JP2558663B2 - Puncture ultrasound endoscope - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial field of application] The present invention relates to puncturing, collecting tissue for cytodiagnosis, injecting a drug solution, etc., to an affected tissue in a body cavity under observation with an endoscope. The present invention relates to a puncture ultrasonic endoscope used when performing.

[Prior Art] The technology closest to the present invention is disclosed in Japanese Patent Application No. 60-216049 (unpublished). This is the tip of the endoscope, and the rigid member containing the puncture needle rotates as a separate body from the tip of the endoscope, and at this time, it is inserted into the puncture needle insertion hole of the endoscope main body. It was made to be able to be located. Then, when the puncture needle is advanced at this position, the puncture needle is inserted into the body cavity through the hole of the endoscope body. Further, the inserted puncture needle can be observed as an ultrasonic image by an ultrasonic observation transducer arranged on the endoscope body side.

Further, in a field different from the present invention, as a device for inserting a puncture needle from the outside of the body into the tissue of the body, JP-B-60-5302
There is one in the official gazette.

[Problems to be Solved by the Invention] In the above-mentioned prior application, a special mechanism for locating the puncture needle in the transmission surface of the ultrasonic wave generated from the ultrasonic transducer incorporated in the tip of the endoscope. Need. As a result, the length of the rigid end portion of the endoscope and the outer diameter of the distal end are increased, and the patient's pain is increased. In addition, the mechanism is also complicated, and when performing sterilization / disinfection work, the sterilization liquid or the like does not spread to the parts of the complicated mechanism, and the sterilization / disinfection effect is not improved.

The present invention has been made by paying attention to the above problems, and with a simple configuration, a puncture needle can be accurately inserted into tissue in a body cavity,
Another object of the present invention is to provide an ultrasonic endoscope for puncture, which can reduce the pain of the patient at the time of inserting the endoscope by reducing the outer diameter of the endoscope tip and shortening the length of the rigid portion.

[Means and Action for Solving Problems] In order to solve the above problems, according to the present invention, a distal end of a distal end rigid portion of an endoscope is arranged on a distal end surface formed obliquely to a longitudinal axis direction of an insertion portion. An optical system for visual observation, an ultrasonic oscillating element for ultrasonic observation, and a puncture needle that can be inserted into the channel in the endoscope, and the tissue in the body cavity is ultrasonically observed by the puncture needle. In the puncturing ultrasonic endoscope that is punctured, the ultrasonic oscillating element is arranged in front of the optical system and oscillates an ultrasonic signal in a substantially fan shape.
A channel port is formed in the vicinity of the optical system of the distal end hard portion so that when the puncture needle projects from the distal end of the endoscope, it projects into the ultrasonic tomographic plane.

As a result, the configuration of the distal end constituent portion of the endoscope is simplified, and the length of the rigid portion can be shortened and the outer diameter can be reduced.

[Embodiment] FIGS. 1 to 5 show a first embodiment of the present invention. FIG. 1 shows the entire ultrasonic endoscope 1, which comprises an insertion portion 2, an operating portion 3 and a universal cord 4. The insertion portion 2 is composed of a flexible tube, a bending portion 6 and a tip hard portion 7. The operation section 3 is provided with a treatment instrument insertion opening 8 and operation buttons 9, 9 in addition to the eyepiece section 7.
An operation knob (not shown) for remotely bending the bending portion 6 is provided. A connector 11 for connecting to a light source for illumination (not shown) is provided at the tip of the universal cord 4. Further, the universal cord 4 is provided with an ultrasonic observing device connecting connector 13 which is connected to the tip of a cord 12 branched from the universal cord 4.

Further, the distal end hard portion 7 of the insertion portion 2 is shown in FIGS.
As shown in the figure, the tip surface 14 is formed obliquely with respect to the major axis direction of the insertion portion 2, and an ultrasonic transducer 15 for transmitting and receiving ultrasonic waves is provided on the tip surface 14.

An illumination window 16 and an observation window 17 for optically observing are provided below the ultrasonic transducer 15 as shown in FIG. 2, and between the illumination window 16 and the observation window 17. A channel port 18 is located in position.

The ultrasonic signal line 21 connected to the ultrasonic transducer 15 is guided through the insertion portion 2, the operation portion 3, the universal cord 4 and the cord 12 and connected to the connector 13 as shown in FIG. The channel 23 communicating with the channel port 18 is formed by the tube 22 inserted into the insertion section 2 and is connected to the treatment instrument insertion port 8 of the operation section 3.

Further, in the distal end rigid portion 7, the channel 23 portion, that is, the guide hole 23a is linearly formed so as to regulate and guide the lead-out direction of the puncture needle 24 led out from the channel opening 18. That is, this derivation direction is directed to the scanning target area of the ultrasonic transducer 15, and the scanning center direction of the ultrasonic wave and the derivation direction intersect at the front as shown in FIG.

On the other hand, the puncture needle 24 is normally drawn into a cylindrical tip guide 25, and the tip guide 25 is connected to the tip of a puncture needle coil 26. Further, the puncture needle 24 is connected to an operation wire 27 that is inserted through the puncture needle coil 26, and is pushed and pulled by the operation wire 27 to produce the tip guide 25.
It is supposed to sink from. The hard length of the puncture needle 24 is a length that can be arranged in the rigid tip portion 7, that is,
It is within the length of the guide 23a.

Thus, the puncture needle 24 together with the tip guide 25 and the puncture needle coil 26 can be projected by the tip rigid portion 7 through the channel 23 of the ultrasonic endoscope 1. Then, the ultrasonic transducer 15 is operated to emit ultrasonic signals in a sector shape to perform ultrasonic observation. Then, when the puncture needle 24 is projected from the channel opening 18, it easily enters the sector-shaped ultrasonic signal surface, and as shown in FIG. 5, the puncture needle 24 is inserted into the body tissue through the body wall. Monitor 35
Can be surely observed on the screen 36 of. In this case, since the ultrasonic transducer 15 is scanned in a sector shape, the puncture needle 24
Appears faster in the ultrasonic image, and the puncture needle 24 can be observed in the shallow portion of the body cavity wall. Therefore, it is possible to prevent inadvertent puncture to cause a problem such as damage to a blood vessel.

Further, as shown in FIG. 3, since the puncture needle 14 can be incorporated in the distal end rigid portion 7 of the ultrasonic endoscope 1, the rigid portion at the tip of the puncture needle 24 in the bent portion 6 is bent. It does not damage the joints 30 and blades 31 of the.

FIG. 4 shows a state in which a tumor in the pancreas is punctured through the stomach wall while actually puncturing the body cavity.

Conventionally, the pancreas is deep inside the human body and a biopsy is performed with a cell brush, etc. through the duodenal papilla, but the route to the pancreas is curved because it passes through the duodenal papilla. Although it was impossible to insert the puncture needle 24 due to a twist, this can be easily done with the above configuration.

Moreover, according to the present invention, it is possible to transcutaneously insert the puncture needle 24 into the pancreas to collect tissue cells and inject a drug solution having an antitumor effect.

Further, as shown in FIG. 3, the ultrasonic transducer disposed at the tip of the endoscope is oriented obliquely with respect to the axial direction of the tip of the endoscope, as shown in FIG. The angle for making close contact with the wall of the body cavity is smaller than the right angle, and it becomes easier to make close contact.

6 and 7 show other image display examples. In the ultrasonic endoscope 1 of the present invention, there are an ultrasonic image a and an endoscopic image b obtained by observing the inner wall of the body cavity as a general endoscope. Simultaneously displays them on the screen 36 of one monitor 35. At this time, as in the present invention, when the ultrasonic element and the observation objective are close to each other at the tip of the endoscope and the tip is in contact with the body wall, the endoscopic image b for observation is obtained. Since there is no ultrasonic image a, it is necessary to preferentially view the ultrasonic image a. Also, when the body cavity is not filled with a liquid such as water, an ultrasonic image cannot be obtained. It is necessary to give priority to viewing. In such a case, the image to be prioritized may be arbitrarily or automatically displayed on the large screen side. To do it automatically, you can compare the images of many parts of the image, and if there is no difference between the images, you can see that the desired image is not obtained (the conditions for obtaining each image are not). There is a method such as making a small screen one with no difference and making a large screen one.

[Effects of the Invention] As described above, according to the present invention, the configuration of the distal end portion of the ultrasonic endoscope for puncture is simplified, the length of the rigid tip portion is short, and the diameter can be reduced. This significantly reduces the patient's pain during insertion into the body cavity. In addition, the puncture needle that punctures the body wall appears on the ultrasonic image quickly after inserting the body wall,
The risk of the puncture needle damaging blood vessels in the body wall is reduced.

Further, since the optical system for visual observation is provided on the distal end surface where the distal end rigid portion of the endoscope is formed obliquely with respect to the longitudinal axis direction of the insertion portion, the observation optical system is provided more than in the lateral direction of the distal end component. The length of the hard tip can be shortened, and when the puncture needle is projected from the endoscope, it enters the field of view faster than when the observation optical system is in the lateral direction as well as the ultrasound image. The insertability into the body can be further improved, the pain can be further reduced, and safer and more accurate puncture can be performed.

If the puncture needle is incorporated in the rigid portion that houses the ultrasonic transducer, the bending operation can be performed smoothly without the rigid portion of the puncture needle being placed on the bending portion.

It should be noted that if the ultrasonic transducer is attached obliquely, it will be easier for the body cavity wall to be more closely attached.

[Brief description of drawings]

FIG. 1 is an overall view of an ultrasonic endoscope according to an embodiment of the present invention, FIG. 2 is a front view of the tip of the insertion portion of the ultrasonic endoscope, and FIG. FIG. 4 is a side sectional view of the distal end portion of the insertion portion of the mirror, FIG. 4 is a side sectional view of the same usage state, FIG. 5 is an image display example of a monitor, FIG. 6 and FIG.
The figures respectively show image display examples of other monitors. 1 ... Ultrasound endoscope, 2 ... Insertion part, 7 ... Hard tip part, 15 ... Ultrasonic transducer, 17 ... Observation window, 24 ... Puncture needle.

Claims (1)

(57) [Claims] 1. An optical system for visual observation in which a distal end of a rigid end portion of an endoscope is arranged on a distal end surface formed obliquely with respect to a longitudinal axis direction of an insertion portion, and ultrasonic oscillation for ultrasonic observation. Element,
In the puncture ultrasonic endoscope, which comprises a puncture needle that can be inserted into a channel in the endoscope, and punctures tissue in a body cavity under ultrasonic observation with the puncture needle, the ultrasonic oscillation element is , Which is disposed in front of the optical system and oscillates an ultrasonic signal in a substantially fan shape, and when a puncture needle is projected from the endoscope tip in the vicinity of the optical system of the tip rigid portion, its ultrasonic tomographic plane An ultrasonic endoscope for puncture, characterized in that a channel mouth is formed so as to project inward.