JP2012070792A - Endoscope apparatus - Google Patents

Abstract

An endoscope apparatus capable of finely adjusting a treatment tool stand up and down and left and right with a simple structure, facilitating operation, and enabling more complicated treatments.
A treatment instrument insertion channel having an endoscope insertion portion to be inserted into a body cavity and through which a treatment instrument for an endoscope is inserted is formed from the distal end of the endoscope insertion portion to the endoscope operation portion. An endoscope apparatus in which a treatment instrument stand 45 for controlling the derivation direction of a treatment instrument guided from a treatment instrument insertion channel is disposed at a distal end rigid portion constituting a distal end of an endoscope insertion section, The instrument stand 45 includes a base end portion 59 supported by the distal end rigid portion, and a treatment instrument guide piece 61 that extends from the base end portion 59 and abuts against the treatment instrument and changes the lead-out direction. A pair of operation wires 43 are connected to both sides of the distal end side opposite to the base end portion 59 of the guide piece 61, and the pair of operation wires 43 can be independently advanced and retracted.
[Selection] Figure 5

Description

  The present invention relates to an endoscope apparatus.

  The operation for disposing the distal end of the treatment tool at the target site in the body cavity is performed by an operation for advancing / retreating the treatment tool on the proximal side of the endoscope or an operation for bending the distal end bending portion of the endoscope insertion portion. . However, in the body cavity where the inner diameter is not so different from the outer diameter of the endoscope insertion portion, the distal end bending portion cannot be greatly bent. In addition, when a lesion to be collected is very small and fine adjustment work is required for selection of the position of the distal end of the treatment tool and determination of its orientation, it may be difficult to cope with bending by the distal end bending portion.

  For example, Patent Document 1 discloses an elastic cylindrical shape in which a treatment tool is separated into first, second, and third pressure chambers by an extended partition wall as an attempt to solve the problem under such circumstances. Deriving using the body is described. According to this configuration, for example, when the working fluid is fed from the first tube to increase the pressure of the first pressure chamber, only the first pressure chamber extends in the axial direction, and the elastic cylindrical body is curved. Become. If the pressure in the third pressure chamber is further increased through the third tube in this state, the elastic cylindrical body can be bent in the other direction. In this manner, the elastic cylindrical body is bent in an arbitrary direction by a combination of pressures applied to the three pressure chambers, and the derivation direction of the treatment instrument can be changed without bending the distal end bending portion.

  Further, in Patent Document 2, an electromagnetic coil that generates a magnetic force when energized is provided on at least a part of the wall portion of the channel opening on the distal end side of the insertion channel in the vicinity of the distal end of the insertion portion, and is inserted into the insertion channel. It is described that a magnetic force of an electromagnetic coil is applied to the treatment instrument to magnetically control the direction in which the treatment instrument is led out from the channel opening. According to this configuration, it is possible to change the position or direction of the leading end of the insertion tool such as a treatment tool inserted into the endoscope channel without bending the distal end of the endoscope insertion portion.

  However, an elastic cylindrical body in which a plurality of separated pressure chambers must be provided has a disadvantage that the structure is complicated and the hard end portion is enlarged. In addition, at least three tubes for feeding the working fluid must be inserted, and the insertion space is larger than that of the wire. Furthermore, since the bending force is obtained through the expansion / contraction of the pressure chamber, it is difficult to make fine adjustments by fine movement. Moreover, in the structure which provides an electromagnetic coil, the accommodation space of an electromagnetic coil is needed and a structure becomes complicated again. In addition, it is expected that fine adjustment by fine movement will be difficult in order to balance each magnetic force by simultaneously exciting two adjacent electromagnetic coils and adjusting the energization amount so as to generate a magnetic force.

JP-A-4-197330 Japanese Patent Laid-Open No. 7-8450

  It is an object of the present invention to provide an endoscope apparatus that can finely adjust a treatment instrument stand up and down and left and right with a simple structure, can be easily operated, and can perform more complicated treatments.

The present invention has the following configuration.
An endoscope insertion portion that is inserted into a body cavity, and a treatment instrument insertion channel for inserting a treatment instrument for an endoscope is formed from a distal end of the endoscope insertion portion to the endoscope operation portion, An endoscope apparatus in which a treatment instrument stand for controlling a derivation direction of the treatment instrument guided from the treatment instrument insertion channel is arranged on a distal end rigid portion constituting a distal end of an endoscope insertion section,
The treatment instrument stand has a base end portion supported by the distal end rigid portion, and a treatment instrument guide piece extending from the base end portion and contacting the treatment instrument to change the lead-out direction,
A pair of operation wires are connected to both sides of the distal end side opposite to the base end portion of the treatment instrument guide piece,
An endoscope apparatus in which the pair of operation wires are independently movable forward and backward.

  According to the endoscope apparatus of the present invention, the treatment instrument stand can be finely adjusted in the vertical and horizontal directions with a simple structure, and the operation becomes easy and more complicated treatment can be performed.

It is a figure for demonstrating embodiment of this invention, and is an external view of an endoscope apparatus. It is a perspective view of the endoscope front-end | tip part shown in FIG. It is sectional drawing of the axial direction of the front-end | tip hard part shown in FIG. (A) is a perspective view of a treatment instrument guide piece, and (B) is an AA cross-sectional view thereof. It is a block diagram showing the traction structure by an operation lever. It is a perspective view of a treatment instrument guide piece when it is swung in the vertical direction. (A) is a plan view of the treatment instrument guide piece when the direction is changed to the left, and (B) is a plan view of the treatment instrument guide piece when the direction is changed to the right. It is a perspective view of the treatment tool which can be moved in any direction up, down, left and right. It is the front view of the liver near the duodenum, stomach, and gallbladder, and the principal part enlarged view which notched the part. (A) is explanatory drawing which shows a mode that the endoscope front-end | tip part has faced the duodenal papilla, (B) is explanatory drawing which shows a mode that the endoscope front-end | tip part was inserted from the incised duodenal papilla. It is a block diagram which shows the structure which calculates | requires the attitude | position of a treatment tool by detecting the amount of forward / backward movement of an operation wire. It is the model of the incision assistance screen which displayed the incision virtual line together with the real image of the nipple. (A) is a perspective view which concerns on the modification of the treatment tool guide piece formed in V shape, (B) is the BB sectional drawing. (A) is a plan view when the treatment instrument placed on the V-shaped treatment instrument guide piece shown in FIG. 13 is linear, and (B) is left and right by the V-shaped treatment instrument guide piece. It is a top view of a treatment tool when the direction is changed. It is a block diagram in case the number of operation wires fixed to a treatment tool guide piece is one. FIG. 5B is a plan view of the treatment instrument guide piece when it is turned to the left by the operation unit including the direction changing means, and FIG. It is a side view of an endoscope operation part provided with a knob. It is a principal part perspective view of the operation part provided with the movement amount ratio change means. (A) is a perspective view of a channel opening in which a treatment instrument guide piece is disposed on the treatment tool lead-out side from the distal end portion of the endoscope insertion section, and (B) is a perspective view of a channel opening closed by the treatment instrument guide piece. FIG.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
FIG. 1 is a view for explaining an embodiment of the present invention, and is an external view of an endoscope apparatus 100.
The endoscope apparatus 100 includes an endoscope operation unit 11 and an endoscope insertion unit 13 that is connected to the endoscope operation unit 11 and is inserted into a body cavity. A universal cord 15 including various pipes and signal cables is connected to the endoscope operation unit 11, and a connector that is detachably connected to a control device (not shown) is attached to the distal end of the universal cord 15. ing. Various buttons 17 such as an air supply / water supply button, a suction button, a shutter button, and a function switching button are arranged in parallel in the endoscope operation unit 11, and a curve provided on the distal end side of the endoscope insertion unit 13. A pair of angle knobs 21 are provided that are stacked one above the other for bending the portion 19.

  The endoscope insertion unit 13 includes a flexible portion 23, a bending portion 19, and a distal end portion (endoscope distal end portion 25) in this order from the endoscope operation unit 11 side. The flexible portion 23 has flexibility and is continuously provided on the proximal end side of the bending portion 19. The bending portion 19 rotates the angle knob 21 of the endoscope operation portion 11 to rotate the endoscope insertion portion. The bending portion wire inserted in 13 is pulled to bend. Thereby, the endoscope front-end | tip part 25 can be turned to a desired direction.

  In the connecting portion 29 between the endoscope operation portion 11 and the endoscope insertion portion 13, a treatment instrument insertion portion 35 of a treatment instrument insertion channel 33 into which a tube such as a treatment instrument or a water supply means is inserted is provided. . The treatment instrument insertion channel 33 is formed from the endoscope distal end portion 25 to the endoscope operation portion 11. The treatment instrument inserted from the treatment instrument insertion portion 35 is led out from the channel opening of the endoscope distal end portion 25. For the treatment tool, for example, a high-frequency knife for incising a desired position (such as a lesion) is used.

FIG. 2 is a perspective view of the endoscope distal end portion 25 shown in FIG.
The endoscope distal end portion 25 is provided with an observation window 39 and a pair of illumination windows 41 arranged so as to sandwich the observation window 39. The illumination light is emitted from the illumination window 41 and the observation image is transmitted through the observation window 39. To get. The illumination window 41 is supplied with light emitted from the light source unit of the control device described above through a fiber bundle inserted into the universal cord 15. Inside the channel opening 37, a treatment instrument stand 45 that is movable by a pair of operation wires 43 is provided on the inner wall portion opposite to the observation window 39.

3 is a cross-sectional view of the distal end rigid portion 47 shown in FIG. 1 in the axial direction.
The endoscope distal end portion 25 has a cylindrical distal end rigid portion 47 made of ceramics or stainless steel. The distal end rigid portion 47 is provided with an imaging optical system 49. The imaging optical system 49 includes an imaging element 51 that images an observation site illuminated by the illumination optical system, and a substrate 53 on which the imaging element 51 is mounted. The imaging signal of the observation image obtained from the imaging element 51 is the substrate 53. The signal is output to the control device by the signal line 55 connected to. The processor unit of the control device displays image information obtained by performing image processing on the input imaging signal on a display unit (not shown). In these series of processes, an instruction can be input from a keyboard or the like connected to the control device. As the imaging element 51 of the imaging optical system 49, a CCD image sensor or a CMOS image sensor is used.

  A treatment instrument insertion channel 33 is provided adjacent to the internal space 57 of the distal end rigid portion 47 provided with the imaging optical system 49. The treatment instrument stand 45 provided in the treatment instrument insertion channel 33 is supported at the proximal end 59 by the treatment instrument insertion channel 33. In addition, the treatment instrument stand 45 supported by the base end portion 59 is arranged so that the treatment instrument stand 45 is raised inside the treatment instrument insertion channel 33 by being pulled by the operation wire 43. When the treatment instrument stand 45 is raised, the treatment instrument 31 placed on the treatment instrument stand 45 is moved along with the raising operation. In other words, the treatment instrument stand 45 can control the direction in which the treatment instrument 31 guided from the treatment instrument insertion channel 33 is led out.

4A is a perspective view of the treatment instrument guide piece 61, and FIG. 4B is an AA cross-sectional view thereof.
The treatment instrument stand 45 includes a base end portion 59 supported by the distal end rigid portion 47 shown in FIG. 3, and a treatment instrument guide piece 61 that extends from the base end portion 59 and abuts against the treatment instrument 31 to change the lead-out direction. And have. In the treatment instrument guide piece 61, a pair of operation wires 43 are connected to both sides of the distal end side opposite to the base end portion 59, and the pair of operation wires 43 can be independently advanced and retracted.

  The treatment instrument guide piece 61 includes a plate-like piece 67 having a pair of side walls 65 formed by bending from the bottom surface portion 63 on both sides of the distal end side. When the treatment instrument stand 45 swings up and down while tilting the treatment instrument guide piece 61 left and right, the treatment instrument 31 is supported on either the left or right side wall 65 as shown in FIG. It is formed to be able to. The treatment instrument guide piece 61 is provided with the fixing portion 69 of the operation wire 43 on both sides of the distal end opposite to the proximal end portion 59, that is, on the free distal end side. It is possible to move the treatment instrument 31 with a smaller traction force than in the case where it is fixed to. Further, since the advance / retreat distance of the operation wire 43 can be increased, it is easy to realize a fine movement for fine adjustment.

FIG. 5 is a configuration diagram showing a pulling structure by the operation lever 71.
The proximal end portion 59 of the treatment instrument stand 45 is supported by a ball joint 75 that includes a spherical portion 73 and a holding portion that rotatably holds the spherical portion 73 at a predetermined angle. A spherical portion 73 provided at one point of the base end portion 59 of the treatment instrument guide piece 61 is held by a bearing portion 77 having an inner surface of a hemisphere provided at the distal end rigid portion 47, and the distal end of the treatment instrument guide piece 61 is a ball joint. The direction can be freely changed up and down and left and right around one point.

  The pair of operation wires 43 fixed to the treatment instrument guide piece 61 extends to the endoscope operation unit 11 (see FIG. 1). The operation wire 43 is individually driven forward and backward in the endoscope operation unit 11. That is, the proximal end of the pair of operation wires 43 fixed to both sides of the distal end side of the treatment instrument guide piece 61 is individually advanced and retracted by the endoscope operation unit 11, so that the treatment instrument stand 45 can be arbitrarily set. It is possible to incline in the direction.

  In the example of illustration, the endoscope operation part 11 has shown the structure provided with the operation lever 71 which advances / retreats a pair of operation wire 43 separately. The operation lever 71 is connected to each of the pair of operation wires 43, and by moving the operation lever 71 back and forth, the operation wire 43 can be moved forward and backward with a simple structure.

FIG. 6 is a schematic perspective view when the treatment instrument stand 45 is swung in the vertical direction, and FIG. 7A is a schematic plan view when the treatment instrument stand 45 is changed in the left direction. B) shows a schematic plan view when the direction is changed to the right.
As shown in FIG. 6, the treatment instrument stand 45 is configured such that when both operation levers 71 (see FIG. 5) are pulled by the same amount at the same time, the pair of operation wires 43 are pulled by the same amount, and the ball is removed from the lying state. It rises upward with the joint 75 as the center. At this time, if the pulling amounts of both the operation levers 71 are the same and the same amount, the treatment instrument stand 45 rises while the left and right sides are horizontal.

  Further, as shown in FIGS. 7A and 7B, the treatment instrument stand 45 changes its direction to the left and right when both the operation levers 71 are operated in the opposite directions. At this time, by setting the operation amount of both operation levers 71 to the same amount and in the opposite direction, the treatment instrument stand 45 and the treatment instrument 31 are changed in the left and right directions while being in a horizontal state. That is, the left-right change can be performed by making the towing amount equal to the feeding amount. In the treatment tool 31 in this case, the range of interference with the channel opening 37 is within the range of the direction change angle θ. For example, the range inclined about 15 degrees from the axis of the distal end rigid portion 47 on one side is the movable range.

Therefore, the treatment instrument stand 45 is movable in any direction, up, down, left, and right by a combination of the above vertical direction and the horizontal direction.
FIG. 8 shows a perspective view of the treatment instrument 31 that is movable in any direction in the vertical and horizontal directions. The extending direction of the line segment from the center of the channel opening 37 toward the center of the observation window 39 is the vertical direction (V direction), and the direction orthogonal to this direction is the horizontal direction (H direction). Can arbitrarily change the protruding direction of the treatment instrument 31 within a plane including the orthogonal V-axis and H-axis.

Next, the operation of the endoscope apparatus 100 having the above configuration will be described.
Here, the case where the inside of a bile duct is observed with an endoscope is shown. FIG. 9 is a front view of the liver 83, stomach 85, and gallbladder 87 in the vicinity of the duodenum 89, and an enlarged view of the main part with a part thereof cut away. In the endoscope apparatus 100, the endoscope distal end portion 25 is inserted to the position of the duodenum 89 by the operator. A common tube 97 in which a bile duct 91 and a pancreatic duct 99 are connected is connected to the duodenum 89, and a duodenal papilla 93 is opened at the connection site. The surgeon operates the angle knob 21 to bend the bending portion 19 and arranges the endoscope distal end portion 25 to face the duodenal papilla 93.

  Then, the surgeon inserts the treatment tool 31 as a high-frequency knife from the treatment tool insertion portion 35 shown in FIGS. 1 and 2 into the treatment tool insertion channel 33 as shown in FIG. Let Then, the surgeon incises the entrance 95 of the duodenal papilla 93 with a high-frequency knife based on the captured image from the observation window 39. At that time, the operator operates the lever 71 shown in FIG. 5 to adjust the inclination of the treatment instrument stand 45 and make an incision while adjusting the direction in which the treatment instrument 31 is led out from the channel opening 37.

  When the incision of the duodenal papilla 93 is completed, the operator inserts the endoscope distal end portion 25 into the incised duodenal papilla 93 and inserts it from the common tube 97 into the bile duct 91 as shown in FIG. Then, endoscopic observation in the bile duct 91 is performed.

  As described above, in the endoscope apparatus 100, the proximal end portion 59 of the treatment instrument guide piece 61 is supported by the distal end rigid portion 47, and both distal ends of the treatment instrument guide piece 61 are respectively supported by the pair of operation wires 43. Since it can be moved forward and backward independently, a delicate operation of moving the treatment tool 31 can be performed easily and accurately. That is, by moving the pair of operation wires 43 back and forth, or by causing a difference in the amount of advance and retreat, the treatment instrument guide piece 61 of the treatment instrument stand 45 and the base end 59 are supported as fulcrums. The inclination in the left-right direction can be finely adjusted.

  In addition to the above configuration, the endoscope insertion portion 13 may have a bending portion 19 that can be bent in only one direction by the endoscope operation portion 11 on the distal end side. In that case, the proximal end portion 59 of the treatment instrument stand 45 is disposed outside the curved portion of the treatment instrument insertion channel 33 to be bent, so that the treatment instrument insertion channel 33 faces the curved inner side toward the curved inner side. The protruding direction can be changed. This facilitates the movement of the treatment tool toward the observation window 39, improves the visibility, and improves the operability of the endoscope.

  Moreover, it is good also as a structure which detects the moving amount | distance of each of a pair of operation wire 43, and grasps | ascertains the moving amount | distance of the treatment tool 31 by the treatment tool stand 45. FIG. That is, as shown in FIG. 11, the movement amount sensor 79 detects the amount of forward / backward movement of each of the pair of operation wires 43. Then, the calculation unit 81 calculates the posture of the treatment instrument stand 45 or the treatment instrument 31 based on the detected movement direction and movement amount of each operation lever 71. Then, the calculation unit 81 causes the display unit 27 to display the obtained posture of the treatment instrument 31 so as to overlap the real map.

According to this configuration, a support system for incision operation of the duodenal papilla 93 can be constructed.
FIG. 12 is a schematic diagram of an incision support screen in which an incision virtual line is displayed together with a real image of the duodenal papilla 93. In the captured image from the observation window 39 displayed on the display unit 27, a vertical line Lv and a horizontal line Lh defined by the image sensor are displayed, and a virtual line La scheduled for incision is also displayed.

  The incision scheduled line La is calculated by the calculation unit 81 using the fact that the inclination of the treatment instrument stand 45 is determined according to the pulling / feeding amount of the operation wire 43. The calculation unit 81 displays the planned incision line La by a predetermined angle θa from the vertical line Lv, and displays the nipple 93 as the start end 101 up to the end 103. The surgeon only has to cut up to the end 103 along the planned incision line La with a high-frequency knife. Thereby, the protruding direction of the high-frequency knife can be set accurately, and the incision operation becomes easy.

Next, a modified example of the above-described endoscope apparatus 100 will be described. In the following description, members that are the same as those shown in FIGS. 1 to 11 are given the same reference numerals, and redundant descriptions are omitted.
FIG. 13A is a perspective view according to a modified example of the treatment instrument guide piece 61 formed in a V shape, and FIG.
In the endoscope apparatus 100 according to this modified example, a cross section orthogonal to the extending direction from the base end portion 59 in the bottom surface portion 63 of the treatment instrument guide piece 61 is formed in a V shape. Accordingly, the bottom surface portion 63 is lowest at the groove bottom 105.

14A is a plan view when the treatment instrument placed on the V-shaped treatment instrument guide piece 61 shown in FIG. 13 is linear, and FIG. 14B is a V-shaped treatment instrument guide piece. FIG. 6 is a plan view of the treatment instrument 31 when the direction is changed left and right by 61.
As shown in FIG. 14A, when the treatment instrument 31 is linear, the treatment instrument 31 is held by the groove bottom 105 and hardly swings from side to side. On the other hand, when the direction of the treatment instrument guide piece 61 is changed to the left and right, the position of the treatment instrument 31 can be regulated on the groove bottom 105 of the bottom surface portion 63 formed in a V shape so that the protruding direction can be easily controlled. Of course, even if the treatment instrument guide piece 61 is tilted up and down at the same time, the position of the treatment instrument 31 on the groove bottom 105 can be regulated to easily control the protruding direction.

FIG. 15 is a configuration diagram when the number of operation wires 43 fixed to the treatment instrument guide piece 61 is one.
In the endoscope apparatus 100 according to this modification, the treatment instrument guide piece 61 is fixed to one operation wire 43. The single operation wire 43 is fixed by being passed through a pair of fixing holes 109 fixed to the distal side lower surface 107 of the treatment instrument guide piece 61. By adopting such an insertion fixing structure, the operation wire 43 and the fixing portion 69 of the operation wire 43 can be manufactured with a simpler structure.

16A is a plan view of the treatment instrument guide piece 61 when it is turned to the left by the operation unit 113 provided with the moving direction changing means 111, and FIG. 6 is a plan view of a treatment instrument guide piece 61. FIG. FIG. 17 is a side view of the endoscope operation unit 11 including the knob 127.
The endoscope apparatus 100 according to this modification includes an operation unit 113 in which the endoscope operation unit 11 operates to advance and retract the pair of operation wires 43 in common. The operation unit 113 further moves the moving direction changing unit 111 that makes the forward / backward movement direction of one operation wire 43 of the pair of operation wires 43 different from the forward / backward movement direction of the other operation wire 43 corresponding to the received operation amount. It has. In this configuration, the pair of operation wires 43 can be advanced / retracted simultaneously by the operation unit 113, and the moving direction changing unit 111 is operated at that time, so that the advance / retreat direction of the pair of operation wires 43 is reversed, whereby the inclination is increased. Easy to do with one action.

  More specifically, the moving direction changing unit 111 includes a rotation drive shaft 115 connected to the operation unit 113, a bevel gear 117 that is driven by the rotation drive shaft 115, and a first follower gear 119 that meshes with the bevel gear 117. And a second driven bevel gear 121. The first driven gear 119 is connected to the first pulley 123, and the second driven gear 121 is connected to the second pulley 125. One operation wire 43 of the pair of operation wires 43 is suspended from the first pulley 123, and the other operation wire 43 is suspended from the second pulley 125.

  According to this modification, the entire operation unit 113 is pushed and pulled, so that the pair of operation wires 43 can advance and retreat as shown in FIG. At this time, as shown in FIG. 16A, when the rotary drive shaft 115 connected to the operation unit 113 is rotated, the bevel gear 117 is rotated and the first slave gear meshed with the bevel gear 117 is engaged. The moving gear 119 and the second driven gear 121 rotate in reverse. Accordingly, the pair of operation wires 43 are advanced and retracted in the opposite directions via the first pulley 123 and the second pulley 125 connected to each. Thereby, the treatment instrument guide piece 61 can be changed in an arbitrary direction.

FIG. 18 is a perspective view of the main part of the operation unit 113 provided with the movement amount ratio changing means 129.
In the endoscope apparatus 100 according to this modification, the endoscope operation unit 11 has an operation unit 113 that performs a forward and backward operation on the pair of operation wires 43 in common, and corresponds to the operation amount received by the operation unit 113. The movement wire ratio changing means 129 is provided for changing the ratio between the movement amount of one operation wire 43 of the operation wire 43 and the movement amount of the other operation wire 43. In this configuration, the pair of operation wires 43 can be simultaneously advanced and retracted by the operation unit 113, and at that time, the movement amount ratio changing unit 129 is operated to change the advance / retreat amount of the pair of operation wires 43. A difference in the amount of advance / retreat occurs between the operation wires 43. Thereby, the inclination can be easily performed by one action.

  More specifically, the movement amount ratio changing means 129 is connected to the rotation drive shaft 115 connected to the operation unit 113 and one operation wire 43 of the pair of operation wires 43 following the rotation drive shaft 115. A third pulley 133 on which one belt 131 is suspended, a fourth pulley 135 on which the other belt 131 connected to the other operation wire 43 is suspended, and a third pulley 133 and a fourth pulley 135. And a pulley control unit 137 for adjusting the axial position.

  Each of the third pulley 133 and the fourth pulley 135 includes a fixed sheave 139 fixed to the rotation drive shaft 115 and a movable sheave 141 movable along the rotation drive shaft 115. Opposing surfaces of the fixed sheave 139 and the movable sheave 141 are formed on a tapered surface 143. The pulley control unit 137 can individually change the distance (W1, W2) between the fixed sheave 139 and the movable sheave 141 in the drive shaft direction for each of the third pulley 133 and the fourth pulley 135. In addition, the base ends of the belts 131 hung on the third pulley 133 and the fourth pulley 135 are fixed to the endoscope operation unit 11 via spring members 145.

  According to this modification, when the rotation drive shaft 115 of the operation unit 113 is rotated, the pair of operation wires 43 are advanced and retracted by the third pulley 133 and the fourth pulley 135 of the rotation drive shaft 115 together. You can advance and retreat. At this time, the movable sheave 141 provided in each of the third pulley 133 and the fourth pulley 135 is moved by the pulley control unit 137, whereby the suspension radius of the belt 131 is changed. As a result, a pair of operation wires There is a difference in the amount of advance and retreat between 43. Thereby, the inclination can be easily performed by one action.

19A is a perspective view of the channel opening 37 in which the treatment instrument guide piece 61 is disposed on the treatment instrument lead-out side from the distal end portion 25 of the endoscope insertion portion, and FIG. 19B is closed by the treatment instrument guide piece 61. It is a perspective view of the channel opening 37 made.
In the endoscope apparatus 100 according to this modified example, at least a part of the treatment instrument guide piece 61 is disposed on the treatment tool derivation destination side from the distal end portion 25 of the endoscope insertion portion, and the treatment instrument stand 45 The proximal end portion 59 is disposed at the endoscope distal end portion 25 outside the treatment instrument insertion channel. The pair of operation wires 43 are inserted through a pair of guide rings 147 fixed to the upper part of the channel opening 37.

According to this modification, by pulling the pair of operation wires 43, the treatment instrument guide piece 61 can be changed in the vertical and horizontal directions with the above-described configuration. Then, since at least a part of the treatment instrument guide piece 61 is disposed so as to protrude from the channel opening 37, the treatment instrument guide piece 61 does not interfere with the inner peripheral surface of the treatment instrument insertion channel, and the treatment instrument guide piece The movable range of 61 can be widened, and the protruding direction of the treatment instrument can be changed in a wider range.
Further, when the pair of operation wires 43 are pulled simultaneously, the treatment instrument guide piece 61 stands vertically, and as shown in FIG. 19B, a channel opening 37 that opens at the distal end of the endoscope insertion portion 13 is provided. It can be closed. Thereby, it is possible to prevent foreign matters and the like from entering the treatment instrument insertion channel 33 through the channel opening 37.

  Therefore, according to the endoscope apparatus 100, the treatment instrument stand 45 can be finely adjusted up and down and left and right with a simple structure, and the operation becomes easy and more complicated treatment can be performed.

As described above, the present invention is not limited to the above-described embodiments, and modifications and applications by those skilled in the art based on the description of the specification and well-known techniques are also within the scope of the present invention. It is included in the range to calculate.
For example, an urging member for releasing the bending from the bending state can be arranged outside the bending portion 19. As the urging member, various members such as a plate-shaped piece arranged along the axial direction of the bending portion 19, an elastic tube serving as a treatment instrument insertion channel, and various signal cables accommodated in the endoscope insertion portion are used. Can do. According to this configuration, the bending state of the bending portion can be returned to the original state by the urging force (elastic restoring force or the like) from the urging member, and it is not necessary to perform the bending releasing operation. Thereby, bending operation can be simplified.

  Further, one end side is fixed to the distal end portion of the endoscope insertion portion (the distal end rigid portion 47 shown in FIGS. 1 and 3 and the distal end side end portion of the bending portion 19), and is curved so as to freely advance and retreat in the axial direction of the endoscope insertion portion. An operation member may be provided, and the other end side of the bending operation member may be connected to the endoscope operation unit 11 so as to advance and retract. As the bending operation member, it is possible to use a wire for a bending portion that can be pulled and fed and connected to the angle knob 21 shown in FIG. In this case, the bending operation and the bending release operation of the bending portion can be performed by the advance / retreat operation to the bending operation member. That is, the bending of the bending portion 19 and the bending cancellation can be easily realized by the forward / backward operation to the bending operation member.

As described above, the following items are disclosed in this specification.
(1) A treatment instrument insertion channel that has an endoscope insertion portion that is inserted into a body cavity and that passes through a treatment instrument for an endoscope is formed from the distal end of the endoscope insertion portion to the endoscope operation portion. An endoscope apparatus in which a treatment instrument stand for controlling the derivation direction of the treatment instrument guided from the treatment instrument insertion channel is arranged at the distal end rigid portion constituting the distal end of the endoscope insertion section. The treatment instrument stand has a base end portion supported by the distal end rigid portion, and a treatment instrument guide piece extending from the base end portion and contacting the treatment instrument to change the derivation direction. An endoscope apparatus in which a pair of operation wires are connected to both sides of the distal end side opposite to the base end portion of the treatment instrument guide piece, and the pair of operation wires are independently movable forward and backward.
According to this endoscope apparatus, the proximal end portion of the treatment instrument guide piece is supported by the distal end rigid portion, and both distal end sides of the treatment instrument guide piece can be independently advanced and retracted by the pair of operation wires. Therefore, when the pair of operation wires are advanced and retracted together, the treatment instrument guide piece swings up and down, and if the difference in the amount of advancement and retraction of the pair of operation wires is caused, the treatment instrument guide piece is moved around the base end portion. Tilt left and right. Therefore, by combining these up and down directions and left and right directions, the treatment instrument placed on the treatment instrument guide piece can be finely adjusted with fine movement without using a pressure chamber or an electromagnetic coil.

(2) The endoscope apparatus according to (1), including the endoscope operation unit extended to the endoscope insertion unit, and the pair of operation wires extending to the endoscope operation unit. An endoscope apparatus that is provided, and in which the endoscope operation unit individually drives the pair of operation wires to advance and retreat.
According to this endoscope apparatus, the proximal end of the operation wire fixed on both sides of the distal end side of the treatment instrument guide piece is led out to the endoscope operation unit, and the operation wire is pulled by the endoscope operation unit. Thus, the stand can be inclined in an arbitrary direction with a simple structure in which the pair of operation wires are individually advanced and retracted.

(3) In the endoscope apparatus according to (1) or (2), a proximal end portion of the treatment instrument stand includes a sphere portion and a holding portion that rotatably holds the sphere portion at a predetermined angle. An endoscope apparatus supported by a configured ball joint.
According to this endoscope apparatus, the spherical body portion provided at one point of the proximal end portion of the treatment instrument guide piece is held by the hemispherical inner surface bearing section provided at the distal end rigid portion, and the distal end of the treatment instrument guide piece The direction can be freely changed up and down and left and right around one point of the ball joint.

(4) The endoscope apparatus according to any one of (1) to (3), wherein the treatment instrument guide piece has a pair of side walls formed by bending from a bottom surface on both sides of the distal end side. An endoscopic device comprising a plate-shaped piece.
According to this endoscope apparatus, when the treatment instrument guide piece is swung up and down while being tilted left and right, the projection direction can be changed by supporting the treatment instrument on either the left or right side wall.

(5) The endoscope apparatus according to (4), wherein the bottom surface portion of the treatment instrument guide piece has a V-shaped cross section perpendicular to the extending direction from the base end portion. .
According to this endoscope apparatus, when changing the direction of the treatment instrument guide piece to the left and right, it is easy to control the protruding direction by regulating the position of the treatment instrument on the groove bottom of the bottom surface portion formed in a V shape. it can.

(6) The endoscope apparatus according to any one of (1) to (5), wherein the endoscope operation unit includes an operation lever that individually advances and retracts the pair of operation wires. Mirror device.
According to this endoscope apparatus, the operation lever is connected to each of the pair of operation wires, and the operation wire can be moved forward and backward with a simple structure by moving the operation lever back and forth.

(7) The endoscope apparatus according to any one of (1) to (5), wherein the endoscope operation unit includes an operation unit that performs a common advance / retreat operation on the pair of operation wires, An endoscope apparatus comprising a moving direction changing means for changing the advancing / retreating direction of one operation wire of the pair of operation wires and the advancing / retreating direction of the other operation wire corresponding to the operation amount received by the operation unit. .
According to this endoscope apparatus, the pair of operation wires can be simultaneously advanced and retracted by the operation unit, and the moving direction changing means is operated at that time, so that the advance and retreat directions of the pair of operation wires are reversed. Can be done easily with a single action, improving operability.

(8) The endoscope apparatus according to (7), wherein the moving direction changing unit is engaged with the rotation drive shaft connected to the operation unit, a bevel gear driven by the rotation drive shaft, and the bevel gear. A first driven gear and a second driven gear, wherein the first driven gear is connected to a first pulley, the second driven gear is connected to a second pulley, and the pair An endoscope apparatus in which one operation wire is suspended from the first pulley and the other operation wire is suspended from the second pulley.
According to this endoscope apparatus, when the entire operation unit is pushed and pulled, both the pair of operation wires can advance and retreat. At this time, when the rotary drive shaft connected to the operation unit is rotated, the bevel gear is rotated, and the first driven gear and the second driven gear engaged with the bevel gear are rotated in reverse directions. A pair of operation wires are advanced and retracted in opposite directions via the connected first pulley and second pulley.

(9) The endoscope apparatus according to any one of (1) to (5), wherein the endoscope operation unit includes an operation unit that performs a common advance / retreat operation on the pair of operation wires, An endoscope provided with a movement amount ratio changing means for changing a ratio between an advancement / retraction movement amount of one operation wire of the pair of operation wires and an advancement / retraction movement amount of the other operation wire corresponding to the operation amount received by the operation unit. Mirror device.
According to this endoscope apparatus, the pair of operation wires can be advanced and retracted simultaneously by the operation unit, and the movement amount ratio changing means is operated at that time, and the advance and retreat amounts of the pair of operation wires are changed. There is a difference in the amount of advance and retreat between the operation wires. Thereby, the inclination can be easily performed with one action, and the operability is improved.

(10) The endoscope apparatus according to (9), wherein the movement amount ratio changing means is a rotary drive shaft connected to the operation section, and is driven by the rotary drive shaft and is one of the pair of operation wires. A third pulley on which one belt connected to the operation wire is suspended, a fourth pulley on which the other belt connected to the other operation wire is suspended, the third pulley and the fourth pulley A pulley control unit that adjusts an axial position of the pulley, and each of the third pulley and the fourth pulley is fixed along the rotation drive shaft and a fixed sheave fixed to the rotation drive shaft. The movable sheave includes a movable sheave, and an opposing surface of the fixed sheave and the movable sheave is formed into a tapered surface, and the pulley control unit sets an interval in the drive shaft direction between the fixed sheave and the movable sheave, The third pulley and the fourth pulley; Endoscope device that changes individually with each pulley.
According to this endoscope apparatus, when the rotation drive shaft of the operation unit is rotated, the pair of operation wires are advanced and retracted by the third pulley and the fourth pulley of the rotation drive shaft and can be advanced and retracted together. . At this time, the movable sheave provided in each of the third pulley and the fourth pulley is moved by the pulley controller, so that the suspension radius of the belt is changed. As a result, the amount of advancement / retraction between the pair of operation wires is changed. The difference arises. Thereby, the inclination can be easily performed with one action, and the operability is improved.

(11) The endoscope apparatus according to any one of (1) to (10),
An endoscope apparatus in which at least a part of the treatment instrument guide piece is disposed on a leading side of the treatment instrument from a distal end portion of the endoscope insertion portion.
According to this endoscope apparatus, at least a part of the treatment instrument guide piece is arranged on the treatment instrument derivation destination side from the distal end portion of the endoscope insertion portion, so that the protruding direction of the treatment instrument can be changed in a wider range. .
(12) The endoscope apparatus according to (11),
The proximal end portion of the treatment instrument stand is disposed at the distal end portion of the endoscope outside the treatment instrument insertion channel,
An endoscope apparatus in which the treatment instrument guide piece is disposed so that a channel opening of the treatment instrument insertion channel that opens at a distal end of the endoscope insertion portion can be opened or closed by pulling the operation wire.
According to this endoscope apparatus, the proximal end portion of the treatment instrument guide piece is disposed in the channel opening, and the treatment instrument guide piece swung around the proximal end portion closes the channel opening. Thereby, it can prevent that a foreign material etc. enter into a treatment tool penetration channel via a channel opening.
(13) The endoscope apparatus according to any one of (1) to (12),
On the distal end side of the endoscope insertion portion, there is a bending portion that can be bent in only one direction by the endoscope operation portion,
An endoscope apparatus in which a proximal end portion of the treatment instrument stand is disposed outside the curve of the treatment instrument insertion channel to be bent.
According to this endoscope apparatus, the protruding direction of the treatment instrument can be changed from the curved outer side of the treatment instrument insertion channel toward the curved inner side.
(14) The endoscope apparatus according to (13),
An endoscope apparatus in which an urging member for releasing the bending from a bending state is disposed outside the bending portion of the bending portion.
According to this endoscope apparatus, the bending state of the bending portion can be returned to the original state by the urging force from the urging member, and it is not necessary to perform the bending releasing operation. Thereby, bending operation can be simplified.
(15) The endoscope device according to (13),
One end side is fixed to the distal end portion of the endoscope insertion portion, and comprises a bending operation member that can advance and retreat in the axial direction of the endoscope insertion portion,
An endoscope apparatus that performs a bending operation and a bending releasing operation of the bending portion by an advance / retreat operation from the other end side of the bending operation member.
According to this endoscope apparatus, the bending of the bending portion and the release of the bending can be easily realized by an advance / retreat operation to the bending operation member.

DESCRIPTION OF SYMBOLS 1 Treatment tool guidance | guide piece 11 Endoscope operation part 13 Endoscope insertion part 19 Bending part 31 Treatment tool 33 Treatment tool insertion channel 37 Channel opening 43 Operation wire 45 Treatment tool stand 47 Tip hard part 59 Base end part 63 Bottom face part 65 Side wall 67 Plate-shaped piece 71 Operation lever 73 Spherical body part 75 Ball joint 77 Bearing part 100 Endoscope apparatus 111 Movement direction change means 113 Operation part 115 Rotation drive shaft 117 Bevel gear 119 First driven gear 121 Second driven gear 123 First pulley 125 Second pulley 129 Movement amount ratio changing means 131 Belt 133 Third pulley 135 Fourth pulley 137 Pulley controller 139 Fixed sheave 141 Movable sheave 143 Tapered surface

Claims (15)

An endoscope insertion portion that is inserted into a body cavity, and a treatment instrument insertion channel for inserting a treatment instrument for an endoscope is formed from a distal end of the endoscope insertion portion to the endoscope operation portion, An endoscope apparatus in which a treatment instrument stand for controlling a derivation direction of the treatment instrument guided from the treatment instrument insertion channel is arranged on a distal end rigid portion constituting a distal end of an endoscope insertion section,
The treatment instrument stand has a base end portion supported by the distal end rigid portion, and a treatment instrument guide piece extending from the base end portion and contacting the treatment instrument to change the lead-out direction,
A pair of operation wires are connected to both sides of the distal end side opposite to the base end portion of the treatment instrument guide piece,
An endoscope apparatus in which the pair of operation wires are independently movable forward and backward. The endoscope apparatus according to claim 1,
The endoscope operation section extended to the endoscope insertion section, the pair of operation wires extending to the endoscope operation section, and the endoscope operation section serving as the pair of operation wires Endoscope device that individually moves forward and backward. The endoscope apparatus according to claim 1 or 2,
An endoscope apparatus in which a proximal end portion of the treatment instrument stand is supported by a ball joint including a sphere portion and a holding portion that rotatably holds the sphere portion at a predetermined angle. The endoscope apparatus according to any one of claims 1 to 3,
An endoscope apparatus comprising a plate-like piece having a pair of side walls formed by bending the treatment instrument guide piece from the bottom surface on both sides of the distal end side. The endoscope apparatus according to claim 4, wherein
An endoscope apparatus in which a bottom surface portion of the treatment instrument guide piece has a V-shaped cross section orthogonal to an extending direction from the base end portion. The endoscope apparatus according to any one of claims 1 to 5,
An endoscope apparatus in which the endoscope operation unit includes an operation lever that individually advances and retracts the pair of operation wires. The endoscope apparatus according to any one of claims 1 to 5,
The endoscope operation unit has an operation unit for performing a common advance / retreat operation of the pair of operation wires, and a forward / backward movement direction of one operation wire of the pair of operation wires corresponding to an operation amount received by the operation unit And an endoscope apparatus comprising movement direction changing means for making the other operation wire move forward and backward. The endoscope apparatus according to claim 7,
The moving direction changing means includes a rotation drive shaft connected to the operation unit, a bevel gear driven by the rotation drive shaft, and a first driven bevel gear and a second driven bevel gear engaged with the bevel gear. Have
The first driven bevel gear is connected to a first pulley, the second driven bevel gear is connected to a second pulley,
An endoscope apparatus in which one operation wire of the pair of operation wires is suspended on the first pulley, and the other operation wire is suspended on the second pulley. The endoscope apparatus according to any one of claims 1 to 5,
The endoscope operation unit has an operation unit that operates the pair of operation wires to advance and retreat in common, and the movement amount of one operation wire of the pair of operation wires corresponding to the operation amount received by the operation unit And an amount-of-movement ratio changing means for changing a ratio between the amount of movement of the other operation wire and the amount of movement of the other operation wire. The endoscope apparatus according to claim 9, wherein
The moving amount ratio changing means includes a rotation drive shaft connected to the operation unit and a belt connected to one operation wire of the pair of operation wires following the rotation drive shaft. A third pulley and a fourth pulley on which the other belt connected to the other operation wire is suspended, and a pulley control unit for adjusting an axial position of the third pulley and the fourth pulley. ,
Each of the third pulley and the fourth pulley includes a fixed sheave fixed to the rotary drive shaft, and a movable sheave movable along the rotary drive shaft,
Opposing surfaces of the fixed sheave and the movable sheave are formed as tapered surfaces,
An endoscope apparatus in which the pulley control unit individually changes an interval in the drive shaft direction between the fixed sheave and the movable sheave in each of the third pulley and the fourth pulley. The endoscope apparatus according to any one of claims 1 to 10,
An endoscope apparatus in which at least a part of the treatment instrument guide piece is disposed on a leading side of the treatment instrument from a distal end portion of the endoscope insertion portion. The endoscope apparatus according to claim 11, wherein
The proximal end portion of the treatment instrument stand is disposed at the distal end portion of the endoscope outside the treatment instrument insertion channel,
An endoscope apparatus in which the treatment instrument guide piece is disposed so that a channel opening of the treatment instrument insertion channel that opens at a distal end of the endoscope insertion portion can be opened or closed by pulling the operation wire. The endoscope apparatus according to any one of claims 1 to 12,
On the distal end side of the endoscope insertion portion, there is a bending portion that can be bent in only one direction by the endoscope operation portion,
An endoscope apparatus in which a proximal end portion of the treatment instrument stand is disposed outside the curve of the treatment instrument insertion channel to be bent. An endoscope apparatus according to claim 13,
An endoscope apparatus in which an urging member for releasing the bending from a bending state is disposed outside the bending portion of the bending portion. An endoscope apparatus according to claim 13,
One end side is fixed to the distal end portion of the endoscope insertion portion, and comprises a bending operation member that can advance and retreat in the axial direction of the endoscope insertion portion,
An endoscope apparatus that performs a bending operation and a bending releasing operation of the bending portion by an advance / retreat operation from the other end side of the bending operation member.

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