CN1649537A - 具有导管的内窥镜 - Google Patents

具有导管的内窥镜 Download PDF

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CN1649537A
CN1649537A CNA038099861A CN03809986A CN1649537A CN 1649537 A CN1649537 A CN 1649537A CN A038099861 A CNA038099861 A CN A038099861A CN 03809986 A CN03809986 A CN 03809986A CN 1649537 A CN1649537 A CN 1649537A
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conduit
endoscope
far
endoscope shaft
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罗斯·贾菲
约瑟夫·M·塔尔塔格利亚
埃米尔·贝尔松
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Neoguide Systems Inc
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Abstract

本文中介绍了具有导管的内窥镜。该组件有内窥镜，该内窥镜可滑动地插入导管的管腔内。导管设置成可沿它的整个长度从松弛结构而刚性化。内窥镜有可操纵的远侧部分，以便于操纵装置通过曲折通路。在松弛结构中，导管的一部分可以呈现由内窥镜的可控制远侧部分确定的形状或曲线。在已经采取内窥镜的形状或曲线之后，导管可以通过医师或外科医生而刚性化，以便保持该形状或曲线，同时内窥镜通过曲折通路向远侧前进，同时不会向组织壁施加任何不合适的压力。

Description

具有导管的内窥镜
相关申请的交叉引用
本申请是美国专利申请No.09/969927(申请日为2001年10月2日)的部分延续，该美国专利申请No.09/969927是美国专利申请No.09/790204(申请日为2001年2月20日)的部分延续，该美国专利申请No.09/790204要求美国临时专利申请No.60/194140(申请日为2000年4月3日)的优先权，这些文献都整个被本文参引。
技术领域
本发明通常涉及内窥镜和内窥镜医疗方法。尤其是，本发明涉及一种便于利用导管装置将柔性内窥镜沿曲折通道插入的方法和装置，例如用于结肠镜检查和治疗。
背景技术
内窥镜是一种用于观察病人身体内部的医疗仪器。内窥镜可以用于各种不同诊断和插入疗法，包括结肠镜检查、支气管镜检查、胸腔镜检查、腹腔镜检查和视频内窥镜检查。
结肠镜检查是一种医疗方法，其中，柔性内窥镜或结肠镜插入病人结肠内，用于结肠的诊断检查和/或手术治疗。标准的结肠镜通常长度为135-185cm，直径为12-19mm，并包括位于仪器顶端的光纤成像集束或小型摄像机、照明光纤、一个或两个仪器槽道(该槽道也可以用于吹入或冲洗)、空气和水槽道、以及真空槽道。
结肠镜通过病人的肛门插入，并通过结肠前进，从而能够直接视觉检查结肠、回盲瓣和回肠末端部分。结肠镜的插入很复杂，因为结肠具有曲折和盘旋的通路。通常需要非常注意地操作结肠镜，以便使结肠镜通过结肠，从而使得治疗更困难和费时间，并增加了发生并发症的可能性，例如肠穿孔。
可操纵的结肠镜必须设计成便于通过曲折的结肠插入正确通路。不过，当结肠镜插入结肠内越来越远时，使结肠镜沿选定通路前进将变得更困难。在每个转弯处，结肠壁都必须保持该结肠镜的弯曲度。结肠镜沿每个转弯处的外侧与结肠的肌肉表面摩擦。结肠镜中的摩擦和松弛在每个转弯处积累，从而越来越难以使结肠镜前进和退回。此外，抵靠结肠壁的力随着摩擦力的积累而增加。当极其曲折时，将根本不可能使结肠镜通过结肠前进。
在下面的美国专利中介绍了用于体内结构的医疗检查或治疗的可操纵内窥镜、导管和插入装置，这些专利文献整个被本文参引：4543090、4753223、5337732、5337733、5383852、5487757和5662587。
发明内容
本发明介绍了一种内窥镜组件和使该组件前进的方法，该组件能够穿过曲折通路，例如结肠，同时不会与结肠壁进行过多接触。该组件通常包括内窥镜的组合，该内窥镜可滑动地插入导管的管腔内。内窥镜可以是任何普通内窥镜，它有从手柄中伸出的轴。优选是，轴的远端包括可控制的远端部分，该远端部分可以进行操作，以便于操纵组件通过曲折通路。导管可以是普通的柔性导管，它设置为能够沿它的整个长度从松弛结构变成刚性。在该松弛结构，导管的一部分能够呈现由内窥镜的可控制远侧部分确定的形状或曲线。当已经呈现内窥镜的形状或曲线时，导管可以由医师或外科医生来刚性化，以便保持形状或曲线。
也可选择，导管也可以与具有自动控制的近侧部分和可选择操纵的远侧部分的内窥镜一起使用。该可控制内窥镜可以有：远侧部分，该远侧部分可以由医师或外科医生来人工操纵，以便呈现能穿过任意弯曲通路的形状；以及近侧部分，该近侧部分例如通过计算机来自动控制，以便当内窥镜前进或退回时沿近侧部分传递所呈现的形状。更详细实例在共同待审的美国专利申请No.09/969927中所述，该专利文献整个被本文参引。
导管可以包括多个单独的段，这些段通过一个或多个拉紧线或元件而彼此邻接。这些拉紧元件可以沿周向绕各段布置，并优选是通过各个段在导管的整个长度上延伸。当导管刚性化时，拉紧元件可以拉紧，以便将段拉在一起，这样，整个导管变成刚性。然后，拉紧元件可以松弛，以便使各段可以彼此相对运动。
例如在结肠中使用时，医师或外科医生通常可以首先使内窥镜的远侧部分在病人体内前进。当到达结肠的第一弯曲处时，用户可以合适操纵内窥镜的远侧部分，以便呈现用于穿过通路的曲线形状。这时，内窥镜优选是保持相对于病人静止，而处于松弛和柔软状态的导管在内窥镜轴上面前进，直到导管的远端在内窥镜的远侧顶端处或经过该远侧顶端很短距离。一旦导管或者至少它的远侧部分呈现由内窥镜的可控制远侧部分形成的曲线形状时，导管可以优选是沿它的长度进行刚性化，以便保持它所呈现的形状。一旦完成，内窥镜可以在刚性化导管中进一步前进，以便在不向结肠壁施加任何压力的情况下穿过弯曲通路。用于使内窥镜前进的步骤可以根据需要重复，直到到达体内的合适区域。
在探查处理过程中的任意时间点，导管都可以从结肠中取出，同时留下内窥镜。为了将组件从结肠中取出，可以首先取出导管，随后可以取出内窥镜。也可选择，可以沿相反顺序重复上述步骤，以便使导管和内窥镜从区域中退出。
优选是，导管的外表面有管形覆盖物，该管形覆盖物覆盖管的至少主要部分，以便防止碎屑和流体进入在各段之间的导管管腔内。覆盖物也通过防止组织夹在段之间而便于导管的前进和退回。为了在组件运动过程中防止组织夹在导管和内窥镜之间，可膨胀波纹管或附加覆盖物可以选择布置在该导管的远侧开口之上。该附加覆盖物可仅仅是在导管表面上面的覆盖物的整体延伸部分，或者它可以是安装在导管远端上的单独覆盖物。该覆盖物也可以安装在内窥镜的远端上或远端附近，以便在内窥镜轴和导管之间保持密封。覆盖物和它们的变化形式可以通过任意可实施的普通方法来安装。当利用在导管远端上面的覆盖物时，当内窥镜轴的远侧部分通过导管向远侧前进，该覆盖物优选是与内窥镜一起向远侧膨胀，或者只是与内窥镜一起向远侧滑动。当轴退回至引导管腔内时，优选是覆盖物再次与内窥镜的远端的向近侧运动一起向近侧退回，或者可以与内窥镜一起简单地人工退出。使用附加覆盖物也可以有助于保持导管的内部管腔的卫生。
附图说明
图1表示了导管组件的变化形式，其中，内窥镜通过导管而推入，并由导管支承。
图2表示了图1的导管组件的剖视图。
图3表示了图1的导管变化形式，其中，为了清楚，导管的一部分进行了局部去除。
图4表示了可操纵内窥镜的变化形式，该可操纵内窥镜具有可选择操纵的远侧部分和可自动控制的近侧部分，该可操纵内窥镜可以与可刚性化导管一起使用。
图5表示了穿过任意弯曲部分的可自动控制内窥镜的一部分的线框模型。
图6A表示了内窥镜的远端保持未安装在柔性覆盖物上的变化形式。
图6B表示了另一变化形式，其中，内窥镜的远端安装在柔性覆盖物上。
图7表示了经过导管的远端而伸出的内窥镜远端以及与内窥镜一起向远侧延伸的柔性覆盖物。
图8A表示了另一变化形式，其中，覆盖物设置为弹性管结构。
图8B表示了另一变化形式，其中，覆盖物设置为弹性隔膜结构。
图9表示了图8A和8B的变化形式，其中，内窥镜向远侧延伸。
图10表示了另一变化形式，其中，塑料覆盖物用于覆盖内窥镜和导管。
图11A至11E表示了当利用导管作为支承件而使内窥镜通过结肠前进的变化形式。
图12表示了一种变化形式，其中，导管可以从结肠中抽出，同时内窥镜留在后面。
具体实施方式
如图1中所示，为了清楚，导管组件10的变化形式表示为部分拆开。组件10通常包括内窥镜12，该内窥镜可通过引导管腔16而插入导管14内。内窥镜12可以为任意普通类型的内窥镜，它有手柄18，该手柄18上伸出有轴20。优选是，轴20的远端包括可控制的远侧部分22，该远侧部分22可以进行操作，以便于操纵装置通过人体。内窥镜轴20可滑动地布置在引导管腔16内，这样，可控制的远侧部分22能够整个通过导管14，并从确定于管14远端的远侧开口24伸出。
也可选择，导管14也可以与具有自动控制的近侧部分和可选择操纵的远侧部分的内窥镜，如后面更详细所述。这样的可控制内窥镜可以有：远侧部分，该远侧部分可由医师或外科医生人工操纵，以便呈现穿过任意弯曲通路的形状；以及近侧部分，该近侧部分例如通过计算机来自动控制，以便当内窥镜前进或缩回时沿近侧部分传递所呈现的形状。在共同待审的美国专利申请No.09/969927中公开了更详细的实例，该专利申请整个被本文参引。
图4表示了该内窥镜的一个实例，该图表示了可操纵内窥镜80的一个变化形式。内窥镜80为细长体82，该细长体82具有可人工或选择操纵的远侧部分84和自动控制的近侧部分86。可选择操纵的远侧部分84可以选择沿任何方向操纵或弯曲高达180°。光纤成像集束92以及一个或多个照明光纤94可以穿过本体82从近端90伸向远端88。也可选择，内窥镜80可以设置为视频内窥镜，具有位于内窥镜本体82的远端88处的小型摄影机，例如CCD摄像机。由摄影机产生的图像可以通过传输电缆或通过无线传输而传递给视频监视器，在该视频监视器处，图像可以实时观察，或者通过记录装置而记录在模拟记录介质(例如磁带)或数字记录介质(例如光盘、数字磁带等)上。也可选择，内窥镜80的本体82可以包括一个或两个仪器槽道96、98，这些仪器槽道96、98可以用于吹入或冲洗、空气和水槽道、真空槽道等。内窥镜80的本体82优选是非常柔软，这样，它能够在不弯折或扭结的情况下绕很小直径的曲线而弯曲，同时保持各个槽道的完整。当设置成用作结肠镜时，内窥镜80的本体82的长度可以为135至185cm，直径为大约12-13mm。内窥镜80可以制成为各种其它尺寸，并设置为用于其它医疗和工业用途。
近侧手柄100安装在细长本体82的近端90上。手柄100可以包括目镜104，该目镜104与光纤成像集束92连接，以便直接观察和/或用于与摄影机106或记录装置108连接。手柄100可以通过照明电缆11 6而与照明源110相连，该照明电缆与照明光纤94相连或连续。在手柄100上的第一luer锁定接头112和第二luer锁定接头114可以与仪器槽道96、98相连。
手柄100可以通过控制器电缆118而与电子运动控制器122连接。操纵控制器102可以通过第二电缆120而与电子运动控制器122连接。操纵控制器102使得用户能够沿合适方向选择地操纵或弯曲本体82的、可选择操纵的远侧部分84。操纵控制器102可以是所示的操纵杆控制器，或者为其它已知的操纵控制机构。电子运动控制器122可以控制本体82的自动控制近侧部分86的运动。电子运动控制器122可以利用在微计算机上运行的运动控制程序或利用专用运动控制器来实施。也可选择，电子运动控制器122可以利用神经网络控制器来实施。
当内窥镜本体82前进和退回时，轴向运动传感器124可以用于测量它的轴向运动。轴向运动传感器124可以制成为多种可能结构。例如，图4中的轴向运动传感器124设置为环126，该环126可以整个或部分环绕内窥镜80的本体82。优选是，轴向运动传感器124安装在固定参考点上，例如手术台或内窥镜80在病人身体上的插入点。当内窥镜80的本体82通过轴向运动传感器124滑动时，它产生表示内窥镜本体82相对于固定参考点的轴向位置的信号，并通过遥测装置或电缆(未示出)而将信号发送给电子运动控制器122。轴向运动传感器124可以利用光学、电子或机械方法来测量内窥镜本体82的轴向位置。用于轴向运动传感器124的其它可能结构在共同待审的美国专利申请No.09/969927中进行了进一步的介绍。
图5表示了内窥镜80本体82的、处于中间或直线位置的部分的帧模型。在附图中，为了清楚，省略了内窥镜本体82的大部分内部结构。内窥镜本体82分成段或部分1、2、3...等。各段的几何形状由沿a、b、c和d轴的四个长度测量值来确定，且各相邻段优选是通过接头相互连接，该接头允许各段彼此相对进行独立的角度运动和/或旋转。例如，段1的几何形状由四个长度测量值l1a、l1b、l1c、l1d确定，段2的几何形状由四个长度测量值l2a、l2b、l2c、l2d确定。各相邻段1、2、3...等优选是通过线性促动器(未示出)例如电马达、气动马达、液压马达等而独立控制。线性促动器可以利用几个不同工作原理中的一个。例如，为了沿a轴方向使内窥镜本体82弯曲，测量值l1a、l2a、l3a...l10a可以缩短，而测量值l1b、l2b、l3b...l10b可以延长相等量。这些测量值的变化量确定了所形成的曲线的曲率半径。也可选择，各马达可以进行驱动，以便使相邻段彼此相对运动，从而产生最终的弯曲，如美国专利申请No.09/969927中更详细所述。
在自动控制的近侧部分86中，各段可以通过电子运动控制器122来自动控制，该电子运动控制器122利用弯曲传播方法来控制内窥镜本体82的形状。内窥镜本体82利用可选择操纵的远侧部分84而操作通过结肠C的弯曲部分，这时自动控制的近侧部分86处于弯曲部分中。当内窥镜本体82向远侧前进一个单位时，段1运动至位置标记1′，段2运动至以前由段1占据的位置，段3运动至以前由段2占据的位置，依此类推。轴向运动传感器124产生表示内窥镜本体82相对于固定参考点的轴向位置的信号，并将该信号发送给电子运动控制器122，在电子运动控制器122的控制下，内窥镜本体82每次前进一个单位，且向在自动控制近侧部分86中的各段发出信号，以便使它呈现以前占据它目前所进入的空间的段的形状。因此，曲线沿内窥镜本体82的自动控制近侧部分86的长度向近侧传播。当内窥镜本体82向远侧前进时，曲线看起来似乎在空间中固定。
同样，当内窥镜本体82向近侧退回时，内窥镜本体82每次向近侧运动一个单位，且向在自动控制近侧部分86中的各段发出信号，以便使它采取以前占据它目前所进入的空间的段的形状。因此，曲线沿内窥镜本体82的自动控制近侧部分86的长度向远侧传播，当内窥镜本体82向近侧前进时，曲线看起来似乎在空间中固定。当内窥镜本体82前进或退回时，轴向运动传感器124优选是检测位置变化，电子运动控制器122使选定的曲线沿内窥镜本体82的自动控制近侧部分86向近侧或向远侧传播，以便在空间的固定位置中保持曲线。这使得内窥镜本体82能够在不向结肠C壁施加不必要的力的情况下通过曲折的弯曲通路。
例如在结肠中使用组件10的一个实例中，医师或外科医生通常可以首先使内窥镜12的远侧部分22前进至病人体内。当到达第一个需要操纵内窥镜12以便通过弯曲通路的点时，用户可以合适操纵远侧部分22，以便呈现用于穿过通路的弯曲形状。在该点，内窥镜12保持相对于病人静止，导管14可以在轴20上面前进，直到导管14的远端处于可控制远端部分22的远侧顶端之前的较短距离处或之后的较短距离处。该较短距离被认为是从几厘米至几英寸的范围内。当导管14在轴20上面前进时，管14优选是处于非刚性状态，并足够柔软，以便呈现由可控制远端部分22形成的弯曲形状。
一旦管14或至少它的远侧部分呈现由可控制远侧部分22形成的弯曲形状，管14优选是沿它的长度而刚性化，以便保持所呈现的形状。一旦完成这些，内窥镜12的轴20可以在刚性化的导管14中进一步前进，以便在不向结肠壁施加任何压力的情况下穿过弯曲通路。
也可选择，当采用可自动控制的内窥镜80时，通常可以以与普通内窥镜12相同的方式使用。不过，因为内窥镜本体82可沿它的整个长度进行自动控制，或者可沿可操纵远端部分84的近侧的几个部分进行自动控制，因此，可操纵远侧部分84可以比普通内窥镜12更远地经过导管14的远端前进。如本文中所述，可控制内窥镜80在其它所有方面可以与普通内窥镜12类似地使用。
参考图1，波纹管或覆盖物26可以覆盖导管14的远侧开口24，以便防止碎屑和流体进入引导管腔16内。当轴20的远侧部分22穿过管14和离开引导管腔16而向远侧前进时，覆盖物26优选是设置成以覆盖轴20或与轴20一起的方式向远侧膨胀，同时保持密封引导管腔16。当轴20退回至引导管腔16内或当导管14相对于轴20向远侧前进时，覆盖物26优选是设置成随着远侧部分22的向近侧运动而向近侧退回成覆盖远侧开口24。覆盖物26为可选择地使用，并可以用于保持引导管腔16的卫生。覆盖物也可以用于防止在轴20退回至引导管腔16中时防止夹住和撕裂组织。
导管14可以为任意普通的合适柔性管，该柔性管能够沿它的整个长度刚性化。图1中所示的变化形式包括多个单独的段28，这些段28通过几个(即超过一个)拉紧线或元件30而彼此邻接。段28可以是一系列相互连接的球-窝连续的段，这使得相邻段能够彼此相对角度旋转，以便形成一定角度，从而穿过弯曲部分。这些段28可以通过拉紧元件30而刚性化，该拉紧元件30可以沿周向布置在段28的周围，如图2所示，该图2是图1的组件10的剖视图。在该变化形式中，有四根拉紧线30A、30B、30C、30D，这四根拉紧线彼此成90°布置。尽管在本例中表示了四根线，但是也可以采用更少的线，例如三根线。各线30A、30B、30C、30D可以穿过确定于各段28的壁中的内部槽道或管腔而布置。而且，它们可以独立操作，或者它们可以都同时操作，以便施加用于沿导管长度使导管14刚性化或松弛的拉紧力。
图2也表示了轴20相对于段28的相对定位。如图所示，轴20可滑动地布置在引导管腔16中，该轴20可以包含任意数目的、用于照明光纤、光纤等槽道34和工作槽道34。该变化形式表示了在轴20的外表面和段28的内表面之间的分开间隙。该间隙可以根据所使用的内窥镜直径和导管14的合适截面面积而变化，但优选是可使得轴20无阻碍地从引导管腔16内穿过的一标称间隔。可以用作本发明的一部分的可刚性化导管结构的实例在授予Zehel等的美国专利No.5251611中更详细介绍，该专利文献整个被本文参引。
优选是，导管14的外表面有管形覆盖物32，该覆盖物32至少覆盖管14的主要部分。当还与覆盖物26一起使用时，管形覆盖物32可以提供在身体环境的碎屑和流体与引导管腔16内部之间的屏障。而且，覆盖物26可以是管形覆盖物32的整体延伸部分，因此可以由连续的材料层来制造。管形覆盖物32还可以提供润滑套，以便于使导管14沿身体管腔的壁插入和运动，同时提供在各段28中间的光滑表面，以便防止夹住或卡住组织。管形覆盖物可以由各种聚合物材料例如PTFE、FEP、Tecoflex等制成。
图3表示了导管变化形式14的侧视图，为了清楚，壁的一部分进行了局部去除。如图所示，各段28与布置在其间的互连套筒40彼此相邻对齐。在该变化形式中，套筒40可以用于提供枢轴转动结构，以便使导管14弯入不同位置。也可选择，段28可以是设置成彼此相互配合的弯曲球-窝型接头。管形覆盖物32也表示为覆盖导管14的至少主要部分。也可选择，导管14的远端部分可以设置成可控制，这样，导管14向内窥镜12的可控制远侧部分22一样可以确定用于穿行的最佳通路。
波纹管或覆盖物26可以选择附加在普通内窥镜轴20或可控制轴82的远端上。在本文的整个说明中，当用于导管14以及与波纹管或覆盖物26一起使用时，可自动控制的内窥镜82可以与普通内窥镜12互换。尽管对使用方法的说明可以介绍为使用普通内窥镜12，但这是为了简明，并不是用于限定。该说明将同样适用于可控制内窥镜80，因为两者可以根据所希望的用途和结果而很容易地互换。图6A表示了一种变化形式，其中，轴20或80不安装在覆盖物26上，这样，内窥镜12可以自由地插入引导管腔16和从引导管腔16中退回。覆盖物26可以从组件中省略，但优选是使用覆盖物26，以便不仅保持引导管腔16无阻塞，而且在组件的前进过程中防止身体管腔的壁夹在内窥镜轴20或80以及导管14之间。如图6A所示，覆盖物26可以在安装区域50处单独安装在导管14的外表面或远端上。覆盖物26还可以包括装角撑板的区域52这使得覆盖物26能够在轴20或80前进的过程中象波纹管一样压缩成很小的紧凑外形以及进行较大膨胀。当轴20或80退回时，角撑板区域52允许覆盖物26重新压缩或返回它自身的紧凑形状。在该变化形式中，覆盖物26并不安装在轴20或80上；因此，一旦组件到达结肠中的预定位置，在一过程开始之前，覆盖物26可以通过内窥镜12内个工作槽道而除去，或者工具可以在开始处理之前简单地刺穿覆盖物26，尽管这并非是优选的。
图6B表示了另一变化形式，其中，覆盖物26可以沿安装区域54而在可控制远侧部分22的远端处或附近安装在内窥镜轴20或80上。当轴20或80在引导管腔16中前进或从引导管腔16中退回时，覆盖物26保持安装在内窥镜12上。图7表示了通过引导管腔16前进至远侧位置的轴20或80。当轴20或80前进时，可以看见，角撑板区域52膨胀，以便适应向远侧运动。根据用途，角撑板区域52可以设置成允许轴20或80超过导管14前进任意实际距离，例如几英寸。对于该变化形式，在首先使轴20或80在病人结肠内前进之前，轴20或80可以穿过引导管腔16伸出至该远侧位置，以便能够有足够空间，这样，可控制远侧部分22可以有足够空间来操作，以便呈现合适形状或曲线，导管14可以沿该曲线前进。
图8A中表示了另一变化形式，其中，覆盖物60可以设置为弹性管部件。如图所示，当内窥镜轴20或80处于退回位置时，覆盖物60可以设置为在松弛时形成管形结构。当内窥镜轴20或80向远侧前进时，如图9所示，覆盖物60可以与轴20或80一起拉伸，以便保持引导管腔16的卫生。
图8B中表示了另一变化形式，其中，覆盖物62可以设置为弹性滚卷膜片。当内窥镜轴20或80退回时，覆盖物62可以设置为翻转到它自身上面，这样，覆盖物62的一部分可以向近侧拉入引导管腔16内。这样的覆盖物62材料可以包括任意数目的弹性体、弹性体材料或橡胶类型材料，例如氯丁橡胶或乳胶。当内窥镜轴20或80向远侧前进时，覆盖物62同样可以翻转，并与轴20或80一起向远侧拉伸，也如图9所示。
也可选择，覆盖物可以只是没有弹性的塑料覆盖物或包装材料64，如图10所示。这样的覆盖物64采用普通方式就可以实现，并可以与内窥镜轴20或80一起前进，并且同样在内窥镜轴20或80退回时退回。
图11A至11E表示了利用导管14使普通内窥镜12前进的一个变化形式。图11A表示了病人结肠C的视图。内窥镜12可以通过病人的肛门A而插入结肠C内。当远侧部分12通过直肠R前进时，它遇到第一弯曲点。这时，可控制远侧部分22可以象普通内窥镜一样操作，以便选择进入乙状结肠S的最佳通路。最佳通路是表示用于使内窥镜12前进且与结肠C的壁的接触量最小的最高效通路。
一旦远侧部分22操作为选择了合适形状，导管14可以通过肛门A和直肠R而在内窥镜12上面前进，而内窥镜12保持相对于结肠C静止。优选是，导管14处于松弛状态，并能够很容易依照由可控制远侧部分22确定的形状。导管14可以前进至远侧部分22的远端，即该部分22的远端的前面较短距离或经过该远端较短距离，如图11B所示。一旦导管14已经向远侧前进，它可以沿长度刚性化，这样，它保持由内窥镜12确定的形状。
然后，对于刚性化的导管14，优选是相对于结肠C保持静止，同时内窥镜12通过导管14进一步前进，直到远侧部分22到达下一个弯曲点。然后，可控制远侧部分22可以进行操作，以便选择进入降结肠D的最佳通路，如图11C所示。一旦已经选择了最佳通路，优选是内窥镜12相对于结肠C保持静止，而导管14布置成松弛状态，并在内窥镜12上面前进。导管14可以向远侧前进，直到到达内窥镜12的远端，如图11D所示。这时，已经呈现由可控制远侧部分22确定的形状的导管14沿它的长度进行刚性化，以便保持该形状。然后，内窥镜12可以再次向远侧前进，如图11E所示，同时利用刚性化的导管14来提供坚固柱体，以便使内窥镜12前进，同时没有与结肠壁C的不必要接触。内窥镜12可以前进，直到远侧部分22到达在降结肠D和横结肠T之间的弯曲处。一旦到达该点，可以根据需要重复上述步骤，直到内窥镜穿过横结肠T和升结肠G、直到到达盲肠E、或者直到到达结肠C内的合适位置。
在所述处理过程中的任何时间点，导管14都可以通过使管退出而从结肠C中取出，同时留下内窥镜12，如图12所示。当内窥镜12留在结肠C内时，内窥镜12可以进行使用和操作，就象任何普通内窥镜在普通结肠镜检查过程中一样。导管14也可以局部退回，以便使远侧部分能够操纵或操作成检查或治疗结肠C，同时会能够支承和引导内窥镜12的近侧部分。为了从结肠C中取出组件，可以首先使导管14退回，如图所示，并可以随后使内窥镜12退回。也可选择，上述步骤可以沿相反顺序重复，以便将导管14和内窥镜12从结肠C中退出。
导管组件的应用以及上述使用方法并不局限于身体领域，而是可以包括多种其它治疗用途。其它处理部位可以包括环绕器官体的身体区域。也可选择，本发明可以用于其它具有曲折通路的环境，例如在管路系统、管等中进行的探查处理。而且，除了这里所述，还可以采用各种其它可刚性化导管装置和用途。本领域技术人员显然可知的、用于实现本发明的上述组件和方法的变化形式以及本发明方面的变化形式都将在权利要求的范围内。

Claims (21)

1.一种用于使内窥镜前进通过一曲折通路的系统，包括：
内窥镜轴，该内窥镜轴有近端、可控制远端和在它们之间的长度；
具有一定长度的细长导管，该导管确定了通过其中的管腔，其中，导管用于在管腔内可滑动地接收该内窥镜轴，该导管还包括至少一个拉紧部件，该拉紧部件沿该导管的长度布置，用于选择性地使该导管的长度刚性化；
其中，当拉紧部件处于拉紧力下时，该导管的至少一部分还适于适应由可控制远端确定的形状，并保持该形状。
2.根据权利要求1所述的系统，其中：该内窥镜轴包括普通内窥镜轴。
3.根据权利要求1所述的系统，其中：内窥镜轴包括细长体，该细长体有近端和可选择操纵的远端，并确定了在它们之间的至少一个管腔，该细长体包括多个段，这些段通过接头互连，且至少一个马达安装在至少大部分段的各段上，用于驱动相邻段，其中，各马达可独立控制，且当远端呈现选定曲线时，该多个段设置成通过使各马达选择驱动相邻段而沿细长体传播选定曲线。
4.根据权利要求1所述的系统，其中：导管包括多个相邻连接的段，其中，至少大部分段可彼此相对进行角度运动。
5.根据权利要求1所述的系统，其中：导管包括沿导管长度布置的至少三个拉紧部件。
6.根据权利要求5所述的系统，其中：各拉紧部件相互沿周向绕导管定位。
7.根据权利要求1所述的系统，还包括：管形覆盖物，该管形覆盖物布置在导管外表面的至少主要部分上面。
8.根据权利要求1所述的系统，还包括：覆盖物，该覆盖物布置在导管管腔的远端上面。
9.根据权利要求8所述的系统，其中：该覆盖物包括装角撑板的区域，该区域用于当该内窥镜轴相对于导管管腔的远端向远侧前进时从第一压缩结构膨胀至第二纵向膨胀结构。
10.根据权利要求8所述的系统，其中：该覆盖物用于当该内窥镜轴位于导管管腔内时翻转至它自身上面。
11.根据权利要求8所述的系统，其中：该覆盖物用于当该内窥镜轴相对于导管的远端向远侧前进时向远侧拉伸。
12.根据权利要求8所述的系统，其中：该覆盖物安装在该导管的远端和该内窥镜轴的远侧位置之间。
13.根据权利要求8所述的系统，其中：该覆盖物安装在该导管的远端和该内窥镜轴的远端之间。
14.根据权利要求8所述的系统，其中：该覆盖物整个布置在该导管管腔的远端和该内窥镜轴的远端上面。
15.一种用于使内窥镜前进通过一曲折通路的方法，包括：
使内窥镜轴沿曲折通路前进，直到遇到在通路中的弯曲部分；
操作该内窥镜轴的可控制远端，以便呈现用于穿过该弯曲部分的任意形状；
使处于柔软状态的导管在该内窥镜轴上面前进，这样，该导管的一部分呈现由内窥镜轴的远端确定的任意形状；
使导管的长度刚性化，这样，通过导管保持该任意形状；以及
使内窥镜轴通过该刚性化的导管进一步前进。
16.根据权利要求15所述的方法，还包括：使导管松弛。
17.根据权利要求15所述的方法，其中：使处于柔软状态的导管前进包括使导管在内窥镜轴上面前进。
18.根据权利要求17所述的方法，其中：导管在内窥镜轴上面前进，直到导管的远端位于该内窥镜轴的远端附近，恰好在该远端近侧或恰好在该远端远侧。
19.根据权利要求15所述的方法，其中：操作内窥镜的可控制远端包括人工控制该远端，以便呈现任意形状。
20.根据权利要求15所述的方法，其中：使该导管前进包括当内窥镜轴相对于该导管向远侧前进时，使布置在导管远端上面的覆盖物膨胀。
21.根据权利要求15所述的方法，其中：使导管长度刚性化包括拉紧沿导管长度布置的至少三个拉紧部件。
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US20020161281A1 (en) 2002-10-31
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US20060009678A1 (en) 2006-01-12
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DE60334449D1 (de) 2010-11-18
ATE483396T1 (de) 2010-10-15
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US20040193008A1 (en) 2004-09-30
US20060015009A1 (en) 2006-01-19
JP2005524431A (ja) 2005-08-18
US20040210109A1 (en) 2004-10-21
US20040193009A1 (en) 2004-09-30
US6837846B2 (en) 2005-01-04
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US20040220450A1 (en) 2004-11-04
US20050124855A1 (en) 2005-06-09

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