JP7639375B2 - Lacrimal Endoscopy - Google Patents

Description

The present invention relates to a lacrimal endoscope.

Lacrimal endoscopes have been developed for use in the examination or treatment of the lacrimal duct (for example, Patent Documents 1 and 2). Lacrimal endoscopes such as those shown in Patent Documents 1 and 2 are provided with an insertion section that can be inserted into the patient's lacrimal duct. The insertion section is tubular, and at its tip, a light that illuminates the subject to be examined and an objective lens that focuses light reflected from the surface of the subject to be examined are provided.

Patent No. 4124423 Patent No. 6180449

When the tubular insertion section of a lacrimal endoscope is used for the examination or treatment of an organ such as the nasolacrimal duct, it is conceivable that a foreign body (e.g., a protein mass) that is stuck in the organ such as the nasolacrimal duct may be pushed out by the tip of the insertion section. In such a case, it is conceivable that a bending moment is generated in the insertion section when the insertion section pushes out the foreign body. Here, the length of the insertion section used for examination or treatment of the nasolacrimal duct is long enough to reach from the lacrimal punctum to the opening of the nasolacrimal duct. Therefore, the degree of bending moment acting on the insertion section becomes large. As a result, there is a possibility that the insertion section may become deformed.

The present invention aims to provide a technology that suppresses deformation of the tubular insertion section of a lacrimal endoscope that has a predetermined length or more and is inserted into an organ to be examined or treated for examination or treatment.

To solve the above problems, the present invention adopts the following configuration.

That is, a lacrimal endoscope according to one aspect of the present invention comprises a tubular insertion section that can be inserted into a lacrimal duct, and an operating section that has a holding section that holds the base end of the insertion section and can operate the insertion section, the outer diameter of the insertion section is 0.91 mm or more and 0.94 mm or less and is substantially uniform along the longitudinal direction, the length of the insertion section is 30 mm or more and 60 mm or less, and the hardness of the insertion section is Vickers hardness 400 HV or more and 450 HV or less.

According to this configuration, the user can insert the insertion part into the patient's lacrimal duct and reach the organ to be examined or treated. Therefore, the path from the lacrimal punctum to the organ to be examined or treated, and the organ to be examined or treated itself can be examined or treated. Furthermore, according to this configuration, the length of the insertion part is 30 mm or more and 60 mm or less. Therefore, for example, when pushing out a foreign body stuck in the organ to be examined or treated with the tip of the insertion part, a large bending moment may be generated in the insertion part. However, the outer diameter of the insertion part in this configuration is 0.91 mm or more and 0.94 mm or less, and the hardness of the insertion part is Vickers hardness 400 HV or more and 450 HV or less. Therefore, deformation of the entire insertion part due to the bending moment acting on the insertion part is suppressed.

Furthermore, with this configuration, the outer diameter of the insertion portion is approximately uniform along the longitudinal direction, which allows the insertion portion to reach the organ to be examined or treated more smoothly than when the insertion portion is tapered so that the outer diameter increases from the distal end to the proximal end.

In the lacrimal endoscope according to the above aspect, the holding section may have an elastic member arranged to cover the outer surface of the base end of the insertion section.

According to this configuration, the length of the insertion portion is 30 mm or more and 60 mm or less. Therefore, for example, when a foreign body stuck in an organ to be examined or treated is pushed out with the tip of the insertion portion, a large bending moment may be generated in the insertion portion. A bending moment larger than the bending moment generated at the tip or center of the insertion portion acts on the base end of the insertion portion. However, according to this configuration, when the base end of the insertion portion tries to deform, the elastic member covering the outer surface of the base end of the insertion portion deforms, so deformation of the base end of the insertion portion is suppressed.

In addition, with this configuration, the outer diameter of the insertion portion is 0.91 mm or more and 0.94 mm or less, and the hardness of the insertion portion is Vickers hardness 400 HV or more and 450 HV or less. Therefore, when a bending moment acts on the tip of the insertion portion, it is expected that deformation at the center of the insertion portion will be suppressed, while the load will be concentrated at the base end of the insertion portion. However, with this configuration, deformation of the base end of the insertion portion is suppressed by the elastic member that covers the outer surface of the base end of the insertion portion.

The lacrimal endoscope according to the above aspect further includes a first tube provided inside the insertion section along the longitudinal direction of the insertion section, through which light incident from the tip of the insertion section passes, and a second tube provided inside the insertion section along the longitudinal direction of the insertion section, through which fluid flowing out from the tip of the insertion section passes, and the insertion section, the first tube, and the second tube may each be made of a material containing metal.

With this configuration, the insertion section, the first tube, and the second tube are each made of a material that contains metal, which improves the rigidity of the insertion section, the first tube, and the second tube. Therefore, deformation of the insertion section, the first tube, and the second tube is suppressed.

In the lacrimal endoscope according to one aspect described above, the first tube and the second tube may be arranged so as to be in contact with the inner wall of the insertion section and to be in contact with each other.

According to this configuration, the first tube and the second tube are arranged so as to be in contact with the inner wall of the insertion section, respectively, and so as to be in contact with each other. Therefore, the insertion section, the first tube, and the second tube can act as one body to resist the bending moment that occurs in the insertion section. Therefore, deformation of the insertion section, the first tube, and the second tube is suppressed.

In the lacrimal endoscope according to one aspect described above, the first tube and the second tube are arranged side by side in the radial direction of the insertion section, and the cross section of the second tube perpendicular to the longitudinal direction is substantially semicircular, and a straight portion of the substantially semicircular shape may be in contact with the first tube.

With this configuration, the cross-sectional area of the second tube can be increased without changing the thickness of the insertion portion, thereby increasing the flow rate of fluid passing through the second tube.

In the lacrimal endoscope according to the above aspect, the ratio of the Vickers hardness of the insertion portion to the outer diameter of the insertion portion may be in the range of 421 to 500, and the ratio of the Vickers hardness of the insertion portion to the length of the insertion portion may be in the range of 6 to 15.

If the ratio of the Vickers hardness of the insertion part to the outer diameter of the insertion part is within the above range, and the ratio of the Vickers hardness of the insertion part to the length of the insertion part is within the above range, even if a bending moment occurs in the insertion part when pushing out a protein mass stuck in an organ to be examined or treated with the tip of the insertion part, it is possible to ensure a hardness of the insertion part that is sufficient to resist the value of the bending moment that occurs, thereby suppressing deformation of the insertion part.

The present invention provides a technology that suppresses deformation of the tubular insertion section of a lacrimal endoscope that has a predetermined length or more and is inserted into an organ to be examined or treated for examination or treatment.

FIG. 1 illustrates an example of the configuration of a lacrimal endoscope according to an embodiment. FIG. 2 shows an outline of an enlarged view of the tip of the insertion section. FIG. 3 illustrates a partially enlarged cross-sectional view of the holding portion. FIG. 4 shows the situation when a lacrimal endoscope is used.

The following describes an embodiment of the present invention. The embodiment described below is an example of an embodiment of the present invention, and does not limit the technical scope of the present invention to the following aspects.

Figure 1 shows an example of the configuration of a lacrimal endoscope 1 according to an embodiment of the present invention. As shown in Figure 1, the lacrimal endoscope 1 has an insertion section 2. The outer shape of the insertion section 2 is formed by a highly rigid stainless steel outer pipe 7 (detailed in Figure 2). The outer pipe 7 is a cylindrical member with a total length of approximately 30 mm to 60 mm and an outer diameter of approximately 0.91 mm.

The outer diameter is generally uniform over the entire length of the outer pipe 7. The outer pipe 7 has a portion that extends linearly from the base end toward the tip, and a portion that curves in a specific direction as it extends. The insertion section 2 has a small and generally uniform outer diameter, so it can be easily inserted into the patient's lacrimal canaliculus 52 (see FIG. 4, described later).

The lacrimal endoscope 1 also includes an operating unit 3 that can operate the insertion portion 2. The operating unit 3 has a thickness that allows the user to grasp it. The operating unit 3 also includes a holding unit 4 that holds and fixes the base end of the insertion portion 2.

The operation unit 3 also includes a first connection unit 5 to which a supply tube through which physiological saline (an example of a fluid of the present invention) supplied from an external device passes is connected. The operation unit 3 also includes a second connection unit 6 to which a transmission cable for transmitting and receiving light between the operation unit 3 and an external imaging system is connected.

Figure 2 shows an overview of an enlarged view of the tip of the insertion section 2 as viewed from the longitudinal direction. As shown in Figure 2, the insertion section 2 has a light guide 8 inside the outer pipe 7. The light guide 8 is, for example, a bundle of multiple illumination optical fibers, and is provided along the longitudinal direction of the outer pipe 7. The light guide 8 also extends to the inside of the operation section 3, and its tip is connected to the second connection section 6. In other words, light supplied from an external imaging system via the second connection section 6 passes through the inside of the light guide 8. The light that passes through the light guide 8 illuminates the surface of the observation object.

The insertion section 2 also has an image fiber pipe 9 inside the outer pipe 7. The image fiber pipe 9 is a cylindrical member made of stainless steel with high rigidity, and is provided so as to contact the inner wall of the outer pipe 7. A plurality of image fibers 10 are provided inside the image fiber pipe 9 along the longitudinal direction. A lens 11 is provided at the tip of the image fiber pipe 9.

The lens 11 focuses the light that is irradiated from the tip of the light guide 8 and reflected on the surface of the object to be observed. The light focused by the lens 11 passes through the image fiber 10. The image fiber 10 also extends to the inside of the operation unit 3, and its tip is connected to the second connection unit 6. In other words, the light that passes through the image fiber 10 is transmitted to an external imaging system. Here, the image fiber pipe 9 is an example of the "first tube" of the present invention.

The insertion section 2 has a channel pipe 12 inside the outer pipe 7. The channel pipe 12 is a highly rigid stainless steel cylindrical member, and the cross section perpendicular to the longitudinal direction is approximately semicircular. The channel pipe 12 is arranged to be aligned with the image fiber pipe 9 in the radial direction of the outer pipe 7. The channel pipe 12 is arranged so that the approximately semicircular straight portion is in contact with the outer surface of the image fiber pipe 9, and the approximately semicircular arc portion is in contact with the inner wall of the outer pipe 7. Thus, the insertion section 2, the image fiber pipe 9, and the channel pipe 12 are each members formed of a highly rigid metal material, and can be integrated to resist the bending moment generated in the insertion section 2. Thus, deformation of the insertion section 2, the image fiber pipe 9, and the channel pipe 12 is suppressed. The hardness of such an insertion section 2 is a Vickers hardness of 400 HV or more and 450 HV or less. The channel pipe 12 is also an example of the "second tube" of the present invention.

In addition, a water passage channel 13 is provided inside the channel pipe 12 along the longitudinal direction. The water passage channel 13 extends into the inside of the operation section 3, and its tip is connected to the first connection section 5. In other words, physiological saline supplied from an external device via the first connection section 5 flows into the water passage channel 13. This physiological saline can flow out from the tip of the water passage channel 13 on the insertion section 2 side to the outside. Although not shown, the operation section 3 is provided with a water passage operation section for performing an operation to cause physiological saline to flow in from the external device via the first connection section 5 and to flow out from the tip of the water passage channel 13 on the insertion section 2 side to the outside.

Here, the cross section perpendicular to the longitudinal direction of the channel pipe 12 is approximately semicircular, and the straight portion of the approximately semicircular shape is in contact with the outer surface of the image fiber pipe 9. By making the cross section of the channel pipe 12 approximately semicircular in this manner, the cross-sectional area of the channel pipe 12 can be made larger without changing the diameter of the outer pipe 7 of the insertion section 2, compared to when a channel pipe 12 with a circular cross section is used. Therefore, the flow path area of the water channel 13 can be made larger, and the flow rate of physiological saline passing through the water channel 13 can be increased.

Figure 3 illustrates an example of a partially enlarged cross section parallel to the longitudinal direction of the holding portion 4. As shown in Figure 3, the holding portion 4 has a hole 14 through which the base end of the insertion portion 2 can be inserted. In addition, in the radial direction of the insertion portion 2, a gap is provided between the outer wall of the insertion portion 2 and the inner wall of the hole 14, and this gap is filled by a damper 15. The damper 15 is an elastic member that can expand and contract in the radial direction of the insertion portion 2.

Here, when the tip of the insertion part 2 is inserted into the lacrimal canaliculus 52, the lacrimal sac 53, or the nasolacrimal duct 54 (described later) for examination or treatment, if there is a foreign body (e.g., a protein mass) stuck in these organs, it is considered that the foreign body is pushed out by the tip of the insertion part. In such a case, since the length of the insertion part 2 is long, about 30 mm to 60 mm, it is considered that a large bending moment is generated in the insertion part 2. In particular, it is considered that a bending moment larger than the bending moment generated at the tip or center of the insertion part 2 is generated at the base end of the insertion part 2. Therefore, it is considered that the base end of the insertion part 2 is more easily deformed than the tip or center of the insertion part 2. However, when the base end of the insertion part 2 tries to deform, the damper 15 elastically deforms, thereby suppressing the deformation of the base end of the insertion part 2.

The outer diameter of the insertion portion 2 is approximately 0.91 mm, and the hardness of the insertion portion 2 is approximately Vickers hardness 400 HV to 450 HV. Therefore, when a bending moment acts on the tip of the insertion portion 2, it is expected that deformation at the center of the insertion portion 2 is suppressed, while the load is concentrated at the base end of the insertion portion 2. However, the damper 15 covering the outer surface of the base end of the insertion portion 2 elastically deforms, suppressing deformation of the base end of the insertion portion 2.

Next, an example of how the lacrimal endoscope 1 is used will be described. FIG. 4 shows a situation in which the lacrimal endoscope 1 is used. The user holds the operating unit 3 of the lacrimal endoscope 1 and inserts the tip of the insertion part 2 from one of the two lacrimal puncta 51 located near the eye to the lacrimal canaliculus 52. Here, for example, according to "Importance of Endoscopes in Lacrimal Surgery, Katsuaki Kurihashi, Head and Neck Surgery, Vol. 8, No. 1," the sum of the total length of the lacrimal canaliculus 52 and the length of the lacrimal sac 53 is, for example, about 16 mm to 30 mm. Therefore, when the insertion part 2, which has a total length of, for example, about 30 mm, is further inserted, the tip of the insertion part 2 reaches the lacrimal sac 53. Also, when the total length of the insertion part 2 is, for example, about 60 mm, which is longer than 30 mm, when the insertion part 2 is further inserted, the tip of the insertion part 2 reaches the opening of the nasolacrimal duct 54 located further back in the lacrimal sac 53.

When the insertion portion 2 is inserted into the lacrimal canaliculus 52, lacrimal sac 53, or nasolacrimal duct 54, it is conceivable that the tip of the insertion portion 2 may push out foreign matter (e.g., protein clumps) that has become lodged in these organs. In such a case, since the overall length of the insertion portion 2 is long, about 30 mm to 60 mm, a large bending moment may be generated in the insertion portion 2. However, the outer diameter of the insertion portion 2 is about 0.91 mm, and the hardness of the insertion portion 2 is a Vickers hardness of 400 HV or more and 450 HV or less. Therefore, deformation of the entire insertion portion 2 due to the bending moment acting on the insertion portion 2 is suppressed.

In addition, while the insertion section 2 reaches the lacrimal canaliculus 52, the lacrimal sac 53, or the nasolacrimal duct 54, the light passing through the light guide 8 irradiates the inner wall surface of the lacrimal canaliculus 52, the lacrimal sac 53, or the nasolacrimal duct 54. Then, the light reflected on the inner wall surface of the lacrimal canaliculus 52, the lacrimal sac 53, or the nasolacrimal duct 54 is collected via the lens 11. The light collected by the lens 11 passes through the image fiber 10. Then, the light passing through the image fiber 10 is transmitted to an external imaging system. Then, in the external imaging system, an image of the inner wall surface of the lacrimal canaliculus 52, the lacrimal sac 53, or the nasolacrimal duct 54 is formed from the transmitted light. Thus, the lacrimal canaliculus 52, the lacrimal sac 53, or the nasolacrimal duct 54 can be examined or treated.

In addition, while the insertion portion 2 is being inserted toward the nasolacrimal duct 54, the user can operate the water flow operation portion of the operation portion 3 to cause saline to flow in from an external device via the first connection portion 5 and cause the saline to flow out from the tip of the water flow channel 13 on the insertion portion 2 side. This operation causes saline to flow into the lacrimal canaliculus 52, which then expands. Thus, the insertion portion 2 can be smoothly inserted into the lacrimal canaliculus 52. In addition, the outer diameter of the insertion portion 2 is not tapered and is substantially uniform, which also allows the insertion portion 2 to be smoothly inserted into the lacrimal canaliculus 52.

The lacrimal canaliculus 52 is also washed with saline. This allows clearer images of the lacrimal canaliculus 52, lacrimal sac 53, or nasolacrimal duct 54 to be obtained.

<Other embodiments>
The length of the insertion portion 2 may be set in the range of 30 mm to 60 mm so that the ratio of the Vickers hardness of the insertion portion 2 to the outer diameter of the insertion portion 2 falls within the range of 6 to 15. When the length of the insertion portion 2 is set in this manner, even if a foreign body stuck in an organ such as the nasolacrimal duct 54 is pushed out with the tip of the insertion portion 2, the hardness of the insertion portion 2 can be secured to be sufficiently large against the value of the bending moment acting on the insertion portion 2 when pushing out the foreign body. Therefore, deformation of the insertion portion 2 is suppressed.

The outer diameter of the insertion portion 2 may be in the range of 0.91 mm to 0.94 mm. When the range of the outer diameter of the insertion portion 2 is determined as described above, the outer diameter of the insertion portion 2 may be set so that the ratio of the Vickers hardness of the insertion portion 2 to the outer diameter of the insertion portion 2 is in the range of 421 to 500. When the outer diameter of the insertion portion 2 is set in this manner, even if a foreign body stuck in an organ such as the nasolacrimal duct 54 is pushed out with the tip of the insertion portion 2, the hardness of the insertion portion 2 can be secured to be sufficiently large relative to the value of the bending moment acting on the insertion portion 2 when pushing out. Therefore, deformation of the insertion portion 2 is suppressed.

The outer pipe 7, the image fiber pipe 9, and the channel pipe 12 may be made of a metal material other than stainless steel. At least one of the outer pipe 7, the image fiber pipe 9, and the channel pipe 12 does not have to be made of metal. The inner wall of the outer pipe 7, the outer wall of the image fiber pipe 9, and the outer wall of the channel pipe 12 do not have to be in contact with each other, and the cross-sectional shape of the channel pipe 12 in the longitudinal direction does not have to be semicircular. A damper 15 does not have to be provided around the base end of the insertion section 2 in the holding section 4.

The embodiments and variations disclosed above can be combined with each other.

1: Lacrimal endoscope 2: Insertion section 3: Operation section 4: Holding section 5: First connection section 6: Second connection section 7: Outer pipe 8: Light guide 9: Image fiber pipe 10: Image fiber 11: Lens 12: Channel pipe 13: Water flow channel 14: Hole 15: Damper 51: Lacrimal punctum 52: Lacrimal canaliculus 53: Lacrimal sac 54: Nasolacrimal duct

Claims (5)

A tubular insertion part that can be inserted into the lacrimal duct;
an operation unit having a holding unit for holding a base end of the insertion unit and capable of operating the insertion unit,
The outer diameter of the insertion portion is equal to or greater than 0.91 mm and equal to or less than 0.94 mm, and is substantially uniform along the longitudinal direction.
The length of the insertion portion is 30 mm or more and 60 mm or less,
The hardness of the insertion portion is 400 HV or more and 450 HV or less in Vickers hardness,
the holding portion has a hole through which the base end of the insertion portion can be inserted, and an elastic member provided so as to cover an outer surface of the base end of the insertion portion,
A gap provided between an outer wall of the insertion portion and an inner wall of the hole is filled with the elastic member.
Lacrimal endoscopy. a first tube provided inside the insertion portion along a longitudinal direction of the insertion portion, the first tube through which light incident from a tip of the insertion portion passes;
A second tube is provided inside the insertion portion along the longitudinal direction of the insertion portion, and through which a fluid flowing out from the tip of the insertion portion passes,
the insert, the first tube, and the second tube are each formed from a material including a metal;
The lacrimal endoscope according to claim 1 . The first tube and the second tube are provided so as to be in contact with an inner wall of the insertion portion and to be in contact with each other.
The lacrimal endoscope according to claim 2 . The first tube and the second tube are arranged side by side in a radial direction of the insertion portion,
A cross section of the second tube perpendicular to the longitudinal direction is substantially semicircular,
The substantially semicircular straight portion is in contact with the first tube.
The lacrimal endoscope according to claim 2 or 3 . A tubular insertion part that can be inserted into the lacrimal duct;
an operation unit having a holding unit for holding a base end of the insertion unit and capable of operating the insertion unit,
the holding portion has a hole through which the base end of the insertion portion can be inserted, and an elastic member provided so as to cover an outer surface of the base end of the insertion portion,
A gap provided between an outer wall of the insertion portion and an inner wall of the hole is filled with the elastic member.
Lacrimal endoscopy.

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