WO2018229982A1 - Endoscope sheath and endoscope system - Google Patents

Endoscope sheath and endoscope system Download PDF

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Publication number
WO2018229982A1
WO2018229982A1 PCT/JP2017/022372 JP2017022372W WO2018229982A1 WO 2018229982 A1 WO2018229982 A1 WO 2018229982A1 JP 2017022372 W JP2017022372 W JP 2017022372W WO 2018229982 A1 WO2018229982 A1 WO 2018229982A1
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WO
WIPO (PCT)
Prior art keywords
endoscope
sheath
distal end
longitudinal axis
curved
Prior art date
Application number
PCT/JP2017/022372
Other languages
French (fr)
Japanese (ja)
Inventor
善朗 岡崎
尚也 杉本
和敏 熊谷
俊二 武井
Original Assignee
オリンパス株式会社
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Publication date
Application filed by オリンパス株式会社 filed Critical オリンパス株式会社
Priority to PCT/JP2017/022372 priority Critical patent/WO2018229982A1/en
Publication of WO2018229982A1 publication Critical patent/WO2018229982A1/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
    • 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
    • A61B1/005—Flexible endoscopes
    • A61B1/01—Guiding arrangements therefore

Definitions

  • the present invention relates to an endoscope sheath and an endoscope system.
  • the bending portion of the tip of the endoscope is arranged so that the tip of the endoscope is located at a position away from the heart surface. It is necessary to bend the tip of the endoscope to the pericardium side.
  • a force pressing to the heart side acts from the pericardium.
  • the distal end portion of the endoscope can receive force from the heart. Due to the force from the pericardium and the heart, there is a problem that the curved distal end portion of the endoscope falls on the heart surface.
  • the present invention has been made in view of the above-described circumstances, and is an endoscope that can stably observe the heart by preventing the bent distal end portion of the endoscope from falling in the pericardial cavity.
  • An object is to provide a mirror sheath and an endoscope system.
  • a tubular sheath body having an endoscope channel that penetrates in a direction along a longitudinal axis and into which an endoscope is inserted, and the endoscope in a first radial direction of the sheath body.
  • an endoscope channel that penetrates in a direction along a longitudinal axis and into which an endoscope is inserted, and the endoscope in a first radial direction of the sheath body.
  • a support portion that supports a side surface of the distal end portion of the endoscope that is curved, and the support portion has a longitudinal axis of the endoscope in the endoscope channel of the curved distal end portion. It is the sheath for endoscopes which controls rotation around.
  • the sheath body is disposed in the pericardial cavity such that the first radial direction is substantially parallel to the surface of the heart, and is disposed in the endoscope channel of the sheath body.
  • the distal end portion of the endoscope that is curved on the distal end side of the sheath body is arranged in the endoscope channel by supporting the side surface in the direction substantially orthogonal to the bending direction by the support portion. It is regulated by the support portion so as not to rotate around the longitudinal axis of the endoscope. As a result, it is possible to prevent the curved distal end portion from falling down due to a force from the pericardium or the heart and to observe the heart stably.
  • the support portion may be disposed in a plane parallel to the second radial direction. In this way, the side surface of the curved distal end portion of the endoscope can be more stably supported by the support portion.
  • the support portion may be provided on both sides of the endoscope channel in the first radial direction. In this way, the curved tip portion is supported by the support portions on both sides, so that the bent tip portion can be more reliably prevented from falling.
  • the support portion may be provided outside the longitudinal axis of the endoscope channel in the second radial direction. In this way, the support portion is provided at the position of the curved distal end portion at a position radially spaced from the longitudinal axis of the endoscope in the endoscope channel that is the rotation center of the curved distal end portion. Support the side. Thereby, the support part can generate a larger second moment of cross section that resists the force received from the curved tip part, and can more reliably prevent the curved tip part from falling over.
  • the support portion can be elastically deformed into a linear shape that is curved in the second radial direction and extends in a direction along the longitudinal axis, and can project and retract from the distal end of the sheath body. It may be provided in the sheath body. By doing in this way, in the state which protruded from the front-end
  • a wire having a tip portion curved in one direction is provided, the support portion is formed of the tip portion of the wire, and the sheath penetrates in a direction along the longitudinal axis, and the wire May have a wire channel inserted so as to be movable in the longitudinal direction.
  • a general purpose wire like a guide wire generally used in cardiac surgery can be used as a support part.
  • the diameter of the sheath body can be reduced by using a thin wire as the support portion.
  • a wire is provided, and the sheath body has a wire channel that penetrates in the direction along the longitudinal axis and is inserted so that the wire can move in the longitudinal direction, and a distal end portion of the wire channel However, it may be inclined outward in the second radial direction toward the tip of the sheath body.
  • the distal end portion of the wire channel since the distal end portion of the wire channel is inclined, the distal end portion of the wire protruding from the wire channel extends in the longitudinal direction of the sheath body so as to extend substantially along the curved distal end portion of the endoscope. And can function as a support portion.
  • a general-purpose wire such as a guide wire generally used in cardiac surgery can be used as the support portion.
  • the diameter of the sheath body can be reduced by using a thin wire as the support portion.
  • an endoscope having a distal end portion that is deformable between a curved shape that is curved in a direction intersecting the longitudinal axis and a linear shape that extends along the longitudinal axis. It is an endoscope system provided with the described sheath for endoscopes.
  • the endoscope has rigidity lower than that of the sheath body, and the distal end portion of the endoscope has the curved shape in a free state and is elastically deformed into the linear shape. It may be possible. By doing so, the distal end portion of the endoscope extends linearly when it is housed in the endoscope channel of the sheath body and spontaneously curves when it protrudes from the distal end of the sheath body. As a result, a mechanical mechanism for bending the distal end portion of the endoscope becomes unnecessary, and the diameter of the endoscope can be reduced.
  • a rotation restricting portion that restricts rotation of the endoscope around the longitudinal axis in the endoscope channel may be provided.
  • the present invention it is possible to prevent the curved distal end portion of the endoscope from falling in the pericardial cavity and to observe the heart stably.
  • FIG. 1B is a perspective view showing a state where a bending portion of the endoscope is curved in the endoscope system of FIG. 1A.
  • FIG. 1A It is a perspective view of the front-end
  • FIG. 10B is a perspective view showing a state where the bending portion of the endoscope is bent in the endoscope system of FIG. 10A.
  • FIG. 10A is a longitudinal cross-sectional view of the front-end
  • FIG. 10B is a perspective view of the distal end portion of a modification of the endoscope sheath of FIG. 10A.
  • FIG. 10B is a perspective view of the distal end portion of another modification of the endoscope sheath of FIG. 10A.
  • FIG. 10B is a perspective view of the distal end portion of another modification of the endoscope sheath of FIG. 10A.
  • FIG. 10B is a perspective view of the distal end portion of another modification of the endoscope sheath of FIG. 10A.
  • FIG. 10B is a perspective view of the distal end portion of another modification of the endoscope sheath of FIG. 10A.
  • FIG. 10B is a perspective view of the distal end portion of another modification of the endoscope sheath of FIG. 10A.
  • FIG. 10B is a side view of the distal end portion of another modification of the endoscope sheath of FIG. 10A. It is a longitudinal cross-sectional view of the front-end
  • FIG. 19B is a longitudinal sectional view of the endoscope sheath showing a state in which a bending portion of the endoscope is bent in the endoscope system of FIG. 19A. It is a longitudinal cross-sectional view of the front-end
  • FIG. 21B is a perspective view showing a state where the bending portion of the endoscope is curved in the endoscope system of FIG. 21A.
  • an endoscope sheath 1 and an endoscope system 100 according to a first embodiment of the present invention will be described below with reference to FIGS. 1A to 9B.
  • an endoscope system 100 according to the present embodiment includes an endoscope 2 and an endoscope sheath 1 into which the endoscope 2 can be inserted.
  • the endoscope 2 includes a soft and long insertion portion 3 that can be inserted into the pericardial cavity, and a distal end portion of the insertion portion 3 that intersects the longitudinal axis of the insertion portion 3. And a bending portion 4 that can be bent in the direction.
  • the bending portion 4 can be bent in at least one direction. The bending operation of the bending section 4 can be controlled by operating an operation section (not shown) connected to the proximal end of the insertion section 3.
  • the endoscope sheath 1 protrudes in a direction along the longitudinal axis of the sheath body 5 from the distal end of the sheath body 5 and a long tubular sheath body 5 having an endoscope channel 5a into which the insertion portion 3 is inserted. And a hood (support portion) 6 to be used.
  • the endoscope sheath 1 has a radial direction orthogonal to the longitudinal axis and a vertical direction (second radial direction) and a horizontal direction (first radial direction) orthogonal to each other.
  • the vertical direction is the direction in which the endoscopic sheath 1 is used in the pericardial cavity, and is disposed in the thickness direction of the pericardial cavity (opposite direction between the pericardium and the heart), and particularly on the heart side.
  • the side to be placed is the lower side, and the side placed on the pericardial side is the upper side.
  • the sheath body 5 has higher rigidity than the insertion portion 3, and the torsional rigidity around the longitudinal axis of the sheath body 5 is higher than the torsional rigidity around the longitudinal axis of the insertion portion 3.
  • the endoscope channel 5a penetrates the sheath body 5 in the direction along the longitudinal axis, and the outer diameter of the insertion portion 3 is such that the insertion portion 3 can move in the longitudinal direction within the endoscope channel 5a. Also has a large inner diameter. Further, the endoscope channel 5a is formed at a position eccentric to the upper side with respect to the longitudinal axis of the sheath body 5, as shown in FIGS. 2A and 2B.
  • the hood 6 has a substantially cylindrical shape extending in the longitudinal direction from the annular distal end surface of the sheath body 5 and resists the force received from the pericardium in the pericardial cavity. It has rigidity that can maintain the shape.
  • the hood 6 has a groove 6a continuous with the endoscope channel 5a in the longitudinal direction.
  • the groove 6 a extends in the vertical direction from the lower side surface to the upper side, and is formed over the entire length in the longitudinal direction from the distal end surface to the proximal end surface of the hood 6.
  • the hood 6 has a substantially U-shape that is disposed on the upper side and both the left and right sides of the endoscope channel 5a when viewed from the distal end side, and projects from the distal end opening of the endoscope channel 5a and is disposed in the groove 6a.
  • the upper side and both left and right sides of the bent portion 4 are covered with the hood 6.
  • the corners between the inner surface of the groove 6a and the tip surface and side surface of the hood 6 are preferably chamfered.
  • the front end of the hood 6 can be observed by extending the curved portion 4 arranged in the groove 6a linearly.
  • the length of the hood 6 is designed so that the hood 6 does not enter the field of view of the endoscope 2 in a state where the curved portion 4 is linearly arranged in the groove 6a.
  • the hood 6 has such a length that the distal end of the hood 6 and the distal end of the insertion portion 3 are disposed at substantially the same position in the longitudinal direction in a state where the entire curved portion 4 is disposed in the groove 6a.
  • the bending portion 4 arranged in the groove 6a is bent downward, so that the heart arranged on the lower side of the hood 6 is passed through the opening of the groove 6a. Can be observed.
  • the width of the groove 6a in the left-right direction is such that the distal end of the insertion part 3 can protrude radially outward from the opening of the groove 6a when the bending part 4 is bent at a large angle. It is larger than the outer diameter.
  • the inner surface of the groove 6a has two flat support surfaces 6b and 6c which are located on the left and right sides of the distal end opening of the endoscope channel 5a and are parallel to each other in the vertical direction.
  • the support surfaces 6b and 6c extend downward from the endoscope channel 5a, and the side surfaces of the curved portion 4 curved downward in the groove 6a are connected to the insertion portion 3 in the endoscope channel 5a. It is supported below the longitudinal axis A.
  • the hood 6 is configured to hold the curved portion 4 so that the curved curved portion 4 does not fall in the left-right direction due to the twist around the longitudinal axis A of the insertion portion 3.
  • the position indicated by the thick solid line indicates the position where the bending portion 4 is supported by the support surfaces 6 b and 6 c of the hood 6.
  • the sheath body 5 is inserted into the body from under the xiphoid process and placed into the pericardial cavity, and the sheath body 5
  • the insertion part 3 of the endoscope 2 is inserted from the outside of the body into the pericardial cavity through the endoscope channel 5a.
  • the rotation angle around the longitudinal axis of the sheath body 5 is adjusted so that the upper side of the sheath body 5 is disposed on the pericardium Y side and the lower side is disposed on the heart X side. As a result, as shown in FIG.
  • the pericardium Y is lifted away from the heart X by the hood 6 having high rigidity, and the distal end of the insertion portion 3 is arranged at a position away from the heart X.
  • the heart X can be observed by the endoscope 2 by bending the bending portion 4 downward in the groove 6a so that the distal end of the insertion portion 3 faces the heart X.
  • the beating heart X may come into contact with the distal end of the insertion portion 3.
  • a force that rotates the bending bending portion 4 around the longitudinal axis A of the insertion portion 3 in the endoscope channel 5a Is acting on the distal end of the insertion portion 3 from the heart X, the bending portion 4 is bent to the left or right side by twisting the insertion portion 3 in the endoscope channel 5a according to the force from the heart X. Lying on the surface of heart X.
  • the curved bending portion 4 supports the hood 6 even in a state where the rotational force around the longitudinal axis A of the insertion portion 3 is acting by contact with the heart X. It is prevented from falling by being supported by the surfaces 6b and 6c.
  • the insertion portion in the endoscope channel 5a. 3 is applied to the support surfaces 6 b and 6 c of the hood 6 from the curved portion 4.
  • the hood 6 that comes into contact with the bending portion 4 at a position spaced downward from the longitudinal axis A of the insertion portion 3 generates a second moment of cross section that resists the pressing force, and collapses the bending portion 4 on which the rotational force acts. You can hold it down.
  • the rotational force around the longitudinal axis A is also transmitted to the sheath body 5 through the hood 6, but the sheath body 5 having higher torsional rigidity than the insertion portion 3 resists the pressing force without being twisted. Therefore, the hood 6 that receives the pressing force on the support surfaces 6b and 6c is stably supported by the sheath body 5 and does not rotate around the longitudinal axis A.
  • the posture of the curved portion 4 that is curved is stably maintained by the hood 6, there is an advantage that the heart X can be observed stably.
  • the endoscope channel 5a is provided at a position deviated upward with respect to the longitudinal axis of the sheath body 5, the area of the side surface of the bending portion 4 supported by the support surfaces 6b and 6c is increased. The falling of the part 4 can be prevented more reliably.
  • a support part can be provided, without increasing the number of members by making the hood 6 for lifting the pericardium Y function also as a support part.
  • the endoscope channel 5 a is provided at a position that is eccentric with respect to the longitudinal axis of the sheath body 5, but may be provided concentrically with the longitudinal axis of the sheath body 5. . Even if it does in this way, compared with the case where the endoscope channel 5a is eccentric, the contact area of the support surfaces 6b and 6c and the side surface of the bending portion 4 is reduced, but the hood 6 prevents the bending portion 4 from falling down. The effect can be demonstrated.
  • the hood 6 is provided on the upper side and the left and right sides of the endoscope channel 5a so that the support surfaces 6b and 6c are disposed on the left and right sides of the endoscope channel 5a.
  • the hood 6 is disposed on the upper side of the endoscope channel 5 a and the support surface 6 b or 6 c is disposed only on the left side or only on the right side of the endoscope channel 5 a. It may be provided only on either the left or right side.
  • the endoscope sheath 1 penetrates in the longitudinal direction from the distal end surface of the hood 6 to the proximal end portion of the sheath body 5, and the lumen 1 a into which the guide wire 20 is inserted. You may have.
  • the pericardium can be lifted from the surface of the heart not only by the hood 6 but also by the distal end portion of the guide wire 20 protruding from the distal end surface of the hood 6.
  • the lumen 1a is opened above the groove 6a on the distal end surface of the hood 6 so that the distal end portion of the guide wire 20 can reliably lift the pericardium to a position farther from the heart than the distal end of the insertion portion 3.
  • it is.
  • a wire 62 may be provided in the endoscope sheath, and the side surface of the bending portion 4 may be supported by the wire 62 instead of the hood 6.
  • the hood 61 is provided only on the upper side of the endoscope channel 5 a so as to cover only the upper side of the bending portion 4.
  • the wire 62 is disposed from the distal end portion of the hood 61 through the sheath body 5 to the proximal end side of the sheath body 5, and the distal end of the wire 62 is fixed to the distal end portion of the hood 61.
  • the wire 62 is made of a shape memory alloy such as nickel titanium, and the tip portion of the wire 62 stores a substantially semicircular arc shape protruding downward.
  • the distal end portion of the wire 62 extends straight along the longitudinal direction of the hood 61 when the proximal end portion of the wire 62 is pulled, and is curved in an arc shape when the proximal end portion of the wire 62 is pressed. It protrudes downward.
  • the arc shape of the distal end portion of the wire 62 so as to support the side surface of the bending portion 4 where the wire 62 is bent below the longitudinal axis A of the insertion portion 3 in the endoscope channel 5a. Is designed.
  • the sheath body 5 and the hood 6 may be provided with lumens 1b for various uses.
  • a lumen 1b for supplying or sucking a fluid or inserting a treatment instrument may be provided.
  • two lumens 1b are provided, but the number of lumens 1b may be only one, or three or more.
  • the endoscope sheath 1 has a circular tube shape, but the endoscope sheath 1 may have another long shape.
  • an endoscope sheath in which the cross-sectional shape of the hood 63 and the sheath body is substantially fan-shaped may be employed.
  • other medical devices can be used by effectively utilizing the space in the access sheath 30 for guiding the endoscope sheath between the outside of the body and the pericardial cavity.
  • a sheath or a treatment instrument can also be disposed in the access sheath 30 together with the endoscope sheath.
  • the rotation restriction that restricts the rotation of the insertion portion 3 around the longitudinal axis A in the endoscope channel 5a so that the lower side of the sheath body 5 and the bendable direction of the bending portion 4 coincide.
  • a part may be provided.
  • the rotation restricting portion includes a projection 71 provided in a part of the circumferential direction of the side surface of the insertion portion 3 on the proximal side of the bending portion 4 and protruding radially outward. And a groove 72 provided in a part of the inner surface of the endoscope channel 5a in the circumferential direction and into which the protrusion 71 is fitted.
  • the protrusion 71 and the groove 72 are provided at positions where the protrusion 4 and the groove 72 are fitted to each other in a state where the curved portion 4 is disposed in the groove 6a of the hood 6, and a part in the longitudinal direction of the insertion portion 3 and the endoscope channel 5a. It may be provided only for each, or may be provided over the entire length. As shown in FIG. 9B, the protrusion 71 may be provided on the inner surface of the endoscope channel 5 a and the groove 72 may be provided on the side surface of the insertion portion 3.
  • FIGS. 10A to 18 an endoscope sheath 10 and an endoscope system 101 according to a second embodiment of the present invention will be described with reference to FIGS. 10A to 18.
  • a configuration different from that of the first embodiment will be described, and a configuration common to the first embodiment will be denoted by the same reference numeral and description thereof will be omitted.
  • This embodiment is different from the first embodiment in that the upper sides of the curved portions 41 and 42 protruding from the endoscope channel 5a are opened.
  • the endoscope system 101 includes an endoscope 21 and an endoscope sheath 10 into which the endoscope 21 can be inserted.
  • the endoscope 21 includes a flexible and long insertion portion 31 that can be inserted into the pericardial cavity, and a distal end portion of the insertion portion 31 that intersects the longitudinal axis of the insertion portion 31.
  • Two bending portions 41 and 42 that can be bent in the direction are provided.
  • the first curved portion 41 on the distal end side and the second curved portion 42 on the proximal end side can be curved in opposite directions so as to form a substantially S shape, as shown in FIGS. 10B and 11A. is there.
  • the bending operations of the bending portions 41 and 42 can be controlled by operating an operation unit (not shown) connected to the proximal end of the insertion unit 31.
  • the endoscope sheath 10 includes a sheath body 5 and two projecting portions 8 that project from the distal end of the sheath body 5 in a direction along the longitudinal axis of the sheath body 5.
  • the protrusion 8 is a semi-cylindrical member extending along the longitudinal direction from the distal end surface of the sheath body 5, and has a curved support surface 8 a on the radial outer side and a flat support surface 8 a on the radial inner side.
  • the two protruding portions 8 are provided on both the left and right sides of the endoscope channel 5a so as to cover both the left and right sides of the curved portions 41 and 42 protruding from the distal end opening of the endoscope channel 5a.
  • the first bending portion 41 protruding above the protruding portion 8 by bending the second bending portion 42 upward between the two protruding portions 8 and bending the first bending portion 41 downward.
  • the pericardium can be lifted to a position away from the surface of the heart, and the heart can be observed with the distal end of the insertion portion 31 facing downward.
  • each protrusion 8 is parallel to the vertical direction, and the side surfaces of the curved portions 41 and 42 that are curved in a substantially S shape in a plane substantially parallel to the vertical direction are provided in the endoscope channel 5a.
  • the insertion portion 31 is supported above the longitudinal axis A.
  • the position shown by a thick solid line has shown the position where the curved parts 41 and 42 are supported by the support surface 8a. Therefore, the support surface 8a is provided at least above the longitudinal axis of the endoscope channel 5a, and preferably provided both above and below the longitudinal axis of the endoscope channel 5a.
  • the pericardium Y is located on the upper side and the heart X is located on the lower side, as in the first embodiment.
  • the sheath body 5 is placed in the pericardial cavity.
  • the bending portions 41 and 42 are disposed between the two protruding portions 8, the second bending portion 42 is bent toward the pericardium Y side, and the first bending portion 41 is bent toward the heart X side. Accordingly, as shown in FIG.
  • the pericardium Y is lifted away from the heart X by the first curved portion 41 protruding from the protruding portion 8 toward the pericardium Y side, and the distal end of the insertion portion 31 is By being directed to the heart X, the heart X can be observed.
  • the first bending portion 41 that is in contact with the pericardium Y is provided with bending portions 41 and 42 that are curved in a substantially S shape in the insertion portion 31 in the endoscope channel 5a.
  • a force in the direction of rotation about the longitudinal axis A acts from the pericardium Y.
  • the pressing force around the longitudinal axis A of the insertion portion 31 in the endoscope channel 5a acts on the support surface 8a from the curved portions 41 and 42.
  • the support surface 8a that is in contact with the curved portions 41 and 42 at a position spaced upward from the longitudinal axis A of the insertion portion 31 generates a cross-sectional secondary moment against the pressing force, and the rotational force is increased.
  • the acting curved portions 41 and 42 can be pressed so as not to fall down.
  • the curved curved portions 41 and 42 are prevented from falling by the contact with the pericardium Y by the support surface 8a, and the curved curved portions 41 and 42 are prevented from falling.
  • the posture is stably maintained by the support surface 8a.
  • the rotation restricting portions 71 and 72 described in the first embodiment may be provided.
  • the endoscope sheath 10 may have a lumen that opens at the tip of the protruding portion 8 and into which a wire is inserted. By doing in this way, a space can be secured in front of the tip of the protrusion 8 by lifting the pericardium with the wire protruding in the longitudinal direction from the tip of the protrusion 8.
  • the support surfaces 8a are arranged on both the left and right sides of the endoscope channel 5a, but instead, as shown in FIG. 13, only the left side or the right side of the endoscope channel 5a. Only the support surface 8a may be arrange
  • the endoscope 21 including the two bending portions 41 and 42 that can be bent in opposite directions is used, but instead of this, a single unit is used as in the first embodiment.
  • An endoscope 2 including a bending portion 4 may be used.
  • the support surface 8a is provided at least on the lower side of the longitudinal axis of the endoscope channel 5a, and the side surface of the curved portion 4 curved downward is inserted into the insertion portion in the endoscope channel 5a. It is comprised so that it may support below the longitudinal axis A of 31.
  • the protruding portion 8 is formed integrally with the sheath body 5, but instead, the protruding portion 81 is separate from the sheath body 5 as shown in FIG. There may be provided so as to be able to project and retract from the tip of the sheath body 5.
  • the protrusion 81 is disposed in a cylindrical space between the side surface of the insertion portion 31 and the inner surface of the endoscope channel 5a, and the position housed in the endoscope channel 5a and the distal end surface of the sheath body 5 It may be provided so as to be movable in the longitudinal direction between the position protruding from the position. By doing in this way, when the protrusion 81 is unnecessary, the protrusion 81 can be retracted into the sheath body 5.
  • a general-purpose endoscope sheath can be used as the sheath body 5.
  • the protruding portion 81 may have a linear shape extending along the longitudinal direction of the sheath body 5, but may be curved downward as shown in FIG. 15 has an arcuate curved shape in a free state where no external force is applied, and can be deformed into a linear shape by its elasticity.
  • the projecting portion 83 having flexibility may be configured to be deformed between the linear shape and the curved shape integrally with the curved portion 4.
  • the projecting portion 83 is connected to the side surface of the bending portion 4 by a connecting tool 83 a such as a rivet at two positions of the distal end portion and the proximal end portion, and follows the bending of the bending portion 4. And may be configured to be bent.
  • the support portion 8a is configured from the flat side surface of the columnar protrusion 8.
  • the wire 84 may have a smaller diameter.
  • the wire 84 in FIG. 17 protrudes from the distal end surface of the sheath body 5 and forms a loop in a plane substantially parallel to the vertical direction.
  • the diameter of the loop shape of the wire 84 increases as the distance from the distal end surface of the sheath body 5 increases.
  • the wire 84 may be fixed to the distal end surface of the sheath body 5, but may be provided so as to be movable with respect to the sheath body 5.
  • the wire 84 extends through the hole formed in the side wall of the sheath body 5 to the proximal end side of the sheath body 5, and pushes and pulls both ends of the wire 84 arranged on the proximal end side of the sheath body 5.
  • the protruding amount of the wire 84 from the distal end surface of the sheath body 5 may be adjustable. By doing so, the wire 84 can be retracted into the sheath body 5 when the support portion is unnecessary.
  • a linear general-purpose guide wire 85 may be used as shown in FIG.
  • the sheath body 5 is formed with a wire channel 5b that penetrates in the longitudinal axis direction and is inserted so that the guide wire 85 is movable in the longitudinal direction on both the left and right sides or one side of the endoscope channel 5a.
  • the distal end portion of the wire channel 5 b is inclined downward toward the distal end of the sheath body 5. Accordingly, the distal end portion of the guide wire 85 protruding from the wire channel 5b supports the side surface of the curved portion 4 that is curved below the longitudinal axis A of the insertion portion 31 in the endoscope channel 5a. It has become. In this manner, the distal end portion of the guide wire 85 protruding from the wire channel 5b can function as a support portion.
  • FIGS. 19A to 21B An endoscope sheath and endoscope system 102 according to a third embodiment of the present invention will be described with reference to FIGS. 19A to 21B.
  • configurations different from those in the first and second embodiments will be described, and configurations common to the first and second embodiments will be denoted by the same reference numerals and description thereof will be omitted.
  • the present embodiment is different from the first and second embodiments in that an endoscope 22 that does not include a bending portion is used.
  • the endoscope system 102 includes an endoscope 22, an endoscope sheath 1, and an endoscope channel 5 a of the endoscope sheath 1. And an inner sheath 9 to be inserted into the inner sheath 9.
  • the endoscope 22 includes a flexible and long insertion portion 32 that can be inserted into the pericardial cavity, and does not include a bending portion.
  • 19A and 19B show the endoscope sheath 1, but in this embodiment, any endoscope having support portions on the left and right sides described in the first and second embodiments. A mirror sheath can be employed.
  • the inner sheath 9 is a long circular tube having a lumen that penetrates in the direction along the longitudinal axis and into which the endoscope 22 is inserted.
  • the inner sheath 9 has an outer diameter smaller than the inner diameter of the endoscope channel 5a, and the inner sheath 9 is movable in the longitudinal direction within the endoscope channel 5a.
  • the lumen of the inner sheath 9 has an inner diameter larger than the outer diameter of the insertion portion 32, and the insertion portion 32 can move in the longitudinal direction within the lumen.
  • the distal end portion 9a of the inner sheath 9 is curved in a direction intersecting the longitudinal axis in a free state where no external force is acting, and can be deformed into a linear shape extending along the longitudinal axis by its elasticity. Further, the inner sheath 9 has lower rigidity than the sheath body 5 and higher rigidity than the insertion portion 32. Therefore, by rotating the inner sheath 9 around the longitudinal axis in the endoscope channel 5a, the deformation between the curved shape and the linear shape of the distal end portion 9a of the inner sheath protruding from the endoscope channel 5a is controlled. Accordingly, the bending of the distal end portion 32a of the insertion portion 32 can be controlled.
  • the distal end portion 9a is curved by rotating the inner sheath 9 about the longitudinal axis and arranging the curved side of the distal end portion 9a on the lower side.
  • the distal end portion 9a extends linearly by arranging the curved side of the distal end portion 9a on the left or right side while the hood 6 is present.
  • the distal end portion 32 a of the insertion portion 32 disposed at the distal end portion 9 a of the inner sheath 9 is also deformed between a curved shape and a linear shape according to the deformation of the distal end portion 9 a of the inner sheath 9.
  • the bending of the distal end portion 32a of the insertion portion 32 is controlled by the curved distal end portion 9a of the inner sheath 9, but instead of this, as shown in FIG.
  • the distal end portion 32a may be curved in a direction intersecting the longitudinal axis in a free state and deformable into a linear shape extending along the longitudinal axis by its elasticity.
  • the distal end portion 32a of the insertion portion 32 is linear in the endoscope channel 5a and gradually curves as it protrudes from the endoscope channel 5a. Even in this case, by rotating the insertion portion 32 around the longitudinal axis in the endoscope channel 5a, the distal end portion 32a of the insertion portion 32 protruding from the endoscope channel 5a is between the curved shape and the linear shape. Can be controlled. Specifically, the distal end portion 3a is curved by rotating the insertion portion 32 around the longitudinal axis so that the curved side of the distal end portion 3a is located on the lower side, and the hood 6 is present on the curved side of the distal end portion 3a. In addition, the tip 3a can be linearly extended by being arranged on the left or right side.
  • the distal end portion 32 a of the insertion portion 32 can swing around the axis 11 intersecting the longitudinal axis of the insertion portion 32, for example, the protrusion 8.
  • the support surface 8a may be supported.
  • the insertion portion 32 is bent between the distal end surface of the sheath body 5 and the shaft 11 by pressing the proximal end portion of the insertion portion 32. At this time, the distal end of the insertion portion 32 swings around the shaft 11 so that the distal end of the insertion portion 32 is directed downward.
  • the inner sheath 9 or the insertion portion 32 having a curved shape changes with time in the curved shape of the inner sheath 9 or the insertion portion 32 by repeating elastic deformation between the curved shape and the linear shape, for example, the curvature becomes small. there is a possibility.
  • the distal end portion 32a of the insertion portion 32 can be reliably bent by an angle corresponding to the pushing amount of the insertion portion 32.
  • the insertion portion 32 is not necessarily curved so as to protrude upward, and the insertion portion 32 may be curved so as to protrude downward and the tip of the insertion portion 32 may be directed upward. is there. Therefore, in order to curve the insertion portion 32 so as to protrude upward, a member for regulating the bending direction of the insertion portion 32 may be provided. For example, a member that prevents the insertion portion 32 from protruding downward may be provided below the endoscope channel 5a between the endoscope channel 5a and the shaft.

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Abstract

This endoscope sheath comprises: a tube-shaped sheath body (5) including an endoscope channel (5a) which penetrates in the direction along the longitudinal axis and into which an endoscope is inserted; and a supporting part (6) that is provided more outside than the endoscope channel (5a) in a first radial direction of the sheath body (5), protrudes from the tip of the sheath body (5a) in the direction along the longitudinal axis, and supports a side face of a tip part (4) of the endoscope, which protrudes from the endoscope channel (5a) and curves in a plane that is substantially parallel to a second radial direction orthogonal to the first radial direction. The supporting part (6) restricts rotation of the curved tip part (4) about the longitudinal axis of the endoscope inside the endoscope channel (5a).

Description

内視鏡用シースおよび内視鏡システムEndoscope sheath and endoscope system
　本発明は、内視鏡用シースおよび内視鏡システムに関するものである。 The present invention relates to an endoscope sheath and an endoscope system.
　従来、剣状突起下から心膜腔に経皮的に内視鏡を挿入し、開胸手術を行うことなく疾患部位を内視鏡で観察する方法が知られている（例えば、特許文献１参照。）。 Conventionally, a method is known in which an endoscope is inserted percutaneously into the pericardial space from under the xiphoid process, and a diseased site is observed with an endoscope without performing a thoracotomy (for example, Patent Document 1). reference.).
米国特許出願公開第２００４／００６４１３８号明細書US Patent Application Publication No. 2004/0064138
　心膜腔内に配置された内視鏡によって心臓の表面を観察するためには、内視鏡の先端が心臓表面から離れた位置に配置されるように、内視鏡の先端部の湾曲部を湾曲させて内視鏡の先端を心膜側に持ち上げる必要がある。しかしながら、心膜腔内に配置された内視鏡には、心臓側に押し付ける力が心膜から作用する。また、拍動する心臓が内視鏡の先端に接触することで、内視鏡の先端部は心臓からも力を受け得る。このような心膜および心臓からの力によって、内視鏡の湾曲している先端部が心臓表面上に倒れてしまうという問題がある。 In order to observe the surface of the heart with an endoscope placed in the pericardial cavity, the bending portion of the tip of the endoscope is arranged so that the tip of the endoscope is located at a position away from the heart surface. It is necessary to bend the tip of the endoscope to the pericardium side. However, in the endoscope disposed in the pericardial cavity, a force pressing to the heart side acts from the pericardium. Further, when the beating heart comes into contact with the distal end of the endoscope, the distal end portion of the endoscope can receive force from the heart. Due to the force from the pericardium and the heart, there is a problem that the curved distal end portion of the endoscope falls on the heart surface.
　本発明は、上述した事情に鑑みてなされたものであって、心膜腔内において内視鏡の湾曲している先端部が倒れることを防ぎ、心臓を安定的に観察することができる内視鏡用シースおよび内視鏡システムを提供することを目的とする。 The present invention has been made in view of the above-described circumstances, and is an endoscope that can stably observe the heart by preventing the bent distal end portion of the endoscope from falling in the pericardial cavity. An object is to provide a mirror sheath and an endoscope system.
　上記目的を達成するため、本発明は以下の手段を提供する。
　本発明の第１の態様は、長手軸に沿う方向に貫通し内視鏡が挿入される内視鏡チャネルを有する管状のシース本体と、前記シース本体の第１の径方向において前記内視鏡チャネルよりも外側に設けられ前記シース本体の先端から前記長手軸に沿う方向に突出し、前記内視鏡チャネルから突出し前記第１の径方向と直交する第２の径方向に略平行な平面内で湾曲している前記内視鏡の先端部の側面を支持する支持部とを備え、該支持部が、前記湾曲している先端部の、前記内視鏡チャネル内における前記内視鏡の長手軸回りの回転を規制する内視鏡用シースである。 In order to achieve the above object, the present invention provides the following means.
According to a first aspect of the present invention, there is provided a tubular sheath body having an endoscope channel that penetrates in a direction along a longitudinal axis and into which an endoscope is inserted, and the endoscope in a first radial direction of the sheath body. Provided outside the channel and projecting from the distal end of the sheath body in a direction along the longitudinal axis, projecting from the endoscope channel and in a plane substantially parallel to a second radial direction perpendicular to the first radial direction. A support portion that supports a side surface of the distal end portion of the endoscope that is curved, and the support portion has a longitudinal axis of the endoscope in the endoscope channel of the curved distal end portion. It is the sheath for endoscopes which controls rotation around.
　本発明の第１の態様によれば、シース本体を第１の径方向が心臓の表面と略平行になるように心膜腔内に配置し、シース本体の内視鏡チャネル内に配置された内視鏡の先端部をシース本体の先端から突出させて心臓側に湾曲させることで、シース本体の側方に位置する心臓を観察することができる。 According to the first aspect of the present invention, the sheath body is disposed in the pericardial cavity such that the first radial direction is substantially parallel to the surface of the heart, and is disposed in the endoscope channel of the sheath body. By projecting the distal end portion of the endoscope from the distal end of the sheath body and curving it toward the heart side, the heart located on the side of the sheath body can be observed.
　この場合に、シース本体の先端側において湾曲している内視鏡の先端部は、湾曲方向と略直交する方向の側面が支持部によって支持されることで、内視鏡チャネル内に配置されている内視鏡の長手軸回りに回転しないように支持部によって規制される。これにより、湾曲している先端部が心膜または心臓からの力によって倒れることを防ぎ、心臓を安定的に観察することができる。 In this case, the distal end portion of the endoscope that is curved on the distal end side of the sheath body is arranged in the endoscope channel by supporting the side surface in the direction substantially orthogonal to the bending direction by the support portion. It is regulated by the support portion so as not to rotate around the longitudinal axis of the endoscope. As a result, it is possible to prevent the curved distal end portion from falling down due to a force from the pericardium or the heart and to observe the heart stably.
　上記第１の態様においては、前記支持部が、前記第２の径方向と平行な面内に配置されていてもよい。
　このようにすることで、内視鏡の湾曲している先端部の側面を支持部によってより安定的に支持することができる。 In the first aspect, the support portion may be disposed in a plane parallel to the second radial direction.
In this way, the side surface of the curved distal end portion of the endoscope can be more stably supported by the support portion.
　上記第１の態様においては、前記支持部が、前記第１の径方向において前記内視鏡チャネルの両側に設けられていてもよい。
　このように、湾曲している先端部が両側において支持部によって支持されることで、湾曲している先端部の倒れをさらに確実に防止することができる。 In the first aspect, the support portion may be provided on both sides of the endoscope channel in the first radial direction.
In this way, the curved tip portion is supported by the support portions on both sides, so that the bent tip portion can be more reliably prevented from falling.
　上記第１の態様においては、前記支持部が、前記第２の径方向において前記内視鏡チャネルの長手軸よりも外側に設けられていてもよい。
　このようにすることで、支持部は、湾曲している先端部の回転中心となる内視鏡チャネル内の内視鏡の長手軸から径方向に離間した位置において、湾曲している先端部の側面を支持する。これにより、支持部は、湾曲している先端部から受ける力に抗するより大きな断面２次モーメントを発生することができ、湾曲している先端部の倒れをより確実に防止することができる。 In the first aspect, the support portion may be provided outside the longitudinal axis of the endoscope channel in the second radial direction.
In this way, the support portion is provided at the position of the curved distal end portion at a position radially spaced from the longitudinal axis of the endoscope in the endoscope channel that is the rotation center of the curved distal end portion. Support the side. Thereby, the support part can generate a larger second moment of cross section that resists the force received from the curved tip part, and can more reliably prevent the curved tip part from falling over.
　上記第１の態様においては、前記支持部が、前記第２の径方向に湾曲するとともに前記長手軸に沿う方向に延びる直線形状に弾性変形可能であり、前記シース本体の先端から突没可能に前記シース本体内に設けられていてもよい。
　このようにすることで、支持部は、シース本体の先端から突出した状態では、内視鏡の湾曲している先端部に沿って延びることで、湾曲している先端部の側面をより広範囲にわたって支持することができる。また、支持部が不要であるときには、支持部をシース本体の長手方向に沿って直線形状に変形させてシース本体内に収納することができる。 In the first aspect, the support portion can be elastically deformed into a linear shape that is curved in the second radial direction and extends in a direction along the longitudinal axis, and can project and retract from the distal end of the sheath body. It may be provided in the sheath body.
By doing in this way, in the state which protruded from the front-end | tip of a sheath main body, a support part is extended along the front-end | tip part which curves the endoscope, and the side surface of the front-end | tip part which curved is spread over a wider range. Can be supported. When the support portion is unnecessary, the support portion can be deformed into a linear shape along the longitudinal direction of the sheath body and stored in the sheath body.
　上記第１の態様においては、一方向に湾曲する先端部を有するワイヤを備え、前記支持部が、前記ワイヤの前記先端部からなり、前記シースが、前記長手軸に沿う方向に貫通し前記ワイヤが長手方向に移動可能に挿入されるワイヤチャネルを有していてもよい。
　このようにすることで、心臓手術において一般に使用されるガイドワイヤのような汎用のワイヤを支持部として利用することができる。また、支持部として細径のワイヤを使用することで、シース本体の細径化を図ることができる。 In the first aspect described above, a wire having a tip portion curved in one direction is provided, the support portion is formed of the tip portion of the wire, and the sheath penetrates in a direction along the longitudinal axis, and the wire May have a wire channel inserted so as to be movable in the longitudinal direction.
By doing in this way, a general purpose wire like a guide wire generally used in cardiac surgery can be used as a support part. Moreover, the diameter of the sheath body can be reduced by using a thin wire as the support portion.
　上記第１の態様においては、ワイヤを備え、前記シース本体は、前記長手軸に沿う方向に貫通し前記ワイヤが長手方向に移動可能に挿入されるワイヤチャネルを有し、該ワイヤチャネルの先端部が、前記シース本体の先端に向かって前記第２の径方向外側に傾斜していてもよい。
　このように、ワイヤチャネルの先端部が傾斜していることで、ワイヤチャネルから突出するワイヤの先端部を、内視鏡の湾曲している先端部に略沿って延びるようにシース本体の長手方向に対して傾斜させ、支持部として機能させることができる。また、心臓手術において一般に使用されるガイドワイヤのような汎用のワイヤを支持部として利用することができる。また、支持部として細径のワイヤを使用することで、シース本体の細径化を図ることができる。 In the first aspect, a wire is provided, and the sheath body has a wire channel that penetrates in the direction along the longitudinal axis and is inserted so that the wire can move in the longitudinal direction, and a distal end portion of the wire channel However, it may be inclined outward in the second radial direction toward the tip of the sheath body.
As described above, since the distal end portion of the wire channel is inclined, the distal end portion of the wire protruding from the wire channel extends in the longitudinal direction of the sheath body so as to extend substantially along the curved distal end portion of the endoscope. And can function as a support portion. A general-purpose wire such as a guide wire generally used in cardiac surgery can be used as the support portion. Moreover, the diameter of the sheath body can be reduced by using a thin wire as the support portion.
　上記第１の態様においては、前記第２の径方向において前記内視鏡チャネルよりも外側に設けられ前記シース本体の先端から前記長手軸に沿う方向に突出するフードを備え、前記支持部が、前記フードと一体的に形成されていてもよい。
　フードが心膜側に位置するようにシース本体を心膜腔内で配置することで、心膜を心臓から離間した位置までフードによって持ち上げて、内視鏡の先端の近傍により広い空間を確保することができる。また、このようなフードに支持部を一体的に設けることで、製造時の組立を容易にすることができる。 In the first aspect, a hood provided outside the endoscope channel in the second radial direction and projecting in a direction along the longitudinal axis from the distal end of the sheath body, the support portion includes: It may be formed integrally with the hood.
By placing the sheath body in the pericardial cavity so that the hood is located on the pericardial side, the pericardium is lifted by the hood to a position away from the heart, and a wider space is secured near the tip of the endoscope. be able to. Moreover, the assembly at the time of manufacture can be made easy by providing a support part integrally in such a hood.
　本発明の第２の態様は、長手軸に交差する方向に湾曲した湾曲形状と前記長手軸に沿って延びる直線形状との間で変形可能な先端部を有する内視鏡と、上記いずれかに記載の内視鏡用シースとを備える内視鏡システムである。 According to a second aspect of the present invention, there is provided an endoscope having a distal end portion that is deformable between a curved shape that is curved in a direction intersecting the longitudinal axis and a linear shape that extends along the longitudinal axis. It is an endoscope system provided with the described sheath for endoscopes.
　上記第２の態様においては、前記内視鏡が、前記シース本体よりも低い剛性を有し、前記内視鏡の前記先端部が、自由状態において前記湾曲形状を有するとともに前記直線形状に弾性変形可能であってもよい。
　このようにすることで、内視鏡の先端部は、シース本体の内視鏡チャネル内に収納されている状態では直線状に延び、シース本体の先端から突出した状態では自発的に湾曲する。これにより、内視鏡の先端部を湾曲させるための機械的な機構が不要となり、内視鏡の細径化を図ることができる。 In the second aspect, the endoscope has rigidity lower than that of the sheath body, and the distal end portion of the endoscope has the curved shape in a free state and is elastically deformed into the linear shape. It may be possible.
By doing so, the distal end portion of the endoscope extends linearly when it is housed in the endoscope channel of the sheath body and spontaneously curves when it protrudes from the distal end of the sheath body. As a result, a mechanical mechanism for bending the distal end portion of the endoscope becomes unnecessary, and the diameter of the endoscope can be reduced.
　上記第２の態様においては、前記内視鏡チャネル内における前記内視鏡の長手軸回りの回転を規制する回転規制部を備えていてもよい。
　このようにすることで、シース本体の先端から突出し湾曲している内視鏡の先端部の倒れをさらに確実に防止することができる。 In the second aspect, a rotation restricting portion that restricts rotation of the endoscope around the longitudinal axis in the endoscope channel may be provided.
By doing so, it is possible to further reliably prevent the tip portion of the endoscope projecting from the tip of the sheath body from being bent.
　本発明によれば、心膜腔内において内視鏡の湾曲している先端部が倒れることを防ぎ、心臓を安定的に観察することができるという効果を奏する。 According to the present invention, it is possible to prevent the curved distal end portion of the endoscope from falling in the pericardial cavity and to observe the heart stably.
本発明の第１の実施形態に係る内視鏡システムの先端部の斜視図である。It is a perspective view of the tip part of the endoscope system concerning a 1st embodiment of the present invention. 図１Ａの内視鏡システムにおいて内視鏡の湾曲部が湾曲している状態を示す斜視図である。FIG. 1B is a perspective view showing a state where a bending portion of the endoscope is curved in the endoscope system of FIG. 1A. 図１Ａの内視鏡用シースの先端部の縦断面図である。It is a longitudinal cross-sectional view of the front-end | tip part of the sheath for endoscopes of FIG. 1A. 図２Ａの内視鏡用シースおよび挿入部を先端側から見た正面図である。It is the front view which looked at the sheath for endoscopes and insertion part of Drawing 2A from the tip side. 図１Ａの内視鏡システムの心膜腔内での使用方法を説明する図である。It is a figure explaining the usage method in the pericardial cavity of the endoscope system of FIG. 1A. 図１Ａの内視鏡用シースの変形例の先端部の斜視図である。It is a perspective view of the front-end | tip part of the modification of the sheath for endoscopes of FIG. 1A. 図１Ａの内視鏡用シースの他の変形例の先端部の斜視図である。It is a perspective view of the front-end | tip part of the other modification of the sheath for endoscopes of FIG. 1A. 図１Ａの内視鏡用シースの他の変形例の先端部の斜視図である。It is a perspective view of the front-end | tip part of the other modification of the sheath for endoscopes of FIG. 1A. 図１Ａの内視鏡用シースの他の変形例の先端部の斜視図である。It is a perspective view of the front-end | tip part of the other modification of the sheath for endoscopes of FIG. 1A. 図１Ａの内視鏡用シースの他の変形例の正面図である。It is a front view of the other modification of the sheath for endoscopes of Drawing 1A. 回転規制部の構成を示す、シース本体および挿入部の横断面図である。It is a cross-sectional view of a sheath body and an insertion portion showing the configuration of the rotation restricting portion. 図９Ａの回転規制部の変形例を示す、シース本体および挿入部の横断面図である。It is a cross-sectional view of a sheath main body and an insertion portion, showing a modification of the rotation restricting portion of FIG. 9A. 本発明の第２の実施形態に係る内視鏡システムの先端部の斜視図である。It is a perspective view of the front-end | tip part of the endoscope system which concerns on the 2nd Embodiment of this invention. 図１０Ａの内視鏡システムにおいて内視鏡の湾曲部が湾曲している状態を示す斜視図である。FIG. 10B is a perspective view showing a state where the bending portion of the endoscope is bent in the endoscope system of FIG. 10A. 図１０Ａの内視鏡用シースの先端部の縦断面図である。It is a longitudinal cross-sectional view of the front-end | tip part of the sheath for endoscopes of FIG. 10A. 図１１Ａの内視鏡用シースおよび挿入部を先端側から見た正面図である。It is the front view which looked at the endoscope sheath and insertion part of FIG. 11A from the front end side. 図１０Ａの内視鏡システムの心膜腔内での使用方法を説明する図である。It is a figure explaining the usage method in the pericardial cavity of the endoscope system of FIG. 10A. 図１０Ａの内視鏡用シースの変形例の先端部の斜視図である。FIG. 10B is a perspective view of the distal end portion of a modification of the endoscope sheath of FIG. 10A. 図１０Ａの内視鏡用シースの他の変形例の先端部の斜視図である。FIG. 10B is a perspective view of the distal end portion of another modification of the endoscope sheath of FIG. 10A. 図１０Ａの内視鏡用シースの他の変形例の先端部の斜視図である。FIG. 10B is a perspective view of the distal end portion of another modification of the endoscope sheath of FIG. 10A. 図１０Ａの内視鏡用シースの他の変形例の先端部の斜視図である。FIG. 10B is a perspective view of the distal end portion of another modification of the endoscope sheath of FIG. 10A. 図１０Ａの内視鏡用シースの他の変形例の先端部の斜視図である。FIG. 10B is a perspective view of the distal end portion of another modification of the endoscope sheath of FIG. 10A. 図１０Ａの内視鏡用シースの他の変形例の先端部の側面図である。FIG. 10B is a side view of the distal end portion of another modification of the endoscope sheath of FIG. 10A. 本発明の第３の実施形態に係る内視鏡システムにおける内視鏡用シースの先端部の縦断面図である。It is a longitudinal cross-sectional view of the front-end | tip part of the sheath for endoscopes in the endoscope system which concerns on the 3rd Embodiment of this invention. 図１９Ａの内視鏡システムにおいて内視鏡の湾曲部が湾曲している状態を示す内視鏡用シースの縦断面図である。FIG. 19B is a longitudinal sectional view of the endoscope sheath showing a state in which a bending portion of the endoscope is bent in the endoscope system of FIG. 19A. 図１９Ａの内視鏡システムの変形例における内視鏡用シースの先端部の縦断面図である。It is a longitudinal cross-sectional view of the front-end | tip part of the sheath for endoscopes in the modification of the endoscope system of FIG. 19A. 図１９Ａの内視鏡システムの他の変形例の先端部の斜視図である。It is a perspective view of the tip part of other modifications of the endoscope system of Drawing 19A. 図２１Ａの内視鏡システムにおいて内視鏡の湾曲部が湾曲している状態を示す斜視図である。FIG. 21B is a perspective view showing a state where the bending portion of the endoscope is curved in the endoscope system of FIG. 21A.
（第１の実施形態）
　本発明の第１の実施形態に係る内視鏡用シース１および内視鏡システム１００について図１Ａから図９Ｂを参照して以下に説明する。
　本実施形態に係る内視鏡システム１００は、図１Ａおよび図１Ｂに示されるように、内視鏡２と、内視鏡２を挿入可能な内視鏡用シース１とを備えている。 (First embodiment)
An endoscope sheath 1 and an endoscope system 100 according to a first embodiment of the present invention will be described below with reference to FIGS. 1A to 9B.
As shown in FIGS. 1A and 1B, an endoscope system 100 according to the present embodiment includes an endoscope 2 and an endoscope sheath 1 into which the endoscope 2 can be inserted.
　内視鏡２は、図２Ａに示されるように、心膜腔内に挿入可能な軟性かつ長尺の挿入部３と、挿入部３の先端部に設けられ挿入部３の長手軸に交差する方向に湾曲可能な湾曲部４とを備えている。湾曲部４は、少なくとも一方向に湾曲可能である。湾曲部４の湾曲動作は、挿入部３の基端に接続された操作部（図示略）の操作によって制御することができるようになっている。 As shown in FIG. 2A, the endoscope 2 includes a soft and long insertion portion 3 that can be inserted into the pericardial cavity, and a distal end portion of the insertion portion 3 that intersects the longitudinal axis of the insertion portion 3. And a bending portion 4 that can be bent in the direction. The bending portion 4 can be bent in at least one direction. The bending operation of the bending section 4 can be controlled by operating an operation section (not shown) connected to the proximal end of the insertion section 3.
　内視鏡用シース１は、挿入部３が挿入される内視鏡チャネル５ａを有する長尺の円管状のシース本体５と、シース本体５の先端からシース本体５の長手軸に沿う方向に突出するフード（支持部）６とを備えている。
　内視鏡用シース１は、長手軸に直交する径方向であって、相互に直交する上下方向（第２の径方向）および左右方向（第１の径方向）を有している。上下方向は、心膜腔内で内視鏡用シース１を使用する際に心膜腔の厚さ方向（心膜と心臓の対向方向）に配置される方向であり、特に、心臓側に配置される側が下側であり、心膜側に配置される側が上側である。 The endoscope sheath 1 protrudes in a direction along the longitudinal axis of the sheath body 5 from the distal end of the sheath body 5 and a long tubular sheath body 5 having an endoscope channel 5a into which the insertion portion 3 is inserted. And a hood (support portion) 6 to be used.
The endoscope sheath 1 has a radial direction orthogonal to the longitudinal axis and a vertical direction (second radial direction) and a horizontal direction (first radial direction) orthogonal to each other. The vertical direction is the direction in which the endoscopic sheath 1 is used in the pericardial cavity, and is disposed in the thickness direction of the pericardial cavity (opposite direction between the pericardium and the heart), and particularly on the heart side. The side to be placed is the lower side, and the side placed on the pericardial side is the upper side.
　シース本体５は、挿入部３よりも高い剛性を有し、シース本体５の長手軸回りのねじり剛性は、挿入部３の長手軸回りのねじり剛性よりも高くなっている。内視鏡チャネル５ａは、シース本体５を長手軸に沿う方向に貫通しており、挿入部３が内視鏡チャネル５ａ内で長手方向に移動することができるように挿入部３の外径よりも大きな内径を有している。また、内視鏡チャネル５ａは、図２Ａおよび図２Ｂに示されるように、シース本体５の長手軸に対して上側に偏心した位置に形成されている。 The sheath body 5 has higher rigidity than the insertion portion 3, and the torsional rigidity around the longitudinal axis of the sheath body 5 is higher than the torsional rigidity around the longitudinal axis of the insertion portion 3. The endoscope channel 5a penetrates the sheath body 5 in the direction along the longitudinal axis, and the outer diameter of the insertion portion 3 is such that the insertion portion 3 can move in the longitudinal direction within the endoscope channel 5a. Also has a large inner diameter. Further, the endoscope channel 5a is formed at a position eccentric to the upper side with respect to the longitudinal axis of the sheath body 5, as shown in FIGS. 2A and 2B.
　フード６は、図２Ａおよび図２Ｂに示されるように、シース本体５の円環状の先端面から長手方向に沿って延びる略円柱状であり、心膜腔内で心膜から受ける力に抗して形状を維持することができる剛性を有している。フード６は、内視鏡チャネル５ａと長手方向に連続する溝６ａを有している。溝６ａは、下側の側面から上側に向かって上下方向に延び、フード６の先端面から基端面まで長手方向の全長にわたって形成されている。したがって、フード６は、先端側から見たときに内視鏡チャネル５ａの上側および左右両側に配置される略Ｕ字形状を有し、内視鏡チャネル５ａの先端開口から突出し溝６ａ内に配置された湾曲部４の上側および左右両側がフード６によって覆われるようになっている。溝６ａの内面と、フード６の先端面および側面との間の角部は、それぞれＲ面取りされていることが好ましい。 As shown in FIGS. 2A and 2B, the hood 6 has a substantially cylindrical shape extending in the longitudinal direction from the annular distal end surface of the sheath body 5 and resists the force received from the pericardium in the pericardial cavity. It has rigidity that can maintain the shape. The hood 6 has a groove 6a continuous with the endoscope channel 5a in the longitudinal direction. The groove 6 a extends in the vertical direction from the lower side surface to the upper side, and is formed over the entire length in the longitudinal direction from the distal end surface to the proximal end surface of the hood 6. Accordingly, the hood 6 has a substantially U-shape that is disposed on the upper side and both the left and right sides of the endoscope channel 5a when viewed from the distal end side, and projects from the distal end opening of the endoscope channel 5a and is disposed in the groove 6a. The upper side and both left and right sides of the bent portion 4 are covered with the hood 6. The corners between the inner surface of the groove 6a and the tip surface and side surface of the hood 6 are preferably chamfered.
　図２Ａにおいて実線で示されるように、溝６ａ内に配置された湾曲部４を直線状に延ばすことで、フード６の先端前方を観察することができる。このように溝６ａ内に湾曲部４を直線状に配置した状態において、フード６が内視鏡２の視野に入らないように、フード６の長さが設計されていることが好ましい。例えば、フード６は、湾曲部４全体を溝６ａ内に配置した状態でフード６の先端と挿入部３の先端とが長手方向において略同一位置に配置されるような長さを有する。 As shown by a solid line in FIG. 2A, the front end of the hood 6 can be observed by extending the curved portion 4 arranged in the groove 6a linearly. Thus, it is preferable that the length of the hood 6 is designed so that the hood 6 does not enter the field of view of the endoscope 2 in a state where the curved portion 4 is linearly arranged in the groove 6a. For example, the hood 6 has such a length that the distal end of the hood 6 and the distal end of the insertion portion 3 are disposed at substantially the same position in the longitudinal direction in a state where the entire curved portion 4 is disposed in the groove 6a.
　一方、図２Ａにおいて二点鎖線で示されるように、溝６ａ内に配置された湾曲部４を下側へ湾曲させることで、フード６の下側に配置された心臓を溝６ａの開口を介して観察することができる。湾曲部４を大きな角度で湾曲させたときに、挿入部３の先端が溝６ａの開口から径方向外方に突出することができるように、左右方向における溝６ａの幅は、湾曲部４の外径よりも大きくなっている。 On the other hand, as shown by a two-dot chain line in FIG. 2A, the bending portion 4 arranged in the groove 6a is bent downward, so that the heart arranged on the lower side of the hood 6 is passed through the opening of the groove 6a. Can be observed. The width of the groove 6a in the left-right direction is such that the distal end of the insertion part 3 can protrude radially outward from the opening of the groove 6a when the bending part 4 is bent at a large angle. It is larger than the outer diameter.
　溝６ａの内面は、内視鏡チャネル５ａの先端開口の左右両側に位置し、上下方向にそれぞれ平行である２つの平坦な支持面６ｂ，６ｃを有する。支持面６ｂ，６ｃは、内視鏡チャネル５ａよりも下側へ延びており、溝６ａ内で下側に湾曲している湾曲部４の側面を、内視鏡チャネル５ａ内の挿入部３の長手軸Ａよりも下側において支持する。これにより、フード６は、湾曲している湾曲部４が挿入部３の長手軸Ａ回りのねじれによって左右方向に倒れないように、湾曲部４を押さえるようになっている。図２Ａおよび図２Ｂにおいて、太い実線で示される位置が、フード６の支持面６ｂ，６ｃによって湾曲部４が支持される位置を示している。 The inner surface of the groove 6a has two flat support surfaces 6b and 6c which are located on the left and right sides of the distal end opening of the endoscope channel 5a and are parallel to each other in the vertical direction. The support surfaces 6b and 6c extend downward from the endoscope channel 5a, and the side surfaces of the curved portion 4 curved downward in the groove 6a are connected to the insertion portion 3 in the endoscope channel 5a. It is supported below the longitudinal axis A. Accordingly, the hood 6 is configured to hold the curved portion 4 so that the curved curved portion 4 does not fall in the left-right direction due to the twist around the longitudinal axis A of the insertion portion 3. In FIG. 2A and FIG. 2B, the position indicated by the thick solid line indicates the position where the bending portion 4 is supported by the support surfaces 6 b and 6 c of the hood 6.
　次に、このように構成された内視鏡システム１００の作用について、図３を参照して説明する。
　本実施形態に係る内視鏡システム１００を使用して心臓Ｘを観察するためには、まず、シース本体５を剣状突起下から体内に挿入して心膜腔内まで配置し、シース本体５の内視鏡チャネル５ａ内を介して内視鏡２の挿入部３を体外から心膜腔内まで挿入する。次に、シース本体５の上側が心膜Ｙ側に配置され、下側が心臓Ｘ側に配置されるように、シース本体５の長手軸回りの回転角度を調整する。これにより、図３に示されるように、高い剛性を有するフード６によって心膜Ｙが心臓Ｘから離間する方向に持ち上げられ、挿入部３の先端が心臓Ｘから離間した位置に配置される。そして、挿入部３の先端が心臓Ｘを向くように溝６ａ内で湾曲部４を下側に湾曲させることで、内視鏡２によって心臓Ｘを観察することができる。 Next, the operation of the endoscope system 100 configured as described above will be described with reference to FIG.
In order to observe the heart X using the endoscope system 100 according to the present embodiment, first, the sheath body 5 is inserted into the body from under the xiphoid process and placed into the pericardial cavity, and the sheath body 5 The insertion part 3 of the endoscope 2 is inserted from the outside of the body into the pericardial cavity through the endoscope channel 5a. Next, the rotation angle around the longitudinal axis of the sheath body 5 is adjusted so that the upper side of the sheath body 5 is disposed on the pericardium Y side and the lower side is disposed on the heart X side. As a result, as shown in FIG. 3, the pericardium Y is lifted away from the heart X by the hood 6 having high rigidity, and the distal end of the insertion portion 3 is arranged at a position away from the heart X. The heart X can be observed by the endoscope 2 by bending the bending portion 4 downward in the groove 6a so that the distal end of the insertion portion 3 faces the heart X.
　心臓Ｘの観察中に、拍動する心臓Ｘが挿入部３の先端と接触することがある。湾曲部４の左右両側に湾曲部４の側面を支持する部材が存在しない場合、湾曲している湾曲部４を内視鏡チャネル５ａ内の挿入部３の長手軸Ａ回りに回転させるような力が心臓Ｘから挿入部３の先端に作用したときに、心臓Ｘからの力に従って内視鏡チャネル５ａ内で挿入部３がねじれることで、湾曲している湾曲部４は左側または右側に倒れて心臓Ｘの表面上に横たわってしまう。 During the observation of the heart X, the beating heart X may come into contact with the distal end of the insertion portion 3. When there is no member that supports the side surface of the bending portion 4 on both the left and right sides of the bending portion 4, a force that rotates the bending bending portion 4 around the longitudinal axis A of the insertion portion 3 in the endoscope channel 5a. Is acting on the distal end of the insertion portion 3 from the heart X, the bending portion 4 is bent to the left or right side by twisting the insertion portion 3 in the endoscope channel 5a according to the force from the heart X. Lying on the surface of heart X.
　これに対し、本実施形態によれば、湾曲している湾曲部４は、心臓Ｘとの接触によって挿入部３の長手軸Ａ回りの回転力が作用している状態においても、フード６の支持面６ｂ，６ｃによって支持されることで倒れることが防止される。 On the other hand, according to the present embodiment, the curved bending portion 4 supports the hood 6 even in a state where the rotational force around the longitudinal axis A of the insertion portion 3 is acting by contact with the heart X. It is prevented from falling by being supported by the surfaces 6b and 6c.
　具体的には、心臓Ｘから湾曲している湾曲部４に、内視鏡チャネル５ａ内の挿入部３の長手軸Ａ回りの回転力が作用したときに、内視鏡チャネル５ａ内の挿入部３の長手軸Ａ回りの押圧力が湾曲部４からフード６の支持面６ｂ，６ｃに作用する。挿入部３の長手軸Ａから下側に離間した位置で湾曲部４と接触するフード６は、押圧力に抗する断面２次モーメントを発生し、回転力が作用している湾曲部４を倒れないように押さえることができる。また、フード６を介してシース本体５にも長手軸Ａ回りの回転力が伝達されるが、挿入部３よりも高いねじれ剛性を有するシース本体５は、ねじれることなく押圧力に抗する。したがって、押圧力を支持面６ｂ，６ｃにおいて受けるフード６は、シース本体５によって安定的に支持され、長手軸Ａ回りに回転することがない。 Specifically, when a rotational force around the longitudinal axis A of the insertion portion 3 in the endoscope channel 5a acts on the bending portion 4 that is bent from the heart X, the insertion portion in the endoscope channel 5a. 3 is applied to the support surfaces 6 b and 6 c of the hood 6 from the curved portion 4. The hood 6 that comes into contact with the bending portion 4 at a position spaced downward from the longitudinal axis A of the insertion portion 3 generates a second moment of cross section that resists the pressing force, and collapses the bending portion 4 on which the rotational force acts. You can hold it down. Further, the rotational force around the longitudinal axis A is also transmitted to the sheath body 5 through the hood 6, but the sheath body 5 having higher torsional rigidity than the insertion portion 3 resists the pressing force without being twisted. Therefore, the hood 6 that receives the pressing force on the support surfaces 6b and 6c is stably supported by the sheath body 5 and does not rotate around the longitudinal axis A.
　このように、湾曲している湾曲部４の姿勢がフード６によって安定的に維持されることで、心臓Ｘを安定して観察することができるという利点がある。また、内視鏡チャネル５ａをシース本体５の長手軸に対して上側に偏心した位置に設けることで、湾曲部４の側面の、支持面６ｂ，６ｃによって支持される面積が大きくなるので、湾曲部４の倒れをさらに確実に防止することができる。また、心膜Ｙを持ち上げるためのフード６を支持部としても機能させることで、部材の数を増加することなく支持部を設けることができるという利点がある。 Thus, since the posture of the curved portion 4 that is curved is stably maintained by the hood 6, there is an advantage that the heart X can be observed stably. Since the endoscope channel 5a is provided at a position deviated upward with respect to the longitudinal axis of the sheath body 5, the area of the side surface of the bending portion 4 supported by the support surfaces 6b and 6c is increased. The falling of the part 4 can be prevented more reliably. Moreover, there exists an advantage that a support part can be provided, without increasing the number of members by making the hood 6 for lifting the pericardium Y function also as a support part.
　本実施形態においては、内視鏡チャネル５ａが、シース本体５の長手軸に対して偏心した位置に設けられていることとしたが、シース本体５の長手軸と同心に設けられていてもよい。
　このようにしても、内視鏡チャネル５ａが偏心している場合と比べて支持面６ｂ，６ｃと湾曲部４の側面との接触面積が小さくなるが、フード６によって湾曲部４の倒れを防止する効果を発揮することができる。 In the present embodiment, the endoscope channel 5 a is provided at a position that is eccentric with respect to the longitudinal axis of the sheath body 5, but may be provided concentrically with the longitudinal axis of the sheath body 5. .
Even if it does in this way, compared with the case where the endoscope channel 5a is eccentric, the contact area of the support surfaces 6b and 6c and the side surface of the bending portion 4 is reduced, but the hood 6 prevents the bending portion 4 from falling down. The effect can be demonstrated.
　本実施形態においては、内視鏡チャネル５ａの左右両側に支持面６ｂ，６ｃが配置されるように、フード６が、内視鏡チャネル５ａの上側および左右両側に設けられていることとしたが、これに代えて、図４に示されるように、内視鏡チャネル５ａの左側のみまたは右側のみに支持面６ｂまたは６ｃが配置されるように、フード６が、内視鏡チャネル５ａの上側および左右のいずれか一方の側のみに設けられていてもよい。 In the present embodiment, the hood 6 is provided on the upper side and the left and right sides of the endoscope channel 5a so that the support surfaces 6b and 6c are disposed on the left and right sides of the endoscope channel 5a. Alternatively, as shown in FIG. 4, the hood 6 is disposed on the upper side of the endoscope channel 5 a and the support surface 6 b or 6 c is disposed only on the left side or only on the right side of the endoscope channel 5 a. It may be provided only on either the left or right side.
　本実施形態においては、内視鏡用シース１が、図５に示されるように、フード６の先端面からシース本体５の基端部まで長手方向に貫通しガイドワイヤ２０が挿入されるルーメン１ａを有していてもよい。このようにすることで、フード６のみならず、フード６の先端面から突出するガイドワイヤ２０の先端部によっても、心膜を心臓の表面から持ち上げることができる。ガイドワイヤ２０の先端部によって心膜を挿入部３の先端よりも心臓から離れた位置まで確実に持ち上げることができるように、ルーメン１ａは、フード６の先端面において溝６ａの上側に開口していることが好ましい。 In the present embodiment, as shown in FIG. 5, the endoscope sheath 1 penetrates in the longitudinal direction from the distal end surface of the hood 6 to the proximal end portion of the sheath body 5, and the lumen 1 a into which the guide wire 20 is inserted. You may have. In this way, the pericardium can be lifted from the surface of the heart not only by the hood 6 but also by the distal end portion of the guide wire 20 protruding from the distal end surface of the hood 6. The lumen 1a is opened above the groove 6a on the distal end surface of the hood 6 so that the distal end portion of the guide wire 20 can reliably lift the pericardium to a position farther from the heart than the distal end of the insertion portion 3. Preferably it is.
　本実施形態においては、図６に示されるように、内視鏡用シースにワイヤ６２が設けられ、フード６に代えて、ワイヤ６２によって湾曲部４の側面を支持するように構成されていてもよい。
　すなわち、フード６１は、湾曲部４の上側のみを覆うように内視鏡チャネル５ａの上側のみに設けられている。ワイヤ６２はフード６１の先端部からシース本体５内を通ってシース本体５の基端側まで配置され、ワイヤ６２の先端はフード６１の先端部に固定されている。 In the present embodiment, as shown in FIG. 6, a wire 62 may be provided in the endoscope sheath, and the side surface of the bending portion 4 may be supported by the wire 62 instead of the hood 6. Good.
That is, the hood 61 is provided only on the upper side of the endoscope channel 5 a so as to cover only the upper side of the bending portion 4. The wire 62 is disposed from the distal end portion of the hood 61 through the sheath body 5 to the proximal end side of the sheath body 5, and the distal end of the wire 62 is fixed to the distal end portion of the hood 61.
　ワイヤ６２は、ニッケルチタンのような形状記憶合金からなり、ワイヤ６２の先端部は、下側に突出する略半円弧形状を記憶している。ワイヤ６２の先端部は、ワイヤ６２の基端部が牽引されることでフード６１の長手方向に沿って真っ直ぐに延伸し、ワイヤ６２の基端部が押圧されることで円弧状に湾曲して下側に突出するようになっている。この場合にも、内視鏡チャネル５ａ内の挿入部３の長手軸Ａよりも下側においてワイヤ６２が湾曲している湾曲部４の側面を支持するように、ワイヤ６２の先端部の円弧形状が設計される。 The wire 62 is made of a shape memory alloy such as nickel titanium, and the tip portion of the wire 62 stores a substantially semicircular arc shape protruding downward. The distal end portion of the wire 62 extends straight along the longitudinal direction of the hood 61 when the proximal end portion of the wire 62 is pulled, and is curved in an arc shape when the proximal end portion of the wire 62 is pressed. It protrudes downward. Also in this case, the arc shape of the distal end portion of the wire 62 so as to support the side surface of the bending portion 4 where the wire 62 is bent below the longitudinal axis A of the insertion portion 3 in the endoscope channel 5a. Is designed.
　本実施形態においては、図７に示されるように、シース本体５およびフード６に、各種用途のルーメン１ｂが設けられていてもよい。例えば、流体を供給したり吸引したり、処置具を挿入したりするためのルーメン１ｂが設けられていてもよい。図７の例では、２つのルーメン１ｂが設けられているが、ルーメン１ｂの数は、１つのみ、または３つ以上であってもよい。 In the present embodiment, as shown in FIG. 7, the sheath body 5 and the hood 6 may be provided with lumens 1b for various uses. For example, a lumen 1b for supplying or sucking a fluid or inserting a treatment instrument may be provided. In the example of FIG. 7, two lumens 1b are provided, but the number of lumens 1b may be only one, or three or more.
　本実施形態においては、内視鏡用シース１が円管状であることとしたが、内視鏡用シース１は、長尺の他の形状であってもよい。
　例えば、図８に示されるように、フード６３およびシース本体の横断面形状が略扇形である内視鏡用シースを採用してもよい。このような内視鏡用シースによれば、内視鏡用シースを体外と心膜腔内との間で案内するためのアクセスシース３０内の空間を有効に利用して、他の医療用デバイス（例えば、シースや処置具）４０も内視鏡用シースと一緒にアクセスシース３０内に配置することができる。 In the present embodiment, the endoscope sheath 1 has a circular tube shape, but the endoscope sheath 1 may have another long shape.
For example, as shown in FIG. 8, an endoscope sheath in which the cross-sectional shape of the hood 63 and the sheath body is substantially fan-shaped may be employed. According to such an endoscope sheath, other medical devices can be used by effectively utilizing the space in the access sheath 30 for guiding the endoscope sheath between the outside of the body and the pericardial cavity. (For example, a sheath or a treatment instrument) 40 can also be disposed in the access sheath 30 together with the endoscope sheath.
　本実施形態においては、シース本体５の下側と湾曲部４の湾曲可能な方向とが一致するように内視鏡チャネル５ａ内での挿入部３の長手軸Ａ回りの回転を規制する回転規制部が設けられていてもよい。
　回転規制部は、例えば、図９Ａに示されるように、湾曲部４よりも基端側において挿入部３の側面の周方向の一部に設けられ径方向外方に突出する突起７１と、内視鏡チャネル５ａの内面の周方向の一部に設けられ突起７１が嵌合する溝７２とを備える。 In the present embodiment, the rotation restriction that restricts the rotation of the insertion portion 3 around the longitudinal axis A in the endoscope channel 5a so that the lower side of the sheath body 5 and the bendable direction of the bending portion 4 coincide. A part may be provided.
For example, as shown in FIG. 9A, the rotation restricting portion includes a projection 71 provided in a part of the circumferential direction of the side surface of the insertion portion 3 on the proximal side of the bending portion 4 and protruding radially outward. And a groove 72 provided in a part of the inner surface of the endoscope channel 5a in the circumferential direction and into which the protrusion 71 is fitted.
　突起７１および溝７２は、フード６の溝６ａ内に湾曲部４が配置されている状態で互いに嵌合する位置に設けられており、挿入部３および内視鏡チャネル５ａの長手方向の一部のみにそれぞれ設けられていてもよく、全長にわたってそれぞれ設けられていてもよい。図９Ｂに示されるように、突起７１が内視鏡チャネル５ａの内面に設けられ、溝７２が挿入部３の側面に設けられていてもよい。 The protrusion 71 and the groove 72 are provided at positions where the protrusion 4 and the groove 72 are fitted to each other in a state where the curved portion 4 is disposed in the groove 6a of the hood 6, and a part in the longitudinal direction of the insertion portion 3 and the endoscope channel 5a. It may be provided only for each, or may be provided over the entire length. As shown in FIG. 9B, the protrusion 71 may be provided on the inner surface of the endoscope channel 5 a and the groove 72 may be provided on the side surface of the insertion portion 3.
　本変形例によれば、湾曲している湾曲部４に、内視鏡チャネル５ａ内の挿入部３の長手軸Ａ回りの回転力が作用したときに、内視鏡チャネル５ａ内での挿入部３の長手軸Ａ回りのねじれが回転規制部によって防止される。これにより、湾曲している湾曲部４の倒れをさらに確実に防止することができる。 According to this modification, when the rotational force around the longitudinal axis A of the insertion portion 3 in the endoscope channel 5a is applied to the bending portion 4 that is curved, the insertion portion in the endoscope channel 5a. 3 is prevented by the rotation restricting portion. Thereby, the fall of the curved part 4 which is curving can be prevented further reliably.
（第２の実施形態）
　次に、本発明の第２の実施形態に係る内視鏡用シース１０および内視鏡システム１０１について図１０Ａから図１８を参照して説明する。
　本実施形態においては、第１の実施形態と異なる構成について説明し、第１の実施形態と共通する構成については同一の符号を付して説明を省略する。本実施形態は、内視鏡チャネル５ａから突出する湾曲部４１，４２の上側が開放されている点において、第１の実施形態と異なっている。 (Second Embodiment)
Next, an endoscope sheath 10 and an endoscope system 101 according to a second embodiment of the present invention will be described with reference to FIGS. 10A to 18.
In the present embodiment, a configuration different from that of the first embodiment will be described, and a configuration common to the first embodiment will be denoted by the same reference numeral and description thereof will be omitted. This embodiment is different from the first embodiment in that the upper sides of the curved portions 41 and 42 protruding from the endoscope channel 5a are opened.
　本実施形態に係る内視鏡システム１０１は、図１０Ａおよび図１０Ｂに示されるように、内視鏡２１と、内視鏡２１を挿入可能な内視鏡用シース１０とを備えている。
　内視鏡２１は、図１１Ａに示されるように、心膜腔内に挿入可能な軟性かつ長尺の挿入部３１と、挿入部３１の先端部に設けられ挿入部３１の長手軸に交差する方向に湾曲可能な２つの湾曲部４１，４２とを備えている。先端側の第１の湾曲部４１と基端側の第２の湾曲部４２は、図１０Ｂおよび図１１Ａに示されるように、略Ｓ字形状を形成するように、互いに反対方向に湾曲可能である。湾曲部４１，４２の湾曲動作は、挿入部３１の基端に接続された操作部（図示略）の操作によって制御することができるようになっている。 As shown in FIGS. 10A and 10B, the endoscope system 101 according to the present embodiment includes an endoscope 21 and an endoscope sheath 10 into which the endoscope 21 can be inserted.
As shown in FIG. 11A, the endoscope 21 includes a flexible and long insertion portion 31 that can be inserted into the pericardial cavity, and a distal end portion of the insertion portion 31 that intersects the longitudinal axis of the insertion portion 31. Two bending portions 41 and 42 that can be bent in the direction are provided. The first curved portion 41 on the distal end side and the second curved portion 42 on the proximal end side can be curved in opposite directions so as to form a substantially S shape, as shown in FIGS. 10B and 11A. is there. The bending operations of the bending portions 41 and 42 can be controlled by operating an operation unit (not shown) connected to the proximal end of the insertion unit 31.
　内視鏡用シース１０は、シース本体５と、シース本体５の先端から該シース本体５の長手軸に沿う方向に突出する２つの突出部８とを備えている。
　突出部８は、シース本体５の先端面から長手方向に沿って延びる半円柱状の部材であり、径方向外側に湾曲面を有し径方向内側に平坦な支持面８ａを有している。２つ突出部８は、内視鏡チャネル５ａの先端開口から突出した湾曲部４１，４２の左右両側を覆うように、内視鏡チャネル５ａの左右両側に設けられている。２つの突出部８の間で第２の湾曲部４２を上側に湾曲させるとともに第１の湾曲部４１を下側に湾曲させることで、突出部８よりも上側に突出する第１の湾曲部４１によって心膜を心臓の表面から離れた位置まで持ち上げるとともに挿入部３１の先端を下側に向けて心臓を観察することができる。 The endoscope sheath 10 includes a sheath body 5 and two projecting portions 8 that project from the distal end of the sheath body 5 in a direction along the longitudinal axis of the sheath body 5.
The protrusion 8 is a semi-cylindrical member extending along the longitudinal direction from the distal end surface of the sheath body 5, and has a curved support surface 8 a on the radial outer side and a flat support surface 8 a on the radial inner side. The two protruding portions 8 are provided on both the left and right sides of the endoscope channel 5a so as to cover both the left and right sides of the curved portions 41 and 42 protruding from the distal end opening of the endoscope channel 5a. The first bending portion 41 protruding above the protruding portion 8 by bending the second bending portion 42 upward between the two protruding portions 8 and bending the first bending portion 41 downward. As a result, the pericardium can be lifted to a position away from the surface of the heart, and the heart can be observed with the distal end of the insertion portion 31 facing downward.
　各突出部８の支持面８ａは、上下方向に平行であり、上下方向に略平行な平面内で略Ｓ字状に湾曲している湾曲部４１，４２の側面を内視鏡チャネル５ａ内の挿入部３１の長手軸Ａよりも上側において支持するようになっている。図１１Ａおよび図１１Ｂにおいて、太い実線で示される位置が、支持面８ａによって湾曲部４１，４２が支持される位置を示している。したがって、支持面８ａは、少なくとも、内視鏡チャネル５ａの長手軸よりも上側に設けられ、好ましくは、内視鏡チャネル５ａの長手軸よりも上側および下側の両方に設けられている。 The support surface 8a of each protrusion 8 is parallel to the vertical direction, and the side surfaces of the curved portions 41 and 42 that are curved in a substantially S shape in a plane substantially parallel to the vertical direction are provided in the endoscope channel 5a. The insertion portion 31 is supported above the longitudinal axis A. In FIG. 11A and FIG. 11B, the position shown by a thick solid line has shown the position where the curved parts 41 and 42 are supported by the support surface 8a. Therefore, the support surface 8a is provided at least above the longitudinal axis of the endoscope channel 5a, and preferably provided both above and below the longitudinal axis of the endoscope channel 5a.
　次に、このように構成された内視鏡システム１０１の作用について、図１２を参照して説明する。
　本実施形態に係る内視鏡システム１０１を使用して心臓Ｘを観察するためには、第１の実施形態と同様にして、上側に心膜Ｙが位置し、下側に心臓Ｘが位置するように、シース本体５を心膜腔内に配置する。次に、湾曲部４１，４２を２つの突出部８の間に配置し、第２の湾曲部４２を心膜Ｙ側に湾曲させるとともに第１の湾曲部４１を心臓Ｘ側に湾曲させる。これにより、図１２に示されるように、突出部８から心膜Ｙ側に突出する第１の湾曲部４１によって心膜Ｙが心臓Ｘから離間する方向に持ち上げられるとともに、挿入部３１の先端が心臓Ｘに向けられることで、心臓Ｘを観察することができる。 Next, the operation of the endoscope system 101 configured as described above will be described with reference to FIG.
In order to observe the heart X using the endoscope system 101 according to the present embodiment, the pericardium Y is located on the upper side and the heart X is located on the lower side, as in the first embodiment. Thus, the sheath body 5 is placed in the pericardial cavity. Next, the bending portions 41 and 42 are disposed between the two protruding portions 8, the second bending portion 42 is bent toward the pericardium Y side, and the first bending portion 41 is bent toward the heart X side. Accordingly, as shown in FIG. 12, the pericardium Y is lifted away from the heart X by the first curved portion 41 protruding from the protruding portion 8 toward the pericardium Y side, and the distal end of the insertion portion 31 is By being directed to the heart X, the heart X can be observed.
　心臓Ｘの観察中に、心膜Ｙと接触している第１の湾曲部４１には、略Ｓ字状に湾曲している湾曲部４１，４２を内視鏡チャネル５ａ内の挿入部３１の長手軸Ａ回りに回転させる方向の力が、心膜Ｙから作用する。そして、内視鏡チャネル５ａ内の挿入部３１の長手軸Ａ回りの押圧力が湾曲部４１，４２から支持面８ａに作用する。本実施形態によれば、挿入部３１の長手軸Ａから上側に離間した位置で湾曲部４１，４２と接触する支持面８ａは、押圧力に抗する断面２次モーメントを発生し、回転力が作用している湾曲部４１，４２を倒れないように押さえることができる。 During the observation of the heart X, the first bending portion 41 that is in contact with the pericardium Y is provided with bending portions 41 and 42 that are curved in a substantially S shape in the insertion portion 31 in the endoscope channel 5a. A force in the direction of rotation about the longitudinal axis A acts from the pericardium Y. Then, the pressing force around the longitudinal axis A of the insertion portion 31 in the endoscope channel 5a acts on the support surface 8a from the curved portions 41 and 42. According to the present embodiment, the support surface 8a that is in contact with the curved portions 41 and 42 at a position spaced upward from the longitudinal axis A of the insertion portion 31 generates a cross-sectional secondary moment against the pressing force, and the rotational force is increased. The acting curved portions 41 and 42 can be pressed so as not to fall down.
　このように、本実施形態によれば、湾曲している湾曲部４１，４２が心膜Ｙとの接触によって倒れてしまうことが支持面８ａによって防止され、湾曲している湾曲部４１，４２の姿勢が支持面８ａによって安定的に維持される。これにより、心臓Ｘを安定して観察することができるという利点がある。
　本実施形態においても、第１の実施形態において説明した回転規制部７１，７２を設けてもよい。 As described above, according to the present embodiment, the curved curved portions 41 and 42 are prevented from falling by the contact with the pericardium Y by the support surface 8a, and the curved curved portions 41 and 42 are prevented from falling. The posture is stably maintained by the support surface 8a. Thereby, there exists an advantage that the heart X can be observed stably.
Also in the present embodiment, the rotation restricting portions 71 and 72 described in the first embodiment may be provided.
　本実施形態においては、内視鏡用シース１０が、突出部８の先端に開口しワイヤが挿入されるルーメンを有していてもよい。
　このようにすることで、突出部８の先端から長手方向に突出するワイヤによって心膜を持ち上げることで、突出部８の先端前方に空間を確保することができる。 In the present embodiment, the endoscope sheath 10 may have a lumen that opens at the tip of the protruding portion 8 and into which a wire is inserted.
By doing in this way, a space can be secured in front of the tip of the protrusion 8 by lifting the pericardium with the wire protruding in the longitudinal direction from the tip of the protrusion 8.
　本実施形態においては、内視鏡チャネル５ａの左右両側に支持面８ａが配置されることとしたが、これに代えて、図１３に示されるように、内視鏡チャネル５ａの左側のみまたは右側のみに支持面８ａが配置されていてもよい。
　このようにしても、湾曲部４１，４２の左右いずれか一方の側への倒れを防止することができる。 In the present embodiment, the support surfaces 8a are arranged on both the left and right sides of the endoscope channel 5a, but instead, as shown in FIG. 13, only the left side or the right side of the endoscope channel 5a. Only the support surface 8a may be arrange | positioned.
Even in this case, it is possible to prevent the bending portions 41 and 42 from falling to the left or right side.
　本実施形態においては、互いに反対方向に湾曲可能な２つの湾曲部４１，４２を備える内視鏡２１を用いることとしたが、これに代えて、第１の実施形態と同様に、単一の湾曲部４を備える内視鏡２を用いてもよい。
　この場合には、支持面８ａは、内視鏡チャネル５ａの長手軸よりも下側に少なくとも設けられ、下側に湾曲している湾曲部４の側面を、内視鏡チャネル５ａ内の挿入部３１の長手軸Ａよりも下側において支持するように構成される。 In the present embodiment, the endoscope 21 including the two bending portions 41 and 42 that can be bent in opposite directions is used, but instead of this, a single unit is used as in the first embodiment. An endoscope 2 including a bending portion 4 may be used.
In this case, the support surface 8a is provided at least on the lower side of the longitudinal axis of the endoscope channel 5a, and the side surface of the curved portion 4 curved downward is inserted into the insertion portion in the endoscope channel 5a. It is comprised so that it may support below the longitudinal axis A of 31. FIG.
　本実施形態においては、突出部８がシース本体５と一体に形成されていることとしたが、これに代えて、図１４に示されるように、突出部８１がシース本体５とは別体であり、シース本体５の先端から突没可能に設けられていてもよい。
　例えば、突出部８１が、挿入部３１の側面と内視鏡チャネル５ａの内面との間の円筒状の空間に配置され、内視鏡チャネル５ａ内に収納された位置とシース本体５の先端面から突出した位置との間で長手方向に移動可能に設けられていてもよい。
　このようにすることで、突出部８１が不要であるときには突出部８１をシース本体５内に引っ込めることができる。また、シース本体５として汎用の内視鏡用シースを使用することができる。 In the present embodiment, the protruding portion 8 is formed integrally with the sheath body 5, but instead, the protruding portion 81 is separate from the sheath body 5 as shown in FIG. There may be provided so as to be able to project and retract from the tip of the sheath body 5.
For example, the protrusion 81 is disposed in a cylindrical space between the side surface of the insertion portion 31 and the inner surface of the endoscope channel 5a, and the position housed in the endoscope channel 5a and the distal end surface of the sheath body 5 It may be provided so as to be movable in the longitudinal direction between the position protruding from the position.
By doing in this way, when the protrusion 81 is unnecessary, the protrusion 81 can be retracted into the sheath body 5. A general-purpose endoscope sheath can be used as the sheath body 5.
　突出部８１は、シース本体５の長手方向に沿って延びる直線状であってもよいが、図１５に示されるように、下側に湾曲していてもよい。図１５の突出部８２は、外力が作用していない自由状態において円弧状の湾曲形状を有し、その弾性によって直線形状に変形可能である。 The protruding portion 81 may have a linear shape extending along the longitudinal direction of the sheath body 5, but may be curved downward as shown in FIG. 15 has an arcuate curved shape in a free state where no external force is applied, and can be deformed into a linear shape by its elasticity.
　本実施形態においては、可撓性を有する突出部８３が、湾曲部４と一体的に直線形状と湾曲形状との間で変形するように構成されていてもよい。
　例えば、図１６に示されるように、突出部８３は、先端部と基端部の２箇所においてリベットのような連結具８３ａによって湾曲部４の側面に連結され、湾曲部４の湾曲に追従して湾曲するように構成されていてもよい。 In the present embodiment, the projecting portion 83 having flexibility may be configured to be deformed between the linear shape and the curved shape integrally with the curved portion 4.
For example, as shown in FIG. 16, the projecting portion 83 is connected to the side surface of the bending portion 4 by a connecting tool 83 a such as a rivet at two positions of the distal end portion and the proximal end portion, and follows the bending of the bending portion 4. And may be configured to be bent.
　本実施形態においては、支持部８ａが、柱状の突出部８の平坦な側面から構成されていることとしたが、これに代えて、図１７に示されるように、支持部が、湾曲部４に比べて細径のワイヤ８４から構成されていてもよい。支持部を細径のワイヤ８４から構成することで、シース本体５の細径化を図ることができる。 In the present embodiment, the support portion 8a is configured from the flat side surface of the columnar protrusion 8. However, instead of this, as shown in FIG. Compared to the wire 84, the wire 84 may have a smaller diameter. By configuring the support portion from the thin wire 84, the sheath body 5 can be reduced in diameter.
　図１７のワイヤ８４は、シース本体５の先端面から突出し上下方向に略平行な平面内でループを形成している。シース本体５の先端面から離間する程、ワイヤ８４がシース本体５の下側へ突出するように、ワイヤ８４のループ形状の径は、シース本体５の先端面から離間するにつれて大きくなっている。これにより、内視鏡チャネル５ａの先端開口から突出し下側に湾曲する湾曲部４の側面を、内視鏡チャネル５ａ内の挿入部３１の長手軸Ａよりも下側においてワイヤ８４によって支持することができる。 The wire 84 in FIG. 17 protrudes from the distal end surface of the sheath body 5 and forms a loop in a plane substantially parallel to the vertical direction. As the distance from the distal end surface of the sheath body 5 increases, the diameter of the loop shape of the wire 84 increases as the distance from the distal end surface of the sheath body 5 increases. Thereby, the side surface of the curved portion 4 that protrudes from the distal end opening of the endoscope channel 5a and curves downward is supported by the wire 84 below the longitudinal axis A of the insertion portion 31 in the endoscope channel 5a. Can do.
　ワイヤ８４は、シース本体５の先端面に固定されていてもよいが、シース本体５に対して移動可能に設けられていてもよい。例えば、ワイヤ８４が、シース本体５の側壁に形成された孔内を通ってシース本体５の基端側へ延び、シース本体５の基端側に配置されたワイヤ８４の両端を押し引きすることで、シース本体５の先端面からのワイヤ８４の突出量を調整可能になっていてもよい。
　このようにすることで、支持部が不要であるときにはワイヤ８４をシース本体５内に引っ込めることができる。 The wire 84 may be fixed to the distal end surface of the sheath body 5, but may be provided so as to be movable with respect to the sheath body 5. For example, the wire 84 extends through the hole formed in the side wall of the sheath body 5 to the proximal end side of the sheath body 5, and pushes and pulls both ends of the wire 84 arranged on the proximal end side of the sheath body 5. Thus, the protruding amount of the wire 84 from the distal end surface of the sheath body 5 may be adjustable.
By doing so, the wire 84 can be retracted into the sheath body 5 when the support portion is unnecessary.
　ワイヤ８４に代えて、図１８に示されるように、直線状の汎用のガイドワイヤ８５を使用してもよい。この場合、シース本体５には、内視鏡チャネル５ａの左右両側または片側において、長手軸方向に貫通しガイドワイヤ８５が長手方向に移動可能に挿入されるワイヤチャネル５ｂが形成される。ワイヤチャネル５ｂの先端部は、シース本体５の先端に向かって下側に傾斜している。これにより、ワイヤチャネル５ｂから突出するガイドワイヤ８５の先端部が、内視鏡チャネル５ａ内の挿入部３１の長手軸Ａよりも下側において、湾曲している湾曲部４の側面を支持するようになっている。このように、ワイヤチャネル５ｂから突出したガイドワイヤ８５の先端部を支持部として機能させることができる。 Instead of the wire 84, a linear general-purpose guide wire 85 may be used as shown in FIG. In this case, the sheath body 5 is formed with a wire channel 5b that penetrates in the longitudinal axis direction and is inserted so that the guide wire 85 is movable in the longitudinal direction on both the left and right sides or one side of the endoscope channel 5a. The distal end portion of the wire channel 5 b is inclined downward toward the distal end of the sheath body 5. Accordingly, the distal end portion of the guide wire 85 protruding from the wire channel 5b supports the side surface of the curved portion 4 that is curved below the longitudinal axis A of the insertion portion 31 in the endoscope channel 5a. It has become. In this manner, the distal end portion of the guide wire 85 protruding from the wire channel 5b can function as a support portion.
（第３の実施形態）
　次に、本発明の第３の実施形態に係る内視鏡用シースおよび内視鏡システム１０２について図１９Ａから図２１Ｂを参照して説明する。
　本実施形態においては、第１および第２の実施形態と異なる構成について説明し、第１および第２の実施形態と共通する構成については同一の符号を付して説明を省略する。本実施形態は、湾曲部を備えない内視鏡２２を用いる点において、第１および第２の実施形態と異なっている。 (Third embodiment)
Next, an endoscope sheath and endoscope system 102 according to a third embodiment of the present invention will be described with reference to FIGS. 19A to 21B.
In the present embodiment, configurations different from those in the first and second embodiments will be described, and configurations common to the first and second embodiments will be denoted by the same reference numerals and description thereof will be omitted. The present embodiment is different from the first and second embodiments in that an endoscope 22 that does not include a bending portion is used.
　本実施形態に係る内視鏡システム１０２は、図１９Ａおよび図１９Ｂに示されるように、内視鏡２２と、内視鏡用シース１と、内視鏡用シース１の内視鏡チャネル５ａ内に挿入される内シース９とを備えている。
　内視鏡２２は、心膜腔内に挿入可能な軟性かつ長尺の挿入部３２を備え、湾曲部を備えていない。
　図１９Ａおよび図１９Ｂには、内視鏡用シース１が示されているが、本実施形態においては、第１および第２の実施形態において説明した、左右両側に支持部を有する任意の内視鏡用シースを採用することができる。 As shown in FIGS. 19A and 19B, the endoscope system 102 according to the present embodiment includes an endoscope 22, an endoscope sheath 1, and an endoscope channel 5 a of the endoscope sheath 1. And an inner sheath 9 to be inserted into the inner sheath 9.
The endoscope 22 includes a flexible and long insertion portion 32 that can be inserted into the pericardial cavity, and does not include a bending portion.
19A and 19B show the endoscope sheath 1, but in this embodiment, any endoscope having support portions on the left and right sides described in the first and second embodiments. A mirror sheath can be employed.
　内シース９は、長手軸に沿う方向に貫通し内視鏡２２が挿入されるルーメンを有する長尺の円管状である。内シース９は、内視鏡チャネル５ａの内径よりも小さい外径を有し、内視鏡チャネル５ａ内で内シース９が長手方向に移動可能である。内シース９のルーメンは、挿入部３２の外径よりも大きな内径を有し、ルーメン内で挿入部３２が長手方向に移動可能である。 The inner sheath 9 is a long circular tube having a lumen that penetrates in the direction along the longitudinal axis and into which the endoscope 22 is inserted. The inner sheath 9 has an outer diameter smaller than the inner diameter of the endoscope channel 5a, and the inner sheath 9 is movable in the longitudinal direction within the endoscope channel 5a. The lumen of the inner sheath 9 has an inner diameter larger than the outer diameter of the insertion portion 32, and the insertion portion 32 can move in the longitudinal direction within the lumen.
　内シース９の先端部９ａは、外力が作用していない自由状態において長手軸に交差する方向に湾曲しており、その弾性によって長手軸に沿って延びる直線形状に変形可能である。また、内シース９は、シース本体５よりも低い剛性を有し、挿入部３２よりも高い剛性を有している。したがって、内視鏡チャネル５ａ内で内シース９を長手軸回りに回転させることで、内視鏡チャネル５ａから突出する内シースの先端部９ａの、湾曲形状と直線形状との間の変形を制御することができ、これにより、挿入部３２の先端部３２ａの湾曲を制御することができる。 The distal end portion 9a of the inner sheath 9 is curved in a direction intersecting the longitudinal axis in a free state where no external force is acting, and can be deformed into a linear shape extending along the longitudinal axis by its elasticity. Further, the inner sheath 9 has lower rigidity than the sheath body 5 and higher rigidity than the insertion portion 32. Therefore, by rotating the inner sheath 9 around the longitudinal axis in the endoscope channel 5a, the deformation between the curved shape and the linear shape of the distal end portion 9a of the inner sheath protruding from the endoscope channel 5a is controlled. Accordingly, the bending of the distal end portion 32a of the insertion portion 32 can be controlled.
　具体的には、図１９Ｂに示されるように、内シース９を長手軸回りに回転させて先端部９ａの湾曲する側を下側に配置することで先端部９ａが湾曲する。一方、図１９Ａに示されるように、先端部９ａの湾曲する側をフード６が存在する上、左または右側に配置することで先端部９ａが直線状に延びる。このときに、内シース９の先端部９ａに配置された挿入部３２の先端部３２ａも、内シース９の先端部９ａの変形に従って、湾曲形状と直線形状との間で変形する。 Specifically, as shown in FIG. 19B, the distal end portion 9a is curved by rotating the inner sheath 9 about the longitudinal axis and arranging the curved side of the distal end portion 9a on the lower side. On the other hand, as shown in FIG. 19A, the distal end portion 9a extends linearly by arranging the curved side of the distal end portion 9a on the left or right side while the hood 6 is present. At this time, the distal end portion 32 a of the insertion portion 32 disposed at the distal end portion 9 a of the inner sheath 9 is also deformed between a curved shape and a linear shape according to the deformation of the distal end portion 9 a of the inner sheath 9.
　このように、挿入部３２の先端部３２ａの湾曲の制御に内シース９を利用することで、挿入部３２の先端部３２ａを湾曲させるための機構（例えば、ワイヤや駒）が不要となる。これにより、湾曲部４，４１，４２を有する挿入部３，３１と比べて、挿入部３２を細径化することができるという利点がある。 Thus, by using the inner sheath 9 to control the bending of the distal end portion 32a of the insertion portion 32, a mechanism (for example, a wire or a piece) for bending the distal end portion 32a of the insertion portion 32 becomes unnecessary. Thereby, compared with the insertion parts 3 and 31 which have the curved parts 4, 41 and 42, there exists an advantage that the diameter of the insertion part 32 can be reduced.
　本実施形態においては、内シース９の湾曲した先端部９ａによって挿入部３２の先端部３２ａの湾曲を制御することとしたが、これに代えて、図２０に示されるように、挿入部３２の先端部３２ａが、自由状態において長手軸に交差する方向に湾曲しており、その弾性によって長手軸に沿って延びる直線形状に変形可能であってもよい。 In the present embodiment, the bending of the distal end portion 32a of the insertion portion 32 is controlled by the curved distal end portion 9a of the inner sheath 9, but instead of this, as shown in FIG. The distal end portion 32a may be curved in a direction intersecting the longitudinal axis in a free state and deformable into a linear shape extending along the longitudinal axis by its elasticity.
　挿入部３２の先端部３２ａは、内視鏡チャネル５ａ内では直線状であり、内視鏡チャネル５ａから突出するにつれて徐々に湾曲する。この場合においても、内視鏡チャネル５ａ内で挿入部３２を長手軸回りに回転させることで、内視鏡チャネル５ａから突出する挿入部３２の先端部３２ａの、湾曲形状と直線形状との間の変形を制御することができる。具体的には、挿入部３２を長手軸回りに回転させて先端部３ａの湾曲する側を下側に配置することで先端部３ａを湾曲させ、先端部３ａの湾曲する側をフード６が存在する上、左または右側に配置することで先端部３ａを直線状に延伸させることができる。 The distal end portion 32a of the insertion portion 32 is linear in the endoscope channel 5a and gradually curves as it protrudes from the endoscope channel 5a. Even in this case, by rotating the insertion portion 32 around the longitudinal axis in the endoscope channel 5a, the distal end portion 32a of the insertion portion 32 protruding from the endoscope channel 5a is between the curved shape and the linear shape. Can be controlled. Specifically, the distal end portion 3a is curved by rotating the insertion portion 32 around the longitudinal axis so that the curved side of the distal end portion 3a is located on the lower side, and the hood 6 is present on the curved side of the distal end portion 3a. In addition, the tip 3a can be linearly extended by being arranged on the left or right side.
　本実施形態においては、図２１Ａおよび図２１Ｂに示されるように、挿入部３２の先端部３２ａが、挿入部３２の長手軸に交差する軸１１回りに揺動可能に支持部、例えば突出部８の支持面８ａに支持されていてもよい。このような挿入部３２によれば、挿入部３２の基端部が押圧されることで、シース本体５の先端面と軸１１との間で挿入部３２が湾曲する。また、このときに軸１１回りに挿入部３２の先端が揺動することで、挿入部３２の先端が下側に向けられる。 In the present embodiment, as shown in FIGS. 21A and 21B, the distal end portion 32 a of the insertion portion 32 can swing around the axis 11 intersecting the longitudinal axis of the insertion portion 32, for example, the protrusion 8. The support surface 8a may be supported. According to such an insertion portion 32, the insertion portion 32 is bent between the distal end surface of the sheath body 5 and the shaft 11 by pressing the proximal end portion of the insertion portion 32. At this time, the distal end of the insertion portion 32 swings around the shaft 11 so that the distal end of the insertion portion 32 is directed downward.
　湾曲形状を有する内シース９または挿入部３２は、湾曲形状と直線形状との間の弾性変形を繰り返すことで内シース９または挿入部３２の湾曲形状が経時的に変化する、例えば曲率が小さくなる可能性がある。これに対し、本変形例によれば、挿入部３２の押し込み量に応じた角度だけ確実に挿入部３２の先端部３２ａを湾曲させることができる。 The inner sheath 9 or the insertion portion 32 having a curved shape changes with time in the curved shape of the inner sheath 9 or the insertion portion 32 by repeating elastic deformation between the curved shape and the linear shape, for example, the curvature becomes small. there is a possibility. On the other hand, according to the present modification, the distal end portion 32a of the insertion portion 32 can be reliably bent by an angle corresponding to the pushing amount of the insertion portion 32.
　本変形例においては、挿入部３２が必ずしも上側に突出するように湾曲するとは限らず、挿入部３２が下側に突出するように湾曲して挿入部３２の先端が上側に向けられる可能性もある。したがって、上側に突出するように挿入部３２を湾曲させるために、挿入部３２の湾曲方向を規制する部材が設けられていてもよい。例えば、内視鏡チャネル５ａと軸との間において内視鏡チャネル５ａよりも下側に、挿入部３２の下側への突出を阻止する部材が設けられていてもよい。 In this modification, the insertion portion 32 is not necessarily curved so as to protrude upward, and the insertion portion 32 may be curved so as to protrude downward and the tip of the insertion portion 32 may be directed upward. is there. Therefore, in order to curve the insertion portion 32 so as to protrude upward, a member for regulating the bending direction of the insertion portion 32 may be provided. For example, a member that prevents the insertion portion 32 from protruding downward may be provided below the endoscope channel 5a between the endoscope channel 5a and the shaft.
１００，１０１，１０２　内視鏡システム
１，１０　内視鏡用シース
１ａ，１ｂ　ルーメン
２，２１，２２　内視鏡
３，３１，３２　挿入部
４，４１，４２　湾曲部
５　シース本体
５ａ　内視鏡チャネル
５ｂ　ワイヤチャネル
６　フード（支持部）
６ａ　溝
６ｂ，６ｃ　支持面
６１，６３　フード
６２　ワイヤ（支持部）
７１　突起（回転規制部）
７２　溝（回転規制部）
８，８１，８２，８３　突出部
８ａ　支持面（支持部）
８４　ワイヤ（支持部）
８５　ガイドワイヤ
９　内シース
９ａ　先端部 DESCRIPTION OF SYMBOLS 100,101,102 Endoscopy system 1,10 Endoscope sheath 1a, 1b Lumen 2, 21, 22 Endoscope 3, 31, 32 Insertion part 4, 41, 42 Bending part 5 Sheath body 5a Endoscope Channel 5b Wire channel 6 Hood (support)
6a Groove 6b, 6c Support surface 61, 63 Hood 62 Wire (support part)
71 Protrusion (rotation restricting part)
72 groove (rotation restricting part)
8, 81, 82, 83 Protruding portion 8a Support surface (support portion)
84 wire (support)
85 Guide wire 9 Inner sheath 9a Tip

Claims (11)

  1. 　長手軸に沿う方向に貫通し内視鏡が挿入される内視鏡チャネルを有する管状のシース本体と、
    　前記シース本体の第１の径方向において前記内視鏡チャネルよりも外側に設けられ前記シース本体の先端から前記長手軸に沿う方向に突出し、前記内視鏡チャネルから突出し前記第１の径方向と直交する第２の径方向に略平行な平面内で湾曲している前記内視鏡の先端部の側面を支持する支持部とを備え、
    　該支持部が、前記湾曲している先端部の、前記内視鏡チャネル内における前記内視鏡の長手軸回りの回転を規制する内視鏡用シース。     A tubular sheath body having an endoscope channel that penetrates in a direction along the longitudinal axis and into which the endoscope is inserted;
    The sheath body is provided outside the endoscope channel in the first radial direction, protrudes from the distal end of the sheath body in a direction along the longitudinal axis, protrudes from the endoscope channel, and extends in the first radial direction. A support portion that supports a side surface of the distal end portion of the endoscope that is curved in a plane substantially parallel to a second radial direction perpendicular to the orthogonal direction,
    An endoscope sheath, wherein the support portion regulates rotation of the curved distal end portion around the longitudinal axis of the endoscope in the endoscope channel.
  2. 　前記支持部が、前記第２の径方向と平行な面内に配置されている請求項１に記載の内視鏡用シース。 The endoscope sheath according to claim 1, wherein the support portion is disposed in a plane parallel to the second radial direction.
  3. 　前記支持部が、前記第１の径方向において前記内視鏡チャネルの両側に設けられている請求項１または請求項２に記載の内視鏡用シース。 The endoscope sheath according to claim 1 or 2, wherein the support portions are provided on both sides of the endoscope channel in the first radial direction.
  4. 　前記支持部が、前記第２の径方向において前記内視鏡チャネルの長手軸よりも外側に設けられている請求項１から請求項３のいずれかに記載の内視鏡用シース。 The endoscope sheath according to any one of claims 1 to 3, wherein the support portion is provided outside the longitudinal axis of the endoscope channel in the second radial direction.
  5. 　前記支持部が、前記第２の径方向に湾曲するとともに前記長手軸に沿う方向に延びる直線形状に弾性変形可能であり、前記シース本体の先端から突没可能に前記シース本体内に設けられている請求項４に記載の内視鏡用シース。 The support portion is elastically deformable into a linear shape that is curved in the second radial direction and extends in a direction along the longitudinal axis, and is provided in the sheath main body so as to protrude and retract from the distal end of the sheath main body. The endoscope sheath according to claim 4.
  6. 　一方向に湾曲する先端部を有するワイヤを備え、
    　前記支持部が、前記ワイヤの前記先端部からなり、
    　前記シース本体が、前記長手軸に沿う方向に貫通し前記ワイヤが長手方向に移動可能に挿入されるワイヤチャネルを有する請求項５に記載の内視鏡用シース。     Comprising a wire having a tip curved in one direction;
    The support portion is composed of the tip portion of the wire,
    The sheath for endoscope according to claim 5, wherein the sheath main body has a wire channel that penetrates in a direction along the longitudinal axis and into which the wire is movably inserted in the longitudinal direction.
  7. 　ワイヤを備え、
    　前記シース本体は、前記長手軸に沿う方向に貫通し前記ワイヤが長手方向に移動可能に挿入されるワイヤチャネルを有し、
    　該ワイヤチャネルの先端部が、前記シース本体の先端に向かって前記第２の径方向外側に傾斜する請求項５に記載の内視鏡用シース。     With wires,
    The sheath body has a wire channel that penetrates in a direction along the longitudinal axis and is inserted so that the wire is movable in the longitudinal direction;
    The endoscope sheath according to claim 5, wherein a distal end portion of the wire channel is inclined outward in the second radial direction toward a distal end of the sheath body.
  8. 　前記第２の径方向において前記内視鏡チャネルよりも外側に設けられ前記シース本体の先端から前記長手軸に沿う方向に突出するフードを備え、
    　前記支持部が、前記フードと一体的に形成されている請求項１から請求項４のいずれかに記載の内視鏡用シース。     A hood that is provided outside the endoscope channel in the second radial direction and protrudes in a direction along the longitudinal axis from the distal end of the sheath body;
    The sheath for endoscope according to any one of claims 1 to 4, wherein the support portion is formed integrally with the hood.
  9. 　長手軸に交差する方向に湾曲した湾曲形状と前記長手軸に沿って延びる直線形状との間で変形可能な先端部を有する内視鏡と、
    　請求項１から請求項８のいずれかに記載の内視鏡用シースとを備える内視鏡システム。     An endoscope having a distal end portion deformable between a curved shape curved in a direction intersecting the longitudinal axis and a linear shape extending along the longitudinal axis;
    An endoscope system comprising the endoscope sheath according to any one of claims 1 to 8.
  10. 　前記内視鏡が、前記シース本体よりも低い剛性を有し、
    　前記内視鏡の前記先端部が、自由状態において前記湾曲形状を有するとともに前記直線形状に弾性変形可能である請求項９に記載の内視鏡システム。     The endoscope has lower rigidity than the sheath body;
    The endoscope system according to claim 9, wherein the distal end portion of the endoscope has the curved shape in a free state and is elastically deformable to the linear shape.
  11. 　前記内視鏡チャネル内における前記内視鏡の長手軸回りの回転を規制する回転規制部を備える請求項９または請求項１０に記載の内視鏡システム。 The endoscope system according to claim 9 or 10, further comprising a rotation restricting portion that restricts rotation of the endoscope around a longitudinal axis in the endoscope channel.
PCT/JP2017/022372 2017-06-16 2017-06-16 Endoscope sheath and endoscope system WO2018229982A1 (en)

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Cited By (2)

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WO2020179044A1 (en) * 2019-03-07 2020-09-10 オリンパス株式会社 Medical device
CN114151193A (en) * 2021-12-16 2022-03-08 中国船舶重工集团公司第七一一研究所 Probe installation assembly, system and endoscopic visualization system of engine

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JP2010284503A (en) * 2009-03-02 2010-12-24 Olympus Corp Endoscope
JP2011010810A (en) * 2009-07-01 2011-01-20 Mikihito Kuroda Endoscope apparatus
JP2014121470A (en) * 2012-12-21 2014-07-03 Olympus Corp Endoscope system
WO2016203606A1 (en) * 2015-06-18 2016-12-22 オリンパス株式会社 Pericardial endoscope system

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JP2010284503A (en) * 2009-03-02 2010-12-24 Olympus Corp Endoscope
JP2011010810A (en) * 2009-07-01 2011-01-20 Mikihito Kuroda Endoscope apparatus
JP2014121470A (en) * 2012-12-21 2014-07-03 Olympus Corp Endoscope system
WO2016203606A1 (en) * 2015-06-18 2016-12-22 オリンパス株式会社 Pericardial endoscope system

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WO2020179044A1 (en) * 2019-03-07 2020-09-10 オリンパス株式会社 Medical device
CN114151193A (en) * 2021-12-16 2022-03-08 中国船舶重工集团公司第七一一研究所 Probe installation assembly, system and endoscopic visualization system of engine

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