JP2018175291A - Sheath set and endoscope system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a sheath set and an endoscope system which can reduce the number of types of tools to be used and can reduce an X-ray exposure dose.SOLUTION: A sheath set 10 having a predefined flexibility includes: an outer-layer sheath 20 having a thin and long through hole 23 along a sheath center axis a21; and an inner-layer sheath component 30 divided into a plurality of parts and configured to be less likely to curve compared to the outer-layer sheath 20, the inner-layer sheath component 30 increasing a rigidity of the outer-layer sheath 20 by assembling all parts thereof into the through hole 23 of the outer-layer sheath 20 so as to be insertable into and removable from the through hole 23 of the outer-layer sheath 20.SELECTED DRAWING: Figure 3B

Description

  The present invention relates to a sheath set and an endoscope system attached to an insertion portion of a flexible medical device.

  A procedure is performed in which an elongated insertion portion of an endoscope is guided through the ureteral tube into the kidney for observation or treatment. In a renal pelvic and ureteroscope which is an endoscope for observing the inside of the kidney and the like, a rigid insertion portion, a bending portion and a flexible tube portion are provided, and the insertion portion has flexibility. There is.

  In recent years, in addition to hard rigid ureteroscopes with a rigid insertion section for treatment of ureteral stones and kidney stones, it is possible to treat not only ureteral stones but also kidney stones by using a flexible ureteroscope with a flexible insertion section. Calculus has been used as a novel treatment.

  In Patent Document 1, for transurethral calculus fracture, an r-TUL using a hard pyelorhroscope (hereinafter referred to as a rigidoscope) and an f− using a flexible pyelorhroscope (hereinafter referred to as a flexible mirror) It is disclosed that there is TUL and the like.

  When the kidney stone is treated with f-TUL, for example, a doctor inserts a rigid scope from the urethral opening, for example, and makes the ureter reach the middle of the ureter through the bladder from the urethra while performing endoscopic observation. Next, the physician pulls a guide wire out of the treatment tool channel of the rigid endoscope into the ureter and places the guide wire into the kidney from the ureter under fluoroscopy.

  The physician then withdraws the rigid scope and inserts the access sheath halfway into the ureter under the guide wire. Next, the physician withdraws the guide wire, inserts a soft endoscope into the access sheath and allows the distal end of the soft endoscope to reach the inside of the kidney for treatment.

  After that, the doctor repeats the procedure of crushing finely while confirming the calculus, the procedure of storing the fragment of crushed calculus in the basket forceps, the procedure of taking out the fragmented basket containing forceps with the flexible scope via the access sheath, etc. Go and finish the treatment.

JP, 2016-168268, A

  However, as described above, in f-TUL, there are many types of instruments used, such as rigid scopes, guide wires, access sheaths, flexible scopes, basket forceps, and the like. And operation of various instruments is complicated and requires time for technical learning. In addition, since the guide wire is inserted under fluoroscopy, in order to reduce patient exposure and the like, it is necessary to shield and minimize fluoroscopy time.

  The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a sheath set and an endoscope system capable of reducing the types of instruments used and reducing the amount of X-ray exposure.

  The sheath set according to one aspect of the present invention has a predetermined flexibility and is configured to be difficult to bend as compared with the outer layer sheath divided into a plurality of outer layer sheaths having a through hole elongated along the central axis. The outer layer sheath is made rigid by being assembled and disposed entirely in the through hole of the outer layer sheath, and the insertion portion of the medical device is disposed on the inner side. And an insertion member.

  The endoscope system according to one aspect of the present invention has an outer sheath having a predetermined flexibility and having an elongated through hole along a central axis, and a plurality of divided sheaths that are bent as compared to the outer sheath. The outer layer sheath is made hard by inserting and removing the outer layer sheath through the through hole of the outer layer sheath, and the insertion portion of the medical device is disposed inside by making the outer layer sheath rigid. A sheath set including an insertion member, and an endoscope which is the medical instrument.

  According to the present invention, it is possible to realize a sheath set and an endoscope system capable of reducing the types of instruments used and reducing the amount of X-ray exposure.

The figure which demonstrates the sheath set and endoscope of this invention A figure explaining an inner layer sheath part constituted by assembling two inner layer sheath constituent members The figure explaining the relationship between the inner layer sheath part which comprises a sheath set, and an outer layer sheath A diagram illustrating a sheath set in which an outer sheath and an inner sheath portion are integrated Diagram for explaining the relationship between the insertion portion of the endoscope and the sheath set The figure which demonstrates the state which arrange | positioned the insertion part of the endoscope in the sheath set The figure explaining the procedure which removes one inner layer sheath component from a sheath set The figure which demonstrates the state which removed the inner-layer sheath structure member from the sheath set, and the insertion part was arrange | positioned in the penetration hole of the outer-layer sheath in the loose fitting state. A diagram for explaining the distal end side of the sheath set and the distal end of the insertion portion projecting from the distal end surface of the sheath set A diagram for explaining a state in which the insertion portion to which the sheath set is attached is introduced into the ureter The figure which illustrates the state which has derived the insertion part from the outer layer sheath after removing the inner layer sheath component from the sheath set introduced into the urethra The figure explaining the notch provided in the inner layer sheath component The figure explaining the inner layer sheath constituent member in which a plurality of notches were formed The figure explaining the state which is bending the inner-layer sheath component member provided with a notch. A diagram for explaining an exemplary configuration of a fixing mechanism Diagram for explaining the relationship between the fixing mechanism and the outer sheath Diagram for explaining another configuration example of the fixing mechanism Diagram for explaining the relationship between the fixing mechanism and the outer sheath The figure explaining the inner layer sheath constituent member which has a position gap control part in one. Step view in the longitudinal direction of the inner layer sheath constituting member integrally having the positional deviation regulating portion A diagram for explaining an exposed sheath portion having a fragile portion and a tensile breaking portion An enlarged view of a portion indicated by arrow Y10B in FIG. 10A A diagram for explaining a positional deviation restricting portion configured by a pair of pressing members and a coupling member Diagram for explaining the relationship between the misalignment control part and the insertion part

Hereinafter, the present invention will be described by the illustrated embodiments.
The drawings used in the following description are schematically shown, and in order to show each component in a recognizable manner in the drawings, the dimensional relationship, the scale, etc. of each member are shown differently for each component May be Therefore, the present invention is limited to the illustrated form only with respect to the number of components described in the drawings, the shapes of the components, the ratio of the sizes of the components, the relative positional relationship of the components, etc. It is not a thing.

An endoscope system 100 shown in FIG. 1 is configured to include an endoscope 1 which is a medical instrument and a sheath set 10. The endoscope 1 is a flexible pelvic ureteroscope, and is mainly configured of an insertion unit 2, an operation unit 3, and an eyepiece unit 4. The eyepiece unit 4 is provided on the proximal end side of the operation unit 3.
Reference numeral 5 denotes a light guide, and the connector 5 c of the light guide 5 is detachable from a light guide connection port (not shown) provided on the side of the operation unit 3.

  The insertion part 2 has flexibility, and the tip part 2a, the bending part 2b, and the flexible tube part 2c are provided in a row in order from the front end side. The tip 2a is made of a hard member. The bending portion 2b is configured to bend in the vertical direction. The flexible tube portion 2c is a flexible tube. On the proximal end side of the flexible tube portion 2c, there is provided a fold prevention portion 6 having a predetermined elastic force, which becomes the proximal end portion of the insertion portion 2.

  The operation unit 3 is provided with a treatment tool insertion port 3a, a bending operation lever 3b, and the like. The bending operation lever 3b is rotatable. The bending portion 2b bends in the upper and lower two directions as the bending wire (not shown) is pulled and loosened along with the turning operation of the lever 3b.

  The distal end surface of the distal end portion 2a of the insertion portion 2 is provided with an observation window and an illumination window treatment instrument opening (not shown). An insertion optical fiber bundle for transmitting illumination light to the illumination window, an observation optical fiber bundle for transmitting an observation image observed through the observation window, a bending wire for upper and lower, a treatment instrument opening and a treatment instrument insertion opening 3a. A treatment instrument channel tube or the like which constitutes a treatment instrument channel communicating with the other is inserted.

  In addition, the endoscope 1 is not limited to a pelvic ureteroscope, and may be an endoscope having a flexible insertion portion. In addition, the bending portion 2b is not limited to the configuration that bends in the upper and lower two directions, and may be configured to bend in the upper, lower, left, and right directions.

On the other hand, the sheath set 10 is composed of an outer layer sheath 20 and a plurality of, for example, two inner layer sheath constituting members 30 divided into two.
The outer sheath 20 is an elongated pipe made of a resin having a predetermined flexibility which can be an access sheath alone. The outer layer sheath 20 includes an elongated sheath main body 21 having a function as an access sheath, and a funnel shaped portion 22 which is a convex portion provided at one end of the sheath main body 21.

  The outer sheath 20 has an elongated through hole 23 in the sheath body 21 along the sheath central axis a21. The through hole 23 is, for example, a straight hole with an inner diameter d. The outer sheath 20 has a distal end side opening 23a and a proximal end opening 23b.

  The code | symbol 22a is an outer side slope and the code | symbol 22b is an introductory hole inner surface. The introduction hole inner surface 22b is configured as a tapered hole whose diameter is continuously reduced from the funnel opening 22m of the funnel shaped portion 22 toward the base end opening 23b.

  In the present embodiment, the two-divided inner layer sheath constituting members 30 shown in FIG. 1 and FIG. 2A are long insertion members made of resin and have the same shape. The inner layer sheath component 30 has a predetermined flexibility and is configured to be less likely to bend than the outer layer sheath 20.

  The inner layer sheath component 30 has an outer surface 31, an inner surface 32, an abutment surface 33, and a convex portion 34. The outer surface 31 is a convex surface, and the inner surface 32 is a concave surface. The protrusion 34 is provided at one end and protrudes outward from the outer surface 31. The convex portion 34 is provided with a defined surface 34 a which is an outer peripheral slope and an abutting surface 34 b which is an inner peripheral slope.

  As shown in FIG. 2A, the contact surface 33 is a mating surface, and the medical device is inserted inside by assembling the contact surfaces of two inner layer sheath component members 30 shown by a solid line and a two-dot chain line. A substantially circular pipe-shaped inner layer sheath portion 30P in which the portions are arranged is configured.

  As shown in FIGS. 2A and 2B, the inner layer sheath portion 30P configured by assembling a plurality of inner layer sheath components 30 has a tubular portion 35 with an outer diameter Dp and a through hole for an insertion portion with an inner diameter dp And 36). The two outer surfaces 31 constitute the outer peripheral surface of the tubular portion 35, and the two inner surfaces 32 constitute the inner peripheral surface of the through hole 36.

  The outer diameter Dp of the tubular portion 35 is set smaller than the inner diameter d of the through hole 23 in advance. Therefore, the inner layer sheath portion 30P configured by combining the two inner layer sheath components 30 can be inserted into the through hole 23 through the inner surface 22b of the outer layer sheath 20 as shown by the arrow in FIG. 2B.

  Then, as shown in FIG. 2C, by arranging the inner layer sheath portion 30P in a predetermined state in the through hole 23 of the sheath main body 21 constituting the outer layer sheath 20, the outer layer sheath 20 and the inner layer sheath portion 30P are integrated. Sheath set 10 is constructed.

  The sheath set 10 functions as a rigid tube in a state in which the inner layer sheath portion 30P is disposed in the through hole 23 of the outer layer sheath 20. That is, the inner layer sheath constituting member 30 of the present embodiment is a function changing member which changes the function of the sheath main body 21 having a function as an access sheath to a rigid tube.

  The defining surface 34 a abuts on the inner surface 22 b of the introduction hole. As a result, the arrangement position of the distal end surface of the inner layer sheath portion 30P in the through hole 23 of the outer layer sheath 20 is defined, and the sheath set 10 is configured. In the drawing, the distal end surface of the inner layer sheath portion 30P and the distal end surface of the sheath main body 21 are substantially the same surface. However, the distal end surface of the inner sheath portion 30P may project forward by a predetermined amount from the distal end surface of the sheath main body 21 in a state where the defining surface 34a abuts on the inner surface 22b of the introducing hole.

  On the other hand, the inner diameter dp of the through hole portion 36 is set in advance to be larger than the outer diameter D (see FIG. 3A) of the insertion portion 2 of the endoscope 1. Therefore, as shown in FIG. 3A, the insertion portion 2 of the endoscope 1 is inserted into the through hole 36 of the sheath set 10 from the through hole introduction port 36 a as shown by the arrow.

  Then, as shown in FIG. 3B, the insertion portion 2 is disposed in the through hole portion 36 of the sheath set 10, whereby the flexible insertion portion 2 becomes a rigid tube. In other words, the endoscope 1 which was a soft nephro-urethrascope by interposing the inner-layer sheath constituting member 30 between the through-hole 23 of the outer-layer sheath 20 and the outer surface of the insertion portion 2 is treated as a rigid nephro-urethrax It will be possible.

  The entire length L1 of the sheath set 10 is set shorter than the effective length L of the insertion portion 2. Therefore, the operation part 3 side of the insertion part 2 is protruded outside from the base end face of the sheath set 10. The code L2 is a margin length, and is a distance from the base end surface of the funnel shaped portion 22 to the tip of the bending prevention portion 6.

  As shown in FIG. 3C, in the state in which the insertion portion 2 is disposed in the through hole portion 36 of the sheath set 10, the inner sheath component 30 is disposed one by one along the sheath central axis a21 as indicated by the arrow Y3C1. It is possible to derive outward from the funnel shaped portion 22 side. Then, after the inner layer sheath constituting member 30 is moved outward substantially by a distance L2, the inner layer sheath constituting member 30 is removed from the sheath set 10 by pulling and moving in the direction of the arrow Y3C2 while bending the inner layer sheath constituting member 30 as shown by a broken line. Is possible.

  Thereafter, the remaining inner layer sheath component 30 can be removed from the sheath set 10 as well. Then, when the inner layer sheath constituting member 30 is removed from the sheath set 10, as shown in FIG. 3D, the insertion portion 2 of the outer diameter D is loosely fitted in the through hole 23 of the inner diameter d of the outer layer sheath 20. It will be in the Therefore, the insertion portion 2 of the flexible pyelorhroscope is disposed in the through hole 23 of the outer sheath 20 so as to be able to move back and forth.

  In the above description, the inner sheath portion 30P is configured as shown in FIG. 2B, and then the inner sheath portion 30P is inserted into the through hole 23 of the outer sheath 20 to construct the sheath set 10. However, the sheath set 10 may be configured by inserting two inner layer sheath component members 30 into the through hole 23 of the outer layer sheath 20 one by one.

  The inner layer sheath component 30 is inserted into the through hole 23 of the outer layer sheath 20 one by one to form the sheath set 10. Further, in a state where the insertion portion 2 is disposed in the through hole portion 36 of the sheath set 10, the inner layer sheath component 30 can be removed from the outer layer sheath 20 along the sheath central axis a21 one by one. That is, the inner layer sheath component 30 can be inserted into and removed from the outer layer sheath 20.

  Therefore, the surface of the outer surface 31 of the inner layer sheath constituting member 30 and the inner peripheral surface of the through hole 23 forming the outer layer sheath 20 are configured to have predetermined clearance and slipperiness. In addition, the surface of the inner surface 32 of the inner layer sheath component 30 has a predetermined slidability with respect to the outer surface of the insertion portion 2.

  In the endoscope system 100 to be actually used, as shown in FIG. 4, the shape of the distal end portion 2a of the insertion portion 2 is shell-shaped, and the shape of the distal end side of the tubular portion 35 of the inner layer sheath portion 30P and the outer layer sheath The shape of the distal end side of the 20 sheath body 21 is made into tapered surfaces 35t, 21t which taper in diameter from the proximal end side to the distal end side, so that the urethra, ureter and the like can be protected and spread.

  Further, in the embodiment described above, the plurality of inner layer sheath component members 30 are two. However, the number of inner layer sheath component members 30 is not limited to two, and may be two or more. In addition, the two inner layer sheath components 30 have the same shape (divided shape). However, the plurality of inner layer sheath components 30 are not limited to the same shape (divided equally), and the plurality of inner layer sheath components 30 are combined and divided into the through holes 23 of the outer layer sheath 20 so as to be insertable. It should just be.

Here, the operation of the sheath set 10 will be described.
The medical worker prepares the endoscope system 100 when performing observation stone treatment in the kidney and the like. The doctor or medical worker arranges the inner layer sheath portion 30P in which the plurality of inner layer sheath constituting members 30 are assembled in advance in the through hole 23 of the sheath main body 21 constituting the outer layer sheath 20 to function as a rigid tube The set 10 is formed.

In addition, the doctor or medical worker arranges the insertion portion 2 in a predetermined state in the through hole portion 36 of the sheath set 10, and the distal end portion 2a of the insertion portion 2 as shown in FIG. Make it project from the end face. Here, the flexible insertion portion 2 is a rigid tube portion by the sheath set 10.
Next, the doctor inserts the sheath set 10 in which the insertion portion 2 is disposed as shown in FIG. 5A into the ureter 103 via the urethra 101 and the bladder 102. The distal end portion 2 a of the insertion portion 2 smoothly advances in the ureter 103.

  At the stage when the distal end portion 2a reaches the middle portion of the ureter, the doctor removes one of the inner layer sheath component members 30 from the sheath set 10. As a result, the outer layer sheath 20 functioning as an access sheath is disposed in the ureter 103 instead of the sheath set 10, and the insertion portion 2 is disposed in the outer layer sheath 20.

  Here, while observing through the eyepiece unit 4, the doctor causes the insertion unit 2 to be drawn out from the tip of the outer sheath 20 and introduced into the kidney 104 as shown in FIG. 5B. Thereafter, the doctor appropriately operates the bending operation lever 3b to bend the bending portion 2b to observe the inside of the kidney 104.

  Doctors treat stones if necessary. At this time, the procedure for removing the laser probe from the treatment tool channel and breaking the calculus, the procedure for pulling out the basket forceps from the treatment tool channel and storing the fragments of the calculus in the basket forceps, the basket forceps containing the fragments together with the insertion portion 2 A treatment is performed in which the procedure of taking it out of the body through the outer sheath 20 is repeated.

  Then, after the observation or treatment is completed, the doctor removes the insertion portion 2a from the body through the outer layer sheath 20 and then removes the outer layer sheath 20.

  As described above, the flexible insertion portion 2 of the endoscope 1 is disposed in the through hole portion 36 of the sheath set 10 including the outer layer sheath 20 and the plurality of inner layer sheath constituting members 30. As a result, the flexible insertion portion 2 functions as a rigid tube by the sheath set 10, and the insertion portion 2 can be handled in the same manner as a rigid endoscope and reach the ureter through, for example, the urethra and the bladder. it can.

  In addition, the plurality of inner layer sheath components 30 can be removed from the through hole 23 of the outer layer sheath 20 from the sheath set 10 functioning as a rigid tube. By this, it is possible to change the sheath set 10 functioning as the rigid tube reaching the urinary tract into the outer layer sheath 20 functioning as an access sheath, and the insertion portion 2 is disposed in the outer layer sheath 20. Can be in the

As a result, the above-mentioned guide wire is led out of the treatment tool channel of the rigid endoscope into the ureter, and the procedure for placing the guide wire into the kidney from the ureter under fluoroscopy, and pulling out the rigid endoscope under the guide wire Eliminates the need to insert the access sheath halfway into the ureter.
Therefore, the need for a guide wire and a rigid scope can be eliminated to reduce the types of tools used. In addition, the reduction of the X-ray exposure dose can be realized.

  In the embodiment described above, the inner layer sheath component 30 is a resin-made long member having a predetermined flexibility, and is configured to be less likely to bend than the outer layer sheath 20. However, the inner layer sheath component 30A may be made of a rigid resin, and in this case, the same function and effect as the inner layer sheath component 30 can be obtained by configuring as described below.

  As shown in FIG. 6A, the notch 37 is provided in the inner layer sheath component 30A. The notch 37 is formed with a predetermined width dimension and a predetermined depth dimension.

  As shown in FIG. 6B, a plurality of notches 37 are formed at predetermined positions in the longitudinal direction of the inner layer sheath component 30A. The interval P of the notches 37 is set to be equal to or less than the margin length L2. Further, the distances Pa and Pb from the intersection of the defined surface 34a and the outer surface 31 to, for example, the center of the first notch 37 are set to predetermined values equal to or less than the margin length L2.

  In addition, the arrangement position of the notches 37 formed in the inner layer sheath constituting member 30A constituting the inner layer sheath portion 30P arranged adjacent to each other in the through hole 23 of the outer layer sheath 20 is in consideration of prevention of strength reduction. It is misaligned by a predetermined distance.

  According to this configuration, when the sheath set 10 is configured by arranging the inner layer sheath portion 30P in the through hole 23 of the sheath main body 21 that constitutes the outer layer sheath 20, the inner layer formed by the plurality of inner layer sheath constituting members 30A It is prevented that the notch 37 is provided over the entire circumference of the sheath portion 30P.

  As a result, it is possible to obtain a sheath set 10 that is resistant to bending while securing a certain rigidity while preventing the inner layer sheath portion 30P formed of the rigid inner layer sheath constituting member 30A from being broken at a specific position.

  In addition, after the inner layer sheath constituting member 30A is drawn out from the inside of the through hole portion 36 of the sheath set 10 along the sheath central axis a21 to expose the notch 37, as shown in FIG. 6C, the convex portion 34 Is moved in the direction of the arrow Y6C. Then, the derived inner layer sheath component 30A is bent from the vicinity of the notch 37 as shown by the broken line. Therefore, the inner layer sheath component 30A can be removed by pulling and moving while being bent as described above.

  Further, by moving the convex portion 34 further in the direction of the arrow Y6C, it is possible to break or fold the vicinity of the notch 37 to remove the inner layer sheath constituting member 30A from the through hole 23 of the outer layer sheath 20.

  The flexibility may be improved by providing a notch 37 in the inner layer sheath constituting member 30 which is flexible and configured to be less easily bent than the outer layer sheath 20.

  In the embodiment described above, the inner layer sheath component 30 is insertable into the through hole 23 of the outer layer sheath 20. The inner layer sheath component 30 is removable from the through hole 23 of the outer layer sheath 20 in a state in which the insertion portion 2 is disposed in the through hole portion 36 of the sheath set 10.

  In order to realize this configuration, between the inner surface of the through hole 23 of the outer layer sheath 20 and the outer surface 31 of the inner layer sheath constituting member 30 and between the inner surface 32 of the through hole 36 and the outer surface of the insertion portion 2 There is a predetermined clearance.

  Therefore, there is a problem that the insertion portion 2 is displaced in the longitudinal direction of the outer sheath 20 by the presence of the above-mentioned clearance in a state where the insertion portion 2 is disposed in the sheath set 10 and functions as a rigid tube. There may be a problem that the insertion portion 2 is displaced in the longitudinal direction of the inner layer sheath component 30. In order to solve this problem, it is preferable to provide a fixing mechanism 40A shown in FIG. 7A and a fixing mechanism 40B shown in FIG. 8A.

  The fixing mechanism 40A mainly includes an O-ring 41 which is an elastic member and an operation ring 42 which is an operating device as shown in FIGS. 7A and 7B. The operation ring 42 is a tubular body, and an internal thread 22 f is formed on the inner peripheral surface.

  In the present embodiment, the funnel shaped portion 22 provided at the end of the outer sheath 20 is divided into two, for example, by providing a slit 22s. The funnel shaped portion 22 is provided with a tip side convex portion 22c, and a male screw 22m is formed on the outer peripheral surface of the tip side convex portion 22c. The funnel-shaped parts 22 divided into two have different shapes from each other.

  The O-ring 41 is provided at a predetermined position on the inner surface of the tip-side convex portion 22c. The inner surface of the O-ring 41 abuts on the outer surface of the inner layer sheath component 30.

  In the present embodiment, the operation ring 42 is screwed to the tip side convex portion 22 c. When the operation ring 42 is rotated and moved on the tip side convex portion 22c toward the funnel shaped portion 22 side, the inner diameter of the tip side convex portion 22c divided into two is gradually contracted and the O ring 41 is elastically deformed I will let you.

  Then, the elastically deformed O-ring 41 presses the inner layer sheath component 30. As a result, by the elastic force of the O-ring 41, the outer layer sheath 20, the inner layer sheath component 30 and the insertion portion 2 can be integrally fixed. Then, when removing the inner layer sheath constituting member 30 from the sheath set 10, the operation ring 42 is moved in the reverse direction to the above to release the fixed state.

  The inner layer sheath component 30 is divided into two, and the shapes of the inner layer sheath 30 may be the same or different.

  Thus, by providing the fixing mechanism 40A, the insertion portion 2 is displaced in the longitudinal axis direction with respect to the outer sheath 20 in a state where the insertion portion 2 functions as a rigid tube portion by the sheath set 10. Alternatively, it is possible to eliminate the problem that the insertion portion 2 is displaced in the longitudinal axis direction with respect to the inner layer sheath component 30.

  As shown in FIGS. 8A and 8B, the fixing mechanism 40B mainly includes an funnel-shaped portion 22G made of, for example, rubber, which is an elastic member that can be elastically deformed, and an O-ring 41. In the present embodiment, the funnel shaped portion 22G is provided with a tip side convex portion 22d.

  An external thread 22m is provided on the outer peripheral surface of the distal end side convex portion 22d, and the inner peripheral surface is in contact with the outer surface of the inner layer sheath constituting member 30. The other configuration is the same as that of the fixing mechanism 40A described above, and the same reference numerals are given to the same members and the description will be omitted.

  In the present embodiment, when the operation ring 42 is rotated and moved on the tip side convex portion 22c toward the funnel shaped portion 22 as described above, the tip side convex portion 22d of the funnel shaped portion 22G made of rubber is elastically deformed It will be done.

  Then, the elastically deformed tip side convex portion 22 d presses the inner layer sheath constituting member 30. As a result, the outer layer sheath 20, the inner layer sheath constituting member 30, and the insertion portion 2 can be integrally fixed by the elastic force of the distal end side convex portion 22d. When the inner layer sheath constituting member 30 is removed from the sheath set 10, the operation ring 42 is moved in the reverse direction to release the fixed state as described above.

  In the fixing mechanism 40A described above, the outer layer sheath 20 and the inner layer sheath constituting member 30 by the elastic force of the distal end side convex portion 22d of the funnel-shaped portion 22G elastically deformable in the fixing mechanism 40B by the elastic force of the O ring 41. The problem is eliminated by making the insertion portion 2 and the integral fixed state.

  However, the presence of the clearance causes the insertion portion 2 to be displaced in the longitudinal direction of the outer sheath 20, or the insertion portion 2 to be displaced in the longitudinal direction of the inner sheath component 30. It may be made to eliminate by position gap control parts 50A and 50B provided between a tip end face of the end face of the bending stop part 6 of the above.

  As shown in FIG. 9A, the positional deviation regulating portion 50A is provided to each of the divided inner layer sheath constituting members 30B which constitute the inner layer sheath portion 30P. As shown to FIG. 9B, the inner-layer sheath structure member 30B integrally has the elongate insertion part 60 made of resin, and the position shift control part 50A.

  The inner layer sheath component 30B is made of a rigid resin, and has a plurality of notches 37 at predetermined positions in the longitudinal direction. The plurality of notches 37 are provided at an interval P as described above.

  The inserting portion 60 has an outer surface 31 similar to the inner layer sheath constituting member 30 which is the above-mentioned inserting member, an inner surface 32, an abutting surface (not shown in the drawing) 33, and a defining surface 34a. have. The defining surface 34a constitutes a tip end surface of the positional deviation regulating portion 50A.

  The positional deviation regulating portion 50A is provided on the further proximal side of the inserting portion 60, and has a contact portion 51 which is a first contact portion, an exposed sheath portion 52, and a second contact portion. And a convex portion 53. The contact portion 51 has a large-diameter cylindrical portion 51a and a defining surface 34a that constitutes the tip end surface of the cylindrical portion 51a.

  The exposed sheath portion 52 is a rod-like portion having a diameter smaller than that of the cylindrical portion 51a, and the notch 37 is provided at a predetermined position. An anti-folding mounting surface 53 a is provided on the anti-folding disposition convex portion 53. The anti-folding mounting surface 53a is a second contact portion, and is a tapered hole whose diameter is continuously reduced from the opening 53b toward the proximal end opening 23b.

  In the present embodiment, after the tapered surface 6t of the bending portion 6 is in contact with the bending installation surface 53a, the defining surface 34a of the contact portion 51 is in contact with the inner surface 22b of the introduction hole. As described above, the arrangement position of the tip surface of the inner layer sheath portion 30P in the through hole 23 of the outer layer sheath 20 is defined, and the sheath set 10 is configured.

  When the insertion portion 2 is disposed in the sheath set 10 in a predetermined state and the insertion portion 2 is a rigid tube portion, the cylindrical portion 51 a of the abutting portion 51 and the exposed sheath portion 52 have the funnel shaped portion 22. Is disposed between the proximal end of the front end and the distal end of the bending portion 6.

  According to this configuration, the tapered surface 6t of the bending portion 6 is abutted against the bending installation surface 53a, and the defining surface 34a of the abutting portion 51 is abutted against the inner surface 22b of the outer sheath 20. It is possible to eliminate the problem that the outer layer sheath 20 is displaced in the longitudinal direction due to the friction with the ureter during the insertion.

  Then, at the stage when the distal end portion 2a of the insertion portion 2 reaches the middle portion of the ureter, the doctor removes the inner layer sheath constituting member 30B from the sheath set 10. At that time, the doctor first moves the folding disposition convex portion 53 in the direction of the arrow Y9B. As a result, a part of the folding disposition convex portion 53 and the exposed sheath portion 52 is bent and cut from the vicinity of the notch 37.

  Next, the doctor holds the tubular portion 51 a and guides the inner layer sheath component 30 B outward from the inside of the through hole portion 36 of the sheath set 10 along the sheath central axis a 21 to expose the notch 37.

  Thereafter, the doctor again cuts or bends and bends to remove the inner layer sheath component 30B from the through hole 23 of the outer layer sheath 20. As a result, as described above, the insertion portion 2 is disposed loosely in the through hole 23 of the outer sheath 20.

  Thus, the inner layer sheath constituting member 30B in which the inserting portion 60 and the displacement regulating portion 50A are integrated is configured, and the abutting portion 51 on the displacement regulating portion 50A, the exposed sheath portion 52, and the bending arrangement convex A part 53, and And when inserting the insertion part 2 arrange | positioned to the sheath set 10 in a ureteral tube etc., the taper surface 6t of the non-breaking part 6 is made to abut, and the prescription | regulation surface 34a of the sticking part 51 abuts. Apply to the inner surface 22 b of the introduction hole of the outer layer sheath 20. As a result, it is possible to eliminate the problem that the outer layer sheath 20 is displaced in the longitudinal direction.

  In the embodiment described above, the notches 37 are provided in the exposed sheath portion 52. Then, when removing the inner layer sheath component 30B from the sheath set 10, first, the exposed sheath portion 52 is cut from the notch 37.

However, as shown in FIGS. 10A and 10B, a fragile portion 61 which is thin may be provided around the exposed sheath portion 52, and a tensile breaking portion 62 for breaking the fragile portion 61 may be provided.
According to this configuration, the fragile portion 61 is gradually broken by pulling and pulling the tensile breaking portion 62 in the circumferential direction, and the exposed sheath portion 52 is separated into two, and the bent portion convex portion 53 of the exposed sheath portion 52 The side can be easily removed from the insert.
As a result, the same operation and effect as those of the above-described embodiment can be obtained.

  As shown in FIG. 11A, the positional deviation regulating portion 50B is configured by a pair of pressing members 71 and a coupling member 72. The positional deviation control unit 50B includes a guide hole 73 through which the insertion portion 2 can pass or in which the insertion portion 2 can be disposed. The integral member 72 is, for example, a surgical tape or a heat-shrinkable tube that integrally fixes the two pressing members 71.

  As shown in FIGS. 11A and 11B, the pressing member 71 is a hard and elongated long member, and the inner surface 73h constituting the inner peripheral surface of the guide hole 73, the contact portion 74, and the support portion 75. , And a convex portion 76 for preventing bending. The contact portion 74 is disposed in contact with the contact surface 34b of the convex portion 34 in which the defining surface 34a is disposed in contact with the inner surface 22b of the introduction hole.

  The fold prevention convex part 76 is provided with the fold prevention installation surface 76a. The anti-folding mounting surface 76a is a tapered hole whose diameter is continuously reduced from the opening 76b toward the proximal end opening 73b, and the tapered surface 6t of the anti-folding portion 6 is disposed in contact.

  In addition, the pressing member 71 is not limited to a pair (divided into two), and may be divided into different shapes. In addition, although it is possible to configure the positional deviation regulating unit 50B with three or more pressing members 71, in consideration of workability, two division is preferable.

  As shown in FIG. 11B, the positional deviation regulating portion 50B is provided between the vicinity of the funnel shaped portion 22 and the tip end of the bending prevention portion 6. The positional deviation regulating portion 50B is in a state in which the tubular portion is configured by fixing the support portions 75 of the pair of pressing members 71 with a surgical tape, or as shown by the broken lines in the figure, the pair of pressing members 71 After being disposed in the insertion portion 2, the support portion 75 is fixed with a surgical tape to form a tube portion.

  Then, the insertion portion 2 is in a predetermined state in the sheath set 10 by the tapered surface 6t of the bending prevention portion 6 abutting on the bending prevention installation surface 76a and the abutting unit 74 abutting on the abutting surface 34b. Be placed.

  In this arrangement state, the insertion portion 2 disposed in the sheath set 10 is displaced in the longitudinal axis direction of the outer layer sheath 20 by the doctor continuing to press the tapered surface 6t against the installation surface 53a, or Misalignment of the insertion portion 2 with the inner layer sheath component 30 is prevented.

  Then, after the treatment is completed, the surgical tape is cut off. As a result, the pressing member 71 is removed from the insertion portion 2 and then the inner layer sheath component 30 is removed from the sheath set 10 as described above. By this, the insertion part 2 will be in the state arrange | positioned in the through-hole 23 of the outer-layer sheath 20 in the loose fitting state.

  The present invention is not limited to the embodiments described above, and various modifications and applications can be made without departing from the scope of the invention.

DESCRIPTION OF SYMBOLS 1 ... Endoscope 2 ... Insertion part 2a ... Tip part 2b ... Curved part 2c ... Flexible tube part 3 ... Operation part 3a ... Treatment tool insertion port 3b ... Curved operation lever 4 ... Eyepiece part 5 ... Light guide
6 ··· Breaking portion 6t ··· Tapered surface 10 ··· Sheath set 20 ··· Outer layer sheath
21: sheath main body 22: convex portion 22G: funnel shaped portion 22b: inner surface of introduction hole 22d: tip side convex portion 23: through hole 23a: distal end side opening 23b: proximal end opening
30, 30A, 30B: inner layer sheath component 30P: inner layer sheath portion 31: outer surface 32: inner surface 33: contact surface 34: convex portion 34a: prescribed surface 34b: contact surface
35 ... tubular portion 36 ... through hole portion 36 a ... through hole portion introduction port 37 ... notch
40A, 40B: Fixing mechanism 41: O ring 42: Operation ring
50A, 50B ... positional deviation control part 51 ... contact part 51a ... cylindrical part
52: Exposed sheath portion 53: Protrusive arrangement convex part 53a ... Provenous installation surface
53b ... opening 60 ... insertion portion 61 ... fragile portion 62 ... destruction portion 71 ... suppression member
72 ... coupling member 73 ... guiding hole 75 ... supporting portion 76 ... convex portion for preventing bending
100 ... endoscopy system 101 ... urethra 102 ... bladder 103 ... urethra 104 ... kidney

Claims (10)

An outer sheath having a predetermined flexibility and having an elongated through hole along a central axis;
The outer layer sheath is divided into a plurality of pieces and is configured to be less likely to bend than the outer layer sheath, and can be inserted into and removed from the through hole of the outer layer sheath. An insertion member which is rigid and on which the insertion part of the medical device is disposed;
A sheath set characterized by comprising: The plurality of insertion members are assembled,
A tubular portion disposed within the through hole of the outer sheath;
Forming an inner layer sheath portion including an insertion portion through hole portion in which the long and flexible insertion portion of the medical device provided in the tubular portion is disposed;
The sheath set according to claim 1, characterized in that:   The sheath set according to claim 1, wherein a plurality of notches are provided at predetermined positions in the longitudinal direction of the plurality of insertion members. The insertion member includes a protrusion having an inclined surface that protrudes outward at one end.
The sheath set according to claim 3, wherein the inclined surface of the convex portion is disposed in contact with the inner surface of the introduction hole provided at one end of the outer layer sheath. The outer sheath is provided with an elastic member at a predetermined position on the proximal end side,
The sheath set according to claim 1, wherein a tube for pressing the elastic member against the plurality of interposed members is disposed on an outer side surface of the elastic member. The plurality of interposition members may be proximal to the
A second contact portion, a rod-like portion extending from the base end side of the first contact portion, and a base end of the insertion portion located at a base end of the rod-like portion; The sheath set according to claim 1, further comprising: a displacement control portion having a contact portion.   The sheath set according to claim 6, wherein a weak portion is provided in the rod-like portion of the positional deviation regulating portion. Furthermore, an inner surface that constitutes a hole through which the insertion portion can pass or can be placed;
An abutment portion abutting on an abutment surface of the inner layer sheath portion disposed in the through hole of the outer layer sheath;
A support that constitutes the tube body;
A convex portion provided with an installation surface on which a fold stop constituting the proximal end of the insertion portion is disposed in contact;
A plurality of rigid and elongated restraining members comprising
A joint member forming a tubular body by bringing together the support portions of the plurality of restraining members;
The sheath set according to claim 1, further comprising: a displacement control unit configured by: The distal end side of the tubular portion of the inner layer sheath portion and the distal end side of the sheath body of the outer layer sheath are tapered surfaces which decrease in diameter from the proximal end side to the distal end side,
The sheath set according to claim 1, characterized in that: A sheath set according to any one of claims 1 to 9;
An endoscope which is a medical instrument,
An endoscope system comprising:

Images