JP2502337B2 - Endoscope device - Google Patents

Description

Description: TECHNICAL FIELD The present invention relates to an intracranial surgical operation, and more particularly to a method for performing suction removal of an injured part such as intracerebral hemorrhage or brain tumor.

[Problems to be Solved by Prior Art and Invention] Cerebral vascular disorders include cerebral hemorrhage and subarachnoid hemorrhage. In order to remove these intracerebral hematomas and the like after the intracerebral hemorrhage, in recent years, for example, "Cranial Neurosurgery" Vol.
Stereotactic brain surgery by the CT (computer tomography) guidance method disclosed in February 2012 is performed.

Stereotactic brain surgery is a stereotactic brain surgery device that is fixed to the patient's head, and the positioning device provided in this device positions the lesion in the brain and inserts a treatment tool such as a drainage tube into the lesion. However, the operation is performed, but the accuracy of the positioning is improved by capturing and positioning the obstacle portion by the tomographic image using CT, and the invasion to the patient can be suppressed.

By the way, as a method of removing intracerebral hematoma by stereotactic brain surgery, a method of inserting a metal suction tube into the hematoma and sucking and removing the hematoma with an aspirator such as a syringe is performed. If this method does not completely remove the indwelling tube, place the indwelling tube in the hematoma cavity, inject a hematolytic agent such as Urokinase, and in several hours, remove the dissolved hematoma by suction from the indwelling tube. A hematolysis method is used. Further, in recent years, a method of crushing a hematoma using an ultrasonic suction device and removing it by suction is being practiced. Furthermore, biopsy of brain tumors, ablation treatment with Nd-YAG laser light, and the like are performed by stereotactic brain surgery.

The surgical device used for the stereotactic brain surgery is Japanese Patent Publication No. 61-25.
No. 377. This is a technique in which a target surgical site in the brain is determined by CT, a sheath is punctured at a target point by a surgical device attached to the skull, and hematomas and the like are suctioned and removed through the sheath.

Further, in U.S. Pat.No. 4,681,103, a swivel ball is mounted in a housing fixed to a skull, and an ultrasonic suction probe inserted in the skull is fixed to the swivel ball to fix the ultrasonic probe in a desired direction. Techniques have been disclosed that allow the sonic probe to be oriented.

By the way, when a hematoma or the like is sucked by the ultrasonic suction device, it is difficult to distinguish between a hematoma and a normal tissue (brain parenchyma), and the hematoma is sucked depending on the intuition of the operator. According to such a conventional method, there is a possibility that normal tissue (brain parenchyma) may be sucked and there is a problem that hematoma cannot be completely sucked.

[Object of the Invention] The object of the present invention was made in view of the above circumstances, and it is possible to distinguish the boundary between a lesion such as a hematoma and normal tissue, and to safely and reliably detect only the lesion such as a hematoma. It is an object of the present invention to provide an endoscope device that can be sucked and removed.

[Means and Actions for Solving Problems] An endoscope that is inserted into a body cavity to obtain an observation image of a lesion, and an endoscope that can be inserted into the endoscope and abuts the lesion, and ultrasonically vibrates the lesion. In an endoscopic device comprising ultrasonic vibrating means for crushing and emulsifying, a color detecting means for extracting a red component signal from an observation image obtained by the endoscope, and a red component signal extracted by the color detecting means. The output control means for controlling the vibration level transmitted to the ultrasonic vibration means in accordance with the red output level is used to perform treatment such as suction while discriminating the lesioned part.

Hereinafter, an embodiment of the present invention will be described with reference to the drawings.

 1 to 5 show a first embodiment of the present invention.

In the present embodiment, the present invention is applied to a brain surgery device.

In FIG. 4, the endoscope device 1 includes a sheath 2, a telescope 3 inserted through the sheath 2, an adapter 4 connected to a rear end of the telescope 3, and a head 9 of a patient. A stereotactic brain surgery device 5 for holding the ultrasonic wave, an ultrasonic suction device 6 as a treatment tool connected to the rear end of the adapter 4,
It is composed of a fixing device 7 for fixing the sheath 2 and the like to the stereotactic brain surgery device 5 and a generator 8 for oscillating ultrasonic waves.

The head 9 of the patient is inserted into the ring 11 of the stereotactic brain surgery device 5, and is fixed to the stereotaxic surgery device 5 by four head fixing pins 12 provided in the ring 11. It has become. On one side of the ring 11, there is provided a positioning device 13 which is slidable in the X, Y and Z directions and rotatable in the α direction. The positioning device 13 has a curved arm 14. It is lined up. The sheath 2 is provided on the arm 14 so as to be slidable in the β direction. Further, on the top of the ring 11, there is provided a fixing device 7 in which a curved arm 16 for holding the sheath 2 is continuously provided together with the arm 14.

The sheath 2 is held by a sheath holder 17 by an arm 14 and an arm 16. Further, the sheath holder 17 supports the slide device 19 via the support 18.

The sheath 2 is connected to the telescope 3 having an eyepiece 21 extending obliquely rearward from the side, and further to the rear of the telescope 3, the ultrasonic suction device 6 is connected. The adapter 4 is provided. A light guide 22 capable of supplying illumination light is connected to the telescope 3, and a water supply tube 23 capable of supplying a perfusate such as physiological saline is connected to the sheath 2.

A cord 24 and a drainage tube 26 extend from the rear end of the ultrasonic suction device 6, the cord 24 is connected to the generator 8, and the drainage tube 26 is a collection bottle for collecting the drainage attached to the generator 8. Connected to 27. A tube 28 extending from the collecting bottle 27 is connected to a drain container (not shown) via a pump 29.

In FIG. 3, the support 18 includes a support member 31 and a support body 33.
It has and. The support member 31 is interposed between the tip of the arm 14 and the rotating member 30 supported by the arm 16 to hold the sheath 2, and the support body 33 is
It is provided on the rear end surface of the support member 31, and is fixed to the support member 31 by a fixing screw 32. On the rear end surface of the support body 33, rod-shaped support shafts 34, 34 are provided in parallel with the axial direction of the sheath 2, and the slide device 19 is supported. This slide device 19 sandwiches the two support shafts 34, 34 between a slide body 36 and a fixed plate 37 and penetrates the fixed plate 37,
Support shaft with a fixing screw 38 screwed into the slide body 36
It is fixed at 34,34. A support body 39 is provided on the upper portion of the slide body 36 so as to be slidable in the axial direction of the sheath 2. An adapter 4 having an ultrasonic suction device 6 connected to its rear end is fixed to the upper portion of the support body 39.

A rack (not shown) is provided on the upper surface of the slide body 36 in the axial direction of the sheath 2 so as to mesh with a pinion (not shown) provided in the support body 39. Both ends of the pinion project from the support body 39, and the knob 41 is fixed to the projecting ends. By rotating this knob 41, the support body 39
Can be moved in the axial direction.

A reference line 35 is provided on the side surface of the slide body 36, and a scale 40 is engraved on the side surface of the support body 39. The support body 39 is moved by rotating the knob 41.
You can see the amount of movement.

In FIG. 2, the insertion portion 42 provided at the distal end portion of the telescope 3 is inserted through the upper portion inside the sheath insertion portion 43 fixed to the sheath holder 17. A large-diameter main body 44 is continuously provided at the rear end of the sheath insertion portion 43, and the rear end of the main body 44 is provided with a connecting member 46 provided at the front of the telescope 3. A connecting portion 50 is provided so that the tip of the can be detachably connected. The main body 44 is provided with a cock 47 to which the water supply tube 23 is connected.

The insertion portion 42 of the telescope 3 is provided in the sheath insertion portion 43.
At the same time, the tubular vibration member 48 of the ultrasonic suction device 6 is inserted. The vibrating member 48 is inserted into a treatment tool channel (not shown) provided in the telescope 3, and its distal end portion is projected from the sheath insertion portion 43 so as to come into contact with a hematoma 49 which is a lesion portion. There is.

In FIG. 1, the insertion portion 42 of the telescope 3 is connected to a tubular lens tube 51 in which an imaging lens system is inserted and a light guide base 52 provided on the side portion of the telescope 3, and an observation site For example, two light guide tubes 53, 53 inserted through a light guide 22 capable of illuminating light and a light projecting fiber 54 capable of transmitting light by forming a pair of color detecting means.
And a light receiving fiber 56. The light guide tubes 53, 53 are provided on both sides of the lower portion of the lens tube 51 so as to be parallel to the lens tube 51, and the tip end surface thereof slightly protrudes from the tip end surface of the lens tube 51. The light projecting fiber 54 and the light receiving fiber 56 are provided on both sides of the lens tube 51 and above the light guide tubes 53, 53 so that the light can be projected and received on the observation site of the telescope 3. Has become.

The light projecting fiber 54 and the light receiving fiber 56 are, for example, inserted through a cable 57 extending to the rear of the telescope 3 and connected to a detecting device 59 by a connector 58.

 The detection device 59 is constructed as shown in FIG.

In the detection device 59, a light source unit 61 capable of intermittently emitting illumination light is provided on the incident end surface of the light projecting fiber 54. The illumination light emitted from the light source unit 61 and transmitted through the light projecting fiber 54 is applied to the observation site, and the reflected light enters the incident end face of the light receiving fiber 56. The incident light is transmitted through the light receiving fiber 56 and is incident on the color sensor 62 provided behind the emission end face of the light receiving fiber 56. This color sensor 62
For example, if the red color of the observed part is strong, the output level is high,
The output level becomes lower as the white color becomes stronger. The output of the color sensor 62 is input to the amplifier 63, and the output signal amplified by the amplifier 63 is input to the power supply control circuit 64. The power supply control circuit 64 removes, for example, a DC component of an input signal by a filter or the like, that is, an illumination light for observation irradiated by a light guide tube 53 (not shown in FIG. 5), and an emission signal is an AC signal. The voltage supplied from the power source 66 connected to the power source control circuit 64 is controlled according to the level of this AC component. The voltage output output from the power supply control circuit 64 is input to the drive circuit 67 provided in the ultrasonic suction device 6. This drive circuit 67 can supply the pulse signal output from the oscillator 68 to the piezoelectric element 69, and the voltage output from the power supply control circuit 64 causes the piezoelectric element to operate.
The voltage applied to 69 is controlled, and the piezoelectric element 69 vibrates the vibrating member 48 when a voltage is applied.

The operation of the endoscope device 1 configured as above will be described.

The sheath 2 punctured into the patient's head 9 is fixed to the sheath holder 17 supported by the arm 14 and the arm 16 of the stereotaxic apparatus 5. The inserting portion 42 of the telescope 3 is inserted into the sheath 2 to connect the connecting member 46 to the connecting portion 50. The tubular vibrating member 48 is inserted from the rear of the telescope 3, the vibrating member 48 is inserted through the insides of the adapter 4 and the telescope 3, and the distal end portion thereof is positioned at the distal end portion of the sheath insertion portion 43. Connect to the rear end of the adapter 4.

When the hematoma 49 is sucked, the cam ring 71 provided on the adapter 4 is rotated while observing with the telescope 3, and the vibrating member 48 is projected from the distal end portion of the sheath 2,
The tip of the vibrating member 48 is brought into contact with the hematoma 49. After that, the oscillator 68 is oscillated and a pulse signal is applied to the piezoelectric element 69 via the drive circuit 67. As a result, the vibrating member 48 vibrates to crush or emulsify the hematoma. The crushed or emulsified hematoma is sucked through a suction line (not shown) provided in the vibrating member 48.

At the time of this suction, the illumination light intermittently emitted from the light source unit 61 is transmitted through the light projecting fiber 54 and applied to the hematoma 49, and the reflected light containing the strong red component of the hematoma 49 is received. It is transmitted through the fiber 56 and enters the color sensor 62.
The color sensor 62 outputs an output signal having a high output level to the amplifier 63 due to the strong red component. The output signal amplified by the amplifier 63 is input to the power supply control circuit 64, and the direct current component is removed by a filter or the like to obtain only the alternating current component. In the power supply control circuit 64, since the voltage level of this AC component is high, the drive circuit 67 is operated to continue the vibration of the vibrating member 48.

When the boundary between the hematoma 49 and the normal tissue comes close to each other, the red component included in the reflected light incident on the light receiving fiber 56 becomes weak and the white becomes strong. Therefore, the output level of the color sensor 62 becomes low, and the voltage level of the AC component generated in the power supply control circuit 64 becomes low. The power supply control circuit 64 stops the operation of the drive circuit 67 when the voltage level becomes low, and causes the vibration member 48 to stop.
End the vibration of.

As described above, according to this embodiment, the boundary between the hematoma 49 and the normal tissue (brain parenchyma) can be discriminated, and when the vibrating member 48 approaches the normal tissue, the vibration of the vibrating member 48 can be stopped and only the hematoma is safe. And, it is possible to surely suck and remove.

In this embodiment, the vibration of the vibrating member 48 is stopped when the boundary between the hematoma 49 and the normal tissue approaches, but the present invention is not limited to this, and an alarm may be issued when the boundary approaches. You may

 FIG. 6 shows a modification of the first embodiment.

In this modification, the telescope also serves as a light-receiving fiber.

Illumination light emitted from a separately provided light source device 73 is incident on the incident end surface of the light guide tube 53 inserted through the sheath 2. The optical image of the observation site illuminated by the illumination light passes through the lens tube 51, and
The light is incident on a polarizing prism 74 provided at the rear of the. This polarizing prism 74 is a color sensor for the transmitted light.
The light is incident on the eyepiece 62 and the reflected light is made incident on the eyepiece lens system 76, so that the operator can observe with naked eyes.

In this modification, the light projecting fiber 54 and the light receiving fiber 56 of the first embodiment are not required, and the outer diameter of the sheath 2 can be reduced.

Other configurations, operations and effects are similar to those of the first embodiment.

In this modification, the light transmitted by the lens tube 51 is split by the polarizing prism 74, but the light receiving fiber 56 may be further provided and the polarizing prism 74 may be omitted.

7 and 8 show another modification of the first embodiment, in which the present invention is applied to an electronic rigid endoscope.

An objective optical system 78 is provided on the distal end surface of the insertion portion 42 of the telescope 3 inserted through the sheath 2, and a solid-state image sensor 79 is provided at the image forming position of the objective optical system 78.
The optical image formed on the solid-state image sensor 79 is photoelectrically converted and provided as an electric signal in the video signal processing device 81 and input to the preamplifier 82. This preamp
The electrical signal amplified by 82 is input to the low-pass filter 83 and the color separation circuit 84, and the low-pass filter 83 passes the signal of the luminance component of the input electrical signal and inputs it to the color encoder 86. . Also, the color separation circuit 84
The color difference signals RY and BY are generated in time series for each horizontal line and are input to the RY signal circuit 87 and the BY signal circuit 88. This RY signal circuit 87
Then, the color difference signal RY is taken out from the input signal, the color difference signal BY is taken out by the BY signal circuit 88, and each is inputted to the color encoder 86. The color encoder 86 receives the input luminance signal Y and color difference signals RY and BY.
And are converted to, for example, an NTSC composite video signal and then monitored.
It is designed to output to 89.

The color difference signal RY output from the RY signal circuit 87 is branched and input to the low-pass filter 91, only the DC component is extracted and input to the voltage control amplifier 92 provided in the ultrasonic suction device 6. It has become so.

An oscillator 68 is provided in the ultrasonic suction device 6,
The pulse signal oscillated by the oscillator 68 can be input to the amplifier 93 via the voltage control amplifier 92. The voltage control amplifier 92 is controlled so that the input level of the oscillator 68 to the amplifier 93 is increased when the voltage level of the color difference signal RY is high, and the pulse signal amplified by the amplifier 93 is It is adapted to be applied to the piezoelectric element 69. The piezoelectric element 69 vibrates the vibrating member 48 when a pulse signal is applied.

As described above, according to this modification, the vibration of the vibrating member can be controlled by taking out the color difference signal R-Y from the video signal processing device, and the normal tissue is not damaged.

Note that, as shown in FIG. 8, a motor may be provided in the positioning device 13 to electrically control the stereotactic brain surgery device 5.

In FIG. 8, a mounting portion 96 provided on the side of the ring 11
A cursor 97 is attached to the so that it can slide in the Y direction.
A sliding portion 99 of an X / Z scale shaft 98 is mounted on the cursor 97 so as to be slidable in the Z direction. Further, the base portion 102 of the arm 14 is slidably fitted in the X direction on the shaft portion 101 of the X / Z scale shaft 98. The mounting portion 96 has a rack 10 in the Y direction.
A pinion (not shown) rotated by a Y-direction adjusting motor 104 provided on a cursor 97 is meshed with the rack 103 so that the rack 103 can move in the Y direction. ing. A rack 106 is engraved in the Z direction on the lower surface of the sliding portion 99.
06 is a motor 107 for adjusting the Z direction provided at the cursor 97
A pinion (not shown) that is rotated by the above meshes with each other to move the X / Z scale shaft 98 in the Z direction. Further, a rack 108 is engraved on the shaft portion 101 in the X direction,
A pinion (not shown) that is rotated by an X-direction adjusting motor 109 provided on the base 102 meshes with the rack 108 to move the base 102 in the X direction.

A worm or worm wheel may be used instead of the rack or pinion.

FIG. 9 shows the second embodiment of the present invention, and is an explanatory view of the distal end portion of the telescope insertion portion.

Light guide tubes 53, 53 capable of transmitting illumination light are provided below and on both sides of a lens tube 51 as an optical image transmitting means constituting the insertion portion 42 of the telescope 3. A light projecting fiber 54 is inserted through the center of the one light guide tube 53, and a light receiving fiber 56 is inserted through the center of the other light guide tube 53.

By inserting the light projecting fiber 54 and the light receiving fiber 56 into the light guide tube 53 as in the present embodiment, the outer diameter of the insertion portion 42 of the telescope 3 can be reduced, and the sheath 2 can be made thinner. Can be measured. Furthermore, the passage area of the perfusion flowing in the sheath 2 can be increased.

Other configurations, operations and effects are similar to those of the first embodiment.

FIG. 10 shows a third embodiment of the present invention and is an explanatory view of the sheath distal end portion.

Below the inner peripheral surface of the sheath insertion portion 43, the light projecting fiber 54
And the light receiving fiber 56 are inserted, and the sheath insertion part
It is fixed at 43.

By fixing the light projecting fiber 54 and the light receiving fiber 56 to the sheath 2 as in this embodiment, it is not always necessary to use the telescope 3 together to perform ultrasonic suction.
The configuration of the entire device can be simplified.

Other configurations, operations and effects are similar to those of the first embodiment.

FIG. 11 shows the fourth embodiment of the present invention and is an explanatory view of the sheath distal end portion.

A lens tube 51 and light guide tubes 53, 53, which form an insertion portion 42 of the telescope 3, are inserted above the sheath 2. Below the lens tube 51 and the light guide tubes 53, 53, a tubular vibrating member 48 constituting the ultrasonic suction device 6 is inserted. On both sides of the vibrating member 48, a light projecting fiber 54 and a light receiving fiber 56 are fixed in parallel.

The vibrating member 48 that projects and directly sucks as in the present embodiment
Since the light projecting fiber 54 and the light receiving fiber 56 are fixed to each other, color detection can be performed from the vicinity of the portion where suction is performed, and highly accurate boundary determination can be performed, which is extremely safe. Is.

A hole or groove may be provided in the longitudinal direction of the outer periphery of the vibrating member 48, and the light projecting fiber 54 and the light receiving fiber 56 may be inserted into the hole or groove. Further, the light projecting fiber 54 and the light receiving fiber 56 may be inserted into the vibrating member 48.

Other configurations, operations and effects are similar to those of the first embodiment.

FIG. 12 is an explanatory view of the tip of the insertion portion of the telescope showing the fifth embodiment of the present invention.

A probe 111 incorporating a light projecting fiber 54 and a light receiving fiber 56 is removably inserted under the lens tube 51 and the light guide tubes 53, 53 that constitute the insertion section 42 of the telescope 3. .

In this way, the probe 111 is separated and can be removed when color detection is not performed, so that the endoscope apparatus 1 can be widely used according to the application.

Other configurations, operations and effects are similar to those of the first embodiment.

In each of the first, second, third, fourth, and fifth embodiments, the light projecting and light receiving fibers are not completely fixed to the lens tube, the light guide tube, the sheath, the vibrating member, etc. The optical fiber and the light receiving fiber may be independently movable back and forth.

 FIG. 13 shows a sixth embodiment of the present invention.

In this embodiment, a light receiving fiber 56 is concentrically arranged around the light projecting fiber 54 and is inserted through the sheath 2.

According to this embodiment, the outer diameter can be reduced as compared with the case where the light projecting fiber 54 and the light receiving fiber 56 are incorporated in the probe 111 as in the fifth embodiment.

The light receiving fiber 56 may be provided in the central portion, and the light projecting fiber 54 may be concentrically arranged on the outer periphery thereof.

Other configurations, operations and effects are similar to those of the first embodiment.

In the seventh embodiment, one fiber as a light transmitting means is inserted into the sheath 2, and this one fiber is used for both light projection and light reception.

With this structure, the fiber can be made thin, and the outer diameter of the sheath can be made small. Also,
The invasion of the patient can be minimized.

In each of the above-mentioned embodiments, the color detecting means using fibers has been described, but the present invention is not limited to this, and other color detecting means such as a color sensor provided at the tip of the sheath may be used.

[Effects of the Invention] As described above, according to the present invention, the boundary between the lesion and the normal tissue can be determined, and only the lesion can be safely and surely removed by suction.

[Brief description of drawings]

1 to 5 relate to a first embodiment of the present invention. FIG. 1 is an explanatory view of an endoscope apparatus having a light projecting fiber and a light receiving fiber, and FIG. 2 is a telescope insertion part inserted therein. Fig. 3 is a cross-sectional view of the sheath, Fig. 3 is an explanatory view of the outer shape of the telescope, Fig. 4 is an overall configuration diagram of the endoscope device, Fig. 5 is a block diagram of a color detection circuit, and Fig. 6 is the first embodiment. FIG. 7 is a block diagram of a color detection circuit according to a modification of the example, and FIG.
According to another modification of the embodiment, FIG. 7 is a block diagram of a color detection circuit, FIG. 8 is a perspective view of a positioning device, and FIG. 9 is a distal end portion of a telescope according to a second embodiment of the present invention. Illustration,
FIG. 10 is an explanatory view of a sheath distal end portion according to a third embodiment of the present invention, FIG. 11 is an explanatory view of a sheath distal end portion according to a fourth embodiment of the present invention, and FIG. 12 is a fifth name of the present name. FIG. 13 is an explanatory diagram of a telescope tip portion according to an embodiment, and FIG. 13 is an explanatory diagram of a light projecting fiber and a light receiving fiber according to a sixth embodiment of the present invention. 2 ... Sheath, 3 ... Telescope 48 ... Vibration member, 51 ... Lens tube 53 ... Light guide tube, 54 ... Emitting fiber 56 ... Receiving fiber

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Tatsuya Kubota 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Inventor Shoichi Gotanda 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Inventor Tadao Hagino 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. Yoshito Inazumi (56) Reference JP-A-57-103622 ( JP, A) JP 58-143744 (JP, A) JP 62-84753 (JP, A)

Claims (1)

(57) [Claims] 1. An endoscope which is inserted through a body cavity to obtain an observation image of a lesion, and ultrasonic vibration which is pierceable by the endoscope and abuts on the lesion to crush and emulsify the lesion by ultrasonic vibration. In the endoscopic device comprising means, according to the color detection means for extracting a red component signal from the observation image obtained by the endoscope, and the red output level of the red component signal extracted by the color detection means. An endoscope apparatus comprising: output control means for controlling a vibration level transmitted to the ultrasonic vibration means.