WO2018229985A1

WO2018229985A1 - Inner sheath, insertion assisting device for endoscope, and endoscope system

Info

Publication number: WO2018229985A1
Application number: PCT/JP2017/022389
Authority: WO
Inventors: 尚也杉本; 康成石原; 善朗岡崎; 俊二武井; 和敏熊谷
Original assignee: オリンパス株式会社
Priority date: 2017-06-16
Filing date: 2017-06-16
Publication date: 2018-12-20

Abstract

This inner sheath (4) comprises: a tubular sheath body (41) having a first lumen (4a) passing through the inner sheath (4) in a longitudinal direction, said first lumen having an endoscope (1) inserted therein, and a second lumen (4b) passing through the inner sheath (4) in the longitudinal direction, said second lumen having treatment tools (20, 30) inserted therein; and a protruding part (43) that is anchored to the distal end surface of the sheath body (41), said protruding part protruding in the longitudinal direction from the distal end surface. The protruding part (43) and the second lumen (4b) are disposed at the distal end surface of the sheath body (41) on both radial-direction sides with the first lumen (4a) interposed therebetween.

Description

Inner sheath, insertion assist device for endoscope, and endoscope system

The present invention relates to an inner sheath, an insertion assisting device for an endoscope, and an endoscope system.

2. Description of the Related Art Conventionally, a medical device used for a procedure for ligating while observing the left atrial appendage attached to the left atrium of the heart with an endoscope, comprising an endoscopic and a left atrial appendage ligation subassembly in the pericardial space A medical device including a sheath for guiding and an expansion subassembly for expanding a pericardial space to secure a working area around the left atrial appendage is known (see, for example, Patent Document 1).

Special table 2010-527697

In order to place the medical device of Patent Document 1 in the pericardial cavity, first, the introduction sheath is inserted into the pericardial cavity, then the expansion subassembly is inserted into the introduction sheath, and then the endoscope. And a multi-lumen tube for guiding the occlusion subassembly is inserted into the expansion subassembly. Thus, since the medical device of the cited document 1 has a triple structure, there are inconveniences that the number of parts increases, the setting work and the procedure become complicated, and it is difficult to reduce the diameter.

The present invention has been made in view of the above-described circumstances, and by reducing the number of components, an inner sheath that can simplify a procedure and can have a small-diameter structure, and an endoscope An object is to provide an insertion assisting device and an endoscope system.

In order to achieve the above object, the present invention provides the following means.
A first aspect of the present invention is a tubular sheath body having a first lumen that penetrates in the longitudinal direction and into which an endoscope is inserted, and a second lumen that penetrates in the longitudinal direction and into which a treatment instrument is inserted. And a projection that is fixed to the distal end surface of the sheath main body and protrudes in the longitudinal direction from the distal end surface, and the projection and the second lumen on the distal end surface of the sheath main body include the first lumen It is an inner sheath arranged on both sides in the radial direction across the lumen.

According to this aspect, the sheath body is inserted into the pericardial cavity through the access sheath that is previously placed percutaneously from the outside of the body to the pericardial cavity, and protrudes along the longitudinal direction from the distal end surface of the sheath body. The sheath body is arranged so that the protruding portion to be positioned is on the pericardial side and the second lumen is on the heart side. As a result, the pericardium is pushed up in the direction away from the heart by the protrusions, so that the pericardial space is expanded in front of the distal end openings of the first and second lumens, and a space for observation and treatment is secured. The

Next, the endoscope and the treatment tool are respectively inserted into the first and second lumens, and the distal end portion of the endoscope and the distal end portion of the treatment tool are protruded from the distal end opening of each lumen. In this state, the distal end portion of the treatment instrument is disposed between the distal end portion of the endoscope and the heart. Therefore, both the treatment tool and the heart can be observed simultaneously with the endoscope, and the heart can be treated with the treatment tool while observing with the endoscope.

In this way, the protrusion for expanding the pericardial cavity is integrally provided in the sheath body, so the number of parts can be reduced, the procedure can be simplified, and a thin access sheath is used. can do. Further, since the protrusion is provided on the opposite side of the second lumen across the first lumen, the protrusion may interfere with the observation of the heart with the endoscope and the treatment of the heart with the treatment instrument. Can be prevented.

In the first aspect, it may have a third lumen that penetrates from the distal end of the protrusion to the proximal end of the sheath body and into which the guide wire is inserted.
In this way, the guide wire protruding from the tip of the protrusion pushes the pericardium away from the heart, thereby further expanding the pericardial space in front of the tip openings of the first and second lumens. be able to. In addition, since the guide wire is disposed closer to the pericardium than the treatment tool protruding from the distal end opening of the second lumen, it is possible to prevent the guide wire from interfering with the treatment of the heart by the treatment tool.

In the first aspect, the protrusion may be a mesh or a balloon that can contract and expand in a radial direction of the sheath body.
By doing so, the size of the space secured in the pericardial cavity can be adjusted by contraction and expansion of the mesh or balloon.

According to a second aspect of the present invention, there is provided the inner sheath according to any one of the above, a tubular access sheath that is open at both ends and into which the sheath body of the inner sheath is inserted along a longitudinal direction, and the access sheath Endoscope insertion aid comprising a sheath positioning portion for positioning the relative position of the access sheath in the longitudinal direction with the sheath body so that the distal end surface of the access sheath and the distal end surface of the sheath body coincide with each other Device.
According to this aspect, by positioning the sheath body of the inner sheath inserted into the access sheath at a position positioned by the positioning portion, the position of the inner sheath is set at a position where only the protruding portion protrudes from the distal end surface of the access sheath. Can be controlled.

According to a third aspect of the present invention, there is provided the inner sheath according to any one of the above, an endoscope that is inserted into the first lumen, and the endoscope that is disposed in the first lumen. An endoscope system including an endoscope positioning unit that positions with respect to an inner sheath.
According to this aspect, by positioning the endoscope with respect to the inner sheath by the endoscope positioning unit, unintentional movement of the endoscope during operation of the treatment instrument is prevented, and the treatment instrument is operated smoothly. can do.

According to the present invention, by reducing the number of parts, the procedure can be simplified and the structure can be reduced in diameter.

It is the perspective view seen from the front end side which shows the whole block diagram of the endoscope system which concerns on one Embodiment of this invention. It is the perspective view which looked at the endoscope system of Drawing 1 from the base end side. It is a side view of the access sheath and inner sheath of FIG. It is the front view which looked at the inner sheath of the endoscope system of Drawing 1 from the tip side in the direction of a longitudinal axis. It is a figure explaining the usage method of the endoscope system of FIG. It is a side view of the front-end | tip part of the inner sheath which shows the modification of a projection part. It is a side view of the front-end | tip part of the inner sheath which shows the other modification of a protrusion part.

Hereinafter, an inner sheath, an endoscope insertion assisting device, and an endoscope system according to an embodiment of the present invention will be described with reference to the drawings.
As shown in FIGS. 1 and 2, the endoscope system 10 according to the present embodiment assists the endoscope 1 for observing the inside of the pericardial cavity and the insertion of the endoscope 1 into the pericardial cavity. And an endoscope insertion auxiliary device 2.

The endoscope 1 has a vertical direction and a horizontal direction that are orthogonal to the longitudinal axis and orthogonal to each other. The up / down / left / right directions of the endoscope 1 correspond to the up / down / left / right directions of the endoscopic image acquired by the endoscope 1. The distal end portion of the endoscope 1 is provided with a bending portion that can be bent at least downward.

The endoscope insertion assisting device 2 includes an access sheath 3 that is inserted into the pericardial cavity, an inner sheath 4 that is inserted into the access sheath 3, and a positioning unit that positions the access sheath 3 and the inner sheath 4 relative to each other. (Sheath positioning part) 5 and a fixture (endoscopy positioning part) 6 for fixing the endoscope 1 to the inner sheath 4 are provided.

As shown in FIG. 3, the access sheath 3 has a long tubular sheath body 31 having a lumen 3 a into which the inner sheath 4 is inserted, and a larger diameter than the sheath body 31 connected to the proximal end of the sheath body 31. The base end portion 32 is provided.

The sheath body 31 is flexible so that it can be bent along the shape of the living tissue in the living body. The lumen 3 a penetrates in the longitudinal direction from the distal end surface of the sheath body 31 to the proximal end surface of the proximal end portion 32. The lumen 3a has an inner diameter larger than the outer diameter of the sheath body 41 of the inner sheath 4, and the sheath body 41 can move in the longitudinal direction and rotate about the longitudinal axis within the lumen 3a.

As shown in FIG. 3, the inner sheath 4 is composed of a multi-lumen tube having two

lumens

4 a and 4 b for the endoscope 1 and the

treatment tools

20 and 30, and a flexible sheath main body 41 and a sheath main body. A proximal end portion 42 connected to the proximal end of the sheath 41 and having a diameter larger than that of the sheath body 41; and a hood (projection portion) 43 that is fixed to the distal end surface of the sheath body 41 and projects from the distal end surface along the longitudinal direction. ing.

The sheath body 41 has a vertical direction and a horizontal direction that are orthogonal to the longitudinal axis and orthogonal to each other. The vertical direction is the direction in which the thickness of the pericardial cavity is arranged in the pericardial cavity. In particular, the sheath body 41 is positioned in the pericardial cavity so that the upper side is located on the pericardial side and the lower side is located on the heart side. Placed in.

The endoscope lumen (first lumen) 4a has a substantially cylindrical shape penetrating in the direction along the longitudinal axis from the distal end surface of the sheath body 41 to the proximal end surface of the proximal end portion 42. The endoscope lumen 4a has an inner diameter larger than the outer diameter of the endoscope 1, and can move in the longitudinal direction and rotate around the longitudinal axis of the endoscope 1 within the endoscope lumen 4a. Yes. As shown in FIG. 4, on the distal end surface of the sheath body 41, the endoscope lumen 4 a is disposed at a position eccentric to the upper side from the longitudinal axis that is the central axis of the sheath body 41. Preferably, the entire endoscope lumen 4 a is disposed above the longitudinal axis of the sheath body 41 on the distal end surface of the sheath body 41.

The treatment instrument lumen (second lumen) 4b extends in parallel with the endoscope lumen 4a and penetrates in the direction along the longitudinal axis from the distal end surface of the sheath body 41 to the proximal end surface of the proximal end portion 42. As shown in FIG. 4, on the distal end surface of the sheath body 41, the treatment instrument lumen 4b is disposed below the endoscope lumen 4a, and the two

treatment instruments

20, 30 such as a ligation device and forceps are arranged. It has an inner diameter that can be inserted simultaneously. Preferably, the treatment instrument lumen 4b has a substantially semi-cylindrical shape that occupies substantially the lower half of the inner sheath 4.

As shown in FIG. 4, the hood 43 is a substantially semi-cylindrical member that is provided above the treatment instrument lumen 4 b and extends from the distal end surface of the sheath body 41 along the longitudinal direction of the sheath body 41. The hood 43 is formed of, for example, a resin and has rigidity capable of maintaining the shape substantially against the pressing force toward the heart side received from the pericardium in the pericardial cavity.

In the distal end surface of the sheath body 41, the hood 43 is provided around the distal end opening of the endoscope lumen 4a, and is disposed on the left, right, and upper side of the distal end opening of the endoscope lumen 4a. Further, the hood 43 opens at a width larger than the diameter of the endoscope lumen 4a on the lower side of the endoscope lumen 4a. Accordingly, the bending portion of the endoscope 1 protruding from the distal end opening of the endoscope lumen 4a is bent to the lower side of the sheath body 41, thereby causing the distal end of the endoscope 1 to protrude in the radial direction from the inside of the hood 43. Thus, the field of view of the inner sheath 4 can be observed by the endoscope 1.

The inner surface of the hood 43 is provided with a mark (not shown) for adjusting the posture around the longitudinal axis of the endoscope 1 in the endoscope lumen 4a. The endoscope 1 is placed at a position where the mark is observed in the endoscopic image, and then the posture of the endoscope 1 is adjusted so that the mark is positioned above the endoscopic image, thereby bending The posture of the endoscope 1 with respect to the sheath main body 41 can be determined so that the portion is curved downwardly of the sheath main body 41.

The inner sheath 4 further includes a guide wire lumen (third lumen) 4c for the guide wire 40 and an air / water supply lumen 4d as a flow path of gas and fluid. The guide wire lumen 4c and the air / water supply lumen 4d penetrate in the direction along the longitudinal axis from the distal end surface of the hood 43 to the proximal end surface of the sheath body 41, and guide wire insertion openings 42a provided in the proximal end portion 42 (FIG. 1). And the connector 42b (see FIG. 1). It is preferable that the guide wire lumen 4c and the air / water supply lumen 4d are provided at both ends in the circumferential direction of the hood 43 so as to be positioned on both the left and right sides of the endoscope lumen 4a. With such an arrangement, the guide wire lumen 4c and the air / water supply lumen 4d can be provided without increasing the outer diameter of the sheath body 41.

As another structure of the air / water supply lumen 4 d, the air / water supply lumen 4 d extends in the direction along the longitudinal axis from the proximal end surface of the sheath main body 41 toward the distal end surface side of the hood 43, and an endoscope in the middle of the hood 43. You may open toward the lumen 4a side or the treatment tool lumen 4b side. By doing so, the cleaning liquid can be ejected from the front end opening of the air / water supply lumen 4 d toward the front end surface of the endoscope 1 to clean the lens on the front end surface of the endoscope 1.

The positioning portion 5 includes a proximal end portion 32 of the access sheath 3 and a proximal end portion 42 of the inner sheath 4. That is, the distal end surface of the proximal end portion 42 of the inner sheath 4 abuts against the proximal end surface of the proximal end portion 32 of the access sheath 3 in a state where the sheath body 41 of the inner sheath 4 is inserted into the lumen 3 a of the access sheath 3. Thus, the insertion amount of the sheath body 41 into the lumen 3a is limited, and the relative positions of the

sheath bodies

31 and 41 in the longitudinal direction are positioned.

Here, in a state where the

sheath bodies

31 and 41 are positioned with respect to each other by the positioning portion 5, the

sheath bodies

31 and 41 are arranged so that the distal end surfaces of the

sheath bodies

31 and 41 are arranged at the same position in the longitudinal direction. The length is designed. Therefore, only the hood 43 of the inner sheath 4 protrudes from the distal end surface of the access sheath 3 in the state of being positioned by the positioning portion 5.

The fixing tool 6 is for fixing the middle position in the longitudinal direction of the endoscope 1 extending outward from the proximal end opening of the endoscope lumen 4 a on the proximal end surface of the proximal end portion 42 of the inner sheath 4 to the inner sheath 4. belongs to. As shown in FIG. 2, the fixture 6 includes an endoscope holding portion 61 that holds the endoscope 1 disposed in the endoscope lumen 4 a, and the endoscope holding portion 61 that is connected to the inner sheath 4. An attachment portion 62 that is detachably attached to the base end portion 42 is provided.

The endoscope holding part 61 has an opening 61 a that penetrates the endoscope 1 and fits into a side surface of the endoscope 1. By fitting the endoscope 1 into the opening 61 a, the endoscope holding unit 61 holds a midway position in the longitudinal direction of the endoscope 1.

The mounting portion 62 has a substantially semicircular arc shape that fits to the side surface of the proximal end portion 42 of the inner sheath 4. The attachment portion 62 is fitted on the upper side of the base end portion 42 so that the endoscope holding portion 61 is attached to the base end portion 42 so that the opening 61a communicates with the endoscope lumen 4a in the longitudinal direction. It has become. Further, the attachment portion 62 is positioned in the circumferential direction with respect to the base end portion 42 by fitting a claw portion 62 a provided at the end portion into a groove 42 c formed on the side surface of the base end portion 42. It has become.

Next, the operation of the endoscope system 10 configured as described above will be described.
In the present embodiment, the case where the left atrial appendage is observed in the pericardial cavity will be described. However, the use of the endoscope system 10 is not limited to the pericardial cavity, and is used for observing other parts of the body. Can also be used.
In order to perform observation and treatment of the left atrial appendage using the endoscope system 10 according to the present embodiment, first, as shown in FIG. 5, the sheath body 31 of the access sheath 3 is moved from outside the body into the pericardial cavity. The distal end surface of the sheath body 31 is placed in the vicinity of the left atrial appendage.

Next, the sheath body 41 of the inner sheath 4 with the guide wire 40 attached in the guide wire lumen 4c is inserted into the lumen 3a of the access sheath 3 until the guide body 40 is positioned by the positioning portion 5, thereby allowing the intrapericardial space to enter. The hood 43 is caused to protrude from the distal end surface of the sheath body 31. Then, the posture around the longitudinal axis of the sheath body 41 in the pericardial cavity is adjusted so that the hood 43 is positioned on the pericardial side and the treatment instrument lumen 4b is positioned on the heart side. Thereby, the pericardium is lifted to a position away from the heart by the hood 43 having high rigidity, and the pericardial space is expanded in front of the distal end surface of the sheath body 41, so that a space is secured between the hood 43 and the heart. The Further, at this time, the guide wire 40 inserted into the guide wire lumen 4 c is protruded from the distal end of the hood 43, whereby the pericardium is also lifted by the guide wire 40 on the distal end side of the hood 43, thereby The pericardial space can be further expanded in front of the surface.

Next, the endoscope 1 is inserted into the pericardial cavity via the endoscope lumen 4a of the inner sheath 4, and the curved portion of the endoscope 1 is disposed in the space between the hood 43 and the heart. Next, based on the mark on the inner surface of the hood 43 observed in the endoscopic image, the posture of the endoscope 1 is adjusted so that the lower side of the endoscope 1 coincides with the heart side. Next, by bending the bending portion downward, the distal end surface of the endoscope 1 can be disposed so as to face the left atrial appendage, and the left atrial appendage can be viewed from above. Next, the middle position in the longitudinal direction of the endoscope 1 extending from the proximal end opening of the endoscope lumen 4a is fixed to the inner sheath 4 by the fixture 6, so that the left atrial appendage is appropriately observed. The endoscope 1 is positioned.

Next,

treatment tools

20, 30 such as a ligation device and forceps are inserted into the pericardial cavity via the treatment tool lumen 4b of the inner sheath 4. Since the distal end opening of the treatment instrument lumen 4b is located between the endoscope lumen 4a and the heart, the distal ends of the

treatment instruments

20 and 30 protruding from the treatment instrument lumen 4b are located between the endoscope 1 and the heart. Be placed. Therefore, the

treatment tools

20 and 30 can be observed together with the left atrial appendage by the endoscope 1, and the left atrial appendage can be treated by the

treatment tools

20 and 30 while observing the endoscopic image.

As described above, according to this embodiment, the hood 43 for expanding the pericardial cavity is integrally provided on the inner sheath 4 for guiding the endoscope 1 and the

treatment tools

20 and 30. By using such an inner sheath 4, the endoscope insertion assisting device 2 having a double structure of the access sheath 3 and the inner sheath 4 can guide the endoscope 1 and the

treatment tools

20 and 30, and the pericardium. Both cavity dilation can be achieved. Thus, there are advantages that the procedure can be simplified and the endoscope insertion assisting device 2 can have a small diameter structure.

Further, in the vertical direction of the sheath body 41, the hood 43 and the treatment instrument lumen 4b are disposed on the upper side and the lower side of the endoscope lumen 4a with the endoscope lumen 4a interposed therebetween. Accordingly, in the pericardial cavity, the hood 43 is disposed on the pericardial side of the endoscope 1 and the

treatment tools

20 and 30 protruding from the distal end openings of the

lumens

4a and 4b. Thus, the hood 43 can be prevented from obstructing the observation of the

treatment instruments

20 and 30 and the left atrial appendage by the endoscope 1 and the treatment of the left atrial appendage by the

treatment instruments

20 and 30.

Further, by fixing the endoscope 1 to the inner sheath 4 by the fixture 6 on the proximal end side of the inner sheath 4, the longitudinal movement and the longitudinal axis of the endoscope 1 within the endoscope lumen 4a are achieved. The endoscope 1 that is prevented from rotating around and extends from the base end portion 42 is held at a position that does not interfere with the operation of inserting and removing the

treatment instruments

20 and 30 from the treatment instrument lumen 4b. Thereby, there exists an advantage that the

treatment tools

20 and 30 can be operated smoothly.

In the present embodiment, the hood 43 has a substantially semi-cylindrical shape and is disposed on the left, right, and upper side of the endoscope lumen 4a. However, the hood 43 is provided only on the upper side of the endoscope lumen 4a. It may be arranged.
Thus, by arranging the hood 43 at least on the upper side of the endoscope lumen 4a, the pericardial cavity can be expanded to secure a space for observation and treatment.

In the present embodiment, the projecting portion is formed of the substantially semi-cylindrical hood 43. However, instead of this, it may be configured by a member that can contract and expand in the radial direction of the sheath body 41. For example, the protrusion may be a mesh 431 as shown in FIG. 6 or a balloon 432 as shown in FIG.
By doing so, the size of the space secured in the pericardial cavity can be adjusted by contraction and expansion of the mesh 431 or the balloon 432.

DESCRIPTION OF SYMBOLS 1 Endoscope 2 Endoscopic insertion auxiliary device 3 Access sheath 4 Inner sheath 4a Endoscopic lumen (first lumen)
4b Treatment tool lumen (second lumen)
4c Guide wire lumen (third lumen)
41 Sheath body 43 Hood (projection)
431 mesh (protrusion)
432 Balloon (protrusion)
5 Positioning part (sheath positioning part)
6 Fixing device (Endoscope positioning part)
DESCRIPTION OF SYMBOLS 10

Endoscope system

20,30 Treatment tool 40 Guide wire

Claims

A tubular sheath body having a first lumen that penetrates in the longitudinal direction and into which the endoscope is inserted, and a second lumen that penetrates in the longitudinal direction and into which the treatment instrument is inserted;
A projection that is fixed to the distal end surface of the sheath body and protrudes in the longitudinal direction from the distal end surface;
An inner sheath in which the protrusion and the second lumen are disposed on both sides in the radial direction across the first lumen on the distal end surface of the sheath body.
The inner sheath according to claim 1, further comprising a third lumen penetrating from a distal end of the protruding portion to a proximal end of the sheath body and into which a guide wire is inserted.
The inner sheath according to claim 1, wherein the protrusion is a mesh or a balloon that can contract and expand in a radial direction of the sheath body.
The inner sheath according to any one of claims 1 to 3,
A tubular access sheath that is open at both ends and into which the sheath body of the inner sheath is inserted along the longitudinal direction;
An internal view comprising a sheath positioning portion that positions a relative position in a longitudinal direction between the access sheath and the sheath main body in the access sheath so that a distal end surface of the access sheath and a distal end surface of the sheath main body coincide with each other. Mirror insertion assist device.
The inner sheath according to any one of claims 1 to 3,
An endoscope inserted into the first lumen;
An endoscope system comprising: an endoscope positioning unit that positions the endoscope disposed in the first lumen with respect to an inner sheath.