーメンに流体を供給してから内側シャフトの強度が変化するまでに時間が掛かるという問題が生じる。一方、応答性を向上させるため、外層の内側全周または外側全周に流体輸送ルーメンを設けた場合、流体輸送ルーメンの数が増大することによって、構成が煩雑になると共に、カテーテルの柔軟性が損なわれるおそれが生じる。 However, in the catheter of Patent Document 1, one or more fluid transport lumens for supplying heated or cooled fluid for changing the strength of the inner shaft are provided inside or outside the outer layer constituting the inner shaft. It is a configuration. For this reason, when there is one fluid transport lumen, there is a problem that it takes time until the strength of the inner shaft changes after the fluid is supplied to the fluid transport lumen. On the other hand, in order to improve responsiveness, when a fluid transport lumen is provided on the entire inner periphery or outer periphery of the outer layer, the number of fluid transport lumens increases, so that the configuration becomes complicated and the flexibility of the catheter is increased. There is a risk of damage.
　本発明は上記事情に鑑みてなされたものであり、加熱された流体または冷却された流体を速やかに供給することによって挿入部の硬度が変化する、応答性に優れた挿入部を備える医療機器を提供することを目的にしている。 The present invention has been made in view of the above circumstances, and a medical device including an insertion portion with excellent responsiveness, in which the hardness of the insertion portion changes by rapidly supplying a heated fluid or a cooled fluid. The purpose is to provide.
　本発明の一態様の医療機器は、内視鏡挿入部の長手軸方向に対して相対的に移動可能に設けられる挿入部を有する医療機器であって、前記挿入部は、予め定めた温度を境に強度が第１の状態と第２の状態とに変化する管状の強度可変部材と、前記強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を、前記強度可変部材の管表面に接触させて供給する流体供給路と、前記流体供給路を介して供給された流体を回収する流体回収路と、前記強度可変部材の先端側に設けられ、前記流体回収路と前記流体供給路とを連通する連通部と、を具備して構成されている。 The medical device of one embodiment of the present invention is a medical device having an insertion portion that is provided so as to be relatively movable with respect to the longitudinal axis direction of the endoscope insertion portion, and the insertion portion has a predetermined temperature. A tubular strength variable member whose strength changes between the first state and the second state at the boundary; and a fluid having a temperature higher than the predetermined temperature that changes the strength variable member to the first state; or A fluid supply path for supplying a fluid having a temperature lower than the predetermined temperature for changing the strength variable member to the second state in contact with a pipe surface of the variable strength member, and supplying the fluid through the fluid supply path A fluid recovery path for recovering the fluid, and a communication portion provided on the distal end side of the strength varying member and communicating the fluid recovery path and the fluid supply path.
　本発明の他の態様の内視鏡装置は、内視鏡挿入部を備える内視鏡と、体内に挿入される挿入部に前記内視鏡挿入部が挿通される長手軸方向の挿入孔を有し、予め定めた温度を境に強度が第１の状態と第２の状態とに変化する管状の強度可変部材を有するオーバーチューブと、前記オーバーチューブの強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を供給する流体供給装置と、を具備し、前記オーバーチューブの挿入部は、前記強度可変部材の管内表面側に設けられ、該管内表面との間に前記流体供給路を構成する管外表面および前記挿入孔を構成する貫通孔を有する第１チューブ部材と、前記強度可変部材の管外表面側に設けられ、該管外表面との間に前記流体回収路を構成する管内表面を有する第２チューブ部材と、を具備している。 An endoscope apparatus according to another aspect of the present invention includes an endoscope having an endoscope insertion portion, and a longitudinal insertion hole through which the endoscope insertion portion is inserted into an insertion portion to be inserted into the body. An overtube having a tubular strength variable member whose strength changes between a first state and a second state at a predetermined temperature, and the strength change member of the overtube in the first state. A fluid supply device for supplying a fluid having a temperature higher than the predetermined temperature to be changed or a fluid having a temperature lower than the predetermined temperature for changing the strength variable member to the second state, and The insertion portion of the overtube is provided on the tube inner surface side of the strength varying member, and has a tube outer surface that constitutes the fluid supply path and a through hole that constitutes the insertion hole between the tube inner surface and the tube. Member and said strength variable member It provided outside the tube surface, and comprises a second tube member having a luminal surface constituting the fluid return path between the tube outer surface.
　本発明の別の態様の内視鏡装置は、内視鏡挿入部に処置具チャンネルを有する内視鏡と、前記内視鏡挿入部の処置具チャンネル内に挿抜自在な挿入部に、予め定めた温度を境に強度が第１の状態と第２の状態とに変化する管状の強度可変部材を有するガイド部材と、前記ガイド部材の強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を供給する流体供給装置と、を具備し、前記ガイド部材の挿入部は、前記強度可変部材の管内表面側に設けられることで、該管内表面との間に前記流体供給路を構成する管外表面および前記流体回収路を構成する貫通孔を有するチューブ部材を具備している。 An endoscope apparatus according to another aspect of the present invention includes an endoscope having a treatment instrument channel in an endoscope insertion portion, and an insertion portion that can be inserted into and removed from the treatment instrument channel of the endoscope insertion portion. A guide member having a tubular strength variable member whose strength changes between the first state and the second state at the boundary of the determined temperature, and the predetermined member for changing the strength variable member of the guide member to the first state. A fluid supply device that supplies a fluid having a temperature higher than a predetermined temperature or a fluid having a temperature lower than the predetermined temperature that changes the strength variable member to the second state, and the insertion portion of the guide member Is provided on the tube inner surface side of the strength variable member, and includes a tube member having a tube outer surface constituting the fluid supply path and a through hole constituting the fluid recovery path between the strength varying member and the tube inner surface. ing.
　本発明のまた他の態様の内視鏡装置は、内視鏡挿入部に処置具チャンネルを有する内視鏡と、体内に挿入される挿入部に前記内視鏡挿入部が挿通される長手軸方向の挿入孔を有し、予め定めた温度を境に強度が第１の状態と第２の状態とに変化する管状の強度可変部材を有するオーバーチューブと、前記オーバーチューブの強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を供給する第１の流体供給装置と、前記処置具チャンネル内に挿通配置される、予め定めた温度を境に強度が第１の状態と第２の状態とに変化する強度可変部材と、前記処置具チャンネル内に予め定めた状態で挿通配置された強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を供給する第２の流体供給装置と、を具備し、前記第２の流体供給装置から供給される前記予め定めた温度より高い温度の流体、又は前記予め定めた温度より低い温度の流体は、前記オーバーチューブと前記内視鏡挿入部との隙間、または、前記処置具チャンネルに挿通配置される強度可変部材と前記処置具チャンネルとの隙間を介して供給される。 An endoscope apparatus according to still another aspect of the present invention includes an endoscope having a treatment instrument channel in an endoscope insertion portion, and a longitudinal axis through which the endoscope insertion portion is inserted into an insertion portion to be inserted into the body. An overtube having a tubular strength variable member having a direction insertion hole, the strength of which changes between a first state and a second state at a predetermined temperature, and a strength variable member of the overtube. A first fluid supply for supplying a fluid having a temperature higher than the predetermined temperature to be changed to the first state or a fluid having a temperature lower than the predetermined temperature for changing the strength variable member to the second state. An apparatus, an intensity variable member that is inserted and disposed in the treatment instrument channel and changes in strength between a first state and a second state with a predetermined temperature as a boundary, and predetermined in the treatment instrument channel Strength variable part inserted and arranged in the state A fluid having a temperature higher than the predetermined temperature that changes the first state to the first state or a fluid having a temperature lower than the predetermined temperature that changes the strength variable member to the second state. And a fluid having a temperature higher than the predetermined temperature or a fluid having a temperature lower than the predetermined temperature supplied from the second fluid supply device. It is supplied through a gap between the endoscope insertion portion or a gap between the strength varying member inserted and disposed in the treatment instrument channel and the treatment instrument channel.
図１－図８は第１実施形態に係り、図１は内視鏡と医療機器であるオーバーチューブとで構成される内視鏡装置を説明する図1 to 8 relate to the first embodiment, and FIG. 1 is a diagram for explaining an endoscope apparatus including an endoscope and an overtube as a medical device. オーバーチューブの構成を説明する長手方向断面図Longitudinal sectional view for explaining the configuration of the overtube 図２のＹ３－Ｙ３線断面図Y3-Y3 line cross-sectional view of FIG. 図２のＹ４－Ｙ４線断面図Y4-Y4 line cross-sectional view of FIG. オーバーチューブのチューブ体を肛門から挿入して、Ｓ字結腸を通過させて下行結腸内に配置するまでの手順を説明する図The figure explaining the procedure from inserting the tube body of an overtube from an anus, passing through a sigmoid colon, and arrange | positioning in the descending colon オーバーチューブのチューブ体を介して内視鏡挿入部を下行結腸内に導出させる手順等を説明する図The figure explaining the procedure etc. which lead out an endoscope insertion part in the descending colon via the tube body of an overtube オーバーチューブのチューブ体を横行結腸に配置する手順等を説明する図The figure explaining the procedure etc. which arrange the tube body of an overtube in the transverse colon オーバーチューブのチューブ体を介して内視鏡挿入部を上行結腸に導出させる手順等を説明する図The figure explaining the procedure etc. which lead an endoscope insertion part to the ascending colon through the tube body of an overtube 図９－図１４は第２実施形態に係り、図９は内視鏡と医療機器であるガイド部材とで構成される内視鏡装置を説明する図FIGS. 9 to 14 relate to the second embodiment, and FIG. 9 is a diagram illustrating an endoscope apparatus including an endoscope and a guide member that is a medical device. ガイド部材の構成を説明する長手方向断面図Longitudinal sectional view for explaining the structure of the guide member ガイド部材のガイド部を肛門から挿入して、Ｓ字結腸を通過させて下行結腸内に配置するまでの手順を説明する図The figure explaining the procedure after inserting the guide part of a guide member from an anus and passing through the sigmoid colon and arrange | positioning in the descending colon ガイド部材のガイド部を介して内視鏡挿入部を下行結腸内に導出させる手順等を説明する図The figure explaining the procedure etc. which lead an endoscope insertion part in the descending colon via the guide part of a guide member 内視鏡挿入部を脾湾曲内に配置する手順等を説明する図The figure explaining the procedure etc. which arrange an endoscope insertion part in splenic curvature 内視鏡挿入部を肝湾曲内に配置する手順等を説明する図The figure explaining the procedure etc. which arrange an endoscope insertion part in a liver curvature 図１５－図１８は第３実施形態に係り、図１５は内視鏡とオーバーチューブと、形状保持部材とで構成される内視鏡装置を説明する図15 to 18 relate to the third embodiment, and FIG. 15 is a diagram for explaining an endoscope apparatus including an endoscope, an overtube, and a shape holding member. オーバーチューブのチューブ体を介して内視鏡挿入部を下行結腸内に導出させる手順等を説明する図The figure explaining the procedure etc. which lead out an endoscope insertion part in the descending colon via the tube body of an overtube オーバーチューブのチューブ体を介して内視鏡挿入部を肝湾曲に配置する手順等を説明する図The figure explaining the procedure etc. which arrange | position an endoscope insertion part to a liver curve via the tube body of an overtube オーバーチューブのチューブ体を介して内視鏡挿入部をもう腸内に配置する手順等を説明する図The figure explaining the procedure etc. which arrange | position an endoscope insertion part already in the intestine via the tube body of an overtube 内視鏡とオーバーチューブと形状保持部材の代わりであるガイド部材とで構成される内視鏡装置を説明する図The figure explaining the endoscope apparatus comprised with an endoscope, an overtube, and the guide member instead of a shape holding member 強度可変部材に配置される流体路形成部材の構成を説明する図The figure explaining the structure of the fluid path formation member arrange | positioned at a strength variable member 複数組みの流体供給路及び流体回収路を有する強度可変部材を説明する図The figure explaining the intensity variable member which has multiple sets of fluid supply paths and fluid recovery paths
　以下、図面を参照して本発明の実施の形態を説明する。　
　図１－図８を参照して本発明の第１実施形態の内視鏡装置を説明する。　
　図１に示すように本実施形態の内視鏡装置１は、内視鏡１０と、医療機器であるオーバーチューブ２０とを備えて主に構成されている。 Embodiments of the present invention will be described below with reference to the drawings.
An endoscope apparatus according to a first embodiment of the present invention will be described with reference to FIGS.
As shown in FIG. 1, the endoscope apparatus 1 of this embodiment is mainly configured by including an endoscope 10 and an overtube 20 that is a medical device.
　内視鏡１０は、内視鏡挿入部１１と内視鏡操作部１２とユニバーサルケーブル１３とを主に備えて構成されている。内視鏡挿入部１１は、先端側から順に先端部１４、湾曲部１５、可撓管部１６を連設して構成される。 The endoscope 10 mainly includes an endoscope insertion portion 11, an endoscope operation portion 12, and a universal cable 13. The endoscope insertion portion 11 is configured by connecting a distal end portion 14, a bending portion 15, and a flexible tube portion 16 sequentially from the distal end side.
　先端部１４内には被検部を撮像するＣＣＤ、Ｃ－ＭＯＳ等の撮像素子を備える撮像部が内蔵されている。湾曲部１５は、例えば上下方向および左右方向に湾曲するように構成されている。可撓管部１６は、予め定められた可撓性を有している。 In the distal end portion 14, an image pickup unit including an image pickup element such as a CCD or a C-MOS for picking up an image of the test part is built. The bending portion 15 is configured to bend in the vertical direction and the horizontal direction, for example. The flexible tube portion 16 has a predetermined flexibility.
　内視鏡操作部１２には、湾曲部１５を湾曲動作させるための湾曲ノブ１７、処置具を図示しない処置具チャンネルに導く処置具チャンネル入口１８等が設けられている。　
　ユニバーサルケーブル１３は、内視鏡操作部１２の基端側の側部から延出している。ユニバーサルケーブル１３の基端部には内視鏡コネクタ１９が設けられている。内視鏡コネクタ１９は、外部装置である例えば光源装置２に着脱自在に接続される。 The endoscope operation section 12 is provided with a bending knob 17 for bending the bending section 15, a treatment instrument channel inlet 18 for guiding the treatment instrument to a treatment instrument channel (not shown), and the like.
The universal cable 13 extends from the side of the proximal end side of the endoscope operation unit 12. An endoscope connector 19 is provided at the proximal end portion of the universal cable 13. The endoscope connector 19 is detachably connected to an external device such as the light source device 2.
　オーバーチューブ２０は、内視鏡挿入部１１が挿通可能な挿入孔２０Ｈを長手軸方向に有する。オーバーチューブ２０は、可撓性を変化させることが可能な挿入部であるチューブ体２１と、把持部である剛性を有するオーバーチューブ操作部２２とを備えて構成されている。 The overtube 20 has an insertion hole 20H in the longitudinal axis direction through which the endoscope insertion portion 11 can be inserted. The overtube 20 includes a tube body 21 that is an insertion portion capable of changing flexibility, and an overtube operation portion 22 having rigidity that is a gripping portion.
　オーバーチューブ操作部２２には、第１チューブ口金２３ａと、第２チューブ口金２３ｂとが設けられている。第１チューブ口金２３ａには流体供給装置３０から延出する第１流体チューブ３が接続される。第２チューブ口金２３ｂには流体供給装置３０から延出する第２流体チューブ４が接続される。 The overtube operation section 22 is provided with a first tube base 23a and a second tube base 23b. The first fluid tube 3 extending from the fluid supply device 30 is connected to the first tube base 23a. A second fluid tube 4 extending from the fluid supply device 30 is connected to the second tube base 23b.
　図２、図３に示すようにチューブ体２１は、管状の強度可変部材２５と、管状の挿入部挿通管２６と、管状のチューブ外装部材２７と、環状の先端構成部材２８とを備えて構成されている。挿入部挿通管２６及びチューブ外装部材２７は、予め定めた可撓性を有するチューブ部材である。 As shown in FIGS. 2 and 3, the tube body 21 includes a tubular strength variable member 25, a tubular insertion portion insertion tube 26, a tubular tube exterior member 27, and an annular tip component member 28. Has been. The insertion portion insertion tube 26 and the tube exterior member 27 are tube members having predetermined flexibility.
　強度可変部材２５は、予め定めた温度を境に硬さ或いは弾性率等の強度が第１の状態と第２の状態とに変化する管状部材である。強度可変部材２５は、例えばガラス転移温度が例えば摂氏１０度から摂氏５５度の間に設定される形状記憶ポリマーで管状、或いは融点が例えば摂氏１０度から摂氏５５度の間に設定される熱可塑性樹脂、低融点合金で管状に形成されている。 The strength varying member 25 is a tubular member whose strength such as hardness or elastic modulus changes between a first state and a second state at a predetermined temperature. The strength-variable member 25 is, for example, a shape memory polymer having a glass transition temperature set between, for example, 10 degrees Celsius and 55 degrees Celsius, or a thermoplastic having a melting point set between, for example, 10 degrees Celsius and 55 degrees Celsius. It is formed in a tubular shape with a resin and a low melting point alloy.
　具体的に、強度可変部材２５は、ガラス転移温度が体温より低い例えば摂氏２５度に設定された形状記憶ポリマーで、内径寸法φｄ、肉厚ｔ、外径寸法φＤで形成されている。強度可変部材２５の強度は、強度可変部材２５の温度がガラス転移温度より高い状態から低い状態に変化することにより、第１の状態である軟らかな状態から第２の状態である硬い状態に変化する。強度可変部材２５の強度は、その逆に、強度可変部材２５の温度がガラス転移温度より低い状態から高い状態に変化することによって、第２の状態から第１の状態に変化する。 Specifically, the strength varying member 25 is a shape memory polymer whose glass transition temperature is lower than the body temperature, for example, set to 25 degrees Celsius, and is formed with an inner diameter dimension φd, a wall thickness t, and an outer diameter dimension φD. The strength of the strength variable member 25 changes from the soft state of the first state to the hard state of the second state by changing the temperature of the strength variable member 25 from a state higher than the glass transition temperature to a lower state. To do. Conversely, the strength of the variable strength member 25 changes from the second state to the first state when the temperature of the variable strength member 25 changes from a lower state to a higher state than the glass transition temperature.
　ここで、強度可変部材２５の第１の状態及び第２の状態とは、強度可変部材２５に予め定めた大きさの外力を予め定めた方向から働きかけたときに変形する大きさの違いである。強度可変部材２５は、第１の状態においては変形が容易である。そして、強度可変部材２５は、第２の状態においては第１の状態に比べて例えば硬度が高くなる。この結果、強度可変部材２５の変形量は、第１の状態で設定した変形量より小さくなる、言い換えれば、第１の状態に比べて変形し難くなる。 Here, the first state and the second state of the strength variable member 25 are differences in the magnitude of deformation when an external force having a predetermined magnitude is applied to the strength variable member 25 from a predetermined direction. . The strength varying member 25 is easily deformable in the first state. The strength variable member 25 has, for example, higher hardness in the second state than in the first state. As a result, the deformation amount of the strength varying member 25 is smaller than the deformation amount set in the first state, in other words, it is difficult to deform compared to the first state.
　強度可変部材２５を備えるチューブ体２１は、そのチューブ体２１が例えば大腸に挿入されたとき、第１の状態であれば、その先端が大腸の壁に当接したとき、チューブ体２１は受動的に変形し、その後、その当接状態が解除されると、再び元の形状に戻る可撓性を有している。なお、本明細書中において、上述したように当接が解除された後、再び元の形状に戻る可撓性を予め定めた可撓性と記載する。 If the tube body 21 including the strength varying member 25 is in the first state when the tube body 21 is inserted into the large intestine, for example, the tube body 21 is passive when the tip abuts against the wall of the large intestine. When the contact state is then released, it has the flexibility to return to its original shape again. In the present specification, the flexibility that returns to the original shape after the contact is released as described above is referred to as a predetermined flexibility.
　これに対して、チューブ体２１の強度可変部材２５が第１の状態から第２の状態に変化されると、チューブ体２１は、軟らかな状態におけるチューブ体２１の湾曲形状を保持する形状保持力を有する。具体的に、本実施形態における、強度可変部材２５の第２の状態における形状保持力は、湾曲形状が保持されているチューブ体２１の挿入孔２０Ｈ内に内視鏡挿入部１１を挿入した際、その先端部１４が挿入孔２０Ｈの湾曲した内周面に当接した場合に、チューブ体２１の湾曲形状が変形されることなく、その湾曲形状を保持するように設定されている。 In contrast, when the strength varying member 25 of the tube body 21 is changed from the first state to the second state, the tube body 21 retains the shape holding force that holds the curved shape of the tube body 21 in the soft state. Have Specifically, the shape holding force in the second state of the strength variable member 25 in the present embodiment is when the endoscope insertion portion 11 is inserted into the insertion hole 20H of the tube body 21 in which the curved shape is held. When the distal end portion 14 comes into contact with the curved inner peripheral surface of the insertion hole 20H, the curved shape of the tube body 21 is set without being deformed.
　挿入部挿通管２６は、第１のチューブ部材である。挿入部挿通管２６は、内視鏡１０の内視鏡挿入部１１が挿入、抜去自在な挿入孔２０Ｈを構成する貫通孔を有している。挿入部挿通管２６の外径は、強度可変部材２５の内径寸法より予め定めた寸法細径である。挿入部挿通管２６は、強度可変部材２５の管内表面側に配置される。強度可変部材２５の管内表面と挿入部挿通管２６の管外表面との間には第１隙間２９ａが構成される。第１隙間２９ａは、流体供給装置３０から供給される流体が送り込まれる流体供給路である。 The insertion portion insertion tube 26 is a first tube member. The insertion portion insertion tube 26 has a through hole that constitutes an insertion hole 20H into which the endoscope insertion portion 11 of the endoscope 10 can be inserted and removed. The outer diameter of the insertion portion insertion tube 26 is smaller than the inner diameter of the strength variable member 25. The insertion portion insertion tube 26 is disposed on the tube inner surface side of the strength variable member 25. A first gap 29 a is formed between the inner surface of the variable strength member 25 and the outer surface of the insertion tube 26. The first gap 29 a is a fluid supply path through which the fluid supplied from the fluid supply device 30 is sent.
　チューブ外装部材２７は、第２のチューブ部材である。チューブ外装部材２７は、チューブ体２１の外装を構成する。チューブ外装部材２７は、強度可変部材２５の外径寸法より予め定めた寸法大径な貫通孔を有している。チューブ外装部材２７は、強度可変部材２５の管外表面側に配置される。強度可変部材２５の管外表面とチューブ外装部材２７の管内表面との間には第２隙間２９ｂが構成される。第１隙間２９ａは、第１隙間２９ａに供給された流体を流体供給装置３０に回収するための流体回収路として構成される。 The tube exterior member 27 is a second tube member. The tube exterior member 27 constitutes the exterior of the tube body 21. The tube exterior member 27 has a through-hole having a diameter larger than the outer diameter of the strength variable member 25 that is determined in advance. The tube exterior member 27 is disposed on the tube outer surface side of the strength variable member 25. A second gap 29 b is formed between the outer surface of the strength variable member 25 and the inner surface of the tube exterior member 27. The first clearance 29 a is configured as a fluid recovery path for recovering the fluid supplied to the first clearance 29 a to the fluid supply device 30.
　先端構成部材２８は、その中央に中央孔２８ｈを備えている。中央孔２８ｈ内には、挿入部挿通管２６の先端部外表面が配置される。挿入部挿通管２６の先端部外表面と、中央孔２８ｈの内表面とは、例えば接着によって一体的に固定される。 The tip component member 28 has a central hole 28h at the center thereof. An outer surface of the distal end portion of the insertion portion insertion tube 26 is disposed in the central hole 28h. The outer surface of the distal end portion of the insertion portion insertion tube 26 and the inner surface of the central hole 28h are integrally fixed, for example, by adhesion.
　また、先端構成部材２８の外周側には周状凹部２８ａが形成されている。周状凹部２８ａには、チューブ外装部材２７の先端部管内面が配置される。周状凹部２８ａの深さは、チューブ外装部材２７の肉厚と略同寸法に設定してある。チューブ外装部材２７の先端部は、周状凹部２８ａに外嵌配置され、例えば接着によって先端構成部材２８と一体的に固定される。 Further, a circumferential recess 28 a is formed on the outer peripheral side of the tip constituent member 28. The inner surface of the distal end portion of the tube exterior member 27 is disposed in the circumferential recess 28a. The depth of the circumferential recess 28 a is set to be approximately the same as the thickness of the tube exterior member 27. The distal end portion of the tube exterior member 27 is externally disposed in the circumferential recess 28a, and is fixed integrally with the distal end component member 28 by, for example, adhesion.
　さらに、先端構成部材２８の基端面の所定位置である中央孔２８ｈの周囲には、円環溝２８ｂが形成されている。円環溝２８ｂには、強度可変部材２５の先端部が係入配置される。強度可変部材２５の先端部は、円環溝２８ｂ内に配置され、例えば接着によって先端構成部材２８と一体的に固定される。 Furthermore, an annular groove 28b is formed around the central hole 28h, which is a predetermined position on the base end face of the tip component member 28. In the annular groove 28b, the tip end portion of the variable strength member 25 is engaged. The distal end portion of the strength varying member 25 is disposed in the annular groove 28b, and is fixed integrally with the distal end component member 28 by, for example, adhesion.
　この構成において、円環溝２８ｂ内に配置される強度可変部材２５の先端部には、予め定めた幅寸法及び先端面から予め定めた深さ寸法の切り欠き部２５ａが周方向に予め定めた間隔で形成されている。切り欠き部２５ａの深さ寸法は、円環溝２８ｂの深さ寸法より予め定めた寸法大きく設定されている。この結果、チューブ中央側に位置する第１隙間２９ａとチューブ外周側に位置する第２隙間２９ｂとは切り欠き部２５ａを介して連通する。 In this configuration, a notch portion 25a having a predetermined width dimension and a predetermined depth dimension from the front end surface is predetermined in the circumferential direction at the distal end portion of the strength varying member 25 disposed in the annular groove 28b. It is formed at intervals. The depth dimension of the notch 25a is set larger than the depth dimension of the annular groove 28b. As a result, the first gap 29a located on the tube center side and the second gap 29b located on the tube outer periphery side communicate with each other via the notch 25a.
　つまり、切り欠き部２５ａは、流体供給路と流体回収路とを連通する連通部である。この構成によれば、第１隙間２９ａに供給された流体は、矢印Ｙ２に示すように切り欠き部２５ａを通過して第２隙間２９ｂ側に供給されていく。 That is, the cutout portion 25a is a communication portion that connects the fluid supply path and the fluid recovery path. According to this configuration, the fluid supplied to the first gap 29a passes through the notch 25a and is supplied to the second gap 29b side as indicated by an arrow Y2.
　オーバーチューブ操作部２２は、図２、図４に示すように例えば、太径部２２ｃと細径部２２ｄとを有する。また、オーバーチューブ操作部２２は、中心軸に沿って中央貫通孔２２ｈを備えている。中央貫通孔２２ｈ内には挿入部挿通管２６の基端部が配置され、例えば接着によりオーバーチューブ操作部２２に一体的に固定される。 The overtube operation unit 22 includes, for example, a large diameter portion 22c and a small diameter portion 22d as shown in FIGS. The overtube operation unit 22 includes a central through hole 22h along the central axis. A proximal end portion of the insertion portion insertion tube 26 is disposed in the central through hole 22h, and is integrally fixed to the overtube operation portion 22 by adhesion, for example.
　オーバーチューブ操作部２２の細径部２２ｄの外周面には、チューブ外装部材２７の基端部が外嵌配置され、例えば接着によってオーバーチューブ操作部２２に一体に固定される。　
　また、細径部２２ｄの先端面の所定位置であって中央貫通孔２２ｈの周囲には、強度可変部材２５の基端部が係入配置される円環溝２２ｊが形成されている。強度可変部材２５の基端部は、円環溝２２ｊ内に配置され、例えば接着によってオーバーチューブ操作部２２に一体に固定される。 A proximal end portion of the tube exterior member 27 is fitted on the outer peripheral surface of the small-diameter portion 22d of the overtube operation portion 22 and is integrally fixed to the overtube operation portion 22 by adhesion, for example.
Further, an annular groove 22j in which the proximal end portion of the strength varying member 25 is engaged is disposed at a predetermined position on the distal end surface of the small diameter portion 22d and around the central through hole 22h. The base end portion of the strength varying member 25 is disposed in the annular groove 22j and is integrally fixed to the overtube operation portion 22 by, for example, adhesion.
　符号２２ａは、第１連通孔であり、符号２２ｂは第２連通孔であり、符号２２ｅは第１空間部であり、符号２２ｆは第２空間部である。第１連通孔２２ａは、第１空間部２２ｅと第１隙間２９ａとを連通する。第２連通孔２２ｂは、第２空間部２２ｆと第２隙間２９ｂとを連通する。第１空間部２２ｅは、太径部２２ｃの外周面側に形成された凹部の開口を第１蓋部材２４ａで塞いで形成される。第２空間部２２ｆは、太径部２２ｃの外周面側に形成された凹部の開口を第２蓋部材２４ｂで塞いで形成される。 Numeral 22a is a first communicating hole, numeral 22b is a second communicating hole, numeral 22e is a first space part, and numeral 22f is a second space part. The first communication hole 22a communicates the first space 22e and the first gap 29a. The second communication hole 22b communicates the second space 22f and the second gap 29b. The first space portion 22e is formed by closing the opening of the concave portion formed on the outer peripheral surface side of the large diameter portion 22c with the first lid member 24a. The second space portion 22f is formed by closing the opening of the concave portion formed on the outer peripheral surface side of the large diameter portion 22c with the second lid member 24b.
　第１チューブ口金２３ａは、第１蓋部材２４ａに固設されている。第２チューブ口金２３ｂは、第２蓋部材２４ｂに固設されている。符号２４ａ１は、貫通孔であり、蓋部材２４ａの一面側及び他面側に開口を有する。符号２４ｂ１は、貫通孔であり、蓋部材２４ｂの一面側及び他面側に開口を有する。 The first tube base 23a is fixed to the first lid member 24a. The second tube base 23b is fixed to the second lid member 24b. Reference numeral 24a1 is a through hole and has openings on one side and the other side of the lid member 24a. Reference numeral 24b1 is a through hole, and has openings on one side and the other side of the lid member 24b.
　図１に示すように流体供給装置３０は、冷却装置３１、加熱装置３２、送液ポンプ３３、吸引ポンプ３４、及び流体制御部３５を備えている。符号５はフットスイッチである。第１流体チューブ３は、流体供給装置３０に備えられた第１流体口金６ａに連結されている。第２流体チューブ４は、第２流体口金６ｂに連結されている。 1, the fluid supply device 30 includes a cooling device 31, a heating device 32, a liquid feed pump 33, a suction pump 34, and a fluid control unit 35. Reference numeral 5 denotes a foot switch. The first fluid tube 3 is connected to a first fluid base 6 a provided in the fluid supply device 30. The second fluid tube 4 is connected to the second fluid base 6b.
　冷却装置３１は、流体供給装置３０内に設けられた送液タンク３６と第１流体口金６ａとを連通する供給管路３７中の予め定めた位置に設置される。冷却装置３１は、送液タンク３６から供給管路３７に供給された流体である例えば水を、強度可変部材２５のガラス転移温度２５度より低い例えば摂氏１０度に冷却する。 The cooling device 31 is installed at a predetermined position in a supply pipe 37 that communicates the liquid feeding tank 36 provided in the fluid supply device 30 and the first fluid base 6a. The cooling device 31 cools, for example, water, which is a fluid supplied from the liquid feeding tank 36 to the supply pipe 37, for example, 10 degrees Celsius, which is lower than the glass transition temperature 25 degrees of the strength variable member 25.
　加熱装置３２は、送液タンク３６内に貯留されている流体である例えば水を、強度可変部材２５のガラス転移温度２５度より高い温度である例えば摂氏４０度に加熱する。加熱装置３２も供給管路３７中の予め定めた位置に設置される。 The heating device 32 heats, for example, water, which is a fluid stored in the liquid supply tank 36, to, for example, 40 degrees Celsius, which is higher than the glass transition temperature 25 degrees of the strength variable member 25. The heating device 32 is also installed at a predetermined position in the supply pipe 37.
　送液ポンプ３３は、稼働状態において、送液タンク３６内に貯留された水を、供給管路３７に供給する。吸引ポンプ３４は、吸引タンク３８に接続され、第２流体口金６ｂに一端が連結された回収管路３９等を介して流体を吸引する。 The liquid feed pump 33 supplies the water stored in the liquid feed tank 36 to the supply pipe 37 in the operating state. The suction pump 34 is connected to a suction tank 38 and sucks fluid through a recovery line 39 or the like having one end connected to the second fluid base 6b.
　フットスイッチ５は、例えば第１スイッチ５ａと第２スイッチ５ｂとを備えている。第１スイッチ５ａがオン操作されることにより、フットスイッチ５から冷却信号が発信される。一方、第２スイッチ５ｂがオン操作されることにより、フットスイッチ５から加熱信号が発信される。 The foot switch 5 includes, for example, a first switch 5a and a second switch 5b. When the first switch 5a is turned on, a cooling signal is transmitted from the foot switch 5. On the other hand, a heating signal is transmitted from the foot switch 5 by turning on the second switch 5b.
　流体制御部３５は、フットスイッチ５からの冷却信号を受けると、冷却装置３１、送液ポンプ３３、及び吸引ポンプ３４をオン状態にする。このことにより、送液ポンプ３３によって送液タンク３６に貯留されている水の供給を開始されると共に、吸引ポンプ３４による供給される水の回収を開始する。 When the fluid control unit 35 receives the cooling signal from the foot switch 5, the fluid control unit 35 turns on the cooling device 31, the liquid feed pump 33, and the suction pump 34. Thus, the supply of water stored in the liquid supply tank 36 is started by the liquid supply pump 33 and the recovery of the water supplied by the suction pump 34 is started.
　この結果、送液タンク３６に貯留されていた水は、供給管路３７に供給され、この供給管路３７内を通過中に冷却装置３１によって摂氏１０度に冷却される。摂氏１０度に冷却された冷却水は、第１流体口金６ａ、第１流体チューブ３、第１チューブ口金２３ａ、第１空間部２２ｅ、第１連通孔２２ａを介して流体供給路である第１隙間２９ａに供給される。そして、第１の隙間２９ａに供給された冷却水は、切り欠き部２５ａを介して第２隙間２９ｂに供給される。その後、冷却水は、流体回収路である第２隙間２９ｂ、第２連通孔２２ｂ、第２空間部２２ｆ、第２チューブ口金２３ｂ、第２流体チューブ４、第２流体口金６ｂ、回収管路３９を介して吸引タンク３８内に回収される。 As a result, the water stored in the liquid supply tank 36 is supplied to the supply pipe 37 and is cooled to 10 degrees Celsius by the cooling device 31 while passing through the supply pipe 37. The cooling water cooled to 10 degrees Celsius is the first fluid supply path through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space 22e, and the first communication hole 22a. It is supplied to the gap 29a. And the cooling water supplied to the 1st clearance gap 29a is supplied to the 2nd clearance gap 29b via the notch part 25a. Thereafter, the cooling water is the second clearance 29b, the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39, which are fluid recovery paths. It is collected in the suction tank 38 via
　そして、流体制御部３５は、第１スイッチ５ａがオフ操作されると、瞬時に送液ポンプ３３をオフ状態に切り替える。一方、流体制御部３５は、吸引ポンプ３４については予め定めた時間を経過した後オフ状態に切り替える。このことによって、オーバーチューブ２０内の冷却水の回収を確実に行える。 Then, when the first switch 5a is turned off, the fluid control unit 35 instantaneously switches the liquid feeding pump 33 to the off state. On the other hand, the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. As a result, the cooling water in the overtube 20 can be reliably recovered.
　流体制御部３５は、フットスイッチ５からの加熱信号を受けると、加熱装置３２、送液ポンプ３３、及び吸引ポンプ３４をオン状態にする。このことにより、送液ポンプ３３によって送液タンク３６に貯留されている水の供給が開始されると共に、吸引ポンプ３４による供給される水の回収を開始する。 When the fluid control unit 35 receives the heating signal from the foot switch 5, the fluid control unit 35 turns on the heating device 32, the liquid feeding pump 33, and the suction pump 34. As a result, supply of water stored in the liquid supply tank 36 is started by the liquid supply pump 33 and recovery of water supplied by the suction pump 34 is started.
　この結果、送液タンク３６に貯留されていた水は、供給管路３７に供給され、この供給管路３７内を通過中に加熱装置３２によって摂氏４０度に加熱される。摂氏４０度に加熱された温水は、第１流体口金６ａ、第１流体チューブ３、第１チューブ口金２３ａ、第１空間部２２ｅ、第１連通孔２２ａを介して流体供給路である第１隙間２９ａに供給される。そして、第１の隙間２９ａに供給された温水は、切り欠き部２５ａを介して第２隙間２９ｂに供給される。その後、温水は、流体回収路である第２隙間２９ｂ、第２連通孔２２ｂ、第２空間部２２ｆ、第２チューブ口金２３ｂ、第２流体チューブ４、第２流体口金６ｂ、回収管路３９を介して吸引タンク３８内に回収される。 As a result, the water stored in the liquid feeding tank 36 is supplied to the supply pipe 37 and heated to 40 degrees Celsius by the heating device 32 while passing through the supply pipe 37. The hot water heated to 40 degrees Celsius is a first gap that is a fluid supply path through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space 22e, and the first communication hole 22a. 29a. And the warm water supplied to the 1st clearance gap 29a is supplied to the 2nd clearance gap 29b via the notch part 25a. Thereafter, the hot water passes through the second gap 29b, the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery pipe line 39, which are fluid recovery paths. Through the suction tank 38.
　そして、流体制御部３５は、第２スイッチ５ｂがオフ操作されると、前記第１スイッチ５ａがオフ操作されたときと同様に、瞬時に送液ポンプ３３をオフ状態に切り替える。一方、流体制御部３５は、吸引ポンプ３４については予め定めた時間を経過した後オフ状態に切り替える。このことによって、オーバーチューブ２０内の温水の回収を確実に行える。 Then, when the second switch 5b is turned off, the fluid control unit 35 instantaneously switches the liquid feed pump 33 to the off state, similarly to the case where the first switch 5a is turned off. On the other hand, the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. This ensures that hot water in the overtube 20 can be collected.
　上述のように構成した内視鏡装置１の作用を説明する。　
　内視鏡挿入部１１を例えば盲腸付近まで挿入して大腸内の検査を行うにあたって、医療関係者は、内視鏡装置１として内視鏡１０、光源装置２、オーバーチューブ２０、流体供給装置３０、フットスイッチ５、図示しない表示装置及びビデオプロセッサ等を準備する。このとき、医療関係者は、チューブ体２１の硬さが術者に指示された例えば摂氏２５度で変化するオーバーチューブ２０を用意する。 The operation of the endoscope apparatus 1 configured as described above will be described.
For example, when the endoscope insertion unit 11 is inserted up to the vicinity of the cecum to perform inspection in the large intestine, the medical staff uses the endoscope 10, the light source device 2, the overtube 20, and the fluid supply device 30 as the endoscope device 1. , A foot switch 5, a display device (not shown), a video processor, and the like are prepared. At this time, the medical staff prepares the overtube 20 in which the hardness of the tube body 21 is changed by, for example, 25 degrees Celsius instructed by the operator.
　一方、術者は、オーバーチューブ２０が指示したものであるかを確認する。指示したものであることを確認後、術者は、流体供給装置３０のメインパネル（不図示）に備えられている設定スイッチを操作して、冷却装置３１によって冷却する水の温度を例えば摂氏１０度に設定すると共に、加熱装置３２によって加熱する水の温度を例えば摂氏４０度に設定する。 On the other hand, the surgeon confirms whether the overtube 20 is instructed. After confirming that the instruction is given, the surgeon operates a setting switch provided on the main panel (not shown) of the fluid supply device 30 to set the temperature of water cooled by the cooling device 31 to, for example, 10 degrees Celsius. The temperature of water heated by the heating device 32 is set to 40 degrees Celsius, for example.
　次に、術者は、オーバーチューブ２０のチューブ体２１の硬さを確認する。すなわち、強度可変部材２５が軟らかな状態であるか否かの確認を行う。術者は、チューブ体２１が予め定めた可撓性であることを確認したなら、図５に示すようにチューブ体２１の先端部を患者の肛門から大腸内に挿入する。そして、押し込み操作、捻り操作等の手元操作を行ってチューブ体２１を大腸の深部に向けて押し進めていく。 Next, the surgeon confirms the hardness of the tube body 21 of the overtube 20. That is, it is confirmed whether or not the strength varying member 25 is in a soft state. When the surgeon confirms that the tube body 21 is flexible in advance, the distal end portion of the tube body 21 is inserted into the large intestine from the patient's anus as shown in FIG. Then, a hand operation such as a push-in operation or a twist operation is performed to push the tube body 21 toward the deep part of the large intestine.
　肛門７１から挿入されたチューブ体２１は、術者の手元操作によって、直腸７２からＳ状結腸７３に進んでいく。そして、チューブ体２１がＳ状結腸７３に到達する。この後、術者は、適宜、押し込み操作、或いは捻り操作等を行って、チューブ体２１を押し進めて、図５の二点鎖線に示すようにチューブ体２１の先端部をＳ状結腸７３より先端側の下行結腸７４内に配置する。 The tube body 21 inserted from the anus 71 advances from the rectum 72 to the sigmoid colon 73 by the operator's hand operation. Then, the tube body 21 reaches the sigmoid colon 73. Thereafter, the surgeon appropriately performs a pushing operation or a twisting operation to push the tube body 21 forward, and the distal end portion of the tube body 21 is distal to the sigmoid colon 73 as shown by a two-dot chain line in FIG. Place in side descending colon 74.
　術者は、チューブ体２１の先端部がＳ状結腸７３を通過したと判断したなら、チューブ体２１の湾曲形状をその湾曲形状のままに保持する目的で、フットスイッチ５の第１スイッチ５ａをオン操作する。すると、フットスイッチ５から流体供給装置３０の流体制御部３５に冷却信号が発信される。 When the surgeon determines that the distal end portion of the tube body 21 has passed through the sigmoid colon 73, the surgeon holds the first switch 5a of the foot switch 5 for the purpose of holding the curved shape of the tube body 21 as it is. Turn on. Then, a cooling signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
　冷却信号を受けた流体制御部３５は、冷却装置３１、送液ポンプ３３及び吸引ポンプ３４をオン状態にして、送液タンク３６に貯留されている水の供給を開始する。すると、送液タンク３６に貯留されていた水は、供給管路３７に供給され、この供給管路３７を通過する間に冷却装置３１によって例えば摂氏１０度に冷却されて冷却水となる。 The fluid control unit 35 that has received the cooling signal turns on the cooling device 31, the liquid feed pump 33, and the suction pump 34 to start supplying water stored in the liquid feed tank 36. Then, the water stored in the liquid feeding tank 36 is supplied to the supply pipe 37 and is cooled to, for example, 10 degrees Celsius by the cooling device 31 while passing through the supply pipe 37 to become cooling water.
　冷却水は、第１流体口金６ａ、第１流体チューブ３、第１チューブ口金２３ａ、第１空間部２２ｅ、第１連通孔２２ａを介して強度可変部材２５の管内表面側に位置する第１隙間２９ａに供給される。その後、第１の隙間２９ａに供給された冷却水は、切り欠き部２５ａを介して強度可変部材２５の管外表面側に位置する第２隙間２９ｂに供給される。 The cooling water passes through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space portion 22e, and the first communication hole 22a, and the first gap located on the inner surface side of the strength variable member 25. 29a. Thereafter, the cooling water supplied to the first gap 29a is supplied to the second gap 29b located on the tube outer surface side of the strength varying member 25 via the notch 25a.
　冷却水が隙間２９ａ、２９ｂに供給されることによって、冷却水が、強度可変部材２５の管内表面の全面及び管外表面の全面に触れることによって、強度可変部材２５の温度が速やかに低下していく。そして、強度可変部材２５の温度がガラス転移温度以下に変化することによって、強度可変部材２５の硬さが第１の状態から第２の状態に変化されて、チューブ体２１の硬さが硬い状態に変化する。すなわち、下行結腸７４内、Ｓ字結腸７３内、直腸７２内、および肛門７１より外部に配置されていた軟らかな状態であったチューブ体２１がその湾曲形状のままで保持される。 When the cooling water is supplied to the gaps 29a and 29b, the cooling water touches the entire inner surface of the pipe of the strength variable member 25 and the entire outer surface of the pipe, so that the temperature of the variable strength member 25 is rapidly reduced. Go. Then, when the temperature of the strength variable member 25 changes below the glass transition temperature, the hardness of the strength variable member 25 is changed from the first state to the second state, and the hardness of the tube body 21 is hard. To change. That is, the tube body 21 that has been placed in the descending colon 74, in the sigmoid colon 73, in the rectum 72, and outside the anus 71 is held in its curved shape.
　なお、第２隙間２９ｂに供給された冷却水は、第２連通孔２２ｂ、第２空間部２２ｆ、第２チューブ口金２３ｂ、第２流体チューブ４、第２流体口金６ｂ、回収管路３９を介して吸引タンク３８内に回収される。つまり、オーバーチューブ２０の第１隙間２９ａ及び第２隙間２９ｂには流体供給装置３０から連続的に冷却水が供給される。 The cooling water supplied to the second gap 29b passes through the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39. And collected in the suction tank 38. That is, the cooling water is continuously supplied from the fluid supply device 30 to the first gap 29 a and the second gap 29 b of the overtube 20.
　術者は、チューブ体２１が硬い状態に変化したことを確認したなら、オーバーチューブ２０のオーバーチューブ操作部２２側から挿入孔２０Ｈ内に内視鏡挿入部１１を挿入する。そして、術者は、内視鏡挿入部１１を押し込み操作する。すると、内視鏡挿入部１１は、挿入孔２０Ｈ内を先端側に向かってスムーズに移動していく。 If the surgeon confirms that the tube body 21 has changed to a hard state, the operator inserts the endoscope insertion portion 11 into the insertion hole 20H from the overtube operation portion 22 side of the overtube 20. Then, the surgeon pushes the endoscope insertion portion 11 and operates it. Then, the endoscope insertion part 11 moves smoothly in the insertion hole 20H toward the distal end side.
　その結果、図６の実線に示すようにチューブ体２１の先端から内視鏡１０の先端部１４、湾曲部１５が下行結腸７４内に導出される。　
　導出後、術者は、表示装置に表示される内視鏡画像を観察しつつ、内視鏡挿入部１１を前進させる操作、即ち、押し込み操作、捩り操作、湾曲操作を継続して行う。そして、内視鏡挿入部１１を可動性に乏しい下行結腸７４の奥方向に向けて挿入していく。 As a result, the distal end portion 14 and the bending portion 15 of the endoscope 10 are led out into the descending colon 74 from the distal end of the tube body 21 as indicated by the solid line in FIG.
After the derivation, the surgeon continuously performs the operation of moving the endoscope insertion portion 11 forward, that is, the pushing operation, the twisting operation, and the bending operation while observing the endoscope image displayed on the display device. And the endoscope insertion part 11 is inserted toward the back direction of the descending colon 74 with poor mobility.
　そして、術者は、表示装置に表示される内視鏡画像を視認して、図６の二点鎖線に示すように先端部１４を下行結腸７４と可動性に富む横行結腸７５との境界である脾湾曲７６近傍の所望する位置に配置する。 Then, the surgeon visually recognizes the endoscopic image displayed on the display device, and places the distal end portion 14 at the boundary between the descending colon 74 and the movable transverse colon 75 as shown by a two-dot chain line in FIG. It arrange | positions in the desired position of a certain spleen curve 76 vicinity.
　ここで、術者は、第１スイッチ５ａをオフ操作すると共に、チューブ体２１の湾曲形状の保持を解除する目的で、フットスイッチ５の第２スイッチ５ｂをオン操作する。すると、フットスイッチ５から流体供給装置３０の流体制御部３５に加熱信号が発信される。 Here, the operator turns on the first switch 5a and turns on the second switch 5b of the foot switch 5 for the purpose of releasing the hold of the curved shape of the tube body 21. Then, a heating signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
　加熱信号を受けた流体制御部３５は、加熱装置３２、送液ポンプ３３及び吸引ポンプ３４をオン状態にする。すると、送液タンク３６に貯留されていた水は、供給管路３７に供給され、この供給管路３７を通過する間に加熱装置３２によって例えば摂氏４０度に加温されて温水となる。 Upon receiving the heating signal, the fluid control unit 35 turns on the heating device 32, the liquid feed pump 33, and the suction pump 34. Then, the water stored in the liquid feeding tank 36 is supplied to the supply pipe 37, and is heated to, for example, 40 degrees Celsius by the heating device 32 while passing through the supply pipe 37 to become hot water.
　温水は、第１流体口金６ａ、第１流体チューブ３、第１チューブ口金２３ａ、第１空間部２２ｅ、第１連通孔２２ａを介して強度可変部材２５の管内表面側に位置する第１隙間２９ａに供給される。その後、第１の隙間２９ａに供給された温水は、切り欠き部２５ａを介して強度可変部材２５の管外表面側に位置する第２隙間２９ｂに供給される。そして、第２隙間２９ｂに供給された温水は、第２連通孔２２ｂ、第２空間部２２ｆ、第２チューブ口金２３ｂ、第２流体チューブ４、第２流体口金６ｂ、回収管路３９を介して吸引タンク３８内に回収される。 The warm water passes through the first fluid base 6a, the first fluid tube 3, the first tube base 23a, the first space 22e, and the first communication hole 22a, and the first gap 29a located on the inner surface side of the strength variable member 25. To be supplied. Thereafter, the hot water supplied to the first gap 29a is supplied to the second gap 29b located on the outer surface side of the strength variable member 25 via the notch 25a. The hot water supplied to the second gap 29b passes through the second communication hole 22b, the second space 22f, the second tube base 23b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39. It is collected in the suction tank 38.
　温水が、第１隙間２９ａ、第２隙間２９ｂに連続的に供給されることによって、温水が、強度可変部材２５の管内表面及び管外表面に触れることによって、強度可変部材２５の温度が速やかに上昇していく。そして、強度可変部材２５の温度がガラス転移温度以上に変化することによって、強度可変部材２５の硬さが、第２の状態から第１の状態に変化されてチューブ体２１の硬さが予め定めた可撓性を有する状態に変化する。すなわち、湾曲形状に保持されていたチューブ体２１が再び予め定めた可撓性を有する状態に戻る。 The hot water is continuously supplied to the first gap 29a and the second gap 29b, so that the hot water touches the inner surface and the outer surface of the strength variable member 25, so that the temperature of the strength variable member 25 is quickly increased. It rises. Then, when the temperature of the strength variable member 25 changes to the glass transition temperature or higher, the hardness of the strength variable member 25 is changed from the second state to the first state, and the hardness of the tube body 21 is determined in advance. It changes to the state which has the flexibility. That is, the tube body 21 held in the curved shape returns to a state having predetermined flexibility again.
　術者は、チューブ体２１が予め定めた可撓性に変化したことを確認したなら、第２スイッチ５ｂをオフ操作する。このことによって、チューブ体２１は、体温によって所望する可撓性に保持される。その後、術者は、予め定めた可撓性のチューブ体２１を、先端部１４が脾湾曲７６近傍に位置する内視鏡挿入部１１に沿わせて深部に向けて前進させる手元操作を行う。 If the surgeon confirms that the tube body 21 has changed to a predetermined flexibility, the operator turns off the second switch 5b. Thus, the tube body 21 is held in a desired flexibility by the body temperature. Thereafter, the surgeon performs a hand operation to advance the predetermined flexible tube body 21 toward the deep portion along the endoscope insertion portion 11 in which the distal end portion 14 is located in the vicinity of the splenic curve 76.
　術者は、表示装置の画面上でチューブ体２１の先端部の画像を確認したなら、チューブ体２１の押し込み操作、捻り操作を行って、図７の実線に示すようにチューブ体２１の先端部を横行結腸７５内に配置する。 When the surgeon confirms the image of the distal end portion of the tube body 21 on the screen of the display device, the surgeon performs a pushing operation and a twisting operation of the tube body 21, and the distal end portion of the tube body 21 as shown by a solid line in FIG. Is placed in the transverse colon 75.
　術者は、チューブ体２１の先端部が横行結腸７５に配置されたと判断したなら、チューブ体２１の湾曲形状をその湾曲形状のままに保持する目的で、再び、フットスイッチ５の第１スイッチ５ａをオン操作する。 When the surgeon determines that the distal end portion of the tube body 21 is disposed in the transverse colon 75, the first switch 5a of the foot switch 5 is again used for the purpose of maintaining the curved shape of the tube body 21 in the curved shape. Turn on the.
　この結果、上述したように、冷却水が、第１隙間２９ａ、第２隙間２９ｂの順に供給されて、脾湾曲７６内、下行結腸７４内、Ｓ字結腸７３内、直腸７２内、および肛門７１より外部に配置されていた軟らかな状態のチューブ体２１がその湾曲形状のままで保持される。 As a result, as described above, the cooling water is supplied in the order of the first gap 29a and the second gap 29b, and within the splenic curve 76, the descending colon 74, the sigmoid colon 73, the rectum 72, and the anus 71. The tube body 21 in the soft state that has been arranged more externally is held in its curved shape.
　ここで、術者は、挿入孔２０Ｈ内に位置する内視鏡挿入部１１の押し込み操作を行う。すると、内視鏡挿入部１１は、挿入孔２０Ｈ内をスムーズに移動して、図７の二点鎖線に示すようにチューブ体２１の先端から横行結腸７５内に導出される。 Here, the surgeon performs the pushing operation of the endoscope insertion portion 11 located in the insertion hole 20H. Then, the endoscope insertion portion 11 smoothly moves in the insertion hole 20H and is led out from the distal end of the tube body 21 into the transverse colon 75 as shown by a two-dot chain line in FIG.
　導出後、術者は、内視鏡画像を観察しつつ、内視鏡挿入部１１を前進させる操作を行って、内視鏡挿入部１１を横行結腸７５と上行結腸７８との境界である肝湾曲７７近傍の所望する位置に配置する。 After the derivation, the surgeon performs an operation of moving the endoscope insertion portion 11 forward while observing the endoscope image, so that the endoscope insertion portion 11 is a liver that is a boundary between the transverse colon 75 and the ascending colon 78. It arrange | positions in the desired position of the curve 77 vicinity.
　ここで、術者は、上述と同様に、第１スイッチ５ａをオフ操作すると共に、チューブ体２１の湾曲形状の保持を解除する目的で、フットスイッチ５の第２スイッチ５ｂをオン操作する。この結果、上述したように、温水が第１隙間２９ａ、第２隙間２９ｂに供給されて強度可変部材２５の温度が上昇を開始して、強度可変部材２５の硬さが、第２の状態から第１の状態に変化する。即ち、湾曲形状に保持されていたチューブ体２１が再び所望する可撓性に戻る。 Here, similarly to the above, the operator turns off the first switch 5a and turns on the second switch 5b of the foot switch 5 in order to release the curved shape of the tube body 21. As a result, as described above, the hot water is supplied to the first gap 29a and the second gap 29b, the temperature of the strength varying member 25 starts to rise, and the hardness of the strength varying member 25 is increased from the second state. Change to the first state. That is, the tube body 21 held in the curved shape returns to the desired flexibility again.
　術者は、チューブ体２１が予め定めた可撓性に変化したことを確認したなら、第２スイッチ５ｂをオフ操作する。その後、術者は、予め定めた可撓性のチューブ体２１を先端部１４が肝湾曲７７近傍に位置する内視鏡挿入部１１に沿わせてチューブ体２１を深部に向けて前進させる手元操作を行う。 If the surgeon confirms that the tube body 21 has changed to a predetermined flexibility, the operator turns off the second switch 5b. Thereafter, the surgeon moves the tube body 21 forward toward the deep part along the endoscope insertion part 11 in which the distal end portion 14 is positioned in the vicinity of the liver curvature 77 with the flexible tube body 21 determined in advance. I do.
　術者は、表示装置の画面上でチューブ体２１の先端部の画像を確認したなら、チューブ体２１の押し込み操作、捻り操作を行って、図８に示すようにチューブ体２１の先端部を上行結腸７８内に配置する。 When the surgeon confirms the image of the distal end portion of the tube body 21 on the screen of the display device, the surgeon performs a pushing operation and a twisting operation of the tube body 21, and ascends the distal end portion of the tube body 21 as shown in FIG. Place in the colon 78.
　術者は、チューブ体２１の先端部が上行結腸７８に配置されたと判断したなら、チューブ体２１の湾曲形状をその湾曲形状のままに保持する目的で、再び、フットスイッチ５の第１スイッチ５ａをオン操作する。 When the surgeon determines that the distal end portion of the tube body 21 is disposed in the ascending colon 78, the first switch 5a of the foot switch 5 is again used for the purpose of holding the curved shape of the tube body 21 as it is. Turn on the.
　この結果、上述したように、冷却水が、第１隙間２９ａ、第２隙間２９ｂの順に供給されて、上行結腸７８内、肝湾曲７７内、横行結腸７５内、脾湾曲７６内、下行結腸７４内、Ｓ字結腸７３内、直腸７２内、および肛門７１より外部に配置されていた軟らかな状態のチューブ体２１がその湾曲形状のままで保持される。 As a result, as described above, the cooling water is supplied in the order of the first gap 29a and the second gap 29b, and in the ascending colon 78, in the liver curve 77, in the transverse colon 75, in the splenic curve 76, and in the descending colon 74. The tube body 21 in a soft state that is disposed inside, inside the sigmoid colon 73, inside the rectum 72, and outside the anus 71 is held in its curved shape.
　ここで、術者は、挿入孔２０Ｈ内に位置する内視鏡挿入部１１の押し込み操作を行う。すると、内視鏡挿入部１１は、挿入孔２０Ｈ内をスムーズに移動して、図８に示すようにチューブ体２１の先端から上行結腸７８内に導出される。導出後、術者は、内視鏡挿入部１１を前進させる操作を行って、内視鏡画像を観察しつつ、内視鏡挿入部１１を盲腸７９近傍に到達させる。 Here, the surgeon performs the pushing operation of the endoscope insertion portion 11 located in the insertion hole 20H. Then, the endoscope insertion portion 11 smoothly moves in the insertion hole 20H and is led out from the distal end of the tube body 21 into the ascending colon 78 as shown in FIG. After the derivation, the surgeon performs an operation of moving the endoscope insertion portion 11 forward, and makes the endoscope insertion portion 11 reach the vicinity of the cecum 79 while observing the endoscope image.
　ここで、術者は、第１スイッチ５ａをオフ操作すると共に、第２スイッチ５ｂをオン操作し、湾曲形状で第２の状態に保持されていたチューブ体を軟らかな状態にする。そして、術者は、チューブ体２１が所望する可撓性に変化したことを確認したなら、第２スイッチ５ｂをオフ操作して、オーバーチューブ２０及び内視鏡挿入部１１を引き戻しながら行う大腸の検査に移行する。 Here, the operator turns off the first switch 5a and turns on the second switch 5b to bring the tube body held in the second state in a curved shape into a soft state. When the operator confirms that the tube body 21 has changed to the desired flexibility, the operator operates the second switch 5b to turn off the large intestine while pulling back the overtube 20 and the endoscope insertion portion 11. Transition to inspection.
　このように、冷却水を、第１隙間２９ａ及び第２隙間２９ｂに供給することによって、強度可変部材２５の管内表面の全体及び管外表面の全体に冷却水させて、強度可変部材２５の温度を速やかに降下させるができる。一方、温水を、第１隙間２９ａ及び第２隙間２９ｂに供給して、強度可変部材２５の管内表面の全体及び管外表面の全体に温水を接触させて、強度可変部材２５の温度を速やかに上昇させるができる。 In this way, by supplying cooling water to the first gap 29a and the second gap 29b, the entire inner surface of the pipe and the entire outer surface of the pipe of the variable strength member 25 are cooled and the temperature of the variable strength member 25 is increased. Can be lowered quickly. On the other hand, the hot water is supplied to the first gap 29a and the second gap 29b, and the hot water is brought into contact with the entire inner surface and the outer surface of the strength variable member 25, so that the temperature of the strength variable member 25 is quickly increased. Can be raised.
　また、第１隙間２９ａを腸壁から離間したチューブ中央側に設ける一方、第２隙間２９ｂを腸壁側であるチューブ外周側に設け、冷却水を第１隙間２９ａ、第２隙間２９ｂの順に連続的に供給している。このことによって、冷却装置３１によって冷却された冷却水を、体温の影響を受けて上昇されることなく、強度可変部材２５に供給することができる。このことよって、強度可変部材２５の温度をより速やかに降下させて、第１の状態から第２の状態に変化させる応答性の向上を図ることができる。 In addition, the first gap 29a is provided on the tube center side separated from the intestinal wall, while the second gap 29b is provided on the tube outer peripheral side, which is the intestinal wall side, and the cooling water is continuously provided in the order of the first gap 29a and the second gap 29b. Supply. Thus, the cooling water cooled by the cooling device 31 can be supplied to the strength variable member 25 without being raised due to the influence of body temperature. Accordingly, it is possible to improve the responsiveness by causing the temperature of the strength varying member 25 to be lowered more quickly and changing from the first state to the second state.
　また、オーバーチューブ２０のチューブ体２１を構成する強度可変部材２５のガラス転移温度、或いは融点を、体温より低い温度に設定することによって、万一、加熱装置３２が故障した場合には、冷却装置３１を停止させることにより、体温によって強度可変部材２５をガラス転移温度、或いは融点よりも高い温度にして、チューブ体２１を軟らかな状態にすることができる。このことによって、チューブ体２１は、確実に体内から抜去される。 In addition, by setting the glass transition temperature or the melting point of the strength variable member 25 constituting the tube body 21 of the overtube 20 to a temperature lower than the body temperature, in the unlikely event that the heating device 32 fails, the cooling device By stopping 31, the strength variable member 25 can be brought to a glass transition temperature or a temperature higher than the melting point by the body temperature, and the tube body 21 can be in a soft state. This ensures that the tube body 21 is removed from the body.
　また、第１スイッチ５ａをオフ操作した後、冷却水をオーバーチューブ２０内から回収することによって、体壁側に位置する強度可変部材２５の管外表面側に速やかに体温を伝達することができる。このことによって、強度可変部材２５の温度は、冷却水の供給が停止されると同時に体温によって上昇を開始する。 In addition, after the first switch 5a is turned off, the cooling water is collected from the overtube 20 so that the body temperature can be quickly transmitted to the outer surface side of the strength variable member 25 located on the body wall side. . As a result, the temperature of the strength varying member 25 starts to rise due to body temperature at the same time as the supply of cooling water is stopped.
　なお、上述した実施形態においては、大腸内の検査を行うにあたって、チューブ体２１の先端部を患者のＳ状結腸を通過させた後、内視鏡挿入部１１を第２の状態にしたチューブ体２１内に挿入するとしている。しかし、予め、内視鏡挿入部１１をチューブ体２１内の所定位置に配置して、内視鏡挿入部１１とチューブ体２１とを略一体な状態で肛門７１から挿入して、直腸７２、Ｓ状結腸７３に押し進めるようにしてもよい。 In the above-described embodiment, when performing an inspection in the large intestine, after the distal end portion of the tube body 21 passes through the sigmoid colon of the patient, the tube body in which the endoscope insertion portion 11 is in the second state. It is supposed to be inserted into 21. However, the endoscope insertion part 11 is previously arranged at a predetermined position in the tube body 21, and the endoscope insertion part 11 and the tube body 21 are inserted from the anus 71 in a substantially integrated state, and the rectum 72, You may make it push forward to the sigmoid colon 73. FIG.
　また、上述した実施形態においては、送液タンク３６から供給管路３７に送られた水を、その管路中で冷却装置３１によって冷却、或いは加熱装置３２によって加熱する構成にしている。しかし、流体供給装置内に送液タンク３６の代わりに、冷却水用タンクと温水用タンクとそれぞれを設け、それぞれのタンクに冷却装置３１、加熱装置３２を設ける構成にしてもよい。　
　この構成によれば、検査中、冷却装置３１及び加熱装置３２をオン状態しておくことによって、流体制御部３５に冷却信号が入力されると同時に冷却水を供給すること、及びは加熱信号が入力されると同時に温水を供給することが可能になる。 In the above-described embodiment, the water sent from the liquid supply tank 36 to the supply pipe 37 is cooled by the cooling device 31 or heated by the heating device 32 in the pipe. However, instead of the liquid supply tank 36 in the fluid supply device, a cooling water tank and a hot water tank may be provided, and a cooling device 31 and a heating device 32 may be provided in each tank.
According to this configuration, the cooling device 31 and the heating device 32 are turned on during the inspection, so that the cooling signal is input to the fluid control unit 35 and the cooling water is supplied at the same time. Hot water can be supplied at the same time as it is input.
　さらに、強度可変部材２５の管外表面及び管内表面に複数の凹凸部を設けるようにしてもよい。この構成によれば、第１隙間２９ａ、第２隙間２９ｂに供給される冷却水、或いは温水に接触する表面積が増大される。この結果、第１の状態から第２の状態に切り替わる応答性、或いはその逆の状態に切り替わる応答性の更なる向上を図ることができる。また、複数の凹凸部を設けることによって、隙間２９ａ、２９ｂ内を流れる流体に乱流を発生させて、流体と管外表面及び管内表面との熱交換率を上げることができる。 Furthermore, a plurality of uneven portions may be provided on the tube outer surface and the tube inner surface of the strength variable member 25. According to this configuration, the surface area in contact with the cooling water or hot water supplied to the first gap 29a and the second gap 29b is increased. As a result, the responsiveness of switching from the first state to the second state or the responsiveness of switching to the opposite state can be further improved. Further, by providing a plurality of concave and convex portions, turbulence can be generated in the fluid flowing in the gaps 29a and 29b, and the heat exchange rate between the fluid and the outer surface of the tube and the inner surface of the tube can be increased.
　また、強度可変部材２５を構成する形状記憶ポリマーに熱伝導率の高いフィラーを混入させることによって、強度可変部材２５を均一に温度変化するように構成するようにしてもよい。そして、混入するフィラーの向きを予め所定の方向に設定することによって、強度可変部材２５の厚み方向に比べて、外表面側及び内表面側の熱伝導を向上させて、より効率良く均一に強度可変部材２５を温度変化させることができる。 Further, the strength variable member 25 may be configured to change temperature uniformly by mixing a filler having high thermal conductivity into the shape memory polymer constituting the variable strength member 25. And by setting the direction of the filler to be mixed in a predetermined direction in advance, the heat conduction on the outer surface side and the inner surface side is improved compared to the thickness direction of the strength variable member 25, and the strength is more efficiently and uniformly. The temperature of the variable member 25 can be changed.
　図９－図１４を参照して本発明の第２実施形態の内視鏡装置を説明する。
　図９に示すように本実施形態の内視鏡装置１Ａは、内視鏡１０と、医療機器であるガイド部材４０とを備えて主に構成されている。内視鏡装置１Ａは、上述した実施形態と同様な構成の内視鏡１０、流体供給装置３０、及びフットスイッチ５を備えている。 An endoscope apparatus according to a second embodiment of the present invention will be described with reference to FIGS.
As shown in FIG. 9, the endoscope apparatus 1A of the present embodiment is mainly configured by including an endoscope 10 and a guide member 40 that is a medical device. The endoscope apparatus 1 </ b> A includes an endoscope 10, a fluid supply device 30, and a foot switch 5 having the same configuration as that of the above-described embodiment.
　ガイド部材４０は、内視鏡操作部１２に設けられた処置具チャンネル入口１８から図示しない処置具チャンネル内を挿通して先端開口（不図示）から体内に導出される。ガイド部材４０は、挿入部であるガイド部４１と、把持部である剛性を有するガイド部操作部４２とを備えて構成されている。ガイド部４１は、可撓性を変化させることが可能に構成されている。ガイド部操作部４２には、第１チューブ口金４３ａと、第２チューブ口金４３ｂとが設けられている。第１チューブ口金４３ａには流体供給装置３０から延出する第１流体チューブ３が接続され、第２チューブ口金４３ｂには流体供給装置３０から延出する第２流体チューブ４が接続されている。符号４４は、基端蓋部材である。 The guide member 40 is inserted into the treatment instrument channel (not shown) from the treatment instrument channel inlet 18 provided in the endoscope operation unit 12 and led out from the distal end opening (not shown) into the body. The guide member 40 includes a guide part 41 as an insertion part and a rigid guide part operation part 42 as a grip part. The guide part 41 is configured to be able to change flexibility. The guide portion operation unit 42 is provided with a first tube base 43a and a second tube base 43b. The first fluid tube 3 extending from the fluid supply device 30 is connected to the first tube base 43a, and the second fluid tube 4 extending from the fluid supply device 30 is connected to the second tube base 43b. Reference numeral 44 denotes a proximal end cover member.
　図１０に示すようにガイド部４１は、筒状でチューブ外装部材を兼ねる強度可変部材４５と、管状の内層チューブ４６とを備えて構成されている。内層チューブ４６は、予め定めた可撓性を有するチューブ部材である。 As shown in FIG. 10, the guide portion 41 includes a tubular variable strength member 45 that also serves as a tube exterior member, and a tubular inner layer tube 46. The inner layer tube 46 is a tube member having predetermined flexibility.
　強度可変部材４５は、予め定めた温度を境に強度が第１の状態と第２の状態とに変化する。強度可変部材４５は、ガラス転移温度が例えば摂氏１０度から摂氏５５度の間に設定される形状記憶ポリマーで筒状、或いは融点が例えば摂氏１０度から摂氏５５度の間に設定される熱可塑性樹脂、低融点合金で筒状に形成されている。つまり、本実施形態において、強度可変部材４５の先端側は、閉塞されている。 The strength variable member 45 changes in strength between the first state and the second state at a predetermined temperature. The strength variable member 45 is a shape memory polymer that has a glass transition temperature set between, for example, 10 degrees Celsius and 55 degrees Celsius, or a thermoplastic that has a melting point that is set between, for example, 10 degrees Celsius and 55 degrees Celsius. It is formed in a cylindrical shape with a resin and a low melting point alloy. That is, in the present embodiment, the distal end side of the strength varying member 45 is closed.
　具体的に、強度可変部材４５は、ガラス転移温度が体温より低い例えば摂氏２５度に設定された形状記憶ポリマーで、内径寸法φｄ１、肉厚ｔ１、外径寸法φＤ１で形成されている。 Specifically, the strength variable member 45 is a shape memory polymer whose glass transition temperature is lower than the body temperature, for example, set to 25 degrees Celsius, and is formed with an inner diameter dimension φd1, a wall thickness t1, and an outer diameter dimension φD1.
　内層チューブ４６は、流体回収路となる貫通孔４６ａを有している。内層チューブ４６の外径は、強度可変部材４５の内径寸法より予め定めた寸法細径である。内層チューブ４６は、強度可変部材４５の管内表面側に配置される。強度可変部材４５の管内表面と内層チューブ４６の管外表面との間には隙間４７が構成される。隙間４７は、流体供給装置３０から供給される流体が送り込まれる流体供給路である。 The inner layer tube 46 has a through hole 46a serving as a fluid recovery path. The outer diameter of the inner layer tube 46 is smaller than the inner diameter of the variable strength member 45 in advance. The inner layer tube 46 is disposed on the inner surface side of the strength variable member 45. A gap 47 is formed between the tube inner surface of the strength varying member 45 and the tube outer surface of the inner layer tube 46. The gap 47 is a fluid supply path through which the fluid supplied from the fluid supply device 30 is sent.
　内層チューブ４６の先端面は、強度可変部材４５の先端部底面から予め定めた寸法、離間して配置されるようにその長さが設定されている。離間部４８は、流体供給路と流体回収路とを連通する連通部である。即ち、本実施形態においては、隙間４７に供給された流体は、矢印Ｙ１０に示すように離間部４８を介して貫通孔４６ａ側に流れ込む。 The length of the distal end surface of the inner layer tube 46 is set so as to be spaced from the bottom surface of the distal end portion of the strength variable member 45 by a predetermined dimension. The separation part 48 is a communication part that communicates the fluid supply path and the fluid recovery path. That is, in the present embodiment, the fluid supplied to the gap 47 flows into the through hole 46a side through the separating portion 48 as indicated by an arrow Y10.
　強度可変部材４５が第１の状態におけるガイド部４１は、例えば大腸に挿入されてその先端が大腸の壁に当接したとき、受動的に変形する。そして、その後、壁との接触が解除されることによって元の形状に戻る予め定めた可撓性を有している。 When the strength varying member 45 is in the first state, the guide portion 41 is passively deformed, for example, when it is inserted into the large intestine and its tip abuts against the large intestine wall. And after that, it has the predetermined flexibility which returns to an original shape by cancelling | contacting with a wall.
　これに対して、強度可変部材４５が第２の状態に切り替えられると、ガイド部４１は、切替時の第１の状態における湾曲形状を保持する形状保持力を有する。そして、本実施形態における強度可変部材４５の形状保持力は、処置具チャンネルの先端開口から導出されて湾曲形状に保持されているガイド部４１に沿わせて内視鏡挿入部１１を移動させた際、移動する内視鏡挿入部１１によってガイド部４１の湾曲形状が変形されることなく、その湾曲形状を保持するように設定されている。 On the other hand, when the strength varying member 45 is switched to the second state, the guide portion 41 has a shape holding force that holds the curved shape in the first state at the time of switching. Then, the shape holding force of the strength varying member 45 in the present embodiment moves the endoscope insertion portion 11 along the guide portion 41 that is derived from the distal end opening of the treatment instrument channel and is held in a curved shape. At this time, the curved shape of the guide portion 41 is not deformed by the moving endoscope insertion portion 11 and is set to hold the curved shape.
　なお、強度可変部材４５を筒状としているが、強度可変部材４５は管状であってもよく、その場合には一端部を例えば円板状の蓋部材で閉塞する。そして、蓋部材を設ける構成においては、蓋部材の一面側に内層チューブ４６を蓋部材に一体に固定するための円環溝を設けるようにしてもよい。この場合、内層チューブ４６に、連通部となる前記切り欠き部２５ａと略同様な構成の切り欠き部を設ける。 Although the variable strength member 45 is cylindrical, the variable strength member 45 may be tubular, and in that case, one end is closed with, for example, a disc-shaped lid member. And in the structure which provides a cover member, you may make it provide the annular groove for fixing the inner layer tube 46 to a cover member integrally on the one surface side of a cover member. In this case, the inner layer tube 46 is provided with a notch having substantially the same configuration as the notch 25a serving as a communication portion.
　ガイド部操作部４２は、例えば、太径部４２ｃと細径部４２ｄとを有する。また、ガイド部操作部４２は、中心軸に沿って中央貫通孔４２ｈを備えている。中央貫通孔４２ｈ内には内層チューブ４６の基端部が配置され、例えば接着によりガイド部操作部４２に一体的に固定される。中央貫通孔４２ｈの基端側開口は、基端蓋部材４４によって塞がれる。 The guide part operation part 42 has, for example, a large diameter part 42c and a small diameter part 42d. Moreover, the guide part operation part 42 is provided with the central through-hole 42h along the central axis. The proximal end portion of the inner layer tube 46 is disposed in the central through hole 42h, and is fixed integrally to the guide portion operation portion 42 by, for example, adhesion. The proximal end side opening of the central through hole 42 h is closed by the proximal end cover member 44.
　ガイド部操作部４２の細径部４２ｄの外周面には、強度可変部材４５の基端部が外嵌配置され、例えば接着によってガイド部操作部４２に一体に固定される。　
　符号４２ａは、連通孔であり、符号４２ｂは空間部である。連通孔４２ａは、空間部４２ｂと隙間４７とを連通する。空間部４２ｂは、太径部４２ｃの外周面側に形成された凹部の開口を蓋部材４９で塞いで形成される。第１チューブ口金４３ａは、蓋部材４９に固設されている。第２チューブ口金４３ｂは、基端蓋部材４４に固設されている。符号４４ｈは、貫通孔であり、蓋部材４４の一面側及び他面側に開口を有する。符号４９ｈは、貫通孔であり、蓋部材４９の一面側及び他面側に開口を有する。 The base end portion of the strength varying member 45 is fitted on the outer peripheral surface of the small diameter portion 42d of the guide portion operation portion 42, and is fixed integrally to the guide portion operation portion 42 by, for example, adhesion.
Reference numeral 42a is a communication hole, and reference numeral 42b is a space portion. The communication hole 42 a communicates the space 42 b and the gap 47. The space portion 42 b is formed by closing the opening of the concave portion formed on the outer peripheral surface side of the large diameter portion 42 c with the lid member 49. The first tube base 43 a is fixed to the lid member 49. The second tube base 43 b is fixed to the base end cover member 44. Reference numeral 44 h is a through hole, and has openings on one side and the other side of the lid member 44. Reference numeral 49h denotes a through hole, which has openings on one side and the other side of the lid member 49.
　図９に示す流体供給装置３０は、冷却装置３１、加熱装置３２、送液ポンプ３３、吸引ポンプ３４、及び流体制御部３５を備えている。フットスイッチ５は、例えば第１スイッチ５ａと第２スイッチ５ｂとを備えている。 The fluid supply device 30 shown in FIG. 9 includes a cooling device 31, a heating device 32, a liquid feed pump 33, a suction pump 34, and a fluid control unit 35. The foot switch 5 includes, for example, a first switch 5a and a second switch 5b.
　流体制御部３５は、冷却信号を受けると、冷却装置３１をオン状態にして、送液ポンプ３３によって送液タンク３６に貯留されていた水の供給を開始すると共に、吸引ポンプ３４による供給された水の回収を開始する。すなわち、送液タンク３６に貯留されていた水は、供給管路３７に供給され、この供給管路３７内を通過中に冷却装置３１によって摂氏１０度に冷却される。摂氏１０度に冷却された冷却水は、第１流体口金６ａ、第１流体チューブ３、第１チューブ口金４３ａ、空間部４２ｂ、連通孔４２ａを介して流体供給路である隙間４７に供給される。そして、隙間４７に供給された冷却水は、離間部４８を介して流体回収路である貫通孔４６ａに流れ込む。その後、冷却水は、貫通孔４６ａから第２チューブ口金４３ｂ、第２流体チューブ４、第２流体口金６ｂ、回収管路３９を介して吸引タンク３８内に回収される。 Upon receiving the cooling signal, the fluid control unit 35 turns on the cooling device 31 and starts supplying the water stored in the liquid supply tank 36 by the liquid supply pump 33 and is supplied by the suction pump 34. Start collecting water. That is, the water stored in the liquid supply tank 36 is supplied to the supply pipe 37 and cooled to 10 degrees Celsius by the cooling device 31 while passing through the supply pipe 37. The cooling water cooled to 10 degrees Celsius is supplied to the gap 47, which is a fluid supply path, through the first fluid base 6a, the first fluid tube 3, the first tube base 43a, the space portion 42b, and the communication hole 42a. . Then, the cooling water supplied to the gap 47 flows into the through hole 46 a that is a fluid recovery path via the separation portion 48. Thereafter, the cooling water is recovered from the through hole 46 a into the suction tank 38 via the second tube base 43 b, the second fluid tube 4, the second fluid base 6 b, and the recovery conduit 39.
　そして、流体制御部３５は、第１スイッチ５ａがオフ操作されると、瞬時に送液ポンプ３３をオフ状態に切り替える。一方、流体制御部３５は、吸引ポンプ３４については予め定めた時間を経過した後オフ状態に切り替える。このことによって、ガイド部材４０内の冷却水の回収を確実に行える。 Then, when the first switch 5a is turned off, the fluid control unit 35 instantaneously switches the liquid feeding pump 33 to the off state. On the other hand, the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. Thereby, the cooling water in the guide member 40 can be reliably collected.
　流体制御部３５は、加熱信号を受けると、加熱装置３２をオン状態にして、送液ポンプ３３によって送液タンク３６に貯留されていた水の供給を開始すると共に、吸引ポンプ３４による供給された水の回収を開始する。即ち、送液タンク３６に貯留されていた水は、供給管路３７に供給され、この供給管路３７内を通過中に加熱装置３２によって摂氏４０度に加熱される。摂氏４０度に加熱された温水は、第１流体口金６ａ、第１流体チューブ３、第１チューブ口金４３ａ、空間部４２ｂ、連通孔４２ａを介して隙間４７に供給される。そして、隙間４７に供給された温水は、離間部４８を介して貫通孔４６ａに流れ込む。その後、温水は、第２チューブ口金４３ｂ、第２流体チューブ４、第２流体口金６ｂ、回収管路３９を介して吸引タンク３８内に回収される。 When the fluid control unit 35 receives the heating signal, the fluid control unit 35 turns on the heating device 32 to start the supply of water stored in the liquid supply tank 36 by the liquid supply pump 33 and the supply by the suction pump 34. Start collecting water. That is, the water stored in the liquid supply tank 36 is supplied to the supply pipe 37 and is heated to 40 degrees Celsius by the heating device 32 while passing through the supply pipe 37. The hot water heated to 40 degrees Celsius is supplied to the gap 47 through the first fluid base 6a, the first fluid tube 3, the first tube base 43a, the space portion 42b, and the communication hole 42a. Then, the hot water supplied to the gap 47 flows into the through hole 46 a via the separation portion 48. Thereafter, the hot water is recovered in the suction tank 38 via the second tube base 43 b, the second fluid tube 4, the second fluid base 6 b, and the recovery conduit 39.
　そして、流体制御部３５は、第２スイッチ５ｂがオフ操作されると、前記第１スイッチ５ａがオフ操作されたときと同様に、瞬時に送液ポンプ３３をオフ状態に切り替える。一方、流体制御部３５は、吸引ポンプ３４については予め定めた時間を経過した後オフ状態に切り替える。このことによって、ガイド部材４０内の温水の回収を確実に行える。 Then, when the second switch 5b is turned off, the fluid control unit 35 instantaneously switches the liquid feed pump 33 to the off state, similarly to the case where the first switch 5a is turned off. On the other hand, the fluid control unit 35 switches the suction pump 34 to the off state after a predetermined time has elapsed. This ensures that hot water in the guide member 40 can be collected.
　上述のように構成した内視鏡装置１Ａの作用を説明する。　
　内視鏡挿入部１１を例えば盲腸付近まで挿入して大腸内の検査を行うにあたって、医療関係者は、内視鏡装置１Ａとして内視鏡１０、光源装置２、ガイド部材４０、流体供給装置３０、フットスイッチ５、図示しない表示装置及びビデオプロセッサ等を準備する。このとき、医療関係者は、ガイド部４１の硬さが術者に指示された例えば摂氏２５度で変化するガイド部材４０を用意する。 The operation of the endoscope apparatus 1A configured as described above will be described.
For example, when the endoscope insertion unit 11 is inserted to the vicinity of the cecum to perform an inspection in the large intestine, the medical staff uses the endoscope 10, the light source device 2, the guide member 40, and the fluid supply device 30 as the endoscope device 1A. , A foot switch 5, a display device (not shown), a video processor, and the like are prepared. At this time, the medical staff prepares the guide member 40 whose hardness of the guide portion 41 is changed by, for example, 25 degrees Celsius instructed by the operator.
　一方、術者は、ガイド部材４０が指示したものであるかを確認する。指示したものであることを確認後、術者は、流体供給装置３０のメインパネル（不図示）に備えられている設定スイッチを操作して、冷却装置３１によって冷却する水の温度を例えば摂氏１０度に設定すると共に、加熱装置３２によって加熱する水の温度を例えば摂氏４０度に設定する。 On the other hand, the surgeon confirms whether the guide member 40 has instructed. After confirming that the instruction is given, the surgeon operates a setting switch provided on the main panel (not shown) of the fluid supply device 30 to set the temperature of water cooled by the cooling device 31 to, for example, 10 degrees Celsius. The temperature of water heated by the heating device 32 is set to 40 degrees Celsius, for example.
　次に、術者は、ガイド部材４０のガイド部４１の硬さを確認する。すなわち、強度可変部材４５が軟らかな状態であるか否かの確認を行う。そして、術者は、ガイド部４１が予め定めた可撓性であることを確認したなら、ガイド部先端部を処置具チャンネル入口１８から先端部１４の先端面に設けられている図示しないチャンネル開口に向けて挿入していく。その後、術者は、ガイド部４１を所望の長さチャンネル開口から外部に導出させる。 Next, the surgeon confirms the hardness of the guide portion 41 of the guide member 40. That is, it is confirmed whether or not the strength varying member 45 is in a soft state. If the surgeon confirms that the guide portion 41 has a predetermined flexibility, a channel opening (not shown) provided on the distal end surface of the distal end portion 14 from the treatment instrument channel inlet 18 to the guide portion distal end portion is provided. Insert it toward. Thereafter, the surgeon guides the guide portion 41 to the outside from the channel opening of a desired length.
　次いで、術者は、ガイド部４１の先端部を患者の肛門から大腸内に挿入する。そして、押し込み操作、捻り操作等の手元操作を行って、ガイド部４１を大腸の深部に向けて押し進めていく。そして、術者は、肛門７１から挿入したガイド部４１の先端部を、図１１に示すようにＳ状結腸７３より先端側の下行結腸７４内に配置する。 Next, the surgeon inserts the distal end portion of the guide portion 41 into the large intestine from the patient's anus. Then, a hand operation such as a pushing operation and a twisting operation is performed to push the guide portion 41 toward the deep part of the large intestine. Then, the operator places the distal end portion of the guide portion 41 inserted from the anus 71 in the descending colon 74 on the distal end side from the sigmoid colon 73 as shown in FIG.
　術者は、ガイド部４１の先端部がＳ状結腸７３を通過したと判断したなら、ガイド部４１の湾曲形状をその湾曲形状のままに保持する目的で、フットスイッチ５の第１スイッチ５ａをオン操作する。すると、フットスイッチ５から流体供給装置３０の流体制御部３５に冷却信号が発信される。 When the surgeon determines that the distal end portion of the guide portion 41 has passed through the sigmoid colon 73, the surgeon holds the first switch 5a of the foot switch 5 for the purpose of holding the curved shape of the guide portion 41 as it is. Turn on. Then, a cooling signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
　冷却信号を受けた流体制御部３０は、第１流体口金６ａを介して冷却水を、第１流体チューブ３、第１チューブ口金４３ａ、空間部４２ｂ、連通孔４２ａを介して強度可変部材４５の管内表面側に位置する隙間４７に供給する。その後、隙間４７に供給された冷却水は、離間部４８を介して貫通孔４６ａに流れ込み、貫通孔４６ａから第２チューブ口金４３ｂ、第２流体チューブ４、第２流体口金６ｂ、回収管路３９を介して吸引タンク３８内に回収される。つまり、ガイド部材４０の隙間４７には流体供給装置３０から連続的に冷却水が供給される。 Upon receiving the cooling signal, the fluid control unit 30 supplies the cooling water via the first fluid base 6a to the strength variable member 45 via the first fluid tube 3, the first tube base 43a, the space part 42b, and the communication hole 42a. It supplies to the clearance 47 located in the pipe inner surface side. Thereafter, the cooling water supplied to the gap 47 flows into the through hole 46a through the separation portion 48, and from the through hole 46a, the second tube base 43b, the second fluid tube 4, the second fluid base 6b, and the recovery conduit 39. It is collected in the suction tank 38 via That is, the cooling water is continuously supplied from the fluid supply device 30 to the gap 47 of the guide member 40.
　隙間４７に連続的に供給された冷却水は、強度可変部材４５の管内表面に触れ、強度可変部材４５の温度を速やかに低下させる。そして、強度可変部材４５の温度がガラス転移温度以下に変化することによって、強度可変部材４５の硬さが第１の状態から第２の状態に変化されて、ガイド部４１の硬さが硬い状態に変化する。すなわち、下行結腸７４内、Ｓ状結腸７３内、直腸７２内、および肛門７１より外部に配置されていた軟らかな状態のガイド部４１がその湾曲形状のままで保持される。 The cooling water continuously supplied to the gap 47 touches the inner surface of the pipe of the strength varying member 45 and quickly reduces the temperature of the strength varying member 45. When the temperature of the strength variable member 45 is changed to the glass transition temperature or lower, the hardness of the strength variable member 45 is changed from the first state to the second state, and the hardness of the guide portion 41 is hard. To change. That is, the guide portion 41 in a soft state that is disposed in the descending colon 74, the sigmoid colon 73, the rectum 72, and the anus 71 is held in its curved shape.
　術者は、ガイド部４１が硬い状態に変化したことを確認したなら、内視鏡挿入部１１を硬い状態のガイド部４１に沿わせて移動していく。つまり、図１１の破線に示すように内視鏡挿入部１１の先端部１４を肛門７１から直腸７２内に挿入し、その後、押し込み操作、捻り操作等の手元操作を行って、内視鏡挿入部１１を硬い状態のガイド部４１に沿わせて図１２の実線に示すように下行結腸７４内に導入する。 When the surgeon confirms that the guide portion 41 has changed to a hard state, the surgeon moves the endoscope insertion portion 11 along the guide portion 41 in a hard state. That is, as shown by a broken line in FIG. 11, the distal end portion 14 of the endoscope insertion portion 11 is inserted into the rectum 72 from the anus 71, and then a hand operation such as a pushing operation and a twisting operation is performed to insert the endoscope. The part 11 is introduced into the descending colon 74 along the hard guide part 41 as shown by the solid line in FIG.
　導入後、術者は、さらに、表示装置に表示される内視鏡画像を観察しつつ、内視鏡挿入部１１を可動性に乏しい下行結腸７４の奥方向に向けて挿入していく。そして、術者は、表示装置に表示される内視鏡画像を視認して図１２の二点鎖線に示すように先端部１４を脾湾曲７６近傍の所望する位置に配置する。 After the introduction, the surgeon further inserts the endoscope insertion portion 11 toward the back of the descending colon 74 having poor mobility while observing the endoscope image displayed on the display device. Then, the surgeon visually recognizes the endoscopic image displayed on the display device and arranges the distal end portion 14 at a desired position in the vicinity of the splenic curve 76 as indicated by a two-dot chain line in FIG.
　ここで、術者は、第１スイッチ５ａをオフ操作すると共に、ガイド部４１の湾曲形状の保持を解除する目的で、フットスイッチ５の第２スイッチ５ｂをオン操作する。すると、フットスイッチ５から流体供給装置３０の流体制御部３５に加熱信号が発信される。 Here, the surgeon turns off the first switch 5a and turns on the second switch 5b of the foot switch 5 for the purpose of releasing the curved shape of the guide portion 41. Then, a heating signal is transmitted from the foot switch 5 to the fluid control unit 35 of the fluid supply device 30.
　加熱信号を受けた流体制御部３５は、第１流体口金６ａを介して温水を、第１流体チューブ３、第１チューブ口金４３ａ、空間部４２ｂ、連通孔４２ａを介して強度可変部材４５の管内表面側に位置する隙間４７に供給する。その後、隙間４７に供給された温水は、離間部４８を介して貫通孔４６ａに流れ込み、貫通孔４６ａから第２チューブ口金４３ｂ、第２流体チューブ４、第２流体口金６ｂ、回収管路３９を介して吸引タンク３８内に回収される。 Upon receiving the heating signal, the fluid control unit 35 supplies the hot water via the first fluid base 6a to the pipe of the variable strength member 45 via the first fluid tube 3, the first tube base 43a, the space 42b, and the communication hole 42a. It supplies to the clearance gap 47 located in the surface side. Thereafter, the hot water supplied to the gap 47 flows into the through hole 46a through the separation portion 48, and passes through the second tube cap 43b, the second fluid tube 4, the second fluid cap 6b, and the recovery conduit 39 from the through hole 46a. Through the suction tank 38.
　隙間４７に連続的に供給された温水は、強度可変部材４５の管内表面に触れ、強度可変部材４５の温度を速やかに上昇させる。そして、強度可変部材４５の温度がガラス転移温度以上に変化することによって、強度可変部材４５の硬さが、第２の状態から第１の状態に変化されて、ガイド部４１の硬さが予め定めた可撓性に変化する。すなわち、湾曲形状に保持されていたガイド部４１が再び所望する可撓性を有する状態に戻る。 The hot water continuously supplied to the gap 47 touches the inner surface of the strength variable member 45 and quickly raises the temperature of the strength variable member 45. Then, when the temperature of the strength variable member 45 changes to the glass transition temperature or higher, the hardness of the strength variable member 45 is changed from the second state to the first state, and the hardness of the guide portion 41 is set in advance. It changes to the defined flexibility. That is, the guide part 41 held in the curved shape returns to the desired flexibility state again.
　術者は、ガイド部４１が予め定めた可撓性に変化したことを確認したなら、第２スイッチ５ｂをオフ操作する。このことによって、ガイド部４１は、体温によって所望する可撓性に保持される。その後、術者は、予め定めた可撓性のガイド部４１を、さらに処置具チャンネルの開口に向けて押し込み操作する。 When the surgeon confirms that the guide portion 41 has changed to the predetermined flexibility, the operator turns off the second switch 5b. Thus, the guide portion 41 is held in a desired flexibility by the body temperature. Thereafter, the surgeon further pushes the predetermined flexible guide portion 41 toward the opening of the treatment instrument channel.
　そして、図１２の破線及び図１３の実線に示すようにガイド部４１の先端部を内視鏡の先端部１４から横行結腸７５内に導出させる。術者は、内視鏡画像でガイド部４１の先端部が横行結腸７５の所望する位置に配置されたことを視認したなら、横行結腸７５、処置具チャンネル内に配置されているガイド部４１の湾曲形状をその湾曲形状のままに保持する目的で、再び、フットスイッチ５の第１スイッチ５ａをオン操作する。 Then, as shown by the broken line in FIG. 12 and the solid line in FIG. 13, the distal end portion of the guide portion 41 is led out into the transverse colon 75 from the distal end portion 14 of the endoscope. If the surgeon visually recognizes that the distal end portion of the guide portion 41 is disposed at a desired position of the transverse colon 75 in the endoscopic image, the transverse portion of the transverse colon 75 and the guide portion 41 disposed in the treatment instrument channel are displayed. The first switch 5a of the foot switch 5 is turned on again for the purpose of maintaining the curved shape as it is.
　この結果、上述したように、冷却水が、隙間４７に供給されて、横行結腸７５内、処置具チャンネル内、および処置具チャンネル入口１８より外部に配置されていた軟らかな状態のガイド部４１がその湾曲形状のままで保持される。 As a result, as described above, the cooling water is supplied to the gap 47, and the guide portion 41 in the soft state that has been arranged in the transverse colon 75, the treatment instrument channel, and the treatment instrument channel inlet 18 is provided. It is held in its curved shape.
　ここで、術者は、内視鏡挿入部１１の押し込み操作、或いは捩り操作を行って、内視鏡挿入部１１を硬い状態のガイド部４１に沿わせて横行結腸７５内に導入させる。導入後、術者は、内視鏡画像を観察しつつ、内視鏡挿入部１１を前進させる操作を行って、内視鏡挿入部１１を図１３の二点鎖線に示すように肝湾曲７７近傍の所望する位置に配置する。 Here, the surgeon performs a pushing operation or a twisting operation of the endoscope insertion portion 11 to introduce the endoscope insertion portion 11 into the transverse colon 75 along the guide portion 41 in a hard state. After the introduction, the surgeon performs an operation of advancing the endoscope insertion portion 11 while observing the endoscope image, so that the endoscope insertion portion 11 is hepatic curved 77 as indicated by a two-dot chain line in FIG. Place it at a desired position in the vicinity.
　配置後、術者は、内視鏡挿入部１１の挿入を停止させる。そして、術者は、第１スイッチ５ａをオフ操作すると共に、ガイド部４１の湾曲形状の保持を解除する目的で、フットスイッチ５の第２スイッチ５ｂをオン操作する。この結果、上述したように、温水が、隙間４７に供給されて、強度可変部材４５の硬さが、第２記状態から第１の状態に変化して、ガイド部４１が再び予め定めた可撓性に戻る。 After the placement, the surgeon stops the insertion of the endoscope insertion portion 11. Then, the operator turns off the first switch 5a and turns on the second switch 5b of the foot switch 5 for the purpose of releasing the curved shape of the guide portion 41. As a result, as described above, the hot water is supplied to the gap 47, the hardness of the strength varying member 45 changes from the second state to the first state, and the guide portion 41 can be preset again. Return to flexibility.
　この後、術者は、第２スイッチ５ｂをオフ操作して、予め定めた可撓性に変化しているガイド部４１を処置具チャンネルの開口に向けてさらに押し込み操作する。このことによって、図１４の実線に示すようにガイド部４１の先端部が上行結腸７８内に導出される。 Thereafter, the operator turns off the second switch 5b, and further pushes the guide portion 41, which has changed to a predetermined flexibility, toward the opening of the treatment instrument channel. As a result, the distal end portion of the guide portion 41 is led into the ascending colon 78 as shown by the solid line in FIG.
　術者は、ガイド部４１の先端部が上行結腸７８に配置されたと判断したなら、ガイド部４１の湾曲形状をその湾曲形状のままに保持する目的で、再び、フットスイッチ５の第１スイッチ５ａをオン操作する。この結果、上述したように、冷却水が、隙間４７に供給されて、上行結腸７８内、横行結腸７５内、処置具チャンネル内、および処置具チャンネル入口１８より外部に配置されていた軟らかな状態のガイド部４１がその湾曲形状のままで保持される。 When the surgeon determines that the distal end portion of the guide portion 41 is disposed in the ascending colon 78, the first switch 5a of the foot switch 5 is again used for the purpose of holding the curved shape of the guide portion 41 in the curved shape. Turn on the. As a result, as described above, the cooling water is supplied to the gap 47 and is in a soft state in which the cooling water is disposed in the ascending colon 78, the transverse colon 75, the treatment instrument channel, and the treatment instrument channel inlet 18. The guide portion 41 is held in its curved shape.
　ここで、術者は、内視鏡挿入部１１の押し込み操作、或いは捩り操作を行って、内視鏡挿入部１１を硬い状態のガイド部４１に沿わせて上行結腸７８内に導入する。導入後、術者は、内視鏡画像を観察しつつ、内視鏡挿入部１１を前進させる操作を行って、内視鏡挿入部１１を盲腸７９近傍に到達させる。 Here, the surgeon performs a pushing operation or a twisting operation of the endoscope insertion portion 11 to introduce the endoscope insertion portion 11 into the ascending colon 78 along the guide portion 41 in a hard state. After the introduction, the surgeon performs an operation of moving the endoscope insertion portion 11 forward while observing the endoscope image, so that the endoscope insertion portion 11 reaches the vicinity of the cecum 79.
　ここで、術者は、第１スイッチ５ａをオフ操作すると共に、第２スイッチ５ｂをオン操作し、湾曲形状に保持されていたガイド部４１を軟らかな状態にする。そして、術者は、ガイド部４１が軟らかな状態に変化したことを確認したなら、第２スイッチ５ｂをオフ操作して、ガイド部材４０を処置具チャンネルから抜去する。そして、ガイド部材４０を抜去した後、内視鏡挿入部１１を引き戻しながら行う大腸の検査に移行する。 Here, the operator turns off the first switch 5a and turns on the second switch 5b to bring the guide portion 41 held in the curved shape into a soft state. When the surgeon confirms that the guide portion 41 has changed to a soft state, the operator turns off the second switch 5b to remove the guide member 40 from the treatment instrument channel. Then, after the guide member 40 is removed, the procedure shifts to an inspection of the large intestine performed while pulling back the endoscope insertion portion 11.
　このように、ガイド部材４０においては、ガイド部４１の最外周側に強度可変部材４５を配置することによって、強度可変部材４５の外径寸法をガイド部４１の許される最大外径寸法に設定して、最大の保持強度を得ることができる。　
　その他の作用及び効果は上述した第１実施形態と同様である。 As described above, in the guide member 40, the outer diameter dimension of the strength variable member 45 is set to the maximum outer diameter dimension permitted by the guide section 41 by arranging the strength variable member 45 on the outermost peripheral side of the guide section 41. Thus, the maximum holding strength can be obtained.
Other operations and effects are the same as those in the first embodiment.
　なお、上述した第２実施形態においては、大腸内の検査を行うにあたって、予め、ガイド部４１の先端部を患者のＳ状結腸７３を通過させた位置に配置しておき、その後に、内視鏡挿入部１１を硬い状態にしたガイド部４１に沿わせて大腸内に挿入するとしている。しかし、内視鏡挿入部１１の処置具チャンネル内に軟らかな状態のガイド部４１を配置して、内視鏡挿入部１１とガイド部４１とを一体に肛門７１から直腸７２に挿入し、その後は適宜に、ガイド部４１を先端部１４から導出させて、ガイド部４１を第２の状態、或いは第１の状態に切り替えて、内視鏡挿入部１１をＳ状結腸７３を通過させるようにしてもよい。 In the second embodiment described above, when performing an inspection in the large intestine, the distal end portion of the guide portion 41 is disposed in advance at a position where the patient's sigmoid colon 73 has passed, and then the endoscopic view is performed. The mirror insertion part 11 is inserted into the large intestine along the guide part 41 which is in a hard state. However, the guide part 41 in a soft state is disposed in the treatment instrument channel of the endoscope insertion part 11, and the endoscope insertion part 11 and the guide part 41 are inserted into the rectum 72 from the anus 71 together. As appropriate, the guide portion 41 is led out from the distal end portion 14 and the guide portion 41 is switched to the second state or the first state so that the endoscope insertion portion 11 passes through the sigmoid colon 73. May be.
　また、ガイド部４１を、例えば、予め、肝湾曲７７近傍に到達させた後、ガイド部４１の硬度を硬く設定して、内視鏡挿入部１１を第２態のガイド部４１に沿わせて大腸の深部に向けて挿入するようにしてもよい。 In addition, for example, after the guide portion 41 has previously reached the vicinity of the liver curvature 77, the hardness of the guide portion 41 is set to be hard, and the endoscope insertion portion 11 is set along the guide portion 41 in the second state. It may be inserted toward the deep part of the large intestine.
　また、上述したチューブ体２１及びガイド部４１においては、軟らかな状態から硬い状態、或いはその逆の状態に変化させる応答性の向上を図る目的で、ガイド部４１を構成する強度可変部材４５の管内表面に熱伝導性の高い部材を配置する、或いはチューブ体２１を構成する強度可変部材２５の管外表面及び管内表面に熱伝導性の高い部材を配置ようにしてもよい。　
　なお、高熱伝導性部材としては、シリコンシート、グラファイトシート、ＰＧＳグラファイトシート、銅繊維を網目状に編んだ網管、グリスを用いる。シリコンシート、グラファイトシート、或いはＰＧＳグラファイトシートを管内表面、或いは管外表面に配置する場合、帯状にしたシリコンシート、グラファイトシート、或いはＰＧＳグラファイトシートを螺旋状に巻回して配置する。このことによって、ガイド部４１及びチューブ体２１の可撓性を損なうことなく、応答性の向上を図ることができる。 Moreover, in the tube body 21 and the guide part 41 mentioned above, the inside of the pipe | tube of the intensity | strength variable member 45 which comprises the guide part 41 is aimed at the improvement of the responsiveness which changes from a soft state to a hard state, or the reverse state. A member having high thermal conductivity may be disposed on the surface, or a member having high thermal conductivity may be disposed on the outer surface and the inner surface of the strength variable member 25 constituting the tube body 21.
In addition, as a high heat conductive member, a silicon sheet, a graphite sheet, a PGS graphite sheet, a mesh tube knitted in a mesh shape, or grease is used. When a silicon sheet, a graphite sheet, or a PGS graphite sheet is disposed on the inner surface of the tube or the outer surface of the tube, the silicon sheet, the graphite sheet, or the PGS graphite sheet having a band shape is spirally wound and disposed. Thereby, the responsiveness can be improved without impairing the flexibility of the guide portion 41 and the tube body 21.
　また、上述においては、冷却水を供給して、ガイド部４１を第２の状態にしている間に、このガイド部４１に沿わせて内視鏡挿入部１１を大腸の深部に向けて移動させる、或いは冷却水を供給してチューブ体２１を第２の状態にしている間に、チューブ体２１の挿入孔２０Ｈ内の内視鏡挿入部１１をチューブ体２１の先端に向けて移動させるとしている。 In the above description, while the cooling water is supplied and the guide portion 41 is in the second state, the endoscope insertion portion 11 is moved toward the deep portion of the large intestine along the guide portion 41. Alternatively, the endoscope insertion portion 11 in the insertion hole 20H of the tube body 21 is moved toward the distal end of the tube body 21 while the cooling water is supplied to bring the tube body 21 into the second state. .
　しかし、冷却水を供給してガイド部４１の湾曲形状を保持している間、ガイド部４１においては、体温、或いは室温によって強度可変部材４５の管外表面側が暖められて冷却水の温度が上昇するおそれがある。一方、チューブ体２１においては、冷却水を供給してチューブ体の湾曲形状を保持している間、挿入部挿通管２６が挿入孔２０Ｈ内に配置された内視鏡挿入部１１の先端部１４に設けられている撮像装置から発する熱、或いは照明窓から発する熱によって、暖められて冷却水の温度が上昇するおそれ、および、チューブ外装部材２７が体温、或いは室温によって暖められて冷却水の温度が上昇するおそれがある。 However, while the cooling water is supplied and the curved shape of the guide portion 41 is maintained, the guide surface 41 is heated at the outer surface side of the strength varying member 45 by the body temperature or room temperature, and the temperature of the cooling water rises. There is a risk. On the other hand, in the tube body 21, while the cooling water is supplied and the curved shape of the tube body is maintained, the distal end portion 14 of the endoscope insertion portion 11 in which the insertion portion insertion tube 26 is disposed in the insertion hole 20H. There is a risk that the temperature of the cooling water may be increased by heat generated from the imaging device provided in the window or heat generated from the illumination window, and the temperature of the cooling water may be increased by heating the tube exterior member 27 at the body temperature or room temperature. May rise.
　このため、チューブ体２１においては、チューブ外装部材２７の外周面又は内周面の少なくとも一方に断熱部を設けるとともに、挿入部挿通管２６の外周面又は内周面の少なくとも一方に断熱部を設ける。このことによって、チューブ外装部材２７を介して第２隙間２９ｂ側に体温、室温が伝達されることを防止することができる。また、挿入部挿通管２６を介して第１隙間２９ａ側に撮像装置、或いは照明窓から発する熱が伝達されることを防止することができる。 For this reason, in the tube body 21, while providing a heat insulating part in at least one of the outer peripheral surface or inner peripheral surface of the tube exterior member 27, a heat insulating part is provided in at least one of the outer peripheral surface or inner peripheral surface of the insertion part insertion pipe 26. . Accordingly, it is possible to prevent body temperature and room temperature from being transmitted to the second gap 29b side via the tube exterior member 27. In addition, it is possible to prevent the heat generated from the imaging device or the illumination window from being transmitted to the first gap 29a via the insertion portion insertion tube 26.
　これに対して、ガイド部４１においては、強度可変部材４５の管外表面又は管内表面の少なくとも一方に断熱部を設ける。このことによって、強度可変部材４５を介して隙間４７に体温、室温が伝達されることを防止することができる。 On the other hand, in the guide portion 41, a heat insulating portion is provided on at least one of the tube outer surface and the tube inner surface of the strength varying member 45. Accordingly, it is possible to prevent body temperature and room temperature from being transmitted to the gap 47 via the strength varying member 45.
　なお、上述した断熱部は、断熱シートであり、例えば帯状の断熱シートを、挿入部挿通管２６、チューブ外装部材２７及び強度可変部材４５の所望の位置に螺旋状に巻回して配置する。このことによって、ガイド部４１及びチューブ体２１の可撓性を損なうことなく、断熱部を設けることができる。また、第１実施形態においては、チューブ体２１のチューブ外装部材２７を、断熱ウレタンフォームで形成するようにしてもよい。 In addition, the heat insulation part mentioned above is a heat insulation sheet, for example, a strip | belt-shaped heat insulation sheet is helically wound and arrange | positioned in the desired position of the insertion part penetration tube 26, the tube exterior member 27, and the intensity | strength variable member 45. Thereby, a heat insulating part can be provided without impairing the flexibility of the guide part 41 and the tube body 21. Moreover, in 1st Embodiment, you may make it form the tube exterior member 27 of the tube body 21 with a heat insulation urethane foam.
　図１５－図１８を参照して本発明の第３実施形態の内視鏡装置を説明する。　
　図１５に示すように本実施形態の内視鏡装置１Ｂは、内視鏡１０と、医療機器であるオーバーチューブ２０と、形状保持部材５０とを備えて主に構成されている。そして、内視鏡装置１Ｂは、上述した実施形態と同様な構成の流体供給装置３０Ｂ１、３０Ｂ２及びフットスイッチ５Ｂ１、５Ｂ２を備えている。　
　形状保持部材５０は、細長な棒状部材である。形状保持部材５０は、内視鏡操作部１２に設けられた処置具チャンネル入口１８から図示しない処置具チャンネル内に挿通され、予め定めた位置に配置される。形状保持部材５０は、可撓性を変化させることが可能な挿入部である形状保持本体５１と、把持部である剛性を有する形状保持操作部５２とを備えて構成されている。 An endoscope apparatus according to a third embodiment of the present invention will be described with reference to FIGS.
As shown in FIG. 15, the endoscope apparatus 1 </ b> B of the present embodiment is mainly configured by including an endoscope 10, an overtube 20 that is a medical device, and a shape holding member 50. The endoscope apparatus 1B includes fluid supply apparatuses 30B1 and 30B2 and foot switches 5B1 and 5B2 having the same configuration as that of the above-described embodiment.
The shape holding member 50 is an elongated rod-shaped member. The shape holding member 50 is inserted into a treatment instrument channel (not shown) from a treatment instrument channel inlet 18 provided in the endoscope operation unit 12 and is disposed at a predetermined position. The shape holding member 50 includes a shape holding main body 51 that is an insertion portion that can change flexibility, and a shape holding operation portion 52 having rigidity that is a gripping portion.
　本実施形態の形状保持本体５１は、中実な強度可変部材によって構成されている。つまり、形状保持本体５１は、ガラス転移温度が体温より低い例えば摂氏２５度に設定された形状記憶ポリマーで、外径寸法が処置具チャンネルの内径より予め定めた寸法小径に形成されている。形状保持本体５１の一端部は、形状保持操作部５２に固設されている。 The shape holding body 51 of the present embodiment is configured by a solid strength variable member. That is, the shape-maintaining body 51 is a shape memory polymer whose glass transition temperature is lower than the body temperature, for example, 25 degrees Celsius, and has an outer diameter dimension that is smaller than the inner diameter of the treatment instrument channel. One end of the shape holding body 51 is fixed to the shape holding operation unit 52.
　本実施形態の処置具チャンネル入口１８には、チューブ口金付栓体（以下、栓体と略記する）５３が取り付けられている。栓体５３は、栓体口金５４を備え、該口金５４には第２流体供給装置３０Ｂ２から延出する第１流体チューブ３Ｂが接続されるようになっている。そして、第１流体チューブ３Ｂから栓体口金５４に供給される例えば水は、処置具チャンネル内に供給されるようになっている。 A plug body with a tube cap (hereinafter abbreviated as a plug body) 53 is attached to the treatment instrument channel inlet 18 of the present embodiment. The plug 53 includes a plug base 54 to which the first fluid tube 3B extending from the second fluid supply device 30B2 is connected. For example, water supplied from the first fluid tube 3B to the plug base 54 is supplied into the treatment instrument channel.
　本実施形態のオーバーチューブ２０のオーバーチューブ操作部２２には、チューブ口金付連通部（以下、連通部と略記する）５５が取り付けられるようになっている。連通部５５は、連通部口金５６と、側孔５７を備える。口金５６には第２流体供給装置３０Ｂ２から延出する第２流体チューブ４Ｂが接続されるようになっている。そして、第２流体チューブ４Ｂは、挿入孔２０Ｈ、側孔５７を介して処置具チャンネルから体内に流出した水を回収するようになっている。 A communication part with a tube cap (hereinafter abbreviated as a communication part) 55 is attached to the overtube operation part 22 of the overtube 20 of the present embodiment. The communication portion 55 includes a communication portion base 56 and a side hole 57. A second fluid tube 4B extending from the second fluid supply device 30B2 is connected to the base 56. And the 2nd fluid tube 4B collect | recovers the water which flowed out into the body from the treatment tool channel via the insertion hole 20H and the side hole 57. FIG.
　なお、第１流体供給装置３０Ｂ１の構成及び第２流体供給装置３０Ｂ２の構成は、上述した流体供給装置３０の構成と同様であり、第１フットスイッチ５Ｂ１の構成及び第２フットスイッチ５Ｂ２の構成は、上述したフットスイッチ５の構成と同様である。また、第１流体チューブ３Ｂは、第１流体チューブ３と同様の構成であり、第２流体チューブ４Ｂは、第２流体チューブ４と同様の構成である。その他の構成は、上述した実施形態と同様であり、同部材には同符号を付して説明を省略する。 The configuration of the first fluid supply device 30B1 and the configuration of the second fluid supply device 30B2 are the same as the configuration of the fluid supply device 30 described above, and the configuration of the first foot switch 5B1 and the configuration of the second foot switch 5B2 are the same. The configuration of the foot switch 5 is the same as that described above. The first fluid tube 3 </ b> B has the same configuration as the first fluid tube 3, and the second fluid tube 4 </ b> B has the same configuration as the second fluid tube 4. Other configurations are the same as those of the above-described embodiment, and the same members are denoted by the same reference numerals and description thereof is omitted.
　上述のように構成した内視鏡装置１Ｂの作用を説明する。　
　本実施形態においては、内視鏡挿入部１１を例えば盲腸付近まで挿入して大腸内の検査を行うにあたって、内視鏡装置１Ｂを使用する。内視鏡装置１Ｂは、内視鏡１０、光源装置２、オーバーチューブ２０、形状保持部材５０、流体供給装置３０Ｂ１、３０Ｂ２、フットスイッチ５Ｂ１、５Ｂ２、図示しない表示装置及びビデオプロセッサ等を備える。 The operation of the endoscope apparatus 1B configured as described above will be described.
In the present embodiment, the endoscope apparatus 1B is used when the endoscope insertion portion 11 is inserted, for example, to the vicinity of the cecum to perform inspection in the large intestine. The endoscope apparatus 1B includes an endoscope 10, a light source device 2, an overtube 20, a shape holding member 50, fluid supply devices 30B1, 30B2, foot switches 5B1, 5B2, a display device (not shown), a video processor, and the like.
　本実施形態において、術者は、軟らかな状態の形状保持部材５０を、予め、内視鏡挿入部１１の処置具チャンネル内に所望する状態で配置しておく。具体的に、術者は、形状保持本体５１を栓体５３の図示しない栓孔を介して処置具チャンネル内に挿入し、形状保持操作部５２の端面を栓体５３に当接させる。このとき、形状保持本体５１の外周面には、栓孔が密着配置され、形状保持本体５１の先端は、例えば湾曲部１５の先端側に位置する。 In this embodiment, the operator places the shape holding member 50 in a soft state in a desired state in the treatment instrument channel of the endoscope insertion portion 11 in advance. Specifically, the surgeon inserts the shape holding main body 51 into the treatment instrument channel through a plug hole (not shown) of the plug 53 and brings the end surface of the shape holding operation portion 52 into contact with the plug 53. At this time, the plug hole is closely attached to the outer peripheral surface of the shape-maintaining main body 51, and the distal end of the shape-maintaining main body 51 is located, for example, on the distal end side of the bending portion 15.
　術者は、流体供給装置３０Ｂ１、３０Ｂ２のメインパネル（不図示）に備えられている設定スイッチを操作して、各流体供給装置３０Ｂ１、３０Ｂ２に備えられている冷却装置３１によって冷却する水の温度を例えば摂氏１０度に設定すると共に、加熱装置３２によって加熱する水の温度を例えば摂氏４０度に設定する。 The surgeon operates a setting switch provided on a main panel (not shown) of the fluid supply devices 30B1 and 30B2, and the temperature of water cooled by the cooling device 31 provided in each fluid supply device 30B1 and 30B2. Is set to 10 degrees Celsius, for example, and the temperature of the water heated by the heating device 32 is set to 40 degrees Celsius, for example.
　そして、術者は、前記内視鏡装置１の作用で説明したように、まず、オーバーチューブ２０のチューブ体２１の硬さが予め定めた可撓性であることを確認する。その後、術者は、チューブ体２１の先端部を患者の肛門から大腸内に挿入して、前記図５の二点鎖線で示したようにチューブ体２１の先端部をＳ状結腸７３より先端側の下行結腸７４内に配置する。 Then, as described in the operation of the endoscope apparatus 1, the surgeon first confirms that the hardness of the tube body 21 of the overtube 20 is a predetermined flexibility. Thereafter, the surgeon inserts the distal end portion of the tube body 21 into the large intestine from the patient's anus and places the distal end portion of the tube body 21 on the distal side of the sigmoid colon 73 as indicated by the two-dot chain line in FIG. In the descending colon 74.
　術者は、チューブ体２１の先端部がＳ状結腸７３を通過したと判断したなら、チューブ体２１の湾曲形状をその湾曲形状のままに保持する目的で、第１フットスイッチ５Ｂ１の第１スイッチ５ａをオン操作する。 When the surgeon determines that the distal end portion of the tube body 21 has passed through the sigmoid colon 73, the first switch of the first foot switch 5B1 is used for the purpose of maintaining the curved shape of the tube body 21 as it is. Turn on 5a.
　すると、上述したように、第１流体供給装置３０Ｂ１で冷却された冷却水は、第１流体口金６ａからチューブ体２１の第１の隙間２９ａ、第２隙間２９ｂに供給される。すると、冷却水によって強度可変部材２５は、速やかに冷却され、下行結腸７４内、Ｓ状結腸７３内、直腸７２内、および肛門７１より外部に配置されていたチューブ体２１が湾曲形状のまま保持される。 Then, as described above, the cooling water cooled by the first fluid supply device 30B1 is supplied from the first fluid base 6a to the first gap 29a and the second gap 29b of the tube body 21. Then, the strength varying member 25 is quickly cooled by the cooling water, and the tube body 21 arranged in the descending colon 74, the sigmoid colon 73, the rectum 72, and the outside of the anus 71 is held in a curved shape. Is done.
　術者は、チューブ体２１が硬い状態に変化したことを確認したなら、オーバーチューブ操作部２２側から挿入孔２０Ｈ内に、形状保持本体５１が処置具チャンネル内に配置されている内視鏡挿入部１１を挿入する。そして、術者は、内視鏡挿入部１１の先端部１４をチューブ体２１の先端に向けて前進させる。 When the operator confirms that the tube body 21 has changed to a hard state, the endoscope is inserted in which the shape-maintaining body 51 is disposed in the treatment instrument channel from the overtube operation portion 22 side into the insertion hole 20H. Insert part 11. Then, the surgeon advances the distal end portion 14 of the endoscope insertion portion 11 toward the distal end of the tube body 21.
　図１６の実線に示すようにチューブ体２１の先端から順に内視鏡挿入部１１の先端部１４、湾曲部１５が下行結腸７４内に導出される。導出後、術者は、表示装置に表示される内視鏡画像を観察しつつ、内視鏡挿入部１１を大腸の深部に挿入する操作を行う。そして、図１６の二点鎖線に示すように先端部１４を脾湾曲７６近傍の所望する位置に配置する。 16, the distal end portion 14 and the bending portion 15 of the endoscope insertion portion 11 are led out into the descending colon 74 in order from the distal end of the tube body 21. After the derivation, the surgeon performs an operation of inserting the endoscope insertion unit 11 into the deep part of the large intestine while observing the endoscope image displayed on the display device. Then, as shown by a two-dot chain line in FIG. 16, the distal end portion 14 is arranged at a desired position in the vicinity of the splenic curve 76.
　ここで、術者は、内視鏡挿入部１１の湾曲形状をその湾曲形状のままに保持する目的、言い換えれば、処置具チャンネル内の形状保持本体５１の湾曲形状をその湾曲形状のままに保持する目的で、第２フットスイッチ５Ｂ２の第１スイッチ５ａをオン操作する。すると、第２フットスイッチ５Ｂ２から第２流体供給装置３０Ｂ２に冷却信号が発信される。 Here, the surgeon holds the curved shape of the endoscope insertion portion 11 as it is, that is, holds the curved shape of the shape holding body 51 in the treatment instrument channel as it is. For this purpose, the first switch 5a of the second foot switch 5B2 is turned on. Then, a cooling signal is transmitted from the second foot switch 5B2 to the second fluid supply device 30B2.
　冷却信号を受けた第２流体供給装置３０Ｂ２は、冷却水を、第１流体チューブ３Ｂ、栓体口金５４を介して処置具チャンネル内に供給する。この状態において、形状保持本体５１の外周面が栓孔に密着していることにより、冷却水は、栓孔を介して外部に漏出されることなく、処置具チャンネルの内周面と形状保持本体５１の外周面との隙間を介して、チャンネル開口に向かって供給されていく。 Upon receiving the cooling signal, the second fluid supply device 30B2 supplies the cooling water into the treatment instrument channel via the first fluid tube 3B and the plug base 54. In this state, since the outer peripheral surface of the shape holding body 51 is in close contact with the plug hole, the cooling water is not leaked to the outside through the plug hole, and the inner peripheral surface of the treatment instrument channel and the shape holding body. It is supplied toward the channel opening through a gap with the outer peripheral surface of 51.
　チャンネル開口に向かう冷却水が、強度可変部材で構成された形状保持本体５１の外表面に、触れることによって、形状保持本体５１は、速やかに冷却される。この結果、図中の破線に示すように、内視鏡挿入部１１の処置具チャンネル内および図示しない処置具チャンネル入口１８より外部に配置されていたガイド部４１の硬さが硬い状態に変化する。すると、内視鏡挿入部１１の湾曲形状が処置具チャンネル内に配置されている形状保持本体５１によって保持された状態なる。 The cooling water toward the channel opening touches the outer surface of the shape holding body 51 made of a variable strength member, whereby the shape holding body 51 is quickly cooled. As a result, as indicated by a broken line in the figure, the hardness of the guide portion 41 arranged in the treatment instrument channel of the endoscope insertion portion 11 and outside the treatment instrument channel inlet 18 (not shown) changes to a hard state. . Then, the curved shape of the endoscope insertion portion 11 is held by the shape holding main body 51 disposed in the treatment instrument channel.
　ここで、術者は、チューブ体２１を硬い状態から軟らかな状態に変化させる目的で、第１フットスイッチ５Ｂ１の第１スイッチ５ａをオフ操作すると共に、第２スイッチ５ｂをオン操作する。すると、第１フットスイッチ５Ｂ１から第１流体供給装置３０Ｂ１に加熱信号が発信されて、温水がチューブ体２１の第１隙間２９ａ、第２隙間２９ｂに供給される。すると、チューブ体２１の強度可変部材２５の温度が上昇して、湾曲形状に保持されていたチューブ体２１が、再び予め定めた可撓性に戻る。 Here, the surgeon turns off the first switch 5a of the first foot switch 5B1 and turns on the second switch 5b for the purpose of changing the tube body 21 from a hard state to a soft state. Then, a heating signal is transmitted from the first foot switch 5B1 to the first fluid supply device 30B1, and hot water is supplied to the first gap 29a and the second gap 29b of the tube body 21. Then, the temperature of the strength varying member 25 of the tube body 21 rises, and the tube body 21 held in the curved shape returns to the predetermined flexibility again.
　術者は、チューブ体２１の可撓性を確認したなら、そのチューブ体２１を、先端部１４が脾湾曲７６近傍に位置する内視鏡挿入部１１に沿わせて前進させる手元操作を行う。このとき、チューブ体２１は、処置具チャンネル内に配置されている形状保持本体５１が第２の状態になって硬い状態である内視鏡挿入部１１に沿ってスムーズに移動していく。 When the operator confirms the flexibility of the tube body 21, the operator performs a hand operation to advance the tube body 21 along the endoscope insertion portion 11 in which the distal end portion 14 is located in the vicinity of the splenic curve 76. At this time, the tube body 21 moves smoothly along the endoscope insertion portion 11 in which the shape holding body 51 disposed in the treatment instrument channel is in the second state and is in a hard state.
　また、術者は、表示装置の画面上でチューブ体２１の先端部の画像を確認したなら、チューブ体２１の押し込み操作、捻り操作を行って、図１７に示すようにチューブ体２１の先端部を横行結腸７５内に配置する。　
　なお、チャンネル開口から体内に流出した冷却水は、内視鏡挿入部１１の外周面と挿入孔２０Ｈの内周面との隙間を介して回収される。 When the surgeon confirms the image of the distal end portion of the tube body 21 on the screen of the display device, the surgeon performs a pushing operation and a twisting operation of the tube body 21, and the distal end portion of the tube body 21 as shown in FIG. Is placed in the transverse colon 75.
The cooling water that has flowed out of the channel opening into the body is collected through a gap between the outer peripheral surface of the endoscope insertion portion 11 and the inner peripheral surface of the insertion hole 20H.
　術者は、チューブ体２１の先端部が横行結腸７５に配置されたと判断したなら、チューブ体２１の湾曲形状をその湾曲形状のままに保持する目的で、再び、第１フットスイッチ５Ｂ１の第１スイッチ５ａをオン操作する。 If the surgeon determines that the distal end portion of the tube body 21 is disposed in the transverse colon 75, the first foot switch 5B1 of the first foot switch 5B1 is again used for the purpose of holding the curved shape of the tube body 21 as it is. The switch 5a is turned on.
　この結果、上述したように、第１流体供給装置３０Ｂ１から第１隙間２９ａ、第２隙間２９ｂに冷却水が供給されて、横行結腸７５内、脾湾曲７６内、下行結腸７４内、Ｓ状結腸７３内、直腸７２内、および肛門７１より外部に配置されていたチューブ体２１が湾曲形状のままで硬い状態に変化する。 As a result, as described above, the cooling water is supplied from the first fluid supply device 30B1 to the first gap 29a and the second gap 29b, and in the transverse colon 75, in the splenic curve 76, in the descending colon 74, and in the sigmoid colon. The tube body 21 arranged outside 73, inside the rectum 72, and outside the anus 71 remains in a curved shape and changes to a hard state.
　また、術者は、内視鏡挿入部１１の湾曲形状の保持を解除する目的、即ち、形状保持本体５１を可撓性を有する状態に戻す目的で、第２フットスイッチ５Ｂ２の第１スイッチ５ａをオフ操作すると共に、第２スイッチ５ｂをオン操作する。 The surgeon also has the first switch 5a of the second foot switch 5B2 for the purpose of releasing the holding of the curved shape of the endoscope insertion portion 11, that is, for the purpose of returning the shape holding body 51 to a flexible state. Is turned off and the second switch 5b is turned on.
　すると、第２流体供給装置３０Ｂ２から供給される温水が、処置具チャンネルと形状保持本体５１との隙間を介して、チャンネル開口に向かって流れていく。すると、形状保持本体５１の温度が上昇して、湾曲状態で第２の状態に保持されていた形状保持本体が再び予め定めた可撓性に戻ることによって、内視鏡挿入部１１が可撓性を有する状態になる。 Then, the hot water supplied from the second fluid supply device 30B2 flows toward the channel opening through the gap between the treatment instrument channel and the shape holding body 51. Then, the temperature of the shape holding body 51 rises, and the shape holding body held in the second state in the curved state returns to the predetermined flexibility again, so that the endoscope insertion portion 11 is flexible. It becomes the state which has sex.
　このとき、温水は、内視鏡挿入部１１の先端部１４がチューブ体２１内に配置されていることによって、体内に流出することなく、内視鏡挿入部１１の外周面と挿入孔２０Ｈの内周面との隙間を介して回収される。 At this time, since the distal end portion 14 of the endoscope insertion portion 11 is disposed in the tube body 21, the warm water does not flow into the body and the outer peripheral surface of the endoscope insertion portion 11 and the insertion hole 20 </ b> H. It is collected through a gap with the inner peripheral surface.
　術者は、形状保持本体５１が第１の状態であることを確認したなら、第２スイッチ５ｂをオフ操作する。そして、術者は、挿入孔２０Ｈ内に位置する内視鏡挿入部１１をチューブ体２１の先端側に移動させる操作を行う。すると、内視鏡挿入部１１は、挿入孔２０Ｈの先端開口側に移動され、チューブ体２１の先端から横行結腸７５内に導出される。その後、術者は、内視鏡画像を観察しつつ、内視鏡挿入部１１を図１７の二点鎖線に示すように肝湾曲７７近傍の所望する位置に配置する。 The surgeon turns off the second switch 5b after confirming that the shape-maintaining body 51 is in the first state. Then, the operator performs an operation of moving the endoscope insertion portion 11 located in the insertion hole 20H to the distal end side of the tube body 21. Then, the endoscope insertion portion 11 is moved to the distal opening side of the insertion hole 20H and is led out from the distal end of the tube body 21 into the transverse colon 75. Thereafter, the operator arranges the endoscope insertion portion 11 at a desired position in the vicinity of the liver curve 77 as shown by a two-dot chain line in FIG. 17 while observing the endoscope image.
　その後、術者は、再び、内視鏡挿入部１１の湾曲形状をその湾曲形状のままに保持する目的で、第２フットスイッチ５Ｂ２の第１スイッチ５ａをオン操作する。この結果、上述したように、冷却水が、処置具チャンネル内をチャンネル開口に向かって流れることによって形状保持本体５１が冷却されて、肝湾曲７７内、横行結腸７５内、処置具チャンネル内、および処置具チャンネル入口１８より外部に配置されていた第１の状態の形状保持本体５１がその湾曲形状のまま第２の状態に保持される。即ち、再び、大腸内の内視鏡挿入部１１の湾曲形状が形状保持本体５１によって硬い状態に保持される。 Thereafter, the operator turns on the first switch 5a of the second foot switch 5B2 again for the purpose of holding the curved shape of the endoscope insertion portion 11 in the curved shape. As a result, as described above, the cooling water flows in the treatment instrument channel toward the channel opening, thereby cooling the shape-maintaining body 51, and in the liver curvature 77, in the transverse colon 75, in the treatment instrument channel, and The shape-maintaining main body 51 in the first state that is disposed outside the treatment instrument channel inlet 18 is held in the second state with its curved shape. That is, again, the curved shape of the endoscope insertion portion 11 in the large intestine is held in a hard state by the shape holding body 51.
　ここで、術者は、チューブ体２１を硬い状態から軟らかな状態に戻す目的で、第１フットスイッチ５Ｂ１の第１スイッチ５ａをオフ操作すると共に、第２スイッチ５ｂをオン操作する。すると、第１流体供給装置３０Ｂ１から温水が第１隙間２９ａ、第２隙間２９ｂに供給されて、チューブ体２１が再び予め定めた可撓性に戻る。 Here, the operator turns off the first switch 5a of the first foot switch 5B1 and turns on the second switch 5b for the purpose of returning the tube body 21 from the hard state to the soft state. Then, hot water is supplied from the first fluid supply device 30B1 to the first gap 29a and the second gap 29b, and the tube body 21 returns to the predetermined flexibility again.
　この後、術者は、可撓性を有するチューブ体２１を、湾曲形状が形状保持本体５１によって硬い状態に保持された内視鏡挿入部１１に沿わせて前進させる手元操作を行い、図１８に示すようにチューブ体２１の先端部を上行結腸７８内に配置する。 Thereafter, the surgeon performs a hand operation to advance the flexible tube body 21 along the endoscope insertion portion 11 in which the curved shape is held in a hard state by the shape-maintaining body 51, and FIG. The distal end of the tube body 21 is placed in the ascending colon 78 as shown in FIG.
　その後、術者は、チューブ体２１の湾曲形状をその湾曲形状のままに保持する目的で、第１フットスイッチ５Ｂ１の第１スイッチ５ａをオン操作する。この結果、上述したように、第１流体供給装置３０Ｂ１から冷却水が、第１隙間２９ａ、第２隙間２９ｂに供給されて強度可変部材２５が冷却されて、上行結腸７８内、肝湾曲７７内、横行結腸７５内、脾湾曲７６内、下行結腸７４内、Ｓ状結腸７３内、直腸７２内、および肛門７１より外部に配置されていたチューブ体２１が湾曲形状のままで硬い状態に変化する。 Thereafter, the operator turns on the first switch 5a of the first foot switch 5B1 for the purpose of holding the curved shape of the tube body 21 in the curved shape. As a result, as described above, the cooling water is supplied from the first fluid supply device 30B1 to the first gap 29a and the second gap 29b, and the strength varying member 25 is cooled, so that the inside of the ascending colon 78 and the liver curve 77 In the transverse colon 75, in the splenic curve 76, in the descending colon 74, in the sigmoid colon 73, in the rectum 72, and outside the anus 71, the tube body 21 remains in a curved shape and changes to a hard state. .
　ここで、術者は、内視鏡挿入部１１の湾曲形状の保持を解除する。即ち、形状保持本体５１を、第１の状態に戻す目的で、第２フットスイッチ５Ｂ２の第１スイッチ５ａをオフ操作すると共に、第２スイッチ５ｂをオン操作する。すると、第２流体供給装置３０Ｂ２から供給される温水によって、形状保持本体５１の温度が上昇して、湾曲状態で第２の状態に保持されていた形状保持本体５１が再び予め定めた可撓性に戻ることにより、内視鏡挿入部１１が可撓性を有する状態になる。 Here, the surgeon releases the holding of the curved shape of the endoscope insertion portion 11. That is, for the purpose of returning the shape-maintaining body 51 to the first state, the first switch 5a of the second foot switch 5B2 is turned off and the second switch 5b is turned on. Then, the temperature of the shape-maintaining main body 51 is increased by the hot water supplied from the second fluid supply device 30B2, and the shape-maintaining main body 51 that has been held in the second state in the curved state is again predetermined flexibility. By returning to, the endoscope insertion portion 11 becomes flexible.
　ここで、術者は、挿入孔２０Ｈ内に位置する内視鏡挿入部１１の押し込み操作を行って、図１８に示すように内視鏡挿入部１１をチューブ体２１の先端から上行結腸７８に導出させる。導出後、術者は、内視鏡画像を観察しつつ、内視鏡挿入部１１を前進させる操作を行って、内視鏡挿入部１１を盲腸７９近傍に到達させる。 Here, the surgeon performs an operation of pushing the endoscope insertion portion 11 located in the insertion hole 20H, and moves the endoscope insertion portion 11 from the distal end of the tube body 21 to the ascending colon 78 as shown in FIG. Let it be derived. After the derivation, the surgeon performs an operation of moving the endoscope insertion portion 11 forward while observing the endoscope image, so that the endoscope insertion portion 11 reaches the vicinity of the cecum 79.
　その後、術者は、第１フットスイッチ５Ｂ１の第１スイッチ５ａをオフ操作すると共に、第２スイッチ５ｂをオン操作し、湾曲形状に保持されていたチューブ体２１を軟らかな状態にする。また、術者は、形状保持本体５１を処置具チャンネル内から抜去する。そして、術者は、オーバーチューブ２０及び内視鏡挿入部１１を引き戻しながら行う大腸の検査に移行する。 After that, the operator turns off the first switch 5a of the first foot switch 5B1 and turns on the second switch 5b to bring the tube body 21 held in the curved shape into a soft state. In addition, the surgeon removes the shape holding body 51 from the treatment instrument channel. Then, the surgeon shifts to an inspection of the large intestine performed while pulling back the overtube 20 and the endoscope insertion portion 11.
　このように、内視鏡１０の処置具チャンネル内に形状保持本体５１を配置し、処置具チャンネル内に冷却水、或いは温水を供給することによって、強度可変部材で構成した形状保持本体５１を第１の状態、或いは第２の状態に変化させる。このことによって、処置具チャンネル内に形状保持本体５１を配置した内視鏡挿入部１１を、予め定めた可撓性を有する状態と、湾曲形状を保持した硬い状態とに変化させることができる。 As described above, the shape holding main body 51 is arranged in the treatment instrument channel of the endoscope 10 and the cooling water or the hot water is supplied into the treatment instrument channel. The state is changed to the first state or the second state. This makes it possible to change the endoscope insertion portion 11 in which the shape-maintaining main body 51 is disposed in the treatment instrument channel between a predetermined flexible state and a hard state that maintains a curved shape.
　また、形状保持本体５１を、中実な強度可変部材で構成することによって、同じ径寸法の管状部材に比べて、より高い強度を得ることができる。　
　この構成によれば、処置具チャンネル内に配置した形状保持本体５１を、湾曲形状を保持する第２の状態にすることにより、オーバーチューブ２０のチューブ体２１を、内視鏡挿入部１１に沿わせて容易に深部に向けて挿入することが可能になる。 Further, by configuring the shape-maintaining main body 51 with a solid strength variable member, it is possible to obtain higher strength than a tubular member having the same diameter.
According to this configuration, the tube body 21 of the overtube 20 is moved along the endoscope insertion portion 11 by setting the shape-maintaining body 51 disposed in the treatment instrument channel to the second state in which the curved shape is maintained. Therefore, it becomes possible to insert it deeply.
　なお、上述した実施形態においては、体内に流出した冷却水を、内視鏡挿入部１１の外周面と挿入孔２０Ｈの内周面との隙間を介して回収するとしている。しかし、内視鏡１０が備える吸引機能を用いて冷却水の回収を行うようにしてもよい。 In the above-described embodiment, the cooling water that has flowed into the body is collected through the gap between the outer peripheral surface of the endoscope insertion portion 11 and the inner peripheral surface of the insertion hole 20H. However, you may make it collect | recover cooling water using the suction function with which the endoscope 10 is provided.
　また、形状保持本体５１の外周に長手軸方向に伸びる溝を複数形成するようにしてもよい。この結果、冷却水、温水が流れる流路を確保することができると共に、形状保持本体５１の表面積を増大させて応答性の向上を図ることができる。 Further, a plurality of grooves extending in the longitudinal axis direction may be formed on the outer periphery of the shape maintaining body 51. As a result, it is possible to secure a flow path through which cooling water and hot water flow, and increase the surface area of the shape-maintaining main body 51 to improve responsiveness.
　さらに、上述した第３実施形態においては、内視鏡挿入部１１が備える処置具チャンネル内に形状保持部材５０の形状保持本体５１を挿入配置し、処置具チャンネル内に冷却水或いは温水を供給する構成を示している。しかし、図１９に示すように内視鏡１０、オーバーチューブ２０、ガイド部材４０、光源装置２、第１の流体供給装置３０Ｂ１、第２の流体供給装置３０Ｂ２、第１のフットスイッチ５Ｂ１、第２のフットスイッチ５Ｂ２、図示しない表示装置、ビデオプロセッサ等を備える内視鏡装置１Ｃを構成して、ガイド部材４０のガイド部４１を形状保持本体５１として使用するようにしてもよい。 Furthermore, in the third embodiment described above, the shape holding body 51 of the shape holding member 50 is inserted and disposed in the treatment instrument channel provided in the endoscope insertion portion 11, and cooling water or hot water is supplied into the treatment instrument channel. The configuration is shown. However, as shown in FIG. 19, the endoscope 10, the overtube 20, the guide member 40, the light source device 2, the first fluid supply device 30B1, the second fluid supply device 30B2, the first foot switch 5B1, the second An endoscope apparatus 1C including the foot switch 5B2, a display device (not shown), a video processor, and the like may be configured, and the guide portion 41 of the guide member 40 may be used as the shape maintaining body 51.
　また、上述した実施形態においては、２つの部材で構成される隙間を流体供給路、流体回収路としている。しかし、図２０に示すように流体供給路、流体回収路となる２つの貫通孔６１、６２を備える断面形状が矩形の帯状部材６３を螺旋状に巻回して流体路形成部材６０として構成し、その流体路形成部材６０を二点鎖線で示す強度可変部材２５、４５の内表面側に配置するようにしてもよい。　
　この構成によれば、管状の強度可変部材２５、４５の可撓性を損なうことなく、長手軸方向の強度を確保して座屈の防止を図ることができる。 In the embodiment described above, a gap formed by two members is used as a fluid supply path and a fluid recovery path. However, as shown in FIG. 20, a belt-shaped member 63 having a rectangular cross-sectional shape including two through holes 61 and 62 serving as a fluid supply path and a fluid recovery path is spirally wound to form a fluid path forming member 60. The fluid path forming member 60 may be arranged on the inner surface side of the strength variable members 25 and 45 indicated by a two-dot chain line.
According to this configuration, it is possible to prevent buckling by securing the strength in the longitudinal axis direction without impairing the flexibility of the tubular strength variable members 25 and 45.
　さらに、強度可変部材２５、４５に、複数の流体供給路、流体回収路を設けるようにしても良い。具体的に、例えば、図２１の強度可変部材２５の肉部２５ｂに複数組みの流体供給孔２５ｃ及び流体回収孔２５ｄを設ける。流体供給孔２５ｃと流体回収孔２５ｄとは交互に配置される。　
　この構成によれば、強度可変部材２５の温度変化をより均等に行うことができる。なお、流体供給孔２５ｃと流体回収孔２５ｄとは強度可変部材２５の先端部側に設けた連通部（不図示）によって連通している。 Further, the variable strength members 25 and 45 may be provided with a plurality of fluid supply paths and fluid recovery paths. Specifically, for example, a plurality of sets of fluid supply holes 25c and fluid recovery holes 25d are provided in the meat portion 25b of the strength varying member 25 in FIG. The fluid supply holes 25c and the fluid recovery holes 25d are alternately arranged.
According to this configuration, the temperature change of the strength variable member 25 can be performed more evenly. The fluid supply hole 25c and the fluid recovery hole 25d communicate with each other through a communication portion (not shown) provided on the distal end side of the strength varying member 25.
　また、上述した実施形態においては、ガラス転移温度を体温以下の温度である２５度に設定している。しかし、ガラス転移温度を、体温を基準に所定の範囲内で設定するようにしてもよい。体温（例えば摂氏３６度）で強度可変部材を第１の状態にして、例えば摂氏１６度の冷却水で強度可変部材を冷却して第２の状態を得る、或いは、体温（例えば摂氏３６度）で強度可変部材を第２の状態にして、例えば摂氏５１度の温水で強度可変部材を暖めて第１の状態を得るようにしても良い。　
　この構成によれば、環境温度とガラス転移温度との差を小さくして、形状記憶ポリマーを容易に温度変化させることが可能になる。 Moreover, in embodiment mentioned above, the glass transition temperature is set to 25 degree | times which is the temperature below body temperature. However, the glass transition temperature may be set within a predetermined range based on the body temperature. The strength variable member is set to the first state at body temperature (for example, 36 degrees Celsius), and the second state is obtained by cooling the strength variable member with, for example, cooling water at 16 degrees Celsius, or the body temperature (for example, 36 degrees Celsius). The strength variable member may be set to the second state, and the first state may be obtained by warming the strength variable member with, for example, hot water of 51 degrees Celsius.
According to this configuration, it becomes possible to easily change the temperature of the shape memory polymer by reducing the difference between the environmental temperature and the glass transition temperature.
　尚、本発明は、以上述べた実施形態のみに限定されるものではなく、発明の要旨を逸脱しない範囲で種々変形実施可能である。 The present invention is not limited to the embodiments described above, and various modifications can be made without departing from the spirit of the invention.
本出願は、２０１０年９月３０日に日本国に出願された特願２０１０－２２２４７５号を優先権主張の基礎として出願するものであり、上記の開示内容は、本願明細書、請求の範囲、図面に引用されたものとする。 This application is filed on the basis of the priority claim of Japanese Patent Application No. 2010-222475 filed in Japan on September 30, 2010, and the above disclosure is disclosed in the present specification, claims, It shall be cited in the drawing.

Claims (12)

  1. 　内視鏡挿入部の長手軸方向に対して相対的に移動可能に設けられる挿入部を有する医療機器において、
    　前記挿入部は、
    　予め定めた温度を境に強度が第１の状態と第２の状態とに変化する管状の強度可変部材と、
    　前記強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を、前記強度可変部材の管表面に接触させて供給する流体供給路と、
    　前記流体供給路を介して供給された流体を回収する流体回収路と、
    　前記強度可変部材の先端側に設けられ、前記流体回収路と前記流体供給路とを連通する連通部と、を
    　具備することを特徴とする医療機器。     In a medical device having an insertion portion provided to be movable relative to the longitudinal axis direction of the endoscope insertion portion,
    The insertion part is
    A tubular strength variable member whose strength changes between a first state and a second state at a predetermined temperature;
    A fluid having a temperature higher than the predetermined temperature for changing the strength variable member to the first state, or a fluid having a temperature lower than the predetermined temperature for changing the strength variable member to the second state, A fluid supply path that is supplied in contact with the tube surface of the variable strength member;
    A fluid recovery path for recovering the fluid supplied through the fluid supply path;
    A medical device, comprising: a communication portion that is provided on a distal end side of the strength varying member and communicates the fluid recovery path and the fluid supply path.
  2. 　前記医療機器は、体内に挿入される前記挿入部の長手軸方向に、前記内視鏡挿入部が挿通される挿入孔を有するオーバーチューブであって、
    　前記オーバーチューブの挿入部は、
    　前記強度可変部材の管内表面側に設けられ、該管内表面との間に前記流体供給路を構成する管外表面および前記挿入孔を構成する貫通孔を有する第１チューブ部材と、
    　前記強度可変部材の管外表面側に設けられ、該管外表面との間に前記流体回収路を構成する管内表面を有する第２チューブ部材と、
    　を具備することを特徴とする請求項１に記載の医療機器。     The medical device is an overtube having an insertion hole through which the endoscope insertion portion is inserted in the longitudinal axis direction of the insertion portion to be inserted into the body,
    The insertion portion of the overtube is
    A first tube member provided on the tube inner surface side of the strength varying member, and having a tube outer surface that constitutes the fluid supply path and a through hole that constitutes the insertion hole between the inner surface and the tube inner surface;
    A second tube member provided on the tube outer surface side of the strength variable member, and having a tube inner surface constituting the fluid recovery path between the second tube member and the tube outer surface;
    The medical device according to claim 1, comprising:
  3. 　前記医療機器は、前記内視鏡挿入部が有する処置具チャンネル内に挿通される挿入部を有するガイド部材であって、
    　前記ガイド部材の挿入部は、
    　前記強度可変部材の管内表面側に設けられ、該管内表面との間に前記流体供給路を構成する管外表面および前記流体回収路を構成する貫通孔を有するチューブ部材を具備することを特徴とする請求項１に記載の医療機器。     The medical device is a guide member having an insertion portion that is inserted into a treatment instrument channel included in the endoscope insertion portion,
    The insertion portion of the guide member is
    A tube member provided on the inner surface side of the pipe of the strength varying member, and having a tube outer surface constituting the fluid supply path and a through-hole constituting the fluid recovery path between the inner surface and the pipe inner surface; The medical device according to claim 1.
  4. 　前記強度可変部材は、ガラス転移温度を摂氏１０度から摂氏５５度の間に設定した形状記憶ポリマーであることを特徴とする請求項１乃至３の何れか１項に記載の医療機器。 The medical device according to any one of claims 1 to 3, wherein the strength variable member is a shape memory polymer having a glass transition temperature set between 10 degrees Celsius and 55 degrees Celsius.
  5. 　前記強度可変部材は、融点を摂氏１０度から摂氏５５度の間に設定した熱可塑性樹脂、または、低融点合金であることを特徴とする請求項１乃至３の何れか１項に記載の医療機器。 The medical device according to any one of claims 1 to 3, wherein the strength variable member is a thermoplastic resin having a melting point set between 10 degrees Celsius and 55 degrees Celsius, or a low melting point alloy. machine.
  6. 　前記強度可変部材の管内表面、及び管外表面のうち、少なくとも管内表面に複数の凹凸部を設けたことを特徴とする請求項２または請求項３に記載の医療機器。 The medical device according to claim 2 or 3, wherein a plurality of uneven portions are provided on at least the inner surface of the tube inner surface and the outer tube surface of the strength variable member.
  7. 　前記強度可変部材の管内表面或いは管外表面のうち、少なくとも管内表面に高熱伝導性部材を配置することを特徴とする請求項２または請求項３に記載の医療機器。 The medical device according to claim 2 or 3, wherein a high thermal conductivity member is disposed on at least a tube inner surface of the tube inner surface or the tube outer surface of the variable strength member.
  8. 　前記オーバーチューブの挿入部を構成する前記第１チューブ部材または前記第２チューブ部材体の少なくとも一方の、外周面または内周面の少なくとも一方に、断熱部を設けることを特徴とする請求項２に記載の医療機器。 The heat insulating part is provided in at least one of the outer peripheral surface or the inner peripheral surface of at least one of the first tube member or the second tube member body constituting the insertion portion of the overtube. The medical device described.
  9. 　前記ガイド部材の挿入部を構成する前記強度可変部材の管外表面または管内表面の少なくとも一方に、断熱部を設けることを特徴とする請求項３に記載の医療機器。 4. The medical device according to claim 3, wherein a heat insulating portion is provided on at least one of the outer surface and the inner surface of the strength variable member constituting the insertion portion of the guide member.
  10. 　内視鏡挿入部を備える内視鏡と、
    　体内に挿入される挿入部に前記内視鏡挿入部が挿通される長手軸方向の挿入孔を有し、
    予め定めた温度を境に強度が第１の状態と第２の状態とに変化する管状の強度可変部材を有するオーバーチューブと、
    　前記オーバーチューブの強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を供給する流体供給装置と、を具備し、
    　前記オーバーチューブの挿入部は、
    　前記強度可変部材の管内表面側に設けられ、該管内表面との間に前記流体供給路を構成する管外表面および前記挿入孔を構成する貫通孔を有する第１チューブ部材と、
    　前記強度可変部材の管外表面側に設けられ、該管外表面との間に前記流体回収路を構成する管内表面を有する第２チューブ部材と、
    　を具備することを特徴とする内視鏡装置。     An endoscope including an endoscope insertion portion;
    The insertion portion to be inserted into the body has an insertion hole in the longitudinal axis direction through which the endoscope insertion portion is inserted,
    An overtube having a tubular strength variable member whose strength changes between a first state and a second state at a predetermined temperature;
    A fluid having a temperature higher than the predetermined temperature that changes the strength variable member of the overtube to the first state, or a temperature lower than the predetermined temperature that changes the strength variable member to the second state. A fluid supply device for supplying fluid,
    The insertion portion of the overtube is
    A first tube member provided on the tube inner surface side of the strength variable member, and having a through-hole forming the outer surface of the tube constituting the fluid supply path and the insertion hole between the inner surface of the tube;
    A second tube member provided on the tube outer surface side of the strength variable member, and having a tube inner surface constituting the fluid recovery path between the second tube member and the tube outer surface;
    An endoscope apparatus comprising:
  11. 　内視鏡挿入部に処置具チャンネルを有する内視鏡と、
    　前記内視鏡挿入部の処置具チャンネル内に挿抜自在な挿入部に、予め定めた温度を境に強度が第１の状態と第２の状態とに変化する管状の強度可変部材を有するガイド部材と、
    　前記ガイド部材の強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を供給する流体供給装置と、を具備し
    　前記ガイド部材の挿入部は、
    　前記強度可変部材の管内表面側に設けられることで、該管内表面との間に前記流体供給路を構成する管外表面および前記流体回収路を構成する貫通孔を有するチューブ部材を具備することを特徴とする内視鏡装置。     An endoscope having a treatment instrument channel in an endoscope insertion portion;
    A guide member having a tubular strength variable member whose strength changes between a first state and a second state at a predetermined temperature at an insertion portion that can be inserted into and removed from the treatment instrument channel of the endoscope insertion portion. When,
    A fluid having a temperature higher than the predetermined temperature for changing the strength variable member of the guide member to the first state, or a temperature lower than the predetermined temperature for changing the strength variable member to the second state. A fluid supply device that supplies fluid, and the insertion portion of the guide member includes:
    By providing the strength varying member on the inner surface side of the tube, a tube member having a tube outer surface constituting the fluid supply path and a through hole constituting the fluid recovery path between the inner surface and the pipe inner surface is provided. Endoscopic device characterized.
  12. 　内視鏡挿入部に処置具チャンネルを有する内視鏡と、
    　体内に挿入される挿入部に前記内視鏡挿入部が挿通される長手軸方向の挿入孔を有し、予め定めた温度を境に強度が第１の状態と第２の状態とに変化する管状の強度可変部材を有するオーバーチューブと、
    　前記オーバーチューブの強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を供給する第１の流体供給装置と、
    　前記処置具チャンネル内に挿通配置される、予め定めた温度を境に強度が第１の状態と第２の状態とに変化する強度可変部材と、
    　前記処置具チャンネル内に予め定めた状態で挿通配置された強度可変部材を前記第１の状態に変化させる前記予め定めた温度より高い温度の流体、又は当該強度可変部材を前記第２の状態に変化させる前記予め定めた温度より低い温度の流体を供給する第２の流体供給装置と、を具備し、
    　前記第２の流体供給装置から供給される前記予め定めた温度より高い温度の流体、又は前記予め定めた温度より低い温度の流体は、前記オーバーチューブと前記内視鏡挿入部との隙間、または、前記処置具チャンネルに挿通配置される強度可変部材と前記処置具チャンネルとの隙間を介して供給されることを特徴とする内視鏡装置。     An endoscope having a treatment instrument channel in an endoscope insertion portion;
    The insertion portion to be inserted into the body has an insertion hole in the longitudinal axis direction through which the endoscope insertion portion is inserted, and the strength changes between the first state and the second state at a predetermined temperature. An overtube having a tubular strength variable member;
    A fluid having a temperature higher than the predetermined temperature that changes the strength variable member of the overtube to the first state, or a temperature lower than the predetermined temperature that changes the strength variable member to the second state. A first fluid supply device for supplying fluid;
    A strength variable member that is inserted and disposed in the treatment instrument channel and whose strength changes between a first state and a second state at a predetermined temperature,
    The strength variable member inserted and arranged in a predetermined state in the treatment instrument channel is changed to the first state, or the fluid having a temperature higher than the predetermined temperature or the strength variable member is changed to the second state. A second fluid supply device for supplying a fluid having a temperature lower than the predetermined temperature to be changed,
    The fluid having a temperature higher than the predetermined temperature or the fluid having a temperature lower than the predetermined temperature supplied from the second fluid supply device is a gap between the overtube and the endoscope insertion portion, or An endoscope apparatus, wherein the endoscope apparatus is supplied through a gap between an intensity variable member inserted and disposed in the treatment instrument channel and the treatment instrument channel.
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