插入管的操作特性重要,特别是对于结肠镜而言。为了易于插入,该仪器必须能够准确传输内镜医师施加的所有细微运动和扭矩。内窥镜医师施加于轴近端部分的任何旋转(扭矩)都必须以1:1的比例传递至器械的远端,尽管这种能力会在器械成环时失去。扁平的螺旋金属带正好在插入管皮下延伸,从而增强了仪器的扭转能力。
The operating characteristics of the insertion tube are important, especially for colonoscopy. For ease of insertion, the instrument must be able to accurately transmit all subtle movements and torques applied by the endoscopist. Any rotation (torque) applied by the endoscopist to the proximal part of the shaft must be transmitted to the distal end of the instrument in a ratio of 1:1, although this ability will be lost when the instrument is looped. The flat spiral metal belt extends just under the skin of the insertion tube, so as to enhance the torsion ability of the instrument.
由于这些带的缠绕方向相反,因此在管子受到扭转时它们会相互锁定,从而将管子一端的旋转准确地传递到另一端。同时,这些螺旋带之间的间隙使轴可以自由弯曲。这些带也使插入管呈圆形。它们的刚度可防止插入管的内部组件受到外力挤压。这些螺旋带被编织成管状网的细丝不锈钢丝覆盖。将塑料聚合物层(通常为黑色(在结肠镜上为深绿色))挤出到该金属丝网上,以创建插入管的光滑外表面。聚合物层为插入管提供了无创,生物相容和水密的表面。
Because the winding direction of these tapes is opposite, they will lock each other when the pipe is twisted, so as to accurately transfer the rotation of one end of the pipe to the other end. At the same time, the clearance between these helical belts allows the shaft to bend freely. These bands also round the insertion tube. Their stiffness prevents the internal components of the inserted tube from being squeezed by external forces. These spiral belts are covered with thin stainless steel wires woven into tubular nets. A plastic polymer layer, usually black (dark green on colonoscopy), is extruded onto the wire mesh to create a smooth outer surface of the insertion tube. The polymer layer provides a non-invasive, biocompatible and watertight surface for the insertion tube.
经验表明,对于检查上消化道的固定解剖结构而言,更坚固的插入管是良好选择。结肠具有曲折和可自由移动的环,用更灵活的仪器检查。仪器应足够松散(非刚性),以易于适应患者的曲折解剖结构,并在结肠壁和肠系膜上施加小的力。器械还应具有足够的柱强度,以防止在推动器械的近端时发生弯曲。结肠镜除具有灵活性外,还应具有足够的弹性,以使其在向后拉时会弹回拉直状态。这有助于消除循环。
Experience has shown that a stronger insertion tube is a good choice for examining the fixed anatomy of the upper gastrointestinal tract. The colon has a tortuous and freely movable ring, which can be examined with a more flexible instrument. The instrument should be loose enough (non rigid) to easily adapt to the patient's tortuous anatomy and exert small forces on the colon wall and mesentery. The instrument shall also have sufficient column strength to prevent bending when pushing the proximal end of the instrument. In addition to flexibility, the colonoscope should also have enough elasticity so that it will bounce back to the straightened state when pulled back. This helps eliminate loops.
获得柔韧性,弹性,柱强度和扭转能力的组合是插入管设计的艺术和科学。这些特性之一的改进通常会对其他一个或多个负面影响。设计通常是这些理想特性之间的折衷,经过几个月的临床测试证实。为了进一步改善插入,胃镜和结肠镜插入管的柔性通常在端部到端部之间变化。正如图3.3示出,远端40cm的结肠镜插入管的是显著比近侧部分更柔软。柔性的这种变化是通过在制造过程中改变管的外部聚合物层在金属丝网上挤出时的配方来实现的。
The combination of flexibility, elasticity, column strength and torsion is the art and science of insert tube design. Improvements in one of these features usually have a negative impact on one or more others. Design is usually a compromise between these ideal characteristics, which has been confirmed by clinical tests for several months. To further improve insertion, the flexibility of gastroscopy and colonoscopy insertion tubes usually varies from end to end. As shown in Figure 3.3, the distal 40 cm colonoscopy insertion tube is significantly softer than the proximal part. This change in flexibility is achieved by changing the formulation of the outer polymer layer of the tube extruded on the wire mesh during the manufacturing process.
挤出机包含两种类型的树脂,一种明显比另一种硬。当插入管的远端穿过机器时,一层柔软的树脂被应用到丝网的远端40厘米处。在靠近管中部的过渡区域内,这种软树脂逐渐被硬树脂替代。插入管的近端部分(50至160 cm)仅由硬质树脂制成。结果是插入管具有柔软的远侧部分,可无创地弯曲通过弯曲的结肠,而较硬的近侧部分可有效防止结肠中已被结肠镜矫正的部分中的环再形成。
The extruder contains two types of resins, one of which is significantly harder than the other. When the distal end of the insertion tube passes through the machine, a layer of soft resin is applied to the distal end of the screen 40 cm. In the transition area near the middle of the pipe, this soft resin is gradually replaced by hard resin. The proximal portion of the insertion tube (50 to 160 cm) is made of hard resin only. As a result, the insertion tube has a soft distal portion that can be noninvasively bent through the curved colon, while the hard proximal portion can effectively prevent the re formation of the ring in the portion of the colon that has been corrected by colonoscopy.
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