WO2021176570A1 - Endoscope system and method for operating endoscope - Google Patents

Abstract

Provided are an endoscope system having excellent insertability and therapeutic properties, and a method for operating an endoscope. This endoscope system comprises an endoscope body including: an image-capturing unit; a bending member having a bending portion on the distal-end side; and a channel through which the bending member can be inserted and withdrawn.

Description

Translated fromJapanese

内視鏡システム、および内視鏡の操作方法Endoscope system and how to operate the endoscope

　本発明は、内視鏡システム、および内視鏡の操作方法に関する。The present invention relates to an endoscope system and a method of operating an endoscope.

　従来、内視鏡は、挿入部を患者等の被検体内に挿入することによって、撮像装置による被検体内の画像データの取得や、処置具等による治療を行っている。内視鏡の挿入部の湾曲部には、複数の湾曲駒等を連結して構成され、湾曲駒の内面に配置したワイヤの操作により湾曲可能とした湾曲管が設けられ、湾曲管を湾曲することで視野の変更や、被検体の湾曲形状に応じた挿入を可能としている。Conventionally, an endoscope inserts an insertion part into a subject such as a patient to acquire image data in the subject by an imaging device and to perform treatment with a treatment tool or the like. The curved portion of the insertion portion of the endoscope is configured by connecting a plurality of curved pieces and the like, and a curved tube that can be bent by operating a wire arranged on the inner surface of the curved piece is provided to bend the curved tube. It is possible to change the field of view and insert it according to the curved shape of the subject.

　内視鏡は、湾曲部の湾曲径が異なるものを使用用途に応じて使い分けされており、例えば、大きな屈曲部を有する大腸等の挿入には湾曲径が大きいものが好ましく、病変の治療には湾曲径の小さい内視鏡が好ましく使用される。湾曲径が異なる内視鏡を使用する場合、内視鏡を観察部位まで挿入した後、体内から内視鏡を引き抜き、治療に好ましい湾曲径の内視鏡を再度挿入して治療を行っている（例えば、特許文献１参照）。Endoscopes with different curved diameters are used according to the intended use. For example, an endoscope having a large curved diameter is preferable for inserting a large intestine or the like having a large curved portion, and for treating lesions. An endoscope with a small bending diameter is preferably used. When using endoscopes with different curvature diameters, after inserting the endoscope to the observation site, the endoscope is pulled out from the body, and the endoscope with a curvature diameter preferable for treatment is reinserted for treatment. (See, for example, Patent Document 1).

　また、内視鏡は、内視鏡の挿入部にカバーを被せた状態で被検体内に挿入し、治療を行う技術も提案されている（例えば、特許文献２および３参照）。Further, a technique has been proposed in which an endoscope is inserted into a subject with a cover on the insertion portion of the endoscope to perform treatment (see, for example,Patent Documents 2 and 3).

特開２０１０－２２０９５１号公報Japanese Unexamined Patent Publication No. 2010-220951特開２００３－２８４６７１号公報Japanese Unexamined Patent Publication No. 2003-284671特開平８－２４２０８号公報Japanese Unexamined Patent Publication No. 8-24208

　特許文献１の技術では、撮像部を備えた内視鏡を一旦引き抜くため、観察位置が保持できず、病変を見失う場合があった。In the technique ofPatent Document 1, since the endoscope provided with the imaging unit is once pulled out, the observation position cannot be maintained and the lesion may be lost.

　本発明は、上記に鑑みてなされたものであって、挿入性および治療性に優れる内視鏡システムおよび内視鏡の操作方法を提供することを目的とする。The present invention has been made in view of the above, and an object of the present invention is to provide an endoscope system having excellent insertability and therapeutic ability and a method of operating the endoscope.

　上述した課題を解決し、目的を達成するために、本発明に係る内視鏡システムは、撮像部と、先端側に湾曲部を有する湾曲部材と、前記湾曲部材を挿抜できるチャンネルと、を有する内視鏡本体を備える。In order to solve the above-mentioned problems and achieve the object, the endoscope system according to the present invention has an imaging unit, a curved member having a curved portion on the tip side, and a channel into which the curved member can be inserted and removed. It is equipped with an endoscope body.

　本発明によれば、湾曲径の異なる第１の湾曲部材および第２の内視鏡湾曲部材を目的に応じて使い分けすることにより、挿入性および治療性にも優れる内視鏡システム、および内視鏡の操作方法を提供することが可能となる。According to the present invention, by properly using the first bending member and the second endoscope bending member having different bending diameters according to the purpose, an endoscope system having excellent insertability and therapeutic ability, and endoscopy. It becomes possible to provide a method of operating a mirror.

図１は、本発明の実施の形態１に係る内視鏡システムの全体構成を模式的に示す図である。FIG. 1 is a diagram schematically showing an overall configuration of an endoscope system according to a first embodiment of the present invention.図２は、内視鏡の構成を示す概略図である。FIG. 2 is a schematic view showing the configuration of an endoscope.図３は、第１の湾曲部材の拡大概略図である。FIG. 3 is an enlarged schematic view of the first curved member.図４は、内視鏡の挿入部の断面図である。FIG. 4 is a cross-sectional view of the insertion portion of the endoscope.図５は、内視鏡の先端部の正面図である。FIG. 5 is a front view of the tip of the endoscope.図６は、内視鏡の操作方法を説明する概略図である。FIG. 6 is a schematic view illustrating a method of operating the endoscope.図７Ａは、第１の湾曲部材を挿入した際の内視鏡先端部の湾曲操作を説明する概略図である。FIG. 7A is a schematic view illustrating a bending operation of the tip of the endoscope when the first bending member is inserted.図７Ｂは、第２の湾曲部材を挿入した際の内視鏡先端部の湾曲操作を説明する概略図である。FIG. 7B is a schematic view illustrating a bending operation of the tip of the endoscope when the second bending member is inserted.図８Ａは、第２の湾曲部材を挿入した際の内視鏡による好適な処置例を説明する概略図である。FIG. 8A is a schematic view illustrating an example of a suitable treatment with an endoscope when the second curved member is inserted.図８Ｂは、第２の湾曲部材を挿入した際の内視鏡による好適な処置例を説明する概略図である。FIG. 8B is a schematic view illustrating an example of a suitable treatment with an endoscope when the second curved member is inserted.図９は、本発明の実施の形態２に係る内視鏡を使用した処置を説明する概略図である。FIG. 9 is a schematic view illustrating a procedure using an endoscope according to a second embodiment of the present invention.

　以下、本発明を実施するための形態（以下、「実施の形態」という）について説明する。また、この実施の形態により本発明が限定されるものではない。さらに、以下の説明において参照する各図は、本発明の内容を理解でき得る程度に形状、大きさ、および位置関係を概略的に示してあるに過ぎない。すなわち、本発明は、各図で例示された形状、大きさおよび位置関係のみに限定されるものではない。さらにまた、図面の相互間においても、互いの寸法や比率が異なる部分が含まれている。Hereinafter, a mode for carrying out the present invention (hereinafter referred to as “a mode”) will be described. Further, the present invention is not limited to this embodiment. Furthermore, each of the figures referred to in the following description merely schematically shows the shape, size, and positional relationship to the extent that the contents of the present invention can be understood. That is, the present invention is not limited to the shape, size, and positional relationship exemplified in each figure. Furthermore, there are parts in which the dimensions and ratios of the drawings are different from each other.

（実施の形態１）
　図１は、本発明の実施の形態１にかかる内視鏡システム１００の全体構成を模式的に示す図である。図１に示すように、本実施の形態にかかる内視鏡システム１は、被検体内に導入され、被検体の体内を撮像して被検体内の画像信号を生成する内視鏡２と、内視鏡２が撮像した画像信号に所定の画像処理を施すとともに内視鏡システム１の各部を制御する情報処理装置３と、内視鏡２の照明光を生成する光源装置４と、情報処理装置３による画像処理後の画像信号を画像表示する表示装置５と、送気送水吸引を行う流体制御装置９と、を備える。(Embodiment 1)
FIG. 1 is a diagram schematically showing the overall configuration of the endoscope system 100 according to the first embodiment of the present invention. As shown in FIG. 1, theendoscope system 1 according to the present embodiment includes anendoscope 2 that is introduced into a subject and images the inside of the subject to generate an image signal in the subject. Information processing includes aninformation processing device 3 that performs predetermined image processing on the image signal captured by theendoscope 2 and controls each part of theendoscope system 1, alight source device 4 that generates illumination light of theendoscope 2, and information processing. It includes adisplay device 5 that displays an image signal after image processing by thedevice 3, and afluid control device 9 that performs air supply and water supply suction.

　内視鏡２は、被検体内に挿入される挿入部６と、挿入部６の基端部側であって術者が把持する操作部７と、操作部７から延伸する可撓性のユニバーサルコード８と、から構成されている。Theendoscope 2 has aninsertion portion 6 to be inserted into the subject, anoperation portion 7 on the base end side of theinsertion portion 6 and gripped by the operator, and a flexible universal extending from theoperation portion 7. It is composed ofcode 8.

　挿入部６は、照明ファイバからなるライトガイド、電気ケーブルまたは光ファイバ等を用いて実現される。挿入部６は、硬質の先端部６ａと、湾曲自在なカバー湾曲部６ｂと、カバー湾曲部６ｂの基端側に設けられた可撓性を有する可撓部６ｃと、を有する。先端部６ａには、照明レンズを経由して被検体内を照明する一対の照明部、被検体内を撮像する撮像装置６４、処置具チャンネル７４、送気送水チャンネル７６、および後述する第１の湾曲部材（第１の内視鏡駆動部）１０および第２の湾曲部材（第２の内視鏡駆動部）２０を挿抜する湾曲部材用チャンネル７７が設けられている（図４および図５参照）。Theinsertion portion 6 is realized by using a light guide made of an illumination fiber, an electric cable, an optical fiber, or the like. Theinsertion portion 6 has ahard tip portion 6a, a bendable cover curvedportion 6b, and a flexibleflexible portion 6c provided on the base end side of the cover curvedportion 6b. Thetip portion 6a includes a pair of illumination units that illuminate the inside of the subject via an illumination lens, animage pickup device 64 that images the inside of the subject, atreatment tool channel 74, an air supply /water supply channel 76, and a first described later. Abending member channel 77 for inserting and removing the bending member (first endoscope driving unit) 10 and the second bending member (second endoscope driving unit) 20 is provided (see FIGS. 4 and 5). ).

　操作部７は、後述する第１の湾曲部材１０および第２の湾曲部材２０を上下方向および左右方向に湾曲させる湾曲ノブ７ａと、被検体の体腔内に生体鉗子、レーザメス等の処置具が挿入される処置具挿入部７ｂと、情報処理装置３、光源装置４、流体制御装置９等の周辺機器の操作を行う複数のスイッチ部７ｃと第１の湾曲部材１０および第２の湾曲部材２０が挿入される湾曲部材挿入部７ｄと、を有する。処置具挿入部７ｂから挿入された処置具は、内部に設けられた処置具用チャンネルを経て挿入部６の先端の開口部６６から表出する（図４参照）。In theoperation unit 7, abending knob 7a that bends thefirst bending member 10 and thesecond bending member 20 described later in the vertical and horizontal directions, and a treatment tool such as a biological forceps and a laser scalpel are inserted into the body cavity of the subject. The treatmenttool insertion unit 7b, the plurality ofswitch units 7c for operating peripheral devices such as theinformation processing device 3, thelight source device 4, and thefluid control device 9, thefirst bending member 10, and thesecond bending member 20 It has a curvedmember insertion portion 7d to be inserted. The treatment tool inserted from the treatmenttool insertion portion 7b is exposed from theopening 66 at the tip of theinsertion portion 6 via the treatment tool channel provided inside (see FIG. 4).

　ユニバーサルコード８は、照明ファイバからなるライトガイド、ケーブル等を用いて構成される。ユニバーサルコード８は、基端で分岐しており、分岐した一方の端部がコネクタ８ａであり、他方の基端がコネクタ８ｂである。コネクタ８ａは、情報処理装置３のコネクタに対して着脱自在である。コネクタ８ａは、光源装置４に対して着脱自在である。ユニバーサルコード８は、光源装置４から出射された照明光を、コネクタ８ｂ、および照明ファイバからなるライトガイドを経由して先端部６ａに伝播する。また、ユニバーサルコード８は、撮像装置が撮像した画像信号を、ケーブルおよびコネクタ８ａを経由して情報処理装置３に伝送する。Theuniversal cord 8 is configured by using a light guide made of a lighting fiber, a cable, or the like. Theuniversal cord 8 is branched at the base end, one of the branched ends is theconnector 8a, and the other base end is theconnector 8b. Theconnector 8a is detachable from the connector of theinformation processing device 3. Theconnector 8a is removable from thelight source device 4. Theuniversal cord 8 propagates the illumination light emitted from thelight source device 4 to thetip portion 6a via the light guide composed of theconnector 8b and the illumination fiber. Further, theuniversal code 8 transmits the image signal captured by the imaging device to theinformation processing device 3 via the cable and theconnector 8a.

　情報処理装置３は、コネクタ８ａから出力される画像信号に所定の画像処理を施すとともに、内視鏡システム１全体を制御する。Theinformation processing device 3 performs predetermined image processing on the image signal output from theconnector 8a and controls theentire endoscope system 1.

　光源装置４は、光を発する光源や、集光レンズ等を用いて構成される。光源装置４は、情報処理装置３の制御のもと、光源から光を発し、コネクタ８ｂおよびユニバーサルコード８の照明ファイバからなるライトガイドを経由して接続された内視鏡２へ、被写体である被検体内に対する照明光として供給する。Thelight source device 4 is configured by using a light source that emits light, a condenser lens, or the like. Thelight source device 4 emits light from the light source under the control of theinformation processing device 3, and is a subject to theendoscope 2 connected via a light guide composed of aconnector 8b and an illumination fiber of auniversal cord 8. It is supplied as illumination light to the inside of the subject.

　表示装置５は、液晶または有機ＥＬ（Electro　Luminescence）を用いた表示ディスプレイ等を用いて構成される。表示装置５は、映像ケーブル５ａを経由して情報処理装置３によって所定の画像処理が施された画像を含む各種情報を表示する。これにより、術者は、表示装置５が表示する画像（体内画像）を見ながら内視鏡２を操作することにより、被検体内の所望の位置の観察および症状を判定することができる。Thedisplay device 5 is configured by using a liquid crystal display, a display display using organic EL (Electro Luminescence), or the like. Thedisplay device 5 displays various information including an image that has been subjected to predetermined image processing by theinformation processing device 3 via thevideo cable 5a. As a result, the operator can observe the desired position in the subject and determine the symptom by operating theendoscope 2 while looking at the image (internal image) displayed by thedisplay device 5.

　次に、実施の形態１に係る内視鏡２の構造について詳細に説明する。図２は、内視鏡２の構成を示す概略図である。内視鏡２は、内視鏡本体２ａと、第１の湾曲部材１０と、第２の湾曲部材２０と、を備える。内視鏡本体２ａは、撮像装置６４と、照明部と、処置具チャンネル７４と、送気送水チャンネル７６と、湾曲部材用チャンネル７７と、を有し、湾曲部材用チャンネル７７に第１の湾曲部材１０および第２の湾曲部材２０が挿抜される。Next, the structure of theendoscope 2 according to the first embodiment will be described in detail. FIG. 2 is a schematic view showing the configuration of theendoscope 2. Theendoscope 2 includes an endoscopemain body 2a, a firstcurved member 10, and a secondcurved member 20. The endoscopemain body 2a includes animage pickup device 64, an illumination unit, atreatment tool channel 74, an air supply /water supply channel 76, and a bendingmember channel 77, and the bendingmember channel 77 has a first curvature. Themember 10 and the secondcurved member 20 are inserted and removed.

　第１の湾曲部材１０は、湾曲自在な湾曲部１１と、湾曲部１１の基端側に接続される可撓性を有する可撓部１２と、を有する。第２の湾曲部材２０は、湾曲自在な湾曲部２１と、湾曲部２１の基端側に接続される可撓性を有する可撓部２２と、を有する。第１の湾曲部材１０の湾曲部１１の湾曲径は、第２の湾曲部材２０の湾曲部２１の湾曲径よりも大きくなっている。Thefirst bending member 10 has a bendingportion 11 that is bendable and aflexible portion 12 that is connected to the base end side of the bendingportion 11. Thesecond bending member 20 has a bendingportion 21 that is bendable and aflexible portion 22 that is connected to the proximal end side of the bendingportion 21. The bending diameter of the bendingportion 11 of the first bendingmember 10 is larger than the bending diameter of the bendingportion 21 of thesecond bending member 20.

　図３は、第１の湾曲部材１０の拡大概略図である。湾曲部１１は、複数の湾曲駒１３が連接され、連接する湾曲駒１３の上下左右には、ワイヤ１４が挿通されている。可撓部１２は、可撓性を有するルーメン１５付きのチューブで構成され、ルーメン１５内にワイヤ１４が挿通されている。第２の湾曲部材２０も第１の湾曲部材１０と同様の構成を有するが、第１の湾曲部材１０の湾曲部の長さｒ１が、第２の湾曲部材の湾曲部２１の長さより長いことにより、湾曲径が大きくなる。FIG. 3 is an enlarged schematic view of the firstcurved member 10. In thecurved portion 11, a plurality ofcurved pieces 13 are connected to each other, andwires 14 are inserted in the upper, lower, left and right sides of the connectedcurved pieces 13. Theflexible portion 12 is composed of a tube with aflexible lumen 15, and awire 14 is inserted into thelumen 15. The secondcurved member 20 has the same configuration as the firstcurved member 10, but the length r1 of the curved portion of the firstcurved member 10 is longer than the length of thecurved portion 21 of the second curved member. As a result, the bending diameter becomes large.

　図４は、内視鏡２の挿入部６の断面図である。内視鏡２の挿入部６の先端側に位置する先端部６ａは、先端カバー６１によって先端部６ａが外嵌されている。先端カバー６１には、観察窓６３、照明部の照明窓７５（図５参照）、送気・送水用の開口部および処置具チャンネル７４を構成する開口部６６が設けられている。観察窓６３の基端側には、被検体内を撮像する撮像装置６４が挿嵌されている。また、先端カバー６１の後方には、送気・送水用の開口部および処置具チャンネル７４を構成する開口部６６にそれぞれ対応するように、送気・送水孔および処置具チャンネル７４などが設けられた先端ブロック６２が配設されている。先端ブロック６２には、湾曲部材挿通孔６５も設けられている。FIG. 4 is a cross-sectional view of theinsertion portion 6 of theendoscope 2. Thetip portion 6a of thetip portion 6a located on the tip end side of theinsertion portion 6 of theendoscope 2 is fitted with thetip portion 6a by thetip cover 61. Thetip cover 61 is provided with anobservation window 63, anillumination window 75 of the illumination unit (see FIG. 5), an opening for air supply / water supply, and anopening 66 forming atreatment tool channel 74. Animaging device 64 for imaging the inside of the subject is inserted in the proximal end side of theobservation window 63. Further, behind thetip cover 61, an air supply / water supply hole, atreatment tool channel 74, and the like are provided so as to correspond to an opening for air supply / water supply and anopening 66 constituting thetreatment tool channel 74, respectively. Thetip block 62 is arranged. Thetip block 62 is also provided with a curvedmember insertion hole 65.

　先端ブロック６２における処置具チャンネル７４の後端部には処置具挿通パイプ６８が設けられており、処置具挿通パイプ６８に処置具挿通チューブ７０が接続されている。また、湾曲部材挿通孔６５の後端部には湾曲部材挿通パイプ６７が設けられており、湾曲部材挿通パイプ６７に湾曲部材挿通チューブ６９が接続されている。開口部６６、処置具挿通パイプ６８および処置具挿通チューブ７０からなる処置具チャンネル７４は、両端が開口するチャンネルであり、湾曲部材挿通孔６５、湾曲部材挿通パイプ６７および湾曲部材挿通チューブ６９からなる湾曲部材用チャンネル７７は、基端部側が開口し、先端側が開口しないチャンネルである。A treatmenttool insertion pipe 68 is provided at the rear end of thetreatment tool channel 74 in thetip block 62, and the treatmenttool insertion tube 70 is connected to the treatmenttool insertion pipe 68. A curvedmember insertion pipe 67 is provided at the rear end of the curvedmember insertion hole 65, and the curvedmember insertion tube 69 is connected to the curvedmember insertion pipe 67. Thetreatment tool channel 74 including theopening 66, the treatmenttool insertion pipe 68, and the treatmenttool insertion tube 70 is a channel that opens at both ends, and is composed of a curvedmember insertion hole 65, a curvedmember insertion pipe 67, and a curvedmember insertion tube 69. Thecurved member channel 77 is a channel that opens on the proximal end side and does not open on the distal end side.

　図５は、内視鏡２の先端部６ａの正面図である。図４および図５に示すように、湾曲部材用チャンネル７７は、内視鏡本体２ａの挿入部６の軸方向の中心に配置され、湾曲部材用チャンネル７７の周囲に、撮像装置６４（観察窓６３）、照明部（照明窓７５）、処置具チャンネル７４および送気送水チャンネル７６が設けられている。湾曲部材用チャンネル７７を挿入部６の軸方向の中心に配置することにより、第１の湾曲部材１０の湾曲部１１および第２の湾曲部材２０の湾曲部２１の湾曲操作により、内視鏡本体２ａの湾曲操作を容易に行うことができる。FIG. 5 is a front view of thetip portion 6a of theendoscope 2. As shown in FIGS. 4 and 5, thecurved member channel 77 is arranged at the center of theinsertion portion 6 of the endoscopemain body 2a in the axial direction, and the imaging device 64 (observation window) is arranged around thecurved member channel 77. 63), an illumination unit (illumination window 75), atreatment tool channel 74, and an air supply /water supply channel 76 are provided. By arranging the bendingmember channel 77 at the center of theinsertion portion 6 in the axial direction, the bending operation of the bendingportion 11 of the first bendingmember 10 and the bendingportion 21 of thesecond bending member 20 causes the endoscope main body. The bending operation of 2a can be easily performed.

　次に、実施の形態１に係る内視鏡２の操作方法について詳細に説明する。図６は、内視鏡２の操作方法を説明する概略図であり、大腸ｌｂを内視鏡で処置する場合を例として説明する。ここで、第１の湾曲部材１０は、例えば、湾曲部１１の長さが１３５ｍｍ程度のものが使用され、第２の湾曲部材２０は、例えば、湾曲部２１の長さが５５ｍｍ程度のものが使用される。１３５ｍｍ程度の長さの湾曲部を有する内視鏡は、従来大腸観察用途に使用されるものであり、５５ｍｍ程度の長さの湾曲部を有する内視鏡は、内視鏡的粘膜下層はく離術に使用されるものである。Next, the operation method of theendoscope 2 according to the first embodiment will be described in detail. FIG. 6 is a schematic view for explaining the operation method of theendoscope 2, and a case where the large intestine lb is treated with an endoscope will be described as an example. Here, as the first bendingmember 10, for example, a member having acurved portion 11 having a length of about 135 mm is used, and for thesecond bending member 20, for example, a member having a bendingportion 21 having a length of about 55 mm is used. used. An endoscope having a curved portion having a length of about 135 mm is conventionally used for large intestine observation, and an endoscope having a curved portion having a length of about 55 mm is used for endoscopic submucosal peeling. It is used for.

　まず、図６（ａ）に示すように、内視鏡２の挿入部６の湾曲部材用チャンネル７７に、湾曲部１１の湾曲長が長い第１の湾曲部材１０を挿入し、図６（ｂ）に示すように、第１の湾曲部材１０を挿入した挿入部６を大腸ｌｂ内に挿入する。挿入部６の大腸への挿入は、第１の湾曲部材１０の湾曲部１１を大腸ｌｂの形状に沿うように湾曲させて、内視鏡本体２ａと一体として進退、捻り操作を行いながら挿入する。大腸ｌｂは比較的大きな径で湾曲しているため、大腸の湾曲部の径に近似する湾曲径を有する第１の湾曲部材１０を挿入し湾曲部１１を湾曲させることにより、カバー湾曲部６ｂも湾曲部１１と同様に湾曲し、挿入部６の挿入が容易となる。First, as shown in FIG. 6A, the first bendingmember 10 having a long bending length of the bendingportion 11 is inserted into the bendingmember channel 77 of theinsertion portion 6 of theendoscope 2, and FIG. 6B ), Theinsertion portion 6 into which the first bendingmember 10 is inserted is inserted into the large intestine lb. To insert theinsertion portion 6 into the large intestine, thecurved portion 11 of the first bendingmember 10 is curved so as to follow the shape of the large intestine lb, and is inserted while performing advancing / retreating and twisting operations integrally with the endoscopemain body 2a. .. Since the large intestine lb is curved with a relatively large diameter, the cover curvedportion 6b is also formed by inserting the firstcurved member 10 having a curved diameter close to the diameter of the curved portion of the large intestine and bending thecurved portion 11. It is curved in the same manner as thecurved portion 11, and theinsertion portion 6 can be easily inserted.

　図６（ｃ）に示すように、挿入部６の先端部６ａが被検体の目標部位、例えば病変Ｐまで挿入した後、病変Ｐの観察診断を行う。観察診断後、挿入部６の湾曲部材用チャンネル７７から第１の湾曲部材１０を引き抜く（図６（ｄ）参照）。湾曲部材用チャンネル７７から第１の湾曲部材１０を引き抜いた後（図６（ｅ）参照）、挿入部６の湾曲部材用チャンネル７７に、湾曲部１１の湾曲長が短い第２の湾曲部材２０を挿入する（図６（ｆ）参照）。第１の湾曲部材１０の引き抜きと第２の湾曲部材２０の挿入の際にも、挿入部６の先端部６ａは病変Ｐの近傍に位置し、撮像装置６４で病変を観察した状態であるため、病変Ｐを見失うおそれはない。As shown in FIG. 6C, after thetip portion 6a of theinsertion portion 6 inserts to the target site of the subject, for example, the lesion P, the observation diagnosis of the lesion P is performed. After the observation diagnosis, the first bendingmember 10 is pulled out from the bendingmember channel 77 of the insertion portion 6 (see FIG. 6D). After the first bendingmember 10 is pulled out from the bending member channel 77 (see FIG. 6E), thesecond bending member 20 having a short bending length of the bendingportion 11 is connected to the bendingmember channel 77 of theinsertion portion 6. Is inserted (see FIG. 6 (f)). Even when the firstcurved member 10 is pulled out and the secondcurved member 20 is inserted, thetip portion 6a of theinsertion portion 6 is located in the vicinity of the lesion P, and the lesion is observed by theimaging device 64. , There is no risk of losing sight of lesion P.

　第２の湾曲部材２０を湾曲部材用チャンネル７７に挿入後（図６（ｇ）参照）、第２の湾曲部材２０の湾曲部２１を湾曲操作して、処置具を病変Ｐに近接させた後、処置具により病変Ｐの治療、例えば、局注、周囲切開、切開剥離、縫合等を行う。湾曲長が長い第１の湾曲部材１０を使用する場合、図７（Ａ）に示すように、大腸ｌｂの管腔径は平均で６０ｍｍ程度と狭いため、脾湾曲部にある病変Ｐに対し、先端部６ａを病変Ｐにアプローチするのが難しくなる。これに対し、湾曲長が短い第２の湾曲部材２０を使用する場合、図７（Ｂ）に示すように、小回りが利くため、狭い管腔内でも病変Ｐに対しアプローチしやすく、処置も行いやすい。また、図８（Ａ）に示すように、湾曲部２１を先端部６ａが反転するまで湾曲させて、病変Ｐを処置する場合や、図８（ｂ）に示すように、病変Ｐが襞裏に存在する場合には、湾曲長が短い第２の湾曲部材２０の使用により、病変Ｐに対しアプローチしやすく、処置が行いやすくなる。なお、湾曲長が短い第２の湾曲部材２０でも病変Ｐにアプローチし難い場合は、より湾曲長が短い第３の湾曲部材や、第１の湾曲部材１０と第２の湾曲部材２０との中間の湾曲長の第４の湾曲部材を使用して治療を行ってもよい。After inserting thesecond bending member 20 into the bending member channel 77 (see FIG. 6 (g)), the bending operation of the bendingportion 21 of thesecond bending member 20 is performed to bring the treatment tool closer to the lesion P. , Treatment of lesion P with a treatment tool, for example, local injection, peri-incision, incision detachment, suturing and the like. When the first bendingmember 10 having a long bending length is used, as shown in FIG. 7A, the lumen diameter of the large intestine lb is as narrow as about 60 mm on average. It becomes difficult to approach the lesion P with thetip 6a. On the other hand, when the secondcurved member 20 having a short curved length is used, as shown in FIG. 7B, it is easy to approach the lesion P even in a narrow lumen because it has a small turning radius, and treatment is also performed. Cheap. Further, as shown in FIG. 8 (A), thecurved portion 21 is curved until thetip portion 6a is inverted to treat the lesion P, or as shown in FIG. 8 (b), the lesion P is the back of the fold. When present in, the use of the secondcurved member 20 having a short curved length facilitates the approach to the lesion P and facilitates the treatment. If it is difficult to approach the lesion P even with the secondcurved member 20 having a short curved length, a third curved member having a shorter curved length or an intermediate between the firstcurved member 10 and the secondcurved member 20. The treatment may be performed using a fourth curved member having a curved length of.

　治療の後、第２の湾曲部材２０とともに内視鏡２の挿入部６を被検体内から抜去する（図６（ｈ）参照）。被検体から抜去した後、湾曲部材用チャンネル７７から第２の湾曲部材２０を抜き取る。処置後、内視鏡本体２ａは廃棄され、第１の湾曲部材１０および第２の湾曲部材２０は、洗浄後、次の手技で再利用することができる。After the treatment, theinsertion portion 6 of theendoscope 2 is removed from the subject together with the second curved member 20 (see FIG. 6 (h)). After removing from the subject, thesecond bending member 20 is pulled out from the bendingmember channel 77. After the treatment, the endoscopemain body 2a is discarded, and the firstcurved member 10 and the secondcurved member 20 can be reused in the next procedure after cleaning.

　実施の形態１では、挿入には長湾曲の第１の湾曲部材１０を使用し、治療には短湾曲の第２の湾曲部材２０を湾曲部材用チャンネル７７に挿入し、挿入部６のカバー湾曲部６ｂを湾曲操作することにより、挿入性と治療性のバランスに優れた内視鏡２を提供することができる。また、被検体と接触する内視鏡本体２ａを使い捨て可能とし、内視鏡本体２ａに挿抜可能な第１の湾曲部材１０および第２の湾曲部材２０を再使用することで、感染リスクを軽減するとともに、コストの上昇を抑制することができる。In the first embodiment, the long-curved firstcurved member 10 is used for insertion, the short-curved secondcurved member 20 is inserted into thecurved member channel 77 for treatment, and the cover curvature of theinsertion portion 6 is performed. By bending theportion 6b, it is possible to provide theendoscope 2 having an excellent balance between insertability and therapeutic property. In addition, the risk of infection is reduced by making theendoscope body 2a that comes into contact with the subject disposable and reusing the firstcurved member 10 and the secondcurved member 20 that can be inserted into and removed from theendoscope body 2a. At the same time, it is possible to suppress an increase in cost.

　さらに、実施の形態１では、第１の湾曲部材１０の挿抜の際、撮像装置６４により病変Ｐを観察しているため、第２の湾曲部材２０の挿入後の病変Ｐへのアプローチが容易となる。また、常に病変Ｐを観察しているため、予期せぬ出血等に対して迅速な対応が可能となる。さらにまた、鉗子で対象を掴んだ状態や、管腔内の状態保持のための送気操作中の湾曲部材の交換も可能となり、湾曲部材交換後に場を作り直す手間を削減することができる。Further, in the first embodiment, since the lesion P is observed by theimaging device 64 when the firstcurved member 10 is inserted and removed, it is easy to approach the lesion P after the insertion of the secondcurved member 20. Become. In addition, since the lesion P is constantly observed, it is possible to quickly respond to unexpected bleeding or the like. Furthermore, it is possible to replace the curved member in a state where the object is grasped by forceps or during the air supply operation for maintaining the state in the lumen, and it is possible to reduce the trouble of recreating the field after replacing the curved member.

　なお、上記の実施の形態１では、撮像装置６４は内視鏡本体２ａに固定され、術後、内視鏡本体２ａとともに廃棄されるが、内視鏡本体２ａから着脱可能として再使用してもよい。In the first embodiment described above, theimage pickup apparatus 64 is fixed to the endoscopemain body 2a and is discarded together with the endoscopemain body 2a after the operation, but is reused as being removable from the endoscopemain body 2a. May be good.

（実施の形態２）
　図９は、本発明の実施の形態２に係る内視鏡を使用した処置を説明する概略図であり、胃Ｓを内視鏡で処置する場合を例として説明する。ここで、第１の湾曲部材１０は、例えば、湾曲部１１の長さが７０ｍｍ程度のものが使用され、第２の湾曲部材２０は、例えば、湾曲部２１の長さが１０５ｍｍ程度のものが使用される。(Embodiment 2)
FIG. 9 is a schematic view illustrating a procedure using an endoscope according to a second embodiment of the present invention, and a case where the stomach S is treated with an endoscope will be described as an example. Here, as the first bendingmember 10, for example, a member having acurved portion 11 having a length of about 70 mm is used, and for thesecond bending member 20, for example, a member having a bendingportion 21 having a length of about 105 mm is used. used.

　実施の形態２では、内視鏡２の挿入部６の湾曲部材用チャンネル７７に、湾曲部１１の湾曲長が短い第１の湾曲部材１０を挿入し、第１の湾曲部材１０を挿入した挿入部６を胃Ｓ内に挿入する。挿入部６の先端部６ａを病変Ｐまで挿入した後、病変Ｐの観察診断を行い、観察診断後、挿入部６から第１の湾曲部材１０を引き抜く。湾曲部材用チャンネル７７から第１の湾曲部材１０を引き抜いた後、内視鏡２の挿入部６の湾曲部材用チャンネル７７に、湾曲部１１の湾曲長が長い第２の湾曲部材２０を挿入し、第２の湾曲部材２０の湾曲部２１を湾曲操作して、処置具により病変Ｐの治療を行う。In the second embodiment, the first bendingmember 10 having a short bending length of the bendingportion 11 is inserted into the bendingmember channel 77 of theinsertion portion 6 of theendoscope 2, and the first bendingmember 10 is inserted into the insertion.Part 6 is inserted into the stomach S. After inserting thetip portion 6a of theinsertion portion 6 to the lesion P, an observation diagnosis of the lesion P is performed, and after the observation diagnosis, the firstcurved member 10 is pulled out from theinsertion portion 6. After pulling out the first bendingmember 10 from the bendingmember channel 77, thesecond bending member 20 having a long bending length of the bendingportion 11 is inserted into the bendingmember channel 77 of theinsertion portion 6 of theendoscope 2. , Thecurved portion 21 of the secondcurved member 20 is curved to treat the lesion P with the treatment tool.

　例えば、小彎に病変Ｐがある場合、図９に示すように、点線で示す湾曲長が長い第２の湾曲部材２０を挿入した挿入部６の方が、実線で示す湾曲長が短い第１の湾曲部材１０よりも病変Ｐに対して胃壁の接線方向でのアプローチが容易となる。For example, when there is a lesion P in the lesser curvature, as shown in FIG. 9, theinsertion portion 6 into which thesecond bending member 20 having a long bending length shown by the dotted line is inserted has the first one having a shorter bending length shown by the solid line. The approach to the lesion P in the tangential direction of the stomach wall becomes easier than that of thecurved member 10.

　本発明に係る内視鏡システムおよび内視鏡の操作方法は、挿入性および治療性に優れる内視鏡に好適に用いることができる。The endoscope system and the method of operating the endoscope according to the present invention can be suitably used for an endoscope having excellent insertability and therapeutic property.

　１　内視鏡システム
　２　内視鏡
　２ａ　内視鏡本体
　３　情報処理装置
　４　光源装置
　５　表示装置
　６　挿入部
　６ａ　先端部
　６ｂ　カバー湾曲部
　６ｃ　可撓部
　７　操作部
　７ａ　湾曲ノブ
　７ｂ　処置具挿入部
　７ｃ　スイッチ部
　７ｄ　湾曲部材挿入部
　８　ユニバーサルコード
　８ａ、８ｂ　コネクタ
　１０　第１の湾曲部材
　１１、２１　湾曲部
　１２、２２　可撓部
　２０　第２の湾曲部材
　６１　先端カバー
　６２　先端ブロック
　６３　観察窓
　６４　撮像装置
　６５　湾曲部材挿通孔
　６６　開口部
　６７　湾曲部材挿通パイプ
　６８　処置具挿通パイプ
　６９　湾曲部材挿通チューブ
　７０　処置具挿通チューブ
　７４　処置具チャンネル
　７５　照明窓
　７６　送気送水チャンネル
　７７　湾曲部材用チャンネル1Endoscope system 2Endoscope2a Endoscope body 3Information processing device 4Light source device 5Display device 6Insertion part6a Tip part 6bCover bending part 6cFlexible part 7Operation part 7aCurved knob 7b Treatmenttool insertion part7c Switch part 7d Curvedmember insertion part 8Universal cord 8a,8b Connector 10 Firstcurved member 11, 21Curved part 12, 22Flexible part 20 Secondcurved member 61Tip cover 62Tip block 63Observation window 64Imaging device 65 Curvedmember insertion hole 66Opening 67 Curvedmember insertion pipe 68 Treatmenttool insertion pipe 69 Curvedmember insertion tube 70 Treatmenttool insertion tube 74Treatment tool channel 75Lighting window 76 Air supplywater supply channel 77 Curved member insertion channel

Claims (10)

Translated fromJapanese

　撮像部と、先端側に湾曲部を有する湾曲部材と、前記湾曲部材を挿抜できるチャンネルと、を有する内視鏡本体を備える内視鏡システム。An endoscope system including an endoscope body having an imaging unit, a curved member having a curved portion on the tip side, and a channel through which the curved member can be inserted / removed.　前記湾曲部材は、第１の湾曲径で湾曲する第１の湾曲部材および、前記第１の湾曲部材の湾曲径と異なる第２の湾曲径で湾曲する第２の湾曲部材とを含む、請求項１に記載の内視鏡システム。A claim that the curved member includes a first curved member that curves with a first curved diameter, and a second curved member that curves with a second curved diameter different from the curved diameter of the first curved member. The endoscopic system according to 1.　前記湾曲部材は、前記内視鏡本体の挿入部の挿入時に使用される第１の湾曲部材と、前記内視鏡本体の挿入部の挿入後に使用される第２の湾曲部材を含む、請求項１に記載の内視鏡システム。A claim that the curved member includes a first curved member used when the insertion portion of the endoscope body is inserted and a second curved member used after the insertion portion of the endoscope body is inserted. The endoscopic system according to 1.　前記第１の湾曲部材の湾曲径は、前記第２の湾曲径よりも大きいことを特徴とする、請求項２に記載の内視鏡システム。The endoscope system according to claim 2, wherein the bending diameter of the first bending member is larger than the bending diameter of the second bending member.　前記内視鏡本体は、先端側が開口しない前記湾曲部材を挿抜できるチャンネルと、両端が開口する処置具チャンネルを有する請求項１に記載の内視鏡システム。The endoscope system according to claim 1, wherein the endoscope main body has a channel through which the curved member whose tip side does not open can be inserted and removed, and a treatment tool channel whose both ends open.　前記湾曲部材を挿抜するチャンネルは、前記内視鏡本体の挿入部の長手軸方向の中心に配置されている請求項１に記載の内視鏡システム。The endoscope system according to claim 1, wherein the channel for inserting and removing the curved member is arranged at the center of the insertion portion of the endoscope body in the longitudinal axis direction.　前記撮像部は、前記内視鏡本体から着脱可能である請求項１に記載の内視鏡システム。The endoscope system according to claim 1, wherein the imaging unit is detachable from the endoscope body.　前記内視鏡本体は、使い捨て可能であり、前記湾曲部材は再使用可能である請求項１に記載の内視鏡システム。The endoscope system according to claim 1, wherein the endoscope body is disposable and the curved member is reusable.　撮像部と、先端側に湾曲部を有する湾曲部材と、前記湾曲部材を挿抜できるチャンネルと、を有する内視鏡本体の前記チャンネルに、第１の湾曲部材を挿入し、
　前記第１の湾曲部材を挿入した内視鏡の挿入部を、被検体の目標部位まで挿入し、
　前記撮像部により病変を観察診断後、前記第１の湾曲部材を前記先チャンネルから抜去し、
　前記チャンネルに、第２の湾曲部材を挿入する内視鏡の操作方法。A first curved member is inserted into the channel of the endoscope main body having an imaging unit, a curved member having a curved portion on the tip side, and a channel through which the curved member can be inserted / removed.
The insertion portion of the endoscope into which the first curved member is inserted is inserted to the target site of the subject, and the insertion portion is inserted.
After observing and diagnosing the lesion with the imaging unit, the first curved member is removed from the tip channel.
A method of operating an endoscope in which a second curved member is inserted into the channel.　前記両端が開口する処置具チャンネルには処置具が挿通され、前記第２の湾曲部材の湾曲部を湾曲させて先端部を病変に近接させた後、前記処置具により処置を行う請求項９に記載の内視鏡の操作方法。The ninth aspect of the present invention, wherein the treatment tool is inserted into the treatment tool channel whose both ends are open, the curved portion of the second bending member is curved so that the tip portion is brought close to the lesion, and then the treatment is performed by the treatment tool. The method of operating the endoscope described.

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