JP2017018274A - Stent-placement endoscope hood and endoscope system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a stent-placement endoscope hood capable of easily and accurately placing a silicone stent at a target site, and preventing damage of an insertion section of an endoscope.SOLUTION: A stent-placement endoscope hood 30 includes: an endoscope mounting part 32 that is mounted at a distal end 6 of an insertion section 2 of an endoscope 1 including a bending section 7 bendingly-operable in at least two directions; a storage part 31 that is consecutively provided at the distal side of the endoscope mounting part 32 and in which a stent 200 to be placed in the body is loaded and stored; and a projection part 34 that is projectingly formed in the storage part 31 in an internal-diameter direction along a longitudinal axis direction of the storage part 31 so as to be within a field of view of the endoscope 1, holds the stent 200, and prescribes a storage position.SELECTED DRAWING: Figure 4

Description

  The present invention relates to an endoscope hood for stent placement that is attached to a distal end portion of an endoscope, and an endoscope system including the endoscope hood for stent placement.

  In recent years, medical devices that are inserted into a subject, such as endoscopes, have been widely used in the medical field and the industrial field.

  In particular, an endoscope used in the medical field observes an organ in a body cavity by inserting a long and thin insertion portion into a body cavity as a subject, and a treatment tool provided in the endoscope as necessary. Various treatments can be performed using the treatment tool inserted into the insertion channel.

  For such an endoscope, various proposals for facilitating treatment of an affected area have been made. For example, as disclosed in Patent Document 1, for an endoscope to be attached to a distal end portion of an insertion portion. Food is known.

  This conventional endoscope hood is for fixing a treatment instrument derived from a treatment instrument insertion channel so as not to move, and facilitating treatment and surgery using the treatment instrument.

JP 2007-82766 A

  By the way, in the respiratory field, when placing a silicone stent for placement at a stenosis site such as trachea and bronchus, generally, a silicone stent is loaded inside a rigid introducer, and the introducer is attached to a rigid mantle tube. After the insertion, the silicone stent is pushed out with a pusher.

  However, when placing a silicon stent, the position of the target site can be determined while looking at an indirect X-ray image using a blind or X-ray impermeable marker provided on the silicon stent without direct visual observation. I have to figure it out.

  Therefore, the position where the silicon stent is placed cannot be accurately grasped, and there is a problem that it is difficult to place the silicon stent in a stenosis site such as trachea and bronchus.

  Furthermore, after the placement of the silicon stent, there was a problem that the placement position of the silicon stent had to be finely adjusted under an endoscope including confirmation.

  Conventionally, when finely adjusting the indwelling position of the silicon stent, an endoscope having a flexible insertion portion having a curved portion may be used. When the flexible insertion portion is inserted into a hard mantle tube, There was also a problem that the insertion portion could be damaged.

  Therefore, the present invention has been made in view of the above circumstances, and an endoscopic hood for stent placement that can easily and accurately place a silicon stent at a target site and prevent damage to an insertion portion of the endoscope, and An object is to provide an endoscope system.

  An endoscope hood for stent placement according to an aspect of the present invention includes an endoscope mounting portion that is mounted on a distal end portion of an insertion portion of an endoscope having a bending portion that can be bent in at least two directions, and the endoscope A receiving portion that is connected to the distal end side of the mirror mounting portion and is loaded with a stent that is placed in the body, and a longitudinal direction of the receiving portion so as to enter the field of view of the endoscope in the inner diameter direction in the receiving portion. A protrusion formed along the axial direction to hold the stent and define a receiving position.

  An endoscope system according to an aspect of the present invention includes an endoscope, an endoscope mounting portion mounted on a distal end portion of the insertion portion of the endoscope having a bending portion that can be bent in at least two directions, A receiving portion that is connected to the distal end side of the endoscope mounting portion and is loaded with a stent to be placed in the body, and that is housed so as to be within the visual field of the endoscope in the inner diameter direction within the housing portion. A protrusion formed along the longitudinal axis direction of the portion to hold the stent and define a receiving position.

  According to the present invention, it is possible to provide a stent placement endoscope hood and an endoscope system in which a silicon stent can be placed easily and accurately at a target site and damage to an insertion portion of an endoscope can be prevented.

The perspective view which shows the structure of the endoscope system of 1 aspect of this invention. The perspective view which shows the front-end | tip part of the endoscope hood for stent placement, and the insertion part of an endoscope same as the above The perspective view which shows the state by which the endoscope hood for stent placement was mounted | worn with the front-end | tip part of the insertion part similarly The perspective view which shows the state with which the Y stent was loaded in the endoscope hood for stent placement same as the above Sectional drawing which shows the state before a Y stent is loaded in the endoscope hood for stent placement same as the above Sectional drawing which shows the state with which the Y stent was loaded in the endoscope hood for stent placement same as the above Same as the arrow VII in FIG. Sectional drawing which shows the state from which the Y stent is extruded from the endoscope hood for stent placement The perspective view which shows the state by which the endoscope hood for stent placement of a modification was mounted | worn with the front-end | tip part of the insertion part similarly The perspective view which shows the front-end | tip part of the insertion part of the endoscope before the straight stent of a reference example is accommodated similarly The front view which shows the front-end | tip part of the insertion part of the endoscope of a reference example similarly The perspective view which shows the front-end | tip part of the insertion part of the endoscope in which the straight stent of the reference example was accommodated. The front view which shows the front-end | tip part of the insertion part of the endoscope in which the straight stent of the reference example was accommodated

  Hereinafter, an endoscope hood and an endoscope system for stent placement according to the present invention will be described. In the following description, the drawings based on each embodiment are schematic, and the relationship between the thickness and width of each part, the thickness ratio of each part, and the like are different from the actual ones. It should be noted that the drawings may include portions having different dimensional relationships and ratios between the drawings.

  1 to 8 relate to an endoscope hood and an endoscope system for stent placement according to one aspect of the present invention, FIG. 1 is a perspective view showing a configuration of the endoscope system, and FIG. 2 is an endoscope for stent placement. FIG. 3 is a perspective view showing a state where the endoscope hood for stent placement is attached to the distal end portion of the insertion portion, and FIG. 4 is a view showing the Y stent as a stent. FIG. 5 is a cross-sectional view showing a state before the Y stent is loaded in the stent placement endoscope hood, and FIG. 6 is a view showing the Y stent in the stent state. FIG. 7 is a cross-sectional view showing a state of being loaded in the indwelling endoscope hood, FIG. 7 is a cross-sectional view taken along arrow VII in FIG. 6, and FIG. 8 is a cross-sectional view showing a state in which the Y stent is pushed out of the stent indwelling endoscope hood. is there.

  As shown in FIG. 1, an endoscope system 100 according to the present embodiment includes an electronic endoscope (hereinafter simply referred to as an endoscope) 1 as a bronchoscope, and an endoscope hood for stent placement (hereinafter referred to as an endoscope). , Simply referred to as an endoscope hood) 30.

  The endoscope 1 is a universal which is an insertion portion 2 formed in an elongated tubular shape, an operation portion 3 connected to the proximal end of the insertion portion 2, and an endoscope cable extending from the operation portion 3. The cord 4 is mainly configured by an endoscope connector 5 and the like disposed at the distal end of the universal cord 4.

  The insertion portion 2 includes, in order from the distal end side, a distal end portion 6 provided with an observation window 21, an illumination window 22, and a treatment instrument channel opening 23 (see FIG. 2), a bending portion 7, and a flexible tube portion 8. It is a tubular member formed with flexibility. Among them, the distal end portion 6 accommodates and arranges an imaging unit which is an imaging apparatus (not shown) provided with imaging means inside, an illumination transmission means (not shown), and the like.

  The endoscope 1 is not limited to an electronic endoscope, and may be a fiberscope in which an image guide fiber that does not include an imaging unit is disposed in the insertion portion 2.

  The bending portion 7 is a mechanism portion configured to be able to actively bend in two upward and downward directions (UP-DOWN) by a turning operation of a bending lever 13 described later among the operation members of the operation portion 3.

  Note that the bending portion 7 is not limited to this type, and includes four directions including the left and right directions in addition to the up and down direction (up-down / left / right operation, all-around direction around the axis, UP-DOWN / RIGHT) -LEFT) may be of a type that can be bent.

  The flexible tube portion 8 is a tubular member formed with flexibility so as to be passively flexible. In addition to a treatment instrument insertion channel to be described later, the flexible tube portion 8 extends from an imaging unit built in the distal end portion 6 and further extends from the operation portion 3 to the inside of the universal cord 4. A light guide (to be described later) for guiding the illumination light from the various signal lines and the light source device and emitting it from the distal end portion 6 is inserted (not shown).

  The operation unit 3 is provided on the distal end side, covers the base end of the flexible tube unit 8 and is connected to the flexible tube unit 8, and the operation unit 3 is connected to the folding unit 9 and is internally viewed by the user. Consists of a gripping part 10 that is gripped by hand when using the mirror 1, operating means for operating various endoscope functions provided on the outer surface of the gripping part 10, a treatment instrument insertion part 11, a suction valve 15, and the like Is done.

  As the operation means provided in the operation unit 3, for example, a plurality of operations for performing respective corresponding operations such as a bending lever 13 that performs a bending operation of the bending unit 7, an air / water supply operation or a suction operation, an imaging unit, and an illumination unit. There is a member 14 or the like.

  The treatment instrument insertion portion 11 includes a treatment instrument insertion port for inserting various treatment instruments (not shown), and is a component that communicates with the treatment instrument insertion channel through the branch member inside the operation section 3.

  The treatment instrument insertion portion 11 is provided with a forceps plug 12 that is a lid member for opening and closing the treatment instrument insertion port and is configured to be detachable (replaceable) with respect to the treatment instrument insertion portion 11. ing.

  The universal cord 4 passes through the insertion portion 2 from the distal end portion 6 of the insertion portion 2 to the operation portion 3, and further passes various signal lines and the like extending from the operation portion 3 to the inside. This is a composite cable through which a light guide or the like for transmitting illumination light from (not shown) is inserted.

  The endoscope connector 5 has an electrical connector portion 16 to which a signal cable for connection with a video processor (not shown) of an external device is connected on a side surface, and is connected to a light source device that is an external device And a light source connector portion 17 to which an after-mentioned light guide bundle and an electric cable (not shown) are connected.

Here, the configuration of the endoscope hood 30 of the present embodiment will be described in detail below.
As shown in FIG. 2, the endoscope hood 30 is an elastically deformable flexible tubular member formed of a resin that is detachable from the distal end portion 6 of the insertion portion 2 of the endoscope 1.

  More specifically, the endoscope hood 30 includes a stent housing portion 31 in which an inner space 33 having a maximum inner diameter of about 10 mm to 12 mm is formed and loaded with a stent having an enlarged diameter on the distal end side, and the stent housing portion 31. And an endoscope mounting portion 32 continuously reduced in diameter on the proximal end side.

  The stent accommodating part 31 is formed with two protrusions projecting in the inner diameter direction and extending in the proximal direction at a position symmetrical to the center point of the inner space 33 in which the stent is accommodated. 34 is formed along the longitudinal axis direction to the middle part (see FIG. 5).

  In the state where the endoscope hood 30 is attached to the distal end portion 6, at least one of these protrusions 34 enters the visual field of the endoscope 1 and opens at the distal end portion 6 of the insertion portion 2 of the endoscope 1. The treatment instrument channel opening 23 is formed outside the projection area.

  The endoscope hood 30 is preferably formed from a transparent silicon resin such as an elastomer.

  As shown in FIG. 3, the endoscope hood 30 configured as described above is mounted such that the endoscope mounting portion 32 covers the distal end portion 6 of the endoscope 1. At this time, the inner diameter of the endoscope mounting portion 32 is set to be smaller than the outer diameter of the distal end portion 6, and the endoscope is attached to the distal end portion 6 by the restoring force due to the elastic deformation of the endoscope mounting portion 32. The mirror hood 30 is mounted so as not to be detached from the tip portion 6.

  Then, as shown in FIGS. 3 to 6, the endoscope hood 30 is placed in a stenosis site such as a trachea or a bronchus, for example, a Y stent 200 which is a transparent silicon stent in an internal space 33 of the stent housing portion 31. It can be accommodated.

  At this time, as shown in FIGS. 5 and 6, the Y-stent 200 is folded so that the two branch pipes 201 are close to each other, and is loaded into the internal space 33 of the stent accommodating portion 31 from the main pipe 202 direction.

  When the Y stent 200 is accommodated in the internal space 33, as shown in FIG. 7, the two protrusions 34 formed in the internal space 33 of the stent accommodating portion 31 hold the two branch pipes 201 and are accommodated in the accommodating position. Is specified.

  That is, the internal space 33 of the stent accommodating portion 31 is formed in a cross-sectional shape by two protrusions 34, and resists a restoring force that attempts to expand the branch pipe 201 of the Y stent 200 in each of the two communicating spaces. The accommodation position is defined in a state where the Y stent 200 is held.

  Note that the endoscope hood 30 accommodates the branch pipe 201 of the Y-stent 200 in parallel in the left-right direction perpendicular to the up-down direction, in which the bending portion 7 of the insertion portion 2 of the endoscope 1 is bent in two directions. Is attached to the distal end portion 6 of the insertion portion 2 at a position around the longitudinal axis.

  That is, the endoscope hood 30 is attached to the distal end portion 6 so that the two protruding portions 34 are positioned in the vertical direction in which the bending portion 7 is bent.

  Further, as shown in FIG. 8, the Y stent 200 in the endoscope hood 30 has two branch pipes in which a dedicated pusher 300 introduced into the treatment instrument channel of the endoscope 1 is introduced into the main pipe 202. By being pushed out against the branching portion 201, it is placed in a stenotic site such as trachea or bronchus.

  At this time, the user who is a doctor can perform the procedure while confirming the endoscopic image obtained by the endoscope 1 by using the transparent Y stent 200 placed in the stenosis site.

  The two projections 34 formed in the stent housing portion 31 of the endoscope hood 30 are formed so as to be outside the projection region of the treatment instrument channel opening 23 opened at the distal end portion 6. The bifurcated portions of the two branch tubes 201 of the Y stent 200 enter the projection region of the treatment instrument channel opening 23.

  Therefore, the tip of the pusher 300 can be reliably pressed against the branch portion of the two branch pipes 201, and the Y stent 200 can be easily led out from the endoscope hood 30.

  Further, by providing two projections 34 along the longitudinal axis direction in the internal space 33 of the endoscope hood 30, the two projections 34 guide the branch pipe 201 so that the Y stent 200 is pushed out. Can be accurately defined.

  And the user can also grasp | ascertain easily the direction of the branch pipe 201 of the Y stent 200, and the bending direction of the bending part 7 because the two projection parts 34 appear in an endoscopic image.

  When the Y stent 200 is placed, the position of the Y stent 200 can be adjusted after placement by using a graspable treatment tool such as a biopsy forceps instead of the pusher 300.

  Furthermore, the endoscope hood 30 is made of a transparent resin, so that the visual field of the endoscope 1 is not blocked, and the workability can be improved.

  In the endoscope system 100 of the present embodiment configured as described above, the endoscope hood 30 is attached to the distal end portion 6 of the insertion portion 2 of the endoscope 1 so that the transparent Y stent 200 is here. Can be performed directly through an endoscopic image when placed in a stenotic site such as trachea or bronchus.

  Therefore, a user who is a doctor can accurately grasp the position where the Y stent 200 is placed, and can easily place the Y stent 200 in a stenotic site such as the trachea and bronchus.

  In addition, after placing the Y stent 200 at the stenosis site, the placement position of the Y stent 200 can be easily finely adjusted using the endoscope 1 inserted into the body as it is.

  Further, unlike the prior art, the insertion portion 2 of the endoscope 1 is not inserted into a hard mantle tube, so that damage to the flexible insertion portion 2 can be prevented.

  As described above, the endoscope system 100 according to the present embodiment includes the endoscope hood 30 that is attached to the distal end portion 6 of the insertion portion 2 of the endoscope 1, so that the Y stent 200 that is a silicon stent is provided. It can be easily and accurately placed at the target site, and damage to the insertion portion 2 of the endoscope 1 can be prevented.

  In the above embodiment, the transparent Y stent 200 is accommodated in the endoscope hood 30 and placed in a stenotic site such as the trachea and bronchus. Of course, a straight type stent is used as the endoscope hood. 30 and can be placed in a stenotic site.

(Modification)
FIG. 9 is a perspective view showing a state where the endoscope hood for stent placement is attached to the distal end portion of the insertion portion.
As shown in FIG. 9, when the endoscope hood 30 is attached to the distal end portion 6 of the insertion portion 2 of the endoscope 1, the attachment position around the central axis of the endoscope hood 30 can be easily determined. Alternatively, a convex portion 6 a may be provided at the distal end portion 6, and a concave cutout portion 32 a into which the convex portion 6 a is engaged may be formed at the proximal end portion of the endoscope mounting portion 32 of the endoscope hood 30.

  Thereby, a doctor, a nurse, or the like can accurately place the endoscope hood 30 on the distal end portion 6 so that the two protruding portions 34 are positioned in the vertical direction in which the bending portion 7 of the insertion portion 2 of the endoscope 1 is bent. Can be installed.

(Reference example)
10 is a perspective view showing the distal end portion of the insertion portion of the endoscope before the straight stent is accommodated, FIG. 11 is a front view showing the distal end portion of the insertion portion of the endoscope, and FIG. 12 is accommodated by the straight stent. FIG. 13 is a front view showing the distal end portion of the insertion portion of the endoscope in which the straight stent of the reference example is accommodated.

  As shown in FIGS. 10 and 11, the endoscope 1 here has a configuration in which the distal end portion 6 of the insertion portion 2 is provided with a stent accommodating portion 25 for accommodating a silicon stent, here, a straight stent 210. Yes.

  The stent housing portion 25 protrudes from the outside in the direction away from the observation window 21 and the two illumination windows 22 toward the center of the inside, and extends along the axial direction (longitudinal axis direction) of the distal end portion 6. A convex portion 26 is formed and has a substantially inverted U-shaped cross section.

  The stent housing portion 25 communicates with the treatment instrument channel 24 and is formed as a space larger than the cross-sectional area of the treatment instrument channel 24, and the treatment instrument channel opening 23 is formed on the wall surface in the distal end portion 6. Is provided.

  As shown in FIG. 12 and FIG. 13, here, the straight stent 210 is folded and loaded into a substantially inverted U shape in accordance with the convex portion 26, as shown in FIGS. 12 and 13.

  At this time, the straight stent 210 is held in the stent housing portion 25 by a restoring force to expand itself.

  Further, the end portion of the straight stent 210 in the stent housing portion 25 has a higher density due to its thickness, and is housed in the stent housing portion 25 so as to cover the treatment instrument channel opening 23.

  Also here, the straight stent 210 in the stent housing portion 25 is pushed out by a dedicated pusher (not shown) introduced into the treatment instrument channel 24, so that the straight stent 210 is placed in a stenosis site such as trachea and bronchus.

  At this time, since the portion where the density of the straight stent 210 is high is located in the treatment instrument channel opening 23 of the treatment instrument channel 24 in the stent accommodating portion 25, the force of the pusher abutting and pushing out efficiently is transmitted without waste. .

  Further, the straight stent 210 can accurately define the push-out direction of the Y-stent 200 when the convex portion 26 of the stent housing portion 25 guides straightly.

  Even in the endoscope 1 configured in this manner, the observation window 21 and the illumination window 22 are exposed at the distal end portion 6, so here, when the straight stent 210 is placed in a stenosis site such as trachea and bronchus, It can be done with direct vision through an endoscopic image.

  The invention described in the above-described embodiment is not limited to the embodiment and modifications, and various modifications can be made without departing from the scope of the invention in the implementation stage. Further, the above embodiments include inventions at various stages, and various inventions can be extracted by appropriately combining a plurality of disclosed constituent elements.

  For example, even if some constituent requirements are deleted from all the constituent requirements shown in the embodiment, the described requirements can be deleted if the stated problem can be solved and the stated effect can be obtained. The configuration can be extracted as an invention.

DESCRIPTION OF SYMBOLS 1 ... Electronic endoscope 2 ... Insertion part 3 ... Operation part 4 ... Universal cord 5 ... Endoscope connector 6 ... End part 6a ... Convex part 7 ... Bending part 8 ... Flexible tube part 9 ... Folding prevention part 10 ... Grasping Part 11 ... treatment instrument insertion part 12 ... forceps plug 13 ... bending lever 14 ... operation member 15 ... suction valve 16 ... electric connector part 17 ... light source connector part 21 ... observation window 22 ... illumination window 23 ... treatment instrument channel opening part 30 ... Endoscope hood 31 for stent placement ... Stent accommodating part 32 ... Endoscope mounting part 32a ... Notch 33 ... Internal space 34 ... Protrusion part 100 ... Endoscope system 200 ... Stent 201 ... Branch pipe 202 ... Main pipe 300 ... Pusher

Claims (5)

An endoscope mounting portion mounted on the distal end portion of the insertion portion of the endoscope having a bending portion that can be bent in at least two directions;
A storage section that is connected to the distal end side of the endoscope mounting section and is loaded with a stent to be placed in the body;
A protrusion that is formed along the longitudinal axis of the storage portion so as to enter the field of view of the endoscope in the inner diameter direction in the storage portion, and holds the stent to define the storage position;
An endoscope hood for indwelling a stent, comprising:   2. The stent placement according to claim 1, wherein the protruding portion is formed to protrude into a field of view of the endoscope in a state where the endoscope mounting portion is mounted on the distal end portion. Endoscope hood.   In a state where the endoscope mounting portion is mounted on the distal end portion, the protruding portion is formed so as to protrude outside the projection region of the treatment instrument channel opening provided on the distal end portion. The endoscope hood for stent placement according to claim 1 or 2, wherein the endoscope hood is placed.   The positioning unit for mounting the endoscope mounting portion on the distal end portion at a position that coincides with the two directions in which the bending portion bends the projection portion. The endoscope hood for stent placement according to any one of the above. The endoscope;
An endoscope hood for stent placement according to any one of claims 1 to 4,
An endoscope system comprising:

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