JP6972676B2 - Guide tube - Google Patents

Description

The present invention relates to a guide tube used in medical practice, and more particularly to a guide tube for feeding an endoscope from the papilla of Vater into the bile duct.

As a method for observing the state in the bile duct of a subject, a method of injecting a contrast medium into the bile duct and then confirming with an X-ray is known.
For example, in Patent Document 1, after the endoscope is inserted to the position of the duodenum in the body, a catheter inserted into the forceps hole of the endoscope is inserted into the bile duct from the papilla of Vater, and a contrast medium is injected from the catheter. The method of doing so is disclosed.

However, according to the method of confirming by X-ray, it may be difficult to distinguish the tumor. In addition, a method of directly photographing the inside of the bile duct with a scope inserted through the forceps hole of the endoscope is also known.

Japanese Unexamined Patent Publication No. 2002-272675

However, the scope inserted into the endoscope in this way is limited in its radial size by the diameter of the forceps hole of the endoscope. For this reason, it was difficult for a scope with a limited size to have a high resolution. If such a scope is provided with high resolution, it may not be adopted due to high cost due to technical problems. In this case, it is difficult to accurately confirm the condition in the bile duct.

The present invention has been made in view of the above problems. That is, it is an object of the present invention to provide a medical device for accurately confirming the state in the bile duct.

The guide tube of the present invention is a guide tube through which an endoscope with a camera can be inserted inside, and the guide tube feeds the endoscope into the papilla of Vater in the duodenum and has a tip. A tube main body having a bent portion on the side and having flexibility, and a bending operation portion provided at the base end portion of the tube main body to bend the bent portion are provided, and the tube main body has the bent portion. An opening is formed on the tip side of the bending starting point of the portion, and the endoscope is projected from the opening of the tube body in which the bending portion is bent toward the papilla of Vater, and the papilla of Vater is projected. It is characterized by being able to be sent inside.

The guide tube of the present invention having the above configuration is provided with a bending portion at the tip of the tube body and a bending operation portion at the base end side of the tube body, whereby the endoscope can be easily sent into the papilla of Vater. The condition inside the bile duct can be confirmed accurately.

It is a figure which shows the state which confirms the inside of a bile duct by an endoscope through the endoscope through the guide tube, and is the explanatory view explaining the whole structure. It is explanatory drawing explaining the bending operation of the bending part of the guide tube. It is a vertical sectional view of the tip part of a guide tube. It is a cross-sectional view of the bent portion of a guide tube, and is the IV-IV cross-sectional view of FIG. It is explanatory drawing which shows the inside of the bending operation part schematically. It is a figure which shows the inside of the bending operation part, and is the VI-VI sectional view of FIG. It is a perspective view which shows the stopper. It is a cross-sectional view of the guide tube in the vicinity of a balloon, and is the VIII-VIII cross-sectional view of FIG. It is a partial cross-sectional view which shows the deaeration prevention valve, the clamp and the lumen connection part. FIG. 4 is a cross-sectional view taken along the line XX of FIG. 4, showing the inner lumen. It is a perspective view which shows the state which the tip of the endoscope protrudes from a guide tube. It is sectional drawing of the guide tube which concerns on 1st modification. It is a vertical sectional view schematically showing the guide tube which concerns on the 2nd modification.

Hereinafter, embodiments of the guide tube of the present invention will be described with reference to the drawings.
It should be noted that the embodiments described below are merely examples for facilitating the understanding of the present invention, and do not limit the present invention. That is, the shapes, dimensions, arrangements, and the like of the members described below can be changed and improved without departing from the spirit of the present invention, and it goes without saying that the present invention includes equivalents thereof.
Further, in all the drawings, similar components are designated by the same reference numerals, and duplicate description will be omitted as appropriate. Further, in the following, the distal side of the guide tube is also referred to as the distal end side, and the proximal side thereof is also referred to as the proximal end side.

<About the overall configuration>
The overall configuration including the guide tube 1 according to the present embodiment will be described mainly with reference to FIGS. 1 to 4. FIG. 1 is a diagram showing a state in which the inside of the bile duct 83 in the pancreas 82 is confirmed by the endoscope 2 through the endoscope 2 in the guide tube 1, and is an explanatory diagram for explaining the overall configuration. FIG. 2 is an explanatory view illustrating the bending operation of the bending portion 3a of the guide tube 1, and FIG. 3 is a vertical sectional view of the tip portion of the guide tube 1. FIG. 4 is a cross-sectional view of the bent portion 3a of the guide tube 1, and is a cross-sectional view taken along the line IV-IV of FIG.

The guide tube 1 has a function of guiding the endoscope 2. The endoscope 2 is used for confirming the state in the bile duct 83 at the tip of the papilla of Vater 83a, and has a configuration in which the tip portion can be bent by the operation portion 2a. Further, the endoscope 2 has a size that can be used for nasal use, and is provided with a camera 2b and a light 2c at the tip portion as shown in FIG. 11 and will be described later.
Specifically, the guide tube 1 guides and feeds the endoscope 2 through the oral cavity and stomach 80 (not shown) into the papilla of Vater 83a in the duodenum 81. That is, in the procedure using the guide tube 1 of the present embodiment, the endoscope 2 which is a transnasal endoscope is orally inserted into the body cavity of the subject together with the guide tube 1.
The guide tube 1 is provided with a main lumen 20 communicating in the axial direction in the center, and is configured so that an endoscope 2 with a camera 2b (see FIG. 11) can be inserted inside.

The guide tube 1 includes a tube main body 3 having a bent portion 3a on the tip end side and having flexibility, and a bending operation portion 4 to be described later, which is provided at the base end portion of the tube main body 3 and bends the bent portion 3a. To prepare for. The tube body 3 is formed with an opening 3b (see FIG. 3) which is on the tip side of the bending starting point of the bending portion 3a, which will be described later, and which communicates with the outside on the extension of the main lumen 20 in the axial direction. ing.
The guide tube 1 includes a bent portion 3a described below at the tip end portion of the tube main body 3. Further, the guide tube 1 is provided with a bending operation portion 4 on the proximal end side of the tube main body 3, so that the bending portion 3a is bent toward the papilla of Vater 83a, and the endoscope 2 is inserted through the opening 3b of the tube main body 3. It is configured so that it can be projected and fed into the papilla of Vater 83a.

<About the tube body>
The tube body 3 is mainly composed of a flexible resin member made of nylon, nylon elastomer, polyurethane or the like, and a reinforcing member such as a coiled metallic reinforcing wire 32 or a holding wire 70. .. The reinforcing member may be a mesh-like braided member or a highly rigid resin material.
Further, the tube main body 3 is a hollow tubular and long member having a main lumen 20 formed therein, and has an inner layer 24 for determining the main lumen 20, a wire reinforcing layer 30, an operation line 60, and the like. The outer layer 50 and the surface layer 50 are provided.

The inner layer 24 determines the main lumen 20 by its inner wall surface. The wall surface of the main lumen 20 is coated with a hydrophilic lubricating coating to make the endoscope 2 slippery and facilitate relative movement with respect to the guide tube 1. The method of supplying the lubricant according to this coating will be described later.

The wire reinforcing layer 30 is a protective layer provided on the inner diameter side of the tube body 3 on the inner diameter side of the operation line 60 to protect the inner layer 24. The presence of the wire reinforcing layer 30 on the inner diameter side of the operation line 60 can prevent the operation line 60 from penetrating from the outer layer 50 to the inner layer 24 and being exposed to the main lumen 20. The wire reinforcing layer 30 is formed by winding the reinforcing wire 32. As the material of the reinforcing wire 32, in addition to the metal material, a resin material having a higher shear strength than the inner layer 24 and the outer layer 50 can be used.

In the outer layer 50, two sub-tubes 40 for movably arranging the two operation lines 60 in the tube main body 3 and a holding wire 70 are embedded, and an outer side for expanding the balloon 10 described later. Lumen 10a is formed.

As shown in FIG. 4, the two sub-tubes 40 are arranged at positions facing each other by 180 degrees with respect to the axis of the tube main body 3. The two sub-tubes 40 extend parallel to the axial direction of the tube body 3. As will be described later, three or four sub-tubes 40 may be arranged around the axis of the tube body 3 at equal intervals.
As shown in FIG. 3, the operation line 60, which will be described later, is slidably inserted into the sub-lumen 42, which is a hollow space of the sub-tube 40.

The holding wire 70 of the present embodiment is a coil, and more specifically, it is a coil in which a plurality of strands are wound in multiple rows (multi-row coil).
The holding wire 70 is spirally wound around the outside of a pair of sub-tubes 40 arranged to face each other around the main lumen 20. The winding shape of the holding wire 70 of the present embodiment is a substantially elliptical shape or a substantially rhombus shape in which the arrangement direction of the subtubes 40 is the major axis direction. In FIG. 4, the holding wire 70 having a substantially rhombic winding shape is shown by a broken line. The holding wire 70 is in contact with the peripheral surface of the sub tube 40, specifically, the outer surface of the main lumen 20 opposite to the axis.
By disposing the holding wire 70, the tube main body 3 has rigidity while having flexibility, so that kinking can be prevented.

The tube body 3 has a function of suppressing surgical invasion when the guide tube 1 is inserted into the body, and is provided with a soft protective member (hood 5) at the tip thereof. The hood 5 is made of a soft resin such as polyvinyl chloride, which is softer than the tube body 3.
The hood 5 is attached to the tip of the tube body 3 and has an opening 5a that communicates the main lumen 20 of the tube body 3 with the outside. By forming the opening 5a in the hood 5 in this way, the endoscope 2 passing through the main lumen 20 is configured to be able to project to the outside through the opening 5a of the hood 5.
The endoscope 2 is inserted into the bile duct 83 from the papilla of Vater 83a through the opening 5a in a state where the hood 5 is arranged so as to surround the circumference of the papilla of Vater 83a and abut against the inner wall of the duodenum 81.
The hood 5 according to the present embodiment is described by taking as an example a member different from the tube main body 3, but if it is made of a soft resin and can suppress surgical invasion, it is integrated with the tube main body 3. It may be formed in.

<About the function and structure of the bent part>
Next, the function and structure of the bent portion 3a will be described.
The guide tube 1 includes two operation lines 60 that pass through the inside of the tube body 3 (strictly speaking, the inside of the auxiliary lumen 42 formed inside the tube body 3).
The operation line 60 is made of a metal wire, the base end of the operation line 60 is connected to a bending operation portion 4 described later, and the tip of the operation line 60 is the tip side of the tube body 3 (particularly, the bending portion 3a). It is fixed to the ring 14 embedded in the ring 14 by soldering. The mode of fixing the operation line 60 to the ring 14 is not particularly limited, and may be fixed by solder joining, heat fusion, adhesion with an adhesive, mechanical hooking of the operation line 60 and the ring 14, and the like. ..
The operation wire 60 may be composed of a single wire rod, or may be a stranded wire composed of a plurality of fine wires twisted together. The number of thin wires constituting one stranded wire of the operation wire 60 is not particularly limited, but is preferably 3 or more. The operation wire 60 of the present embodiment is a stranded wire obtained by twisting seven strands to each other.

As the operation wire 60, low carbon steel (piano wire), stainless steel (SUS), corrosion-resistant coated steel wire, titanium or titanium alloy, or a metal wire such as tungsten can be used. In addition, as the operation line 60, polyvinylidene fluoride (PVDF), high density polyethylene (HDPE), poly (paraphenylene benzobisoxazole) (PBO), polyetheretherketone (PEEK), polyphenylene sulfide (PPS), etc. Polymer fibers such as polybutylene terephthalate (PBT), polyimide (PI), polytetrafluoroethylene (PTFE), or boron fiber can be used.

As shown in FIG. 3, the bent portion 3a is a portion from the non-formed region of the wire reinforcing layer 30 whose bending rigidity is lowered to the tip of the tube main body 3 because the reinforcing wire 32 in the tube main body 3 is not arranged. be.
The bent portion according to the present invention may have a lower bending rigidity than a portion that is not a bent portion. Therefore, the bending rigidity is not limited to the one in which the reinforcing wire 32 according to the present embodiment is not arranged. For example, the tube body 3 is made of different materials, and the bending rigidity of the material on the tip end side of the tube body 3 is lower than the bending rigidity of the material on the proximal end side. May form a bend.
Further, the base end portion of the non-formed region of the wire reinforcing layer 30 on the tip end side of the tube main body 3 corresponds to the bending starting point portion according to the embodiment of the present invention. Similarly, in this respect as well, when the bent portion is formed by the difference in the bending rigidity of the above-mentioned materials, the base end portion of the material having low bending rigidity corresponds to the bending starting point.

As shown in FIG. 2, the bent portion 3a is bent with respect to a portion on the proximal end side of the tube body 3 when the operation line 60 is drawn (traction operation) by the bending operation portion 4 described later. Specifically, the bending force 3a is bent by applying the tensile force due to the pulling of the operation line 60 to the ring 14 on the tip end side of the bending portion 3a that does not overlap the axial center of the tube body 3. Will be.
The practitioner can guide the endoscope 2 and bend the guide tube 1 passing through the duodenum 81 toward the papilla of Vater 83a by operating the bending operation unit 4 described later.

<Structure of bending operation part>
Next, the structure of the bending operation portion 4 for operating the bending condition of the bending portion 3a will be described mainly with reference to FIGS. 5 to 7. 5 is an explanatory view schematically showing the inside of the bending operation unit 4, FIG. 6 is a view showing the inside of the bending operation unit 4, a VI-VI cross-sectional view of FIG. 5, and FIG. 7 shows a stopper 27. It is a perspective view which shows.

The bending operation unit 4 rotates the action drum 15 that applies a tensile force to the two operation lines 60, the angle holding portion 4A that can hold the bending portion 3a stepwise at a plurality of bending angles, and the action drum 15. It is mainly composed of an operation knob 92, a housing 18 and a housing lid 19.

The housing 18 includes a middle plate 18a formed near the center in the vertical direction, which separates the upper space from the lower space. The guide tube 1 is passed through the lower space of the housing 18, and the working drum 15, the angle holding portion 4A, and a part of the operation knob 92 are arranged in the upper space. The middle plate 18a is formed with a through hole 18c through which the upper and lower spaces are communicated and the operation line 60 is passed.
Further, in the vicinity of the engaging member 25 in the housing 18, an insertion hole 18b for inserting a stopper 27 described later from the outside is formed.
The housing lid 19 covers the open portion of the space above the housing 18 from above, and rotatably supports the operation knob 92.

The action drum 15 is a portion that pulls the engaging end portion 60a of the operation line 60, and is formed by penetrating two insertion holes 15a in parallel in a virtual plane parallel to the axial direction of the guide tube 1. There is.

The operation knob 92 is provided with a round bar-shaped fitting portion 92a that is fitted to the upper portion of the gear portion 16 to be described later and transmits rotational torque at the lower portion. Similarly, the lower portion of the gear portion 16 is fitted to the upper portion of the working drum 15 to transmit the rotational torque. With such a configuration, when the practitioner rotates the operation knob 92, the gear portion 16 and the action drum 15 fitted to the fitting portion 92a rotate.

A drawer hole 50a is formed on both side surfaces of the guide tube 1 so that the operation line 60 can be pulled out from the inside to the outside.
The two operation lines 60 are each drawn out from the inside of the two sub-tubes 40 through the drawer holes 50a, and are passed from the lower space to the upper space via the through holes 18c, respectively. The two operation lines 60 are passed through the insertion holes 15a of the working drum 15. An engaging end portion 60a is formed at the base end portion of the two operation lines 60. The engaging end portion 60a is arranged so as to be engageable with the working end edge 15b on the base end side of the insertion hole 15a according to the rotational state of the working drum.

When the action drum 15 is rotated by the rotation operation of the operation knob 92, the action end edge 15b abuts on one of the engagement ends 60a of the two operation lines 60 and is pulled toward the base end side. Tension is applied to one of the operation lines 60. At this time, since the working end edge 15b is separated from the other engaging end portion 60a, no tension is generated in the other operating line 60. One of the operation lines 60 pulled from the engaging end portion 60a by the working end edge 15b bends the bent portion 3a at the tip of the guide tube 1 by the tension thereof.

<About the angle holder>
The angle holding portion 4A is composed of a gear portion 16, an engaging member 25, and a spring 26.
The gear portion 16 is provided with a plurality of teeth 16a protruding outward in the radial direction on the outer periphery thereof.
In the present embodiment, the engaging member 25 includes three engaging teeth 25a that can be engaged with the teeth 16a of the gear portion 16 at positions facing the teeth 16a. The engaging member 25 is urged by the spring 26 in the direction from the proximal end side toward the gear portion 16. The engaging member 25 and the gear portion 16 are arranged at positions where the engaging teeth 25a of the engaging member 25 and the teeth 16a of the gear portion 16 mesh with each other when the spring 26 is in a natural state.

When the practitioner rotates the operation knob 92, the angle holding portion 4A configured in this way causes the teeth 16a to push the engaging teeth 25a toward the proximal end side against the urging force of the spring 26. , The engaging member 25 is moved in the direction of the alternate long and short dash line shown in FIG. At this time, one of the two operation lines 60 abuts on the working edge 15b and is pulled by the working drum 15, so that the bent portion 3a is bent in one direction.
Then, when the groove portion between the adjacent teeth 16a moves to the portion of the engaging member 25 facing the engaging tooth 25a, the restoring force of the spring 26 causes the engaging member 25 to move and engage with the engaging member 25. The teeth 25a and the teeth 16a mesh with each other, and the state is temporarily maintained. That is, the state in which the bent portion 3a is bent by a predetermined angle is maintained.
Further, if the practitioner rotates the operation knob 92 so that a force equal to or greater than the urging force of the spring 26 is applied, the engaging member 25 is moved and the bent portion 3a is bent by a predetermined amount in the same manner as described above. Will be.

In this way, the angle holding portion 4A allows the bending angle of the bending portion 3a to be adjusted stepwise so that the angle is such that the papilla of Vater 83a is located on the extension of the opening 3b. Therefore, the practitioner can hold the bent portion 3a at a desired angle and easily project the endoscope 2 from the guide tube 1 toward the papilla of Vater 83a, so that the practitioner can easily access the papilla of Vater 83a. Will be.

Further, the bending operation portion 4 is provided with a bending fixing portion (stopper 27) for fixing the bending angle of the bending portion 3a shown in FIGS. 5 and 7.
The stopper 27 is a plate piece formed in a U shape having a linear groove 27a. The stopper 27 is inserted into the inside of the housing 18 through the insertion hole 18b formed in the housing 18, and the engaging member 25 is provided so that the engaging state of the engaging teeth 25a and the teeth 16a is maintained. Restrict movement. The groove 27a is for avoiding interference between the stopper 27 and the spring 26 when the stopper 27 is inserted into the inside of the housing 18 through the insertion hole 18b.
The position where the stopper 27 is inserted prevents the engaging member 25 from retracting from the gear portion 16 while accommodating the spring 26 in the groove 27a and maintaining the engaged state between the teeth 16a and the engaging teeth 25a. The position. That is, the insertion hole 18b into which the stopper 27 is inserted is formed at this position.

The practitioner inserts the endoscope 27 into the insertion hole 18b of the housing 18, fixes the engaging member 25, and fixes the bending angle of the bending portion 3a, thereby inserting the endoscope 2 into the papilla of Vater 83a. Work becomes easy.
The bending fixing portion (stopper 27) of the present embodiment limits the rotation of the gear portion 16 by limiting the movement of the engaging member 25, but the bending fixing portion (stopper 27) is designed to directly engage with the gear portion 16. It may be set to limit the rotation.
If the angle holding portion 4A can sufficiently hold the bent state of the bent portion 3a, the stopper 27 is not always necessary.
Further, as the bending fixing portion, it is sufficient that a part of the operating line 60 can be relatively fixed to the tube main body 3 so that the movement of the operating line 60 can be restricted, and the bending fixing portion is not necessarily provided in the bending operating portion 4. Not limited to.

<About balloons>
Next, in addition to FIG. 3, the balloon 10 will be described mainly with reference to FIGS. 8 and 9. 8 is a cross-sectional view of the guide tube 1 in the vicinity of the balloon 10, FIG. 3 is a cross-sectional view of VIII-VIII of FIG. 3, and FIG. 9 is a partial cross-sectional view showing a degassing prevention valve 6, a clamp 7, and a lumen connection portion 8. be.

A balloon 10 that expands radially outward of the guide tube 1 is attached to the tube body 3, and a flow path (outer lumen 10a) for sending a liquid (distilled water 10b) or a gas to the balloon 10 is formed. ing.
The balloon 10 has a function of fastening the guide tube 1 in a predetermined position in the body cavity (duodenum 81 in this embodiment) by expanding.

As shown in FIG. 9, the proximal end portion of the outer lumen 10a is connected to a syringe connecting portion 11 for connecting to a syringe (not shown) provided in the lumen connecting portion 8 via a connecting tube 11a. Distilled water 10b is pushed from a plunger (not shown) and filled into the balloon 10 via the syringe connection portion 11 and the like and the outer lumen 10a, whereby the balloon 10 is expanded.
Further, as shown in FIG. 3, the balloon 10 is arranged away from the bending portion 3a toward the proximal end side so as not to affect the bending operation of the bending portion 3a.
As described above, the bent portion 3a is bent at the portion where the bending rigidity is lowered due to the arrangement of the reinforcing wire 32.
In the present embodiment, the boundary between the portion where the reinforcing wire 32 is not arranged and the portion where the reinforcing wire 32 is arranged is the position on the most proximal side, which is the proximal end of the bending of the bent portion 3a. Therefore, the balloon 10 is arranged so that the tip of the balloon 10 is located closer to the proximal end side than the boundary position so as not to affect the bending motion of the bending portion 3a.

As described above, the balloon 10 is attached to the tube body 3, and a flow path (outer lumen 10a) for sending a liquid or gas to the balloon 10 is formed. Therefore, the balloon 10 can be expanded to fix the guide tube 1 at a predetermined position, and the endoscope 2 can be stably fed into the papilla of Vater 83a.
Specifically, when the endoscope 2 is inserted into the body by the frictional force caused by the contact between the inner surface of the guide tube 1 and the outer surface of the endoscope 2 at a plurality of points, the endoscope 2 is inserted. The guide tube 1 tries to move. At this point, the balloon 10 expands and presses against the inner wall of the duodenum 81, so that the guide tube 1 can be fixed at a predetermined position of the duodenum 81. Therefore, the balloon 10 can prevent the guide tube 1 from moving with the endoscope 2, and the endoscope 2 can easily protrude from the guide tube 1.
As long as the balloon 10 can be expanded and contracted, the fluid filled in the balloon 10 is not limited to the distilled water 10b, and may be another liquid or gas.

<Lumen for lubricant>
Next, the lumen for the lubricant will be described mainly with reference to FIG. 10 in addition to FIGS. 3 and 9.
In addition to the main lumen 20 through which the endoscope 2 is passed, the tube main body 3 is formed with a sub-lumen (inner lumen 21) communicating with the main lumen 20 in the tube main body 3.
The inner lumen 21 has a function of introducing a lubricant into the main lumen 20 through the plurality of openings 21a.
As shown in FIG. 9, the proximal end portion of the inner lumen 21 is connected to a syringe connecting portion 12 for connecting to a syringe (not shown) provided in the lumen connecting portion 8 via a connecting tube 12a. A lubricant (not shown) is pushed in from a plunger (not shown) and supplied into the main lumen 20 via the syringe connection portion 12 and the like and the inner lumen 21.
By forming the sub-lumen (inner lumen 21) communicating with the main lumen 20 in the tube body 3 in this way, the lubricant can be supplied to the main lumen 20 via the sub-lumen (inner lumen 21). It will be possible. The lubricant supplied in the main lumen 20 allows the endoscope 2 to be smoothly moved relative to the guide tube 1 when the endoscope 2 is sent into the papilla of Vater 83a.
In particular, at least a part of the opening 21a is formed at a position corresponding to the bent portion 3a in the main lumen 20. When the tube body 3 is bent, the endoscope 2 is likely to come into contact with the bent portion 3a. In this way, by supplying the lubricant from the inner lumen 21 through the opening 21a into the main lumen 20 at the position of the bent portion 3a, the endoscope 2 can be more smoothly projected from the tube body 3. Is possible.
Further, the number of openings 21a is not limited to the number shown in FIG. 10, and a plurality of openings 21a may be formed.

The timing of supplying the lubricant into the main lumen 20 is not limited to the time when the endoscope 2 is projected from the guide tube 1 toward the papilla of Vater 83a. For example, when the guide tube 1 and the endoscope 2 are inserted into the body, the lubricant may be supplied into the main lumen 20. By doing so, it is possible to prevent the guide tube 1 and the endoscope 2 from interfering with each other when the guide tube 1 and the endoscope 2 are inserted into the body.

<About fixing the endoscope>
Next, the clamp 7 for locking and unlocking the guide tube 1 and the endoscope 2 will be described with reference to FIG. 11 in addition to FIG. FIG. 11 is a perspective view showing a state in which the tip end portion of the endoscope 2 is projected from the guide tube 1.
The guide tube 1 itself does not have a camera. Therefore, if only the guide tube 1 is inserted into the body, the position of the tip of the guide tube 1 cannot be grasped, and it is difficult to suppress surgical invasion such as contact with the inner wall of the stomach 80 or the duodenum 81. The guide tube 1 according to the present embodiment is not inserted into the body by itself, but is inside the body by using the camera 2b provided in the endoscope 2 with the endoscope 2 attached to the guide tube 1. It is to be inserted into.

The guide tube 1 is provided with a locking mechanism (clamp 7) for locking and unlocking the endoscope 2 so that the camera 2b can be maintained in the vicinity of the tip of the guide tube 1.
The lock mechanism (clamp 7) is provided so as to be lockable with the camera 2b exposed from the guide tube 1. Specifically, the clamp 7 is mainly composed of a pair of portions formed in an arc shape, and the pair of portions are connected so as to be able to form a virtual circle. This pair has a pair of opposite end pieces 7a, and a hexagonal screw 7b is passed through the pair of end pieces 7a. A female screw hole is formed in one of the pair of end pieces 7a.
Then, when the hexagonal screw 7b is tightened, the pair of end pieces 7a approach each other, so that the diameter of the clamp 7 is narrowed, and a load is applied to the guide tube 1 in the central direction to deform the main lumen 20 locally. It can be narrowed down to and locked with respect to the endoscope 2.
On the contrary, if the hexagonal screw 7b is loosened, the pair of end pieces 7a are separated from each other, the diameter of the clamp 7 is widened, the load in the central direction on the guide tube 1 is weakened, and the lock on the endoscope 2 is released. The Rukoto.

Further, the state in which the camera 2b is exposed from the guide tube 1 is not limited to the state in which the camera 2b is completely exposed to the outside of the guide tube 1. A state in which the outside of the guide tube 1 can be projected, for example, a state in which the camera 2b is located inside the guide tube 1 and includes a state in which the outside can be projected from the opening 3b of the guide tube 1. ..
The guide tube 1 can be inserted into the body with the guide tube 1 and the endoscope 2 locked. Therefore, the guide tube 1 and the endoscope 2 can be inserted into the body while confirming the insertion positions of the guide tube 1 and the endoscope 2 by the camera 2b of the endoscope 2.
As a specific treatment method, when the papilla of Vater 83a enters the field of view of the camera 2b, the bending portion 3a is bent by the bending operation portion 4. Further, the lock by the clamp 7 is released so that the endoscope 2 is projected from the guide tube 1 and the endoscope 2 is fed toward the papilla of Vater 83a.

<About the degassing prevention valve>
As shown in FIG. 9, a degassing prevention valve 6 is provided on the base end side of the tube body 3.
The degassing prevention valve 6 prevents the flow of gas from the tip end to the base end of the tube main body 3, and has a substantially cylindrical main body 6a and a sealing film 6b attached to the inner surface of the main body 6a. Be prepared.
The sealing film 6b has a hole penetrating in the thickness direction in the central portion in the radial direction, and is formed so as to undulate toward the tip end side and the base end portion side toward the inside in the radial direction. It is formed to have elasticity in the direction.
The degassing prevention valve 6 thus formed is passed through the hole of the sealing film 6b, and the side surface of the base end portion of the guide tube 1 is aligned with the inner surface of the main body 6a so that the sealing film 6b is formed. Attach it so that it abuts on the tip surface of the guide tube 1. The degassing prevention valve 6 attached in this way can seal the space between the guide tube 1 and the tube body 3. According to the degassing prevention valve 6, even if there is a gap between the guide tube 1 and the degassing prevention valve 6, the gas introduced into the stomach 80, the duodenum 81, etc. is degassed from this gap. Can be prevented. Therefore, the internal organs such as the stomach 80 can be kept inflated with gas, and the guide tube 1 can be easily inserted into the internal organs.

Further, a mouthpiece 9 is attached to the tip end side of the guide tube 1 with respect to the bending operation portion 4 so as to be fitted into the oral cavity of a person to facilitate the passage of the guide tube 1. The mouthpiece 9 can prevent gas from leaking from the outside of the guide tube 1.

(First modification)
The guide tube 1 according to the above embodiment has been described as including an operation line 60 arranged at a position 180 degrees opposite to the axis of the tube body 3 and a sub tube 40 into which the operation line 60 is loosely inserted. However, the present invention is not limited to such a configuration, and as in the guide tube 1X shown in FIG. 12, the operation line 60 and the operation line 60 are loosely inserted at positions facing each other at 90 degrees with respect to the axis of the tube body 3. It may be provided with a sub tube 40. FIG. 12 is a cross-sectional view of the guide tube 1X according to the first modification.
According to the guide tube 1X having such a configuration, the degree of freedom in the bending direction of the bent portion 3a can be further increased, and the operability of the guide tube 1X can be improved. In this case, the bending operation portion may be spherical.

(Second modification)
In the guide tube 1 according to the above embodiment, the opening 3b of the main lumen 20 is formed in the axial direction of the guide tube 1, and the endoscope 2 protrudes from the opening 3b. However, the present invention is not limited to such a configuration, and as in the guide tube 1Y shown in FIG. 13, a horizontal hole 1Ya perpendicular to the axial direction of the guide tube 1Y is formed, so that the horizontal hole 1Y can be formed. The endoscope 2 may be configured to protrude. FIG. 13 is a vertical sectional view schematically showing the guide tube 1Y according to the second modification.
According to the guide tube 1Y having such a configuration, even if the bending due to the bending portion 3a is small, the papilla of Vater 83a on the wall surface of the duodenum 81 can be easily accessed. Further, depending on the arrangement relationship between the guide tube 1Y and the papilla of Vater 83a, the endoscope 2 can be inserted into the papilla of Vater 83a without bending the bending portion 3a.

The above embodiment includes the following technical ideas.
(1) A guide tube through which an endoscope with a camera can be inserted inside.
The guide tube feeds the endoscope into the papilla of Vater in the duodenum.
A tube body that has a bent part on the tip side and has flexibility,
A bending operation portion provided at the base end portion of the tube body and for bending the bending portion is provided.
The tube body has an opening formed on the tip end side of the bending starting point of the bending portion.
A guide tube configured so that the endoscope can be projected into the papilla of Vater by projecting the endoscope from the opening of the tube body in which the bent portion is bent toward the papilla of Vater.
(2) An operation line that is connected to the bending operation portion and passes through the inside of the tube body is provided.
The tip of the operation line is fixed to the tip side of the bent portion.
The guide tube according to (1), wherein the bent portion is bent by drawing the operation line by operating the bending operation portion.
(3) Further provided with a locking mechanism for locking and unlocking the endoscope,
The guide tube according to (1) or (2), wherein the locking mechanism is provided so as to be lockable with the camera exposed from the guide tube.
(4) A balloon that expands radially outward of the guide tube is attached to the tube body, and a flow path for sending a liquid or gas to the balloon is formed from (1) to (3). ) The guide tube according to any one of the items.
(5) In addition to the main lumen through which the endoscope is passed, a sublumen communicating with the main lumen is formed in the tube main body according to any one of (1) to (4). The guide tube described in.
(6) The guide tube according to any one of (1) to (5), further comprising an angle holding portion capable of stepwisely holding the bent portion at a plurality of bending angles.
(7) The guide tube according to any one of (1) to (6), further comprising a bending fixing portion for fixing the bending angle of the bending portion.
(8) A degassing prevention valve is provided on the base end side of the tube body.
The guide tube according to any one of (1) to (7), wherein the degassing prevention valve prevents gas from flowing from the tip end to the base end of the tube body.
(9) The guide tube according to any one of (1) to (8), wherein the tube main body is provided with a soft protective member at its tip.

1,1X, 1Y guide tube 1Y side hole 2 endoscope (endoscope with camera)
2a Operation part 2b Camera 2c Light 3 Tube body 3a Bending part 3b Opening part 4 Bending operation part 4A Angle holding part 5 Hood (protective member)
5a Opening 6 Degassing prevention valve 6a Main body 6b Sealing membrane 7 Clamp (lock mechanism)
7a End piece 7b Hexagon screw 8 Lumen connection 9 Mouthpiece 10 Balloon 10a Outer lumen (flow path)
10b Distilled water 11, 12 Syringe connection part 11a, 12a Connecting tube 14 Ring 15 Working drum 15a Insertion hole 15b Working end edge 16 Gear part (angle holding part)
16a Tooth 18 Housing 18a Middle plate 18b Insertion hole 18c Through hole 19 Housing lid 20 Main lumen 21 Inner lumen (sub lumen)
21a Opening 24 Inner layer 25 Engaging member (angle holding part)
25a Engagement tooth 26 Spring 27 Stopper (bending and fixing part)
27a Groove 30 Wire Reinforcing Layer 32 Reinforcing Wire 40 Subtube 42 Sub-Lumen 50 Outer Layer 50a Drawer Hole 60 Operating Line 60a Engaging End 70 Holding Wire 80 Stomach 81 Duodenum 82 Pancreas 83 Bile Duct 83a Ferter Papillary 92 Operation Knob 92a Fitting

Claims (7)

A guide tube through which an endoscope with a camera can be inserted inside.
The guide tube feeds the endoscope into the papilla of Vater in the duodenum.
A tube body that has a bent part on the tip side and has flexibility,
An operation line disposed in the tube body and having the tip fixed to the tip side of the tube body,
Provided at the base end portion of the tube body, and a bending action portion to the proximal end of the operation wire is connected is bent the bent portion,
A bending fixing portion for fixing the bending angle of the bending portion is provided.
The tube body has an opening formed on the tip end side of the bending starting point of the bending portion.
The endoscope is configured to be able to be fed into the papilla of Vater by projecting the endoscope from the opening of the tube body in which the bent portion is bent toward the papilla of Vater .
The bending operation portion includes an angle holding portion capable of stepwisely holding the bending portion at a plurality of bending angles.
The angle holding portion includes a gear portion having a plurality of teeth and an engaging member having engaging teeth that can be engaged with the teeth.
The bending fixing portion is a guide tube arranged at a position that restricts the operation of the gear portion or the engaging member. An operation line connected to the bending operation portion and passing through the inside of the tube body is provided.
The tip of the operation line is fixed to the tip side of the bent portion.
The guide tube according to claim 1, wherein the bent portion is bent by drawing the operation line by operating the bending operation portion. Further provided with a locking mechanism for locking and unlocking the endoscope,
The locking mechanism is a clamp composed of a pair of arcuate parts and a screw screwed into each opposite end of the pair of parts.
The clamp is attached to the outer periphery of the tube body, and with the endoscope inserted through the tube body, the screw is tightened to apply a load in the center direction to the tube body so that the camera can perform the camera. The guide tube according to claim 1 or 2, which is provided so that the endoscope can be locked while being exposed from the guide tube. One of claims 1 to 3, wherein a balloon that expands radially outward of the guide tube is attached to the tube body, and a flow path for sending a liquid or gas to the balloon is formed. The guide tube described in the section. The guide tube according to any one of claims 1 to 4, wherein the tube body has a main lumen through which the endoscope is passed and a sublumen communicating with the main lumen is formed in the tube body. .. A degassing prevention valve is provided on the base end side of the tube body.
The degassing prevention valve is provided with a main body and a sealing film attached to the inner surface of the main body to prevent the flow of gas from the tip end to the base end of the tube main body .
The sealing film has a hole in the central portion in the radial direction through which the tube body is passed through in the thickness direction, and undulates toward the tip end side and the base end portion side toward the inside in the radial direction. The guide tube according to any one of claims 1 to 5 , which is formed. The guide tube according to any one of claims 1 to 6 , wherein the tube body is provided with a soft protective member at the tip thereof.

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