Abstract:
An insertion assisting tool for an endoscope which is a tubular insertion assisting tool which is provided with an inflatable and deflatable balloon attached to a tip end outer peripheral part, and through which an insertion section for an endoscope is capable of being inserted, comprising: an air hole formed at an outer periphery and/or a tip end part of the insertion assisting tool.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     1. Field of the Invention  
         [0002]     The present invention relates to an insertion assisting tool including a balloon at a tip end outer peripheral portion, and a double balloon type insertion assisting tool for an endoscope, which is fitted onto an endoscope insertion section also including a balloon at a tip end outer peripheral portion and guides the endoscope insertion section into a body cavity, and an endoscope operation method.  
         [0003]     2. Description of the Related Art  
         [0004]     When the insertion section of an endoscope is inserted into a deep alimentary canal such as a small intestine, by only pushing the insertion section into the deep alimentary canal, the force is difficult to transmit to a tip end of the insertion section due to complicated bending of an intestinal canal, and insertion into a deep part is difficult. Namely, if excessive bending and deflection occur to the insertion section, it is difficult to insert the insertion section further into a deeper part. Thus, there is proposed an endoscope apparatus which prevents excessive bending and deflection of the insertion section by inserting the insertion section into a body cavity with an insertion assisting tool called an over tube or a sliding tube attached to the insertion section of the endoscope, and guiding the insertion section with this insertion assisting tool (for example, Japanese Patent Application Publication No. 10-248794).  
         [0005]     Meanwhile, a double balloon type endoscope apparatus disclosed in Japanese Patent Application Publication No. 2002-301019 includes an endoscope with a first inflatable and deflatable balloon attached to a tip end outer peripheral portion of an endoscope insertion section, and an over tube which serves as a guide at the time of insertion of the insertion section, with a second inflatable and deflatable balloon attached to the tip end peripheral portion, and the endoscope insertion section inserted into the over tube. This double balloon type endoscope apparatus is for inserting the endoscope insertion section into a deep part of an alimentary canal by carrying out an inserting operation of the over tube and the endoscope insertion section and the inflation and deflation operations of the first and the second balloons in accordance with a predetermined procedure.  
       SUMMARY OF THE INVENTION  
       [0006]     However, the double balloon type endoscope apparatus in Japanese Patent Application Publication No. 2002-301019 has the problem that when, for example, the second balloon is inflated and closely fitted to the intestinal wall and thereafter, an operation of moving the over tube in the extracting direction is performed, the over tube cannot be smoothly moved. Namely, this is considered to result from addition of compression to the air stored at a base end part side of the over tube with respect to the second balloon (air stored in a gap between the over tube and the intestinal wall) by the operation of the over tube, and the air pressure caused by this gives a difficulty to the extracting operation of the over tube.  
         [0007]     The present invention is made in view of the above circumstances, and has its object to provide an insertion assisting tool for an endoscope and an endoscope operation method capable of smoothly performing an extracting operation of the insertion assisting tool in the state in which a balloon of the insertion assisting tool is inflated.  
         [0008]     In order to attain the above-described object, a first aspect of the present invention is an insertion assisting tool for an endoscope which is a tubular insertion assisting tool, which is provided with an inflatable and deflatable balloon attached to a tip end outer peripheral portion, and through which an insertion section of an endoscope is capable of being inserted, comprising an air hole formed at an outer periphery and/or a tip end part of the insertion assisting tool.  
         [0009]     A second aspect of the present invention is the insertion assisting tool for an endoscope according to the first aspect, wherein the endoscope insertion section includes an inflatable and deflatable balloon at a tip end part of the endoscope insertion section.  
         [0010]     In order to attain the above-described object, a third aspect of the present invention is, in an endoscope operating method of combining an endoscope including a first inflatable and deflatable balloon at an insertion section tip end part, and a tubular insertion assisting tool, which is provided with a second inflatable and deflatable balloon attached to a tip end outer peripheral part, and through which the insertion section is capable of being inserted, and inserting the endoscope into a region to be observed under each operation of inflating and deflating operations of the first balloon and the second balloon, an inserting operation of the insertion part by insertion guide by the insertion assisting tool, and an inserting operation of the insertion assisting tool for guiding insertion of the insertion section, including the steps of performing an operation of supplying air via an air hole formed at an outer periphery and/or a tip end part of the insertion assisting tool at a time of the inserting operation, and discharging air via the air hole at a time of extracting operation of the endoscope insertion section and/or the insertion assisting tool.  
         [0011]     According to the present invention, when the extracting operation of the insertion assisting tool in the state in which the balloon of the insertion assisting tool is inflated, the air stored in the gap between the insertion assisting tool and the intestinal wall flows from the air hole of the insertion assisting tool, and is discharged to the outside via the insertion assisting tool. Thereby, at the time of extracting operation of the insertion assisting tool, the air pressure is not exerted on the insertion assisting tool, and therefore, the extracting operation of the insertion assisting tool can be performed smoothly.  
         [0012]     According to the present invention, the air in the intestinal space sealed between the balloon of the insertion assisting tool and the balloon at the tip end of the endoscope insertion section is discharged to the outside from the air hole via the insertion assisting tool when the air pressure is to rise. Accordingly, air pressure rise in the intestinal space can be prevented, and therefore, influence on the intestinal wall by the air pressure rise can be eliminated.  
         [0013]     According to the insertion assisting tool for an endoscope and the endoscope operating method according to the present invention, the air hole is formed at an outer periphery and/or the tip end part of the insertion assisting tool, and therefore, the extracting operation of the insertion assisting tool in the state in which the balloon of the insertion assisting tool is inflated can be performed smoothly.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0014]      FIG. 1  is a system schematic diagram of an endoscope apparatus to which an over tube according to the present invention is applied;  
         [0015]      FIG. 2  is a perspective view showing a tip end part of an insertion section of an endoscope;  
         [0016]      FIG. 3  is a perspective view showing the tip end rigid part of the insertion section onto which a first balloon is fitted;  
         [0017]      FIG. 4  is a side view of an over tube;  
         [0018]      FIG. 5  is a sectional side view showing a tip end part of the over tube through which the insertion section is inserted; and  
         [0019]      FIGS. 6A  to  6 H are explanatory views showing an operation method of the endoscope apparatus shown in  FIG. 1 . 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0020]     A preferred embodiment of an insertion assisting tool for an endoscope and an endoscope operation method according to the present invention will be explained in accordance with the following attached drawings.  
         [0021]      FIG. 1  shows a system schematic diagram of an endoscope apparatus to which an insertion assisting tool according to the present invention is applied. The endoscope apparatus shown in the drawing is constructed by an endoscope  10 , an over tube (corresponding to the insertion assisting tool)  50 , and a balloon control device  100 .  
         [0022]     The endoscope  10  includes a hand operation section  14 , and an insertion section  12  connected to the hand operation section  14 . A universal cable  15  is connected to the hand operation section  14 , and a connecter (not shown) connected to a processor and a light source device not shown is provided at a tip end of the universal cable  15 .  
         [0023]     An air/water passing button  16 , a suction button  18 , and a shutter button  20  which are operated by an operator are provided in parallel on the hand operation section  14 , and a pair of angle knobs  22  and  22 , and the forceps insertion part  24  are provided respectively at predetermined positions. Further, the hand operation section  14  is provided with a balloon air port  26  for supplying air to a first balloon  30  and sucking air from the first balloon  30 .  
         [0024]     The insertion section  12  is constructed by a flexible part  32 , a curving part  34  and a tip end rigid part  36 . The curving part  34  is constructed by connecting a plurality of node rings to be able to curve, and is remotely operated to curve by the rotational operation of a pair of angle knobs  22  and  22  provided on the hand operation section  14 . Thereby, a tip end surface  37  of the tip end rigid part  36  can be faced in a desired direction.  
         [0025]     As shown in  FIG. 2 , the tip end surface  37  of the tip end rigid part  36  is provided with an object optical system  38 , an illumination lens  40 , air/water passing nozzle  42 , a forceps port  44  and the like in predetermined positions. An air supply/suction port  28  is provided on an outer peripheral surface of the tip end rigid part  36 , and this air supply/suction port  28  communicates with the balloon air port  26  in  FIG. 1  via an air supply tube (not shown) with an inner diameter of about 0.8 mm which is inserted into the insertion section  12 . Accordingly, air is blown out of the air supply/suction port  28  of the tip end rigid part  36  by supplying air to the balloon air port  26 , and on the other hand, air is sucked from the air supply/suction port  28  by sucking air from the balloon air port  26 .  
         [0026]     As shown in  FIG. 1 , the first balloon  30  constituted of an elastic body such as rubber is detachably attached to the tip end rigid part  36  of the insertion section  12 . The fist balloon  30  is formed by a bulging portion  30   c  in a center and attaching portions  30   a  and  30   b  at both ends of the bulging portion  30   c , and is attached to the tip end rigid part  36  side so that the air supply/suction port  28  is located inside the bulging portion  30   c  as shown in  FIG. 3 . The attaching portions  30   a  and  30   b  are formed to have smaller diameters than the diameter of the tip end rigid portion  36 , and after being closely fitted onto the tip end part  36  with their elastic forces, the attaching portions  30   a  and  30   b  are fixed with threads not shown wound around the attaching portions  30   a  and  30   b . The fixation is not limited to the thread winding fixation, but the attaching portions  30   a  and  30   b  may be fixed to the tip end rigid part  36  by fitting fixing rings onto the attaching portions  30   a  and  30   b.    
         [0027]     The first balloon  30  fitted onto the tip end rigid part  36  has its bulging portion  30   c  inflated in a substantially spherical shape by blowing air from the air supply/suction port  28  shown in  FIG. 2 . On the other hand, by sucking air from the air supply/suction port  28 , the bulging portion  30   c  is deflated and is closely fitted onto the outer peripheral surface of the tip end rigid part  36 .  
         [0028]     The over tube  50  shown in  FIG. 1  is constructed by a tube body  51 , and a gripping part  52 . The tube body  51  is formed into a cylindrical shape and has a slightly larger inner diameter than an outer diameter of the insertion section  12 , as shown in  FIGS. 4 and 5 . The tube body  51  is constructed by covering an outer side of a flexible resin tube made of urethane or the like with lubricating coat and covering an inner side with the lubricating coat.  
         [0029]     The gripping part  52  is formed into a cylindrical shape as shown in  FIG. 4 , and constructed by a body portion  52 A having a large diameter which is gripped by an operator, and a connecting portion  52 B fitted onto the base end part of the tube body  51 . The insertion section  12  of the endoscope  10  shown in  FIG. 1  is inserted toward the tube body  51  from the body portion  52 A of the gripping part  52  shown in  FIG. 4 .  
         [0030]     A balloon air port  54  is provided at the base end side of the tube body  51 . An air supply tube  56  with an inner diameter of about  1  mm is connected to the balloon air port  54 , and this tube  56  is bonded to an outer peripheral surface of the tube body  51  and is provided to extend to a tip end portion of the tube body  51  as shown in  FIG. 5 .  
         [0031]     A tip end  58  of the tube body  51  is formed into a tapered shape. A second balloon  60  constituted of an elastic body such as rubber is fitted onto the base end side of the tip end  58  of the tube body  51 . The second balloon  60  is fitted in the state in which the tube body  51  penetrates through the balloon  60  as shown in  FIG. 5 , and is constructed by a bulging portion  60   c  in a center, and attaching portions  60   a  and  60   b  at both ends of the bulging portion  60   c . The attaching portion  60   a  at the tip end side is folded back to the inside of the bulging portion  60   c , and the attaching portion  60   a  folded back is fixed to the tube body  51  with an X-ray contrast thread  62  wound around the attaching portion  60   a  which is folded back. The attaching portion  60   b  at the base end side is disposed outside the second balloon  60 , and is fixed to the tube body  51  with a thread  64  wound around the attaching portion  60   b.    
         [0032]     The bulging portion  60   c  is formed into a substantially spherical shape in a natural state (the state in which the bulging portion  60   c  does not inflate or deflate), and as for the size, the bulging portion  60   c  is formed to be larger than the size of the first balloon  30  in a natural state (the state in which the balloon  30  does not inflate or deflate). Accordingly, when the air is supplied to the first balloon  30  and the second balloon  60  at the same pressure, the outer diameter of the bulging portion  60   c  of the second balloon  60  becomes larger than the outer diameter of the bulging portion  30   c  of the first balloon  30 . The outer diameter of the second balloon  60  is constructed so as to be φ50 mm when the outer diameter of the first balloon  30  is φ25 mm, for example.  
         [0033]     The aforementioned tube  56  is opened in the inside of the bulging portion  60   c , and the opening is formed as an air supply/suction port  57 . Accordingly, when air is supplied from the balloon air port  54 , the air is blown from the air supply/suction port  57  and thereby, the bulging portion  60   c  is inflated. When air is sucked from the balloon air port  54 , the air is sucked from the air supply/suction portion  57 , and the second balloon  60  is deflated.  
         [0034]     Reference numeral  66  in  FIG. 4  designates an inlet port for filling a lubricating liquid such as water into the tube body  51 , and the inlet port  66  communicates with the base end part side of the tube body  51  via a tube  68  with a thin diameter.  
         [0035]     Incidentally, in the over tube  50  in this embodiment, an air release hole (air hole)  80  is formed at a base end part side from the second balloon attaching position of the tube body  51 . This air release hole  80  is opened as a suction hole  84  at the base end part of the tube body  51  via an air tube  82  integrally formed at or bonded to the tube body  51 . In the over tube  5  shown in  FIG. 4 , the example in which the air release hole  80  is formed at only one location, but a plurality of air release holes  80  may be formed, and the forming position may be any position if only it is at the base end part side from the second balloon attaching position. This air release hole  80  has the function of releasing air stored between the tube body  51  and the intestinal canal (not shown), and therefore, it is preferable to form the air release holes  80  equidistantly around the tube body  51  and at equal spaces in the axial direction.  
         [0036]     In the over tube  50 , an air release hole (air hole)  86  is formed at the tip end part side from the second balloon attaching position of the tube body  51 . This air release hole  86  is opened at the base end part of the tube body  51  as a suction port  90  via an air tube  88  integrally formed at or bonded to the tube body  51 . As a result, the air in an intestinal space sealed between the second balloon  60  and the first balloon  30  is discharged from the air release hole  86  to outside air from the suction port  90  at the base end part of the tube body  51  via the air tube  88 .  
         [0037]     Meanwhile, the balloon control device  100  in  FIG. 1  is the device which supplies and sucks fluid such as air to and from the first balloon  30 , and supplies and sucks fluid such as air to and from the second balloon  60 . The balloon control device  100  is constructed by a device body  102  including a pump, sequencer and the like not shown, and a hand switch  104  for remote control.  
         [0038]     A front panel of the device body  102  is provided with a power supply switch SW 1 , a stop switch SW 2 , a pressure gauge  106  for the first balloon  30  and a pressure gauge  108  for the second balloon  60 . A tube  110  for supplying/sucking air to and from the first balloon  30 , and a tube  120  for supplying/sucking air to and from the second balloon  60  are attached to the front panel of the device body  102 . Liquid storing tanks  130  and  140  for storing body fluid, which flows backward from the first balloon  30  and the second balloon  60  when the first balloon  30  and the second balloon  60  are broken, are respectively provided at midpoints of the respective tubes  110  and  120 .  
         [0039]     Meanwhile, the hand switch  104  is provided with a similar stop switch SW 3  to the stop switch SW 2  at the side of the device body  102 , an ON/OFF switch SW 4  for supporting pressurization/decompression of the first balloon  30 , a pose switch SW 5  for keeping the pressure of the first balloon  30 , an ON/OFF switch SW 6  for supporting pressurization/decompression of the second balloon  60 , and a pose switch SW 7  for keeping the pressure of the second balloon  60 . This hand switch  104  is electrically connected to the device body  102  via a cable  150 .  
         [0040]     The balloon control device  100  which is constructed as above supplies air to the first balloon  30  and the second balloon  60  and inflates the first balloon  30  and the second balloon  60 , and controls the air pressure at a fixed value to keep the first balloon  30  and the second balloon  60  in the inflated state. The balloon control device  100  sucks air from the first balloon  30  and the second balloon  60  and deflates the first balloon  30  and the second balloon  60 , and controls the air pressure at a fixed value to keep the first balloon  30  and the second balloon  60  in the deflated state.  
         [0041]     Next, an operation method of the endoscope apparatus will be explained in accordance with  FIGS. 6A  to  6 H.  
         [0042]     First, as shown in  FIG. 6A , the insertion section  12  is inserted into an intestinal canal (for example, descending limb of duodenum)  70  in the state in which the over tube  50  covers the insertion section  12 . At this time, the first balloon  30  and the second balloon  60  are deflated.  
         [0043]     Next, as shown in  FIG. 6B , in the state in which the tip end  58  of the over tube  50  is inserted into a bent portion of the intestinal canal  70 , air is supplied to the second balloon  60  to inflate the second balloon  60 . As a result, the second balloon  60  is closely fitted to and caught by the intestinal canal  70 , and the tip end  58  of the over tube  50  is fixed to the intestinal canal  70 .  
         [0044]     Next, as shown in  FIG. 6C , only the insertion section  12  of the endoscope  10  is inserted to a deep part of the intestinal canal  70  with the over tube  50  as a guide. Then, as shown in  FIG. 6D , air is supplied to the first balloon  30  to inflate the first balloon  30 . As a result, the first balloon  30  is closely fitted and fixed to the intestinal canal  70 . In this case, the first balloon  30  is smaller in the size at the time of inflation than the second balloon  60 , and therefore the burden exerted on the intestinal canal  70  is small, thus making it possible to prevent damage to the intestinal canal  70 .  
         [0045]     Next, after air is sucked from the second balloon  60  to deflate the second balloon  60 , the over tube  50  is pushed in, and inserted along the insertion section  12 , as shown in  FIG. 6E . Then, after the tip end  58  of the over tube  50  is pushed into the vicinity of the first balloon  30 , air is supplied to the second balloon  60  to inflate the second balloon  60  as shown in  FIG. 6F . As a result, the second balloon  60  is closely fitted and fixed to the intestinal canal  70 . Namely, the intestinal canal  70  is gripped by the second balloon  60 .  
         [0046]     Next, as shown in  FIG. 6G , the operation of drawing in the intestinal canal  70  by operating the over tube  50  in the drawing direction is performed. Thereby, the intestinal canal  70  contracts substantially straight, and excessive deflection and bending of the over tube  50  are eliminated. When the over tube  50  is drawn in at this time, both the first balloon  30  and the second balloon  60  are caught in the intestinal canal  70 , but the friction resistance of the first balloon  30  is smaller than the friction resistance of the second balloon  60 . Therefore, even if the first balloon  30  and the second balloon  60  move to separate from each other, the first balloon  30  with small friction resistance slides with respect to the intestinal canal  70 , and therefore, it does not happen that the intestinal canal  70  is damaged by being pulled by both the balloons  30  and  60 .  
         [0047]     At this time, the air stored in the gap between the tube body  51  and the intestinal wall flows in from the air release hole  80  (see  FIG. 4 ) of the tube body  51 , and is discharged to the outside air from the suction port  84  formed at the base end part of the tube body  51  via the air tube  82 . As a result, at the time of the operation of the over tube  50  in the drawing direction, the air pressure occurring as a result that the air stored in the gap between the over tube  50  and the intestinal wall is compressed is not exerted on the over tube  50 , and therefore, the operation of the over tube  50  in the drawing direction can be performed smoothly. The stored air can be discharged by opening the suction port  84  to atmosphere, but a manual suction tool such as an injector is connected to the suction port  84 , and the air may be forcefully discharged by the manual suction tool.  
         [0048]     Next, as shown in  FIG. 6H , air is sucked from the first balloon  30  to deflate the first balloon  30 . Then, the tip end rigid part  36  of the insertion section  12  is inserted into as deep a part of the intestinal canal  70  as possible. Namely, the inserting operation as shown in  FIG. 6C  is performed again. Thereby, the tip end rigid part  36  of the insertion section  12  can be inserted into a deep part of the intestinal canal  70 . When the insertion section  12  is further inserted into a deep part, the pushing operation as shown in  FIG. 6E  is performed after the fixing operation as shown in  FIG. 6D  is performed, the gripping operation as shown in  FIG. 6F  and the drawing operation as shown in  FIG. 6G , and the inserting operation as shown in  FIG. 6H  are repeatedly performed in sequence. Thus, the insertion section  12  can be further inserted into a deep part of the intestinal canal  70 .  
         [0049]     In the over tube  50  of the embodiment, the air release hole  86  is formed at the tip end part side from the second balloon attaching position of the tube body  51 , and therefore, when the air pressure in the sealed intestinal space between the second balloon  60  and the first balloon  30  is to rise during the above operation, the air in the intestinal space is discharged from the air release hole  86  to the outside air from the suction port  90  formed at the base end part of the tube body  51 . Accordingly, rise in the air pressure in the intestinal space can be prevented, and therefore, influence on the intestinal wall by the rise in the air pressure can be eliminated.  
         [0050]     As an example of the operation method of the endoscope apparatus, there is the operation method of inserting the insertion section  12  and the over tube  50  into the intestinal canal  70  while inflating the intestinal canal  70  by injecting air from the air/water passing nozzle  42  after inserting the endoscope insertion section  12  into the intestine canal  70 .  
         [0051]     When the drawing operation of the intestinal canal  70  by the over tube  50  shown in  FIG. 6G  is carried out after the above operation, the air does not sufficiently released when the intestinal canal  70  is to be drawn in since the air is inside the intestinal canal  70 , thus causing the phenomena in which the air is stored in some mid point in some cases. In such a case, the air stored in the intestinal canal  70  can be discharged from the air release hole  86  according to the over tube  50  in which the air release hole  86  is formed at the tip end part side of the tube body  51  of the over tube  50 , and therefore, storing of air at the time of drawing in the intestinal canal  70  can be prevented.  
         [0052]     In this embodiment, the over tube  50  is shown as an example as the insertion assisting tool, but the present invention is not limited to this, and a sliding tube which is inserted per anus can be used.