JP4950928B2 - Ultrasound endoscope device - Google Patents

Description

  The present invention relates to an ultrasonic endoscope apparatus in which a balloon is attached to the distal end of an ultrasonic endoscope, and more particularly, an ultrasonic endoscope that controls an injection operation or a discharge operation of an ultrasonic transmission medium to a balloon. Relates to the device.

  Conventionally, ultrasonic endoscopes have been used in the medical field. An ultrasonic endoscope is configured by integrally arranging an imaging element and a plurality of ultrasonic transducers at the distal end of an insertion portion to be inserted into the body. Each ultrasonic transducer irradiates an observation site in the body with ultrasonic waves and receives an echo signal thereof. The received echo signal is transmitted from the ultrasonic transducer to the ultrasonic observation apparatus, subjected to various signal processing, and then displayed as an ultrasonic tomographic image on a monitor or the like.

  Since ultrasonic waves and echo signals are significantly attenuated in the air, it is necessary to interpose an ultrasonic transmission medium (for example, water or oil) between the ultrasonic transducer and the site to be observed. Therefore, a stretchable bag-like balloon is attached to the distal end portion of the ultrasonic endoscope, and an ultrasonic transmission medium is injected into the balloon to be inflated, and brought into contact with the observation site. Thereby, air is excluded from between the ultrasonic transducer and the site to be observed, and attenuation of ultrasonic waves and echo signals is prevented.

  When a lesion or a suspicious site is confirmed as a result of ultrasonic examination, a treatment tool such as a puncture needle is introduced into the body, and cell tissues are collected or a drug solution is administered. . For this reason, a forceps channel for passing the treatment tool is inserted into the ultrasonic endoscope, and the treatment tool is introduced into the body from the opening at the distal end communicating with the forceps channel. At this time, if the balloon is inflated, there is a risk that the tip of the treatment tool protruding from the opening contacts the balloon and the balloon bursts.

  Therefore, various measures for preventing contact between the treatment tool and the balloon have been proposed. For example, Patent Literature 1 discloses an ultrasonic endoscope apparatus that can change the standing angle from the opening of the treatment instrument and displays the standing angle with a scale or the like. Patent Document 2 proposes an ultrasonic endoscope in which a guide member that rotates and displaces in order to change a standing angle is provided in the vicinity of an opening while guiding a treatment instrument.

Patent Document 3 describes an ultrasonic endoscope in which a component arrangement layout at the distal end is devised so that the state of the protrusion of the treatment tool in the opening can be satisfactorily monitored with an ultrasonic image. In Patent Document 4, a guide hole for penetrating a treatment instrument is provided in a balloon.
JP-A-5-56912 JP 2007-252458 A Japanese Patent Application Laid-Open No. 5-344773 JP-A-61-64235

  Since the balloon has elasticity, it may be deformed or displaced when it is pressed against the body duct, and may contact the treatment instrument. In such a state, when an ultrasonic transmission medium is injected into or discharged from the balloon, the load applied to the treatment tool is unexpectedly changed due to the contact of the balloon, the protruding state of the treatment tool becomes unstable, and the body duct is damaged. There is a danger such as end. In order to avoid such a risk, it is necessary to control the injection and discharge of the ultrasonic transmission medium while the treatment instrument is introduced into the body to prevent the balloon from being inflated or deflated. However, any of the above prior arts is effective when the treatment instrument is introduced into the body, but the countermeasure against the danger caused by the treatment instrument after introduction coming into contact with the balloon is not considered.

  The present invention has been made in view of the above problems, and by controlling the injection operation or the discharge operation of the ultrasonic transmission medium to the balloon, the balloon is unexpectedly expanded or contracted, and the treatment tool is used. An object of the present invention is to provide an ultrasonic endoscope apparatus that can ensure safety during treatment.

  In order to achieve the above object, the present invention is equipped with an ultrasonic transducer, a forceps channel for introducing a treatment instrument into the body, and an ultrasonic transducer so as to cover or inject an ultrasonic transmission medium. An ultrasonic endoscopic device comprising a bag-shaped balloon, and detecting means for detecting whether or not the treatment tool protrudes from the outlet of the forceps channel; and when the treatment tool does not protrude from the outlet, And a control means for invalidating the injection operation or the discharging operation when the injection operation or the discharging operation of the ultrasonic transmission medium is validated and the treatment instrument protrudes from the outlet.

  Further, an invalidation canceling means for instructing the control means to cancel the invalidation is further provided, and the control means is instructed to cancel the invalidation by the invalidation canceling means in a state where the injection operation or the discharge operation is invalidated. In this case, it is preferable to temporarily permit the invalidation operation. In this case, it is preferable that the control unit invalidates the injection operation or the discharge operation again after allowing a predetermined number of injection operations or the discharge operation.

  In addition, a timer for measuring an elapsed time after allowing the injection operation or the discharge operation is further provided, and the control means performs the injection operation or the discharge operation again after a predetermined time has elapsed after allowing the injection operation or the discharge operation. You may make it invalidate.

  The detection means is preferably an optical sensor provided in the vicinity of the outlet of the forceps channel. Furthermore, it is preferable to provide an informing means for informing whether the position of the treatment tool and whether the injection operation or the discharge operation is invalidated.

  According to the present invention, the injection operation or the discharge operation of the ultrasonic transmission medium is controlled according to the position of the treatment instrument. Since the balloon is not inflated or deflated while the treatment instrument protrudes from the forceps channel outlet into the body, the load applied to the treatment instrument in use due to the contact of the balloon does not change unexpectedly. Further, there is no possibility that the balloon is pressed by the treatment tool during the treatment and the balloon is broken. Therefore, it is possible to safely perform the treatment with the balloon attached to the distal end portion of the ultrasonic endoscope.

  In FIG. 1, an ultrasonic endoscope apparatus 1 includes an ultrasonic endoscope 2 that is inserted into a body and acquires an image of an organ, an ultrasonic observation apparatus 3 that obtains an ultrasonic tomographic image, and a pump apparatus 4. It consists of and. The ultrasonic endoscope 2 is connected to the ultrasonic observation apparatus 3 through a universal cord 5 provided continuously at the base end portion thereof. The universal cord 5 is a bundle of various signal lines for transmitting image signals and control signals with a resin outer jacket. Among these signal lines, a cable 6 for transmitting a detection signal, which will be described later, branches in the middle of the universal cord 5 and is connected to the pump device 4.

  The ultrasonic endoscope 2 includes an operation unit 7 that is grasped and operated by an operator such as a doctor, and an insertion unit 8 that is inserted into the body of the subject. The insertion portion 8 is divided into a long and bendable flexible portion 9 and a distal end portion 10 provided at the distal end of the flexible portion 9, and an ultrasonic transmission medium is placed in the distal end portion of the flexible portion 9. An infusion / exhaust channel 26 for supplying to the device 10, a forceps channel 28 for passing a treatment tool such as a puncture needle (both see FIG. 2), etc. are inserted.

  The operation unit 7 is provided with a plurality of operation buttons, an angle knob 11 for bending the flexible portion 9, a forceps port 12, and an injection / discharge port 13. The forceps port 12 is connected to a forceps channel 28, from which a treatment tool is inserted and introduced into the body of the subject. The injection / discharge port 13 communicates with the injection / discharge channel 26, and is connected to the pump device 4 by a tube 14.

  The pump device 4 is for sending an ultrasonic transmission medium into the ultrasonic endoscope 2, and includes a storage container 15 that contains water used as the ultrasonic transmission medium, and a pump that pressurizes or depressurizes the inside of the storage container 15. 16 and a control unit 17 that controls the operation of the pump 16. The pump device 4 is further connected to a foot switch 18 provided with a water injection button 18a and a drainage button 18b for causing the control unit 17 to perform injection and discharge control. When the water injection button 18 a of the foot switch 18 is pressed, the control unit 17 operates the pump 16 to pressurize the inside of the storage container 15. Thereby, the water in the storage container 15 is injected into the ultrasonic endoscope 2 through the tube 14. Further, when the drain button 18b of the foot switch 18 is pressed, the control unit 17 operates the pump 16 to depressurize the inside of the storage container 15. Thereby, the water injected into the ultrasonic endoscope 2 is discharged to the storage container 15 through the tube 14. Reference numeral 18c denotes an unlock button described in the second embodiment.

  As shown in FIG. 2, the distal end portion 10 of the ultrasonic endoscope 2 has an imaging unit 21 for obtaining an endoscopic image by photographing an observation site in the body, and an ultrasonic tomographic image. A plurality of ultrasonic transducers 22 are provided. The ultrasonic transducers 22 are arranged in a convex curve along the longitudinal direction of the distal end portion 10 at equal intervals, sequentially irradiate ultrasonic waves toward the site to be observed, and receive the echo signals. Thereby, convex ultrasonic electronic scanning is performed on the site to be observed. The received echo signal is transmitted from the universal code 5 to the ultrasonic observation apparatus 3 and subjected to various signal processing, and then displayed on the monitor 19 (see FIG. 1) as an ultrasonic tomographic image.

  In order to prevent attenuation of ultrasonic waves and echo signals, a bag-like balloon 23 is attached to the distal end portion 10 so as to cover the ultrasonic transducer 22. The balloon 23 is made of an elastic material having elasticity, and an elastic locking ring 24 is formed at an opening end thereof. The distal end portion 10 is formed with a locking groove 25 over the entire circumference thereof. By fitting a locking ring 24 into the locking groove 25, the balloon 23 can be attached to and detached from the distal end portion 10. Installed. Further, an opening 27 that is an outlet of the injection / discharge channel 26 is formed on the tip side of the locking groove 25. After the distal end portion 10 is inserted into the body, the water in the storage container 15 is injected into the balloon 23 through the opening 27 and inflated until it comes into contact with the body duct. As a result, the space between the site to be observed and the ultrasonic transducer is filled with water, and air that causes signal attenuation is eliminated. When the insertion portion 8 is pulled out of the body, the water in the balloon 23 is discharged to the storage container 15 so that the balloon 23 is not caught in the body duct and the balloon 23 is torn or damaged. Thus, the balloon 23 is deflated in the same manner as when the insertion portion 8 is inserted into the body.

  An opening 29 that is an outlet of the forceps channel 28 is formed between the imaging unit 21 and the ultrasonic transducer 22, and the treatment tool 30 is introduced into the body from here. The opening 29 is located closer to the proximal end than the locking groove 25, but is arranged close to the ultrasonic transducer 22 so that the movement of the treatment instrument 30 can be confirmed by an ultrasonic image.

  The treatment tool 30 includes a puncture needle 30a and a sheath 30b that holds the puncture needle 30a in a retractable manner. The treatment instrument 30 is set at a protruding position (shown position) protruding from the opening 29 toward the distal end side. When performing treatment such as collection of cellular tissue, first, the sheath 30b of the treatment tool 30 is inserted into the forceps channel 28 from the forceps port 12 with the puncture needle 30a submerged, and set at the protruding position. Then, the puncture needle 30a is pushed out from the sheath 30b, and the puncture needle 30a is inserted into the body duct.

  An optical sensor (detection means) 31 such as a photo interrupter that detects the position of the treatment instrument 30 is provided in the forceps channel 28. The optical sensor 31 is arranged in the vicinity of the opening 29, and outputs, for example, a high level detection signal while the treatment instrument 30 is in the protruding position. When the treatment tool 30 is not in the protruding position, for example, a low level detection signal is output. This detection signal is transmitted to the control unit 17 of the pump device 4 via the cable 6.

  As shown in FIG. 3, the control unit 17 of the pump device 4 includes a signal input unit 35, a signal determination unit 36, an operation control unit 37 that controls the operation of the pump 16, and a CPU 38 that controls each unit. ing. The signal input unit 35 receives the detection signal from the optical sensor 31 and inputs it to the signal determination unit 36. The signal determination unit 36 monitors the output level of the detection signal. The signal determination unit 36 determines that the treatment instrument 30 is not in the protruding position when the detection signal is changed from the high level to the low level, and conversely, when the detection signal is changed from the low level to the high level, the treatment is performed. It is determined that the tool 30 is in the protruding position. The signal determination unit 36 outputs a signal representing the determination result to the CPU 38.

  The CPU 38 validates or invalidates the pressing operation of the water injection button 18a and the drainage button 18b according to the signal from the signal determination unit 36. That is, when the CPU 38 receives a signal from the signal determination unit 36 that the treatment instrument 30 is not in the protruding position, the CPU 38 validates the pressing operation of the water injection button 18a and the drain button 18b. In this case, the CPU 38 controls the operation of the pump 16 via the operation control unit 37 in accordance with the pressing operation of the water injection button 18a and the water discharge button 18b, and causes water injection and water discharge to the balloon 23.

  On the other hand, when the CPU 38 receives a signal indicating that the treatment instrument 30 is in the protruding position from the signal determination unit 36, the CPU 38 invalidates the pressing operation of the water injection button 18a and the drainage button 18b. In this case, even if the water injection button 18a and the drainage button 18b are pressed and an operation signal is input, the CPU 38 does not operate the pump 16, and therefore the water injection and drainage to the balloon 23 are not performed. This prevents the balloon 23 from being inflated or deflated unexpectedly while the treatment tool 30 is projected. As a method for enabling or disabling the pressing operation of the water injection button 18a and the drainage button 18b, a switch such as a relay may be provided on the signal line of the water injection button 18a and the drainage button 18b and the CPU 38, and this may be turned on / off. However, the mechanical switch operation may be incorporated into the software processing sequence of the CPU 38.

  As shown in FIG. 4, since the balloon 23 has elasticity, it may be deformed from a broken line state to a solid line state and come into contact with the treatment instrument 30 when pressed against the body duct. At this time, the weight of water in the balloon 23 is applied to the treatment instrument 30 as a load. When the drainage operation is performed in this state, the balloon 23 is contracted and separated from the treatment instrument 30, and the load applied to the treatment instrument 30 is changed unexpectedly. For this reason, the protruding state of the treatment instrument 30 becomes unstable, and there is a risk of damaging the body duct with the puncture needle 30a. Even if the balloon 23 and the treatment tool 30 are not initially in contact, the balloon 23 may be inflated and contact the treatment tool 30 if a water injection operation is performed thereafter. Even in such a case, since the load applied to the treatment instrument 30 fluctuates unexpectedly, the same danger arises.

  However, as described above, while the treatment tool 30 is in the protruding position, the water pouring operation by the water pouring button 18a and the water draining button 18b is always invalidated. As a result, the balloon 23 is prevented from being inflated or contracted unexpectedly, and even when the balloon 23 and the treatment instrument 30 are in contact with each other, it is possible to safely perform the treatment. In addition, there is no possibility that the balloon 23 that has not been in contact with the treatment instrument 30 initially contacts the treatment instrument 30 during the treatment and is damaged.

  When the treatment is completed and the treatment tool 30 is pulled out from the forceps channel 28, the optical sensor 31 outputs a low level detection signal. Thereby, the signal determination unit 36 inputs a signal to the CPU 38 that the treatment instrument 30 is not in the protruding position. In response to this signal, the CPU 38 validates the water injection / drainage operation by the water injection button 18a and the water discharge button 18b. As a result, water can be poured into and discharged from the balloon 23.

  Next, the effect | action by the said structure is demonstrated with reference to FIG. When the power supply of the ultrasonic endoscope apparatus 1 is turned on, the optical sensor 31 is activated and a detection signal is output from the optical sensor 31. The detection signal of the optical sensor 31 is input to the signal determination unit 36 via the signal input unit 35. The signal determination unit 36 monitors the output level of the detection signal and determines whether or not the treatment instrument 30 is in the protruding position. A signal representing the determination result of the signal determination unit 36 is input to the CPU 38.

  When the signal determination unit 36 determines that the treatment tool 30 is not in the protruding position, the CPU 38 validates the pressing operation of the water injection button 18a and the drain button 18b. On the other hand, when the signal determination unit 36 determines that the treatment tool 30 is in the protruding position, the CPU 38 invalidates the pressing operation of the water injection button 18a and the drain button 18b. Therefore, even if the foot switch 18 is mistakenly operated during the treatment, the balloon 23 is not inadvertently inflated or deflated, and the treatment can be performed safely.

  When performing the examination, the insertion portion 8 of the ultrasonic endoscope 2 is inserted into the body of the subject with the balloon 23 contracted. Then, while observing an endoscopic image obtained by the imaging unit 21, an ultrasonic image by the ultrasonic transducer 22 is observed as necessary. At this time, the surgeon presses the water injection button 18a, injects water into the balloon 23 with the pump device 4, inflates the balloon 23, and interposes water between the ultrasonic transducer 22 and the site to be observed. In this state, the treatment tool 30 is not inserted into the forceps channel 28, the output of the optical sensor 31 is at the low level, and the signal determination unit 36 determines that the treatment tool 30 is not in the protruding position. The water injection operation by is enabled.

  When it is necessary to perform treatment with the treatment tool 30, the operator inserts the treatment tool 30 into the forceps channel 28, sets the treatment tool 30 at the protruding position, and removes the puncture needle 30a from the sheath 30b to perform the treatment. . In this state, the output of the optical sensor 31 is at a high level, and the signal determination unit 36 determines that the treatment tool 30 is in the protruding position, so that the water injection operation using the water injection button 18a and the water discharge button 18b is invalidated. When the treatment is completed and the treatment tool 30 is pulled out from the forceps channel 28, the water pouring / draining operation by the water pouring button 18a and the water draining button 18b is validated again.

  In the above embodiment, when the treatment instrument 30 is in the protruding position, the water injection / drainage operation by the water injection button 18a and the water discharge button 18b is always invalidated. At this time, the water injection / drainage operation is temporarily allowed. May be. For example, as shown in FIG. 6, the lock release button 18 c (see FIG. 1) is provided on the foot switch 18 of the pump device 4, and the timer 41 is provided on the control unit 40. The unlock button 18c inputs to the CPU 38 an unlock signal for temporarily canceling invalidation of the pouring operation. As illustrated in FIG. 7, when the CPU 38 receives the lock release signal when the pouring operation is invalidated, the CPU 38 temporarily cancels the invalidation and allows the pouring operation. Then, after allowing the pouring operation, when the predetermined time set by the timer 41 has elapsed, the pouring operation is invalidated again. In this way, even when the pouring operation is invalidated, the size of the balloon 23 can be finely adjusted according to the field of view of the ultrasonic tomographic image, the angle of the treatment instrument 30, and the like. Note that, without using the timer 41, the pouring / draining operation may be invalidated again when the pouring / draining operation is performed a predetermined number of times (for example, once) after allowing the pouring / draining operation. Further, by combining both, the pouring / draining operation may be invalidated again when either the elapse of the predetermined time or the predetermined number of operations is satisfied.

  Note that, as shown in FIG. 8, a message 50 for notifying the position of the treatment instrument 30 and whether or not the drainage operation is invalidated (for example, “the balloon drainage operation is locked because the treatment instrument is being used. Or the like ”may be displayed on the monitor 19 together with the ultrasonic tomographic image. In this way, it is possible to notify the reason why the operation of the foot switch 18 is invalidated, and it is possible to prevent the foot switch 18 from being erroneously operated during the treatment.

  In each of the above embodiments, when the treatment instrument 30 is in the protruding position, the water injection operation by the water injection button 18a and the water discharge operation by the water discharge button 18b are both invalidated, but either the water injection operation or the water discharge operation is invalidated. You may make it make it.

  In each of the above embodiments, the optical sensor 31 is used as the position detection unit. However, the position detection unit may be, for example, an ultrasonic sensor. In addition to water, oil or the like can be used as the ultrasonic transmission medium. Furthermore, the scanning direction of ultrasonic electronic scanning is arbitrary, and in addition to the above-described convex direction, it can be a linear direction or a radial direction.

It is the schematic which shows the structure of the ultrasonic endoscope apparatus of this invention. It is sectional drawing of the front-end | tip part of an ultrasonic endoscope. It is a block diagram which shows the outline of the control part of a pump apparatus. It is sectional drawing which shows a mode that the balloon deform | transformed. It is a flowchart which shows the process which validates / invalidates the pouring operation to a balloon. It is a block diagram which shows the outline of another embodiment of a control part. It is a flowchart which shows the procedure which accept | permits a pouring / draining operation temporarily when the pouring / draining operation is invalidated. It is a monitor screen on which an example of a message is displayed.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Ultrasonic endoscope apparatus 2 Ultrasound endoscope 10 Tip part 17, 40 Control part 18 Foot switch 18a Water injection button 18b Drain button 18c Unlock button 19 Monitor 22 Ultrasonic transducer 23 Balloon 28 Forceps channel 30 Treatment tool 31 Optical Sensor 41 Timer 50 Message

Claims (6)

Ultrasound comprising an ultrasonic transducer, a forceps channel for introducing a treatment instrument into the body, and a bag-like balloon that is attached so as to cover the ultrasonic transducer and into which an ultrasonic transmission medium is injected or discharged In an endoscopic device,
Detecting means for detecting whether or not the treatment tool protrudes from the outlet of the forceps channel;
When the treatment tool does not protrude from the outlet of the forceps channel, the injection operation or discharge operation of the ultrasonic transmission medium is validated, and when the treatment tool protrudes from the outlet of the forceps channel, the injection operation Alternatively, an ultrasonic endoscope apparatus comprising control means for invalidating the discharge operation.   Invalidation cancellation means for instructing the control means to cancel invalidation is further provided, and the control means cancels invalidation by the invalidation cancellation means in a state where the injection operation or the discharge operation is invalidated. The ultrasonic endoscope apparatus according to claim 1, wherein the operation in the invalidation state is temporarily allowed when an instruction is issued.   3. The ultrasonic endoscope apparatus according to claim 2, wherein the control unit invalidates the injection operation or the discharge operation again after allowing a predetermined number of injection operations or the discharge operation.   A timer for measuring an elapsed time after allowing the injection operation or the discharge operation is further provided, and the control unit invalidates the injection operation or the discharge operation again after a predetermined time has elapsed after allowing the injection operation or the discharge operation. The ultrasonic endoscope apparatus according to claim 2, wherein the ultrasonic endoscope apparatus is formed.   The ultrasonic endoscope apparatus according to claim 1, wherein the detection unit is an optical sensor provided in the vicinity of an outlet of the forceps channel.   The ultrasonic endoscope according to any one of claims 1 to 5, further comprising notification means for notifying the position of the treatment instrument and whether or not the injection operation or the discharge operation is invalidated. apparatus.

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