JP4469987B2 - Laryngopharyngeal examination treatment device - Google Patents

Description

  The present invention relates to a laryngeal pharyngeal examination and treatment apparatus comprising an endoscope and a laryngeal pharyngeal forceps or a suction tube. Since the hollow tube to be inserted is flexible, the present invention relates to a laryngeal pharyngeal examination treatment apparatus capable of performing laryngo-pharyngeal surgery, treatment, treatment of foreign body removal, and the like accurately, reliably, efficiently, and quickly.

  Conventionally, in the otolaryngology department, in order to remove foreign bodies from the larynx and pharynx, excision of the tumor, etc., an operation of inserting an endoscope from the nasal cavity to observe the pharynx and larynx and inserting laryngopharyngeal forceps from the oral cavity has been performed.

  As a laryngopharyngeal forceps commonly used in otolaryngology, a so-called universal laryngopharyngeal forceps shown in FIG. 14 is known. The universal laryngopharyngeal forceps has a rod portion whose front half is bent nearly 90 ° so that the forceps can be easily inserted from the patient's oral cavity (horizontal) to the laryngeal pharynx (vertical).

  In addition, a Schmidt forceps shown in FIG. 15 is known as a forceps used (see Patent Document 1). The Schmitt forceps can be bent so that the rod portion can be easily inserted into the oral cavity and the larynx and pharynx.

  In addition, a laryngopharyngeal treatment device is known that can be grasped and operated with one hand by combining a laryngopharyngeal forceps and an endoscope (see Patent Document 2).

US Pat. No. 3,895,636 JP 2000-300574 A

However, the treatment tool according to the above prior art has the following problems (1) to (4).
(1) In the treatment of inserting the endoscope from the nasal cavity and observing the larynx and pharynx and inserting the laryngopharyngeal forceps from the oral cavity, insertion of the endoscope from the nasal cavity causes pain and anxiety to the patient. In addition, the endoscope to be inserted can be bent only at its distal end, and the shape cannot be fixed at other parts. For this reason, it is not easy to match the observation position of the endoscope with the affected part.

(2) In the above-mentioned so-called universal laryngopharyngeal forceps (FIG. 14), the curved shape near 90 ° of the rod half often does not match or match the shape of the patient's laryngopharynx or the position of the affected part. , Treatment is prolonged and causes pain and anxiety to the patient.

(3) The above-mentioned Schmitt forceps (FIG. 15) can be bent in accordance with the shape of the larynx and pharynx, but when an endoscope is inserted separately from the forceps, as in (1) above, It is not easy to adapt the observation position of the endoscope to the affected part.

(4) The laryngopharyngeal examination and treatment device disclosed in Patent Document 2 described above includes a flexible endoscope along the rod of the universal laryngopharyngeal forceps, and an observation window and an illumination window of the endoscope are provided. Since it is attached to the tip of the rod, the observation position of the endoscope can be fixed around the affected area, but since the rod is rigid, the shape of the rod does not match the shape of the patient's larynx and pharynx and If the position does not fit, accurate and rapid laryngopharyngeal treatment is not easy and causes pain and anxiety to the patient.

  The object of the present invention is to perform laryngopharyngeal treatment by insertion only from the oral cavity, and the site inserted into the larynx and pharynx can be transformed into a shape suitable for the patient, safely and accurately. An object of the present invention is to provide a laryngopharyngeal examination treatment apparatus capable of performing laryngopharyngeal treatment.

  In order to solve the above-mentioned problems, the present inventor has intensively researched and tried and error based on many years of deep academic experience, and as a result, the clinical operation is simple and easy, and the accurate and quick larynx. The present inventors have succeeded in creating a laryngopharyngeal examination and treatment apparatus that enables pharyngeal treatment and is extremely ergonomically friendly to the patient, thereby completing the present invention.

  That is, the present invention includes (1) a grip body, an operating portion provided on the grip body, and an external force that is supported by the grip body and extended forward and received during insertion and operation into the larynx and pharynx. A flexible hollow tube that is not deformed and can be deformed into a desired shape with an external force greater than the external force received during insertion and operation, and is supported by the grip body and inserted into the flexible hollow tube And a forceps or suction tube supported by the grip main body and supported by the operation of the grip main body in an inserted state through the flexible hollow tube. The present invention relates to a laryngopharyngeal examination treatment device.

  The present invention also provides (2) a laryngopharyngeal examination treatment device according to (1) above, wherein the flexible hollow tube is a bellows-like hollow tube, and (3) a flexible hollow tube. An angle adjusting member is provided at the distal end of the tube, and the laryngopharyngeal examination / treatment device according to (1) or (2) above, (4) around the axis of the endoscope and / or forceps The present invention relates to a laryngopharyngeal examination treatment device according to any one of the above (1) to (3), wherein the direction can be adjusted.

  Furthermore, the present invention provides (5) a laryngopharyngeal examination treatment device according to any one of the above (1) to (4), wherein adjustment in the direction around the axis of the flexible hollow tube is possible. Or (6) a laryngopharyngeal examination / treatment device according to any one of (1) to (5) above, wherein (6) a flexible hollow tube is provided. The laryngopharyngeal examination and treatment apparatus according to any one of (1) to (6) above, which is detachable, and (8) an endoscope, which converts an observation image into an electrical signal and transmits it wirelessly The present invention relates to a laryngopharyngeal examination / treatment device according to any one of the above (1) to (7).

  According to the laryngopharyngeal examination and treatment apparatus of the present invention, laryngopharyngeal treatment can be performed by insertion from only the oral cavity, and the portion inserted into the larynx and pharynx can be transformed into a shape suitable for the patient. Can safely and accurately perform laryngopharyngeal treatment. In addition, since the structure is extremely friendly to the patient in terms of ergonomics, the patient's pain, anxiety, stress, etc. associated with laryngopharyngeal treatment can be greatly reduced.

  The laryngeal pharyngeal examination and treatment device of the present invention includes a grip body, an operation portion provided on the grip body, and supported by the grip body and extended forward, during insertion and operation into the larynx and pharynx A flexible hollow tube that is not deformed by an external force received and can be deformed into a desired shape by an external force greater than the external force received during insertion and operation, and the flexible hollow tube supported by the grip body. An endoscope supported in an inserted state and a forceps supported by the grip body and controlled by an operation portion of the grip body supported by the flexible hollow tube in an inserted state Or if it is an apparatus provided with the suction tube, it will not restrict | limit in particular, According to this invention, a flexible hollow tube can be deform | transformed into a desired curve shape (curved shape) with the force of a hand. Keeps such a curved shape Can be inserted into the patient's oral cavity and laryngopharynx for treatment, and if the shape of the curved flexible hollow tube does not fit or match the patient's laryngopharyngeal shape or position of the affected area, The laryngopharyngeal examination treatment device can be removed from the oral cavity again and the flexible hollow tube can be adjusted to the appropriate shape by hand force. Therefore, compression of the larynx and pharynx can be reduced, and the pain given to the patient can be reduced. Further, since the endoscope and the forceps or the suction tube are accommodated in the flexible hollow tube, even if a large deflection occurs in the flexible part such as the endoscope, the endoscope or the like The flexible portion does not come into contact with the larynx and pharynx, reducing the burden on the patient and improving the operability of the operator.

  The grip body of the present invention is not particularly limited as long as the operator can hold and operate the entire laryngopharyngeal examination treatment apparatus, and can be held and operated more stably. From the point of view, a pistol grip body is preferable. The material of the grip body may be a metal such as stainless steel or plastic.

  The operation unit of the present invention controls the operation of forceps or a suction tube provided in the grip body. For example, a switch-type operation unit, a button-type operation unit, or a trigger-type operation unit (Trigger) can be exemplified. In the present invention, a configuration in which the grip body is a pistol grip body and the operation portion is a trigger is particularly preferable from the viewpoint of operability. Further, the operation unit may control not only the operation of the forceps or the suction tube but also the operation of the endoscope.

  The flexible hollow tube of the present invention is supported by the grip body and extended forward, and is not deformed by the external force received during insertion and operation into the larynx and pharynx. The hollow tube is not particularly limited as long as it can be deformed into a desired shape with a larger external force, and examples thereof include a bellows-like tube, and the material may be a metal such as stainless steel. However, plastic may be used, and more specifically, a structure similar to a bellows-shaped water pipe can be mentioned.

  Such a flexible hollow tube is, for example, a tube having a diameter of about 2 to 12 mm and a length of about 5 to 25 mm, and a tube having a diameter of about 3 to 10 mm and a length of about 10 to 20 mm. preferable. In addition, the flexible hollow tube is preferably detachable from the grip body, whereby cleaning and disinfection can be performed more easily, and depending on the type of endoscope used for treatment, etc. They can be exchanged as appropriate. In addition, it is preferable that a distal end portion of the flexible hollow tube is provided with a fixed portion that supports the endoscope and the forceps or the suction tube, and the endoscope and the forceps or the suction tube are inserted. It can be reliably supported without causing a displacement. Examples of the fixing portion include a notched arc-shaped fixing member provided inside the flexible hollow tube, an arc-shaped fixing holder provided with a fixing screw, and the like. It may be fixed.

  Moreover, it is preferable that the flexible hollow tube of the present invention can be adjusted in the direction around its axis. Specifically, the flexible hollow tube itself (the whole) is appropriately rotated in the circumferential direction. And a structure having a twisted portion that can be rotated around an axis. Thereby, the position of the endoscope fixed to the flexible hollow tube and the forceps or the suction tube can be changed. Note that the flexible portion that can be deformed into a curved shape and the twisted portion that can rotate around the axis may be all or part of the flexible hollow tube.

  Moreover, it is preferable that an angle adjusting member is provided at the distal end portion of the flexible hollow tube, so that a fine adjustment of the position of the endoscope or the like can be easily performed. When the angle adjusting member is provided, it is preferable that the fixing portion that supports the endoscope or the like is provided inside the angle adjusting member.

  The endoscope of the present invention is supported by the grip body and supported by the flexible hollow tube in an inserted state, and is a flexible material that is inserted into the flexible hollow tube. And has an endoscopic camera at its distal end. Here, being supported in the insertion state by the flexible hollow tube means that the flexible hollow tube is supported by simply inserting it after adjusting the diameter of the flexible hollow tube or the like. The case where it supports by the fixing | fixed part provided in the front-end | tip part is included. Such an endoscope preferably includes a transmitter that converts an observation image into an electric signal and transmits the signal wirelessly. The endoscope receives an electric signal from the transmitter by a receiver, and displays the signal on a monitor, for example. The inside of the pharynx can be observed. Thereby, the cable which sends an electric signal to a receiver can be omitted, and the convenience at the time of treatment can be improved.

  Moreover, it is preferable that the endoscope is detachable from the grip body and the flexible hollow tube, whereby cleaning can be performed more easily. The endoscope is preferably adjustable in the direction around the axis. The endoscope can be adjusted by tightening the fixing portion provided in the flexible hollow tube, or the endoscope. An example is a structure in which an adjustment mechanism in the direction around the axis is provided. Thereby, for example, when the position of the observation window and the illumination window of the endoscope is in a position where a large amount of flare is generated in the observation image due to the reflection of the illumination light from the forceps with respect to the forceps, the endoscope The flare can be changed to a position where the flare is reduced by rotating. In addition, since the image projected by the endoscope can be rotated by rotating the endoscope, for example, when performing treatment while projecting the image of the endoscope on the monitor screen, the image from the endoscope is processed. When the image cannot be rotated by the rotation, the angle of the image can be adjusted according to the sense of movement of the hand.

  The forceps and suction tube of the present invention are supported by the grip body and supported by the operation portion of the grip body supported by the flexible hollow tube in an inserted state. Like an endoscope, it has a flexible part inserted through the inside of a flexible hollow tube, and in the case of forceps, a forceps piece is provided at the tip. Here, being supported in the insertion state in the flexible hollow tube means that, as in the case of the endoscope, it is supported by simply being inserted, or the fixing provided at the distal end portion of the flexible hollow tube. In the case where relatively large forceps (pieces) are used, including the case where they are supported by a portion, it is preferable to fix them by a fixing portion. Examples of the forceps piece include a hook-shaped forceps piece and a hook-shaped forceps piece, and commercially available ones can be used. The operation of the forceps is controlled by an operation unit provided in the grip body, and opening or closing is performed by turning on the operation unit. For example, when the operation unit is a trigger, the forceps piece may be opened by pulling the trigger, or the forceps piece may be closed. Similarly, the operation of the suction tube is controlled by an operation unit provided in the grip body, and suction is started or stopped when the operation unit is turned on. The forceps and the suction tube are preferably detachable from the grip body and the flexible hollow tube. Thereby, it can wash | clean more easily and can replace | exchange for the thing of various shapes according to an affected part.

  The forceps is preferably adjustable in the direction around its axis. The forceps can be adjusted by tightening the fixing portion provided on the flexible hollow tube, or the forceps themselves can be A structure provided with an adjustment mechanism in the circumferential direction can be given. Thereby, for example, when the forceps is a hook-shaped forceps that opens and closes only one side, the opening and closing direction can be adjusted to the affected part, so that the affected part can be reliably captured.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. Note that the present invention is not limited thereby.

(First embodiment)
FIG. 1 is a schematic configuration diagram of a laryngopharyngeal examination treatment apparatus according to a first embodiment of the present invention. The laryngeal pharyngeal examination and treatment apparatus according to the first embodiment includes a grip body 11 having a trigger 40, a flexible hollow tube 20 inserted into the oral cavity and the larynx and pharynx extending from the grip body 11 to the front, A forceps 30 and an endoscope 50 are provided. The forceps 30 and the endoscope 50 are supported by being inserted through the flexible hollow tube 20, and a forceps piece provided at the tip of the forceps 30 and an endoscope camera provided at the tip of the endoscope 50 are provided. It is installed in a state exposed from the tip of the flexible hollow tube 20. The endoscope 50 is a so-called cableless one that wirelessly transfers an observation image obtained by the endoscope camera, or an extension of a cable 56 for transmitting the observation image to an external device as shown in FIG. Can be used.

(Second Embodiment)
FIG. 3 is a schematic configuration diagram of a laryngopharyngeal examination treatment apparatus according to the second embodiment of the present invention. The laryngeal pharyngeal examination treatment device according to the second embodiment is a device for sucking and removing foreign matter in the larynx and pharynx, and is extended from the grip body 11 having the trigger 40 to the front. A flexible hollow tube 20 to be inserted into the oral cavity and the larynx and pharynx, a suction tube 60, and an endoscope 50 are provided. The suction tube 60 and the endoscope 50 are supported by being inserted through the flexible hollow tube 20, and the endoscope camera provided at the distal end portion of the suction tube 60 and the distal end of the endoscope 50 is flexible. It is installed in a state exposed from the tip of the empty tube 20.

  Examples of the present invention will be described below.

  4A and 4B are explanatory diagrams of the laryngopharyngeal examination treatment apparatus according to the first embodiment, where FIG. 4A is a side view, FIG. 4B is an enlarged view of arrow A, and FIG. 4C is an enlarged side view when the forceps piece is opened. FIG. FIG. 5 is a side view of the flexible hollow tube. FIG. 6 is an explanatory diagram of an endoscope, in which (a) is a side view and (b) is an enlarged view of arrow A.

  The laryngopharyngeal examination and treatment apparatus according to Example 1 includes a pistol-type grip body 11 having a trigger 40, a flexible hollow tube 20 inserted into the oral cavity and the larynx and pharynx extending from the grip body 11 to the front, A forceps 30 and an endoscope 50 are provided. The forceps 30 and the endoscope 50 are supported by being inserted through the flexible hollow tube 20, and a forceps piece provided at the distal end of the forceps 30 and an endoscope camera provided at the distal end of the endoscope 50. 52 is installed in a state exposed from the tip of the flexible hollow tube 20.

  The grip body 11 is a pistol grip body formed by cutting an aluminum alloy and can be stably held with one hand. An endoscope holder 12 is provided at the upper rear end of the grip body 11, and a cylindrical endoscope body 51 is inserted and supported, and an internal fixing screw 13 at the tip of the endoscope holder 12 The endoscope flexible tube 53 connecting the endoscope main body 51 and the endoscope camera at the tip is pressed and supported so as not to twist. Note that the endoscope main body 51 can be appropriately rotated around the axis and supported by the endoscope holder 12 at a desired position.

  A flexible hollow tube holder 14 and a fixing screw 15 are provided at the upper end of the grip body 11, and a metal fitting 23 (see FIG. 5) attached to the rear end of the flexible hollow tube 20. Inserted and the flexible hollow tube 20 is supported by the fixing screw 15. The flexible hollow tube 20 can be appropriately rotated around the axis and supported by the flexible hollow tube holder 14 at a desired position.

  The trigger 40 is attached to the grip body 11 via a fulcrum 41. In addition, an operation wire fixing screw 42 is provided on the upper portion of the trigger 40 to fix the operation wire 31 of the forceps 30. In the illustrated example, the fixing screw 42 is moved forward by the trigger pulling operation and the forceps piece is closed. However, by adding the fulcrum and the action point, the fixing screw 42 is moved by the trigger pulling operation. It can also be set as the structure which is moved back and a forceps piece closes.

  As shown in FIG. 5, the flexible hollow tube 20 is configured by attaching metal fittings 22 and metal fittings 23 to both ends of a bellows-shaped flexible tube 21 made of stainless steel that is commercially available for water pipes. The outer peripheral surface of the flexible hollow tube 20 is covered with a protective film made of a soft material such as vinyl.

  The forceps piece of the forceps 30 is removed from the universal laryngopharyngeal forceps shown in FIG. This forceps 30 is a hook-like forceps piece that opens and closes only one as shown in FIG. 4C, and the hook-like forceps piece closes when the operation wire 31 is pushed. It is. Further, the forceps 30 is rotatable around the axis of the operation wire 31 and is fixed to the rotation by tightening the screw fitting 32. The forceps 30 are fixed to the flexible hollow tube 20 with screws.

  As shown in FIG. 6, the endoscope 50 used was a flexible endoscope (trade name N Nano, manufactured by RF Co., Ltd.) equipped with a micro CCD camera 54. The endoscope 50 is formed by connecting a cylindrical endoscope main body 51 and an endoscope camera 52 by a flexible tube 53. The endoscope camera 52 has an outer diameter of 5.5 mm, and four high-intensity white LED lights 55 are arranged around the CCD camera 54 located at the center. The endoscope main body 51 incorporates a transmitter that wirelessly transmits a captured image to the image processing apparatus and a rechargeable battery that operates the camera, and is so-called cableless. Note that the image transmitted by the endoscope 50 is received by a wireless receiving device (trade name Morse, manufactured by RF Co., Ltd.) and projected on a monitor connected to the wireless receiving device.

  FIG. 7 shows a state in which the forceps 30 is adjusted by rotating in the direction around the axis in the laryngopharyngeal examination treatment apparatus according to the first embodiment as described above. Similarly, FIG. 8 shows how the endoscope is adjusted by rotating in the direction around the axis. FIG. 9 shows a state in which the flexible hollow tube is adjusted by rotating it around the axis. In FIG. 9, a notched arc-shaped forceps fixing portion 25 for fixing a forceps 30 inside the metal fitting 22 provided on the end portion of the bellows-shaped flexible tube 21 to be inserted into the oral cavity, and an endoscope A notch arc-shaped endoscope fixing portion 26 for fixing 50 is provided. 7 to 9 are views taken along the arrow A in FIG.

  In addition, as shown in FIG. 10, the laryngeal pharyngeal examination and treatment apparatus according to Example 1 may be provided with an angle adjusting member 24 at the tip of the flexible hollow tube. As a result, finer adjustments such as forceps can be made, which is very convenient to use.

  As shown in FIG. 11, the pharyngeal and laryngeal examination and treatment apparatus according to Example 1 can be used by being introduced into the pharyngeal larynx from the oral cavity. Images actually taken in such a usage state are shown in FIGS. FIG. 12 is an image showing a state of removing the epiglottis tumor, and FIG. 13 is an image showing a state of removing the tonsillar tumor.

1 is a schematic configuration diagram of a laryngopharyngeal examination treatment apparatus according to a first embodiment. It is the composition schematic of the modification of the laryngeal pharynx examination treatment device concerning a 1st embodiment. It is a block schematic diagram of the laryngeal pharynx examination treatment device concerning a 2nd embodiment. It is explanatory drawing of the laryngopharyngeal test | inspection treatment apparatus which concerns on Example 1, (a) is a side view, (b) is an arrow A enlarged view, (c) is a side enlarged view at the time of opening operation of a forceps piece. It is a side view of the flexible hollow tube of this invention. It is explanatory drawing of an endoscope, (a) is a side view, (b) is an arrow A enlarged view. FIG. 5 is an arrow A view in FIG. 4 showing rotation of forceps. FIG. 6 is an arrow A view in FIG. 4 illustrating rotation of the endoscope. It is an arrow A figure in FIG. 4 which shows rotation of a flexible hollow tube. It is a figure which shows the modification of the laryngopharyngeal test | inspection treatment apparatus which concerns on Example 1. FIG. It is a figure which shows the usage condition of the laryngopharyngeal test | inspection treatment apparatus which concerns on Example 1. FIG. 3 is an image actually taken using the laryngeal pharyngeal examination treatment apparatus according to Example 1. FIG. 3 is an image actually taken using the laryngeal pharyngeal examination treatment apparatus according to Example 1. FIG. It is a side view of what is called a universal laryngopharyngeal forceps which an otolaryngologist uses for laryngopharyngeal surgery. It is a side view of the Schmidt forceps which an otolaryngologist uses for laryngopharyngeal surgery.

Explanation of symbols

DESCRIPTION OF SYMBOLS 11 ... Grip main body 12 ... Holder 13 ... Fixing screw 14 ... Holder 15 ... Fixing screw 20 ... Flexible hollow tube 21 ... Flexible tube 22 ... Metal fitting 23 ... Metal fitting 24 Angle adjustment member 25 Forceps fixing | fixed part 26 Endoscope fixing Unit 30 ... Forceps 31 ... Operation wire 32 ... Screw fitting 40 ... Trigger 41 ... Support point 42 ... Operation wire fixing screw 50 ... Endoscope 51 ... Endoscope body 52 ... Endoscope camera 53 ... Tube 54 ... CCD camera 55 ... White LED illumination 56 ... Cable 60 for transmitting an endoscope image ... Suction tube 61 ... Tube for extending the suction tube

Claims (8)

The grip body,
An operation section provided on the grip body;
It is supported by the grip body and extended forward, and it does not deform by external force received during insertion and operation into the larynx and pharynx, but can be deformed to a desired shape with external force greater than external force received during the insertion and operation. A flexible hollow tube;
An endoscope supported by the grip body and supported in an inserted state by the flexible hollow tube;
A forceps or a suction tube supported by the grip body and supported by the flexible hollow tube in an inserted state, the operation of which is controlled by an operation portion of the grip body. Laryngopharyngeal examination treatment device.   The laryngopharyngeal examination treatment device according to claim 1, wherein the flexible hollow tube is a bellows-like hollow tube.   The laryngopharyngeal examination treatment apparatus according to claim 1 or 2, wherein an angle adjusting member is provided at a distal end portion of the flexible hollow tube.   The laryngeal pharyngeal examination treatment device according to any one of claims 1 to 3, wherein adjustment in the direction around the axis of the endoscope and / or forceps is possible.   The laryngeal pharyngeal examination treatment device according to any one of claims 1 to 4, wherein adjustment of the direction around the axis of the flexible hollow tube is possible.   6. The laryngopharyngeal examination treatment device according to claim 1, wherein forceps or a suction tube are detachable.   The laryngopharyngeal examination treatment device according to any one of claims 1 to 6, wherein the flexible hollow tube is detachable.   The laryngopharyngeal examination treatment device according to any one of claims 1 to 7, wherein the endoscope includes a transmitter that converts an observation image into an electrical signal and transmits the signal wirelessly.