JPH07194594A - Treating tool inserting passage for in vivo inspecting device - Google Patents

Abstract

PURPOSE:To raise up a treating tool large after it is derived from a shallow angle when the treating tool is inserted in an inserting part of an in vivo inspecting device and is projected outside from a side surface of a tip hard part. CONSTITUTION:In a boring-piercing tool 30 to be inserted into an inserting part, a tube 32 is inserted into an overcoat tube 31, and a boring-piercing needle 33 is connected to this tube 32, and the overcoat tube 31 is composed of a soft part 31a and a hard part 31b, and a ring-shaped stopper member 31c is fitted in and fixed to a base end part of the hard part. A boring-piercing tool inserting passage becomes a direction changing passage 37 inside of a tip hard part, and in this direction changing passage, a width becomes a dimension to pass a stopper part, but an upper surface side wall part becomes a gentle inclined guide wall 37a to derive the boring-piercing tool 30 at a shallow angle, and becomes a sharp inclined guide wall 37b to raise up the boring-piercing needle 33 by a prescribed angle.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a treatment instrument insertion passage for inserting a treatment instrument, which is provided in an in-vivo inspection apparatus such as an endoscope, an ultrasonic probe, and an ultrasonic endoscope.

[0002]

2. Description of the Related Art A typical internal inspection device is
There are endoscopes, ultrasonic probes, and the like, and ultrasonic endoscopes having the functions of both the endoscope and the ultrasonic probe are also used. For example, in an ultrasonic endoscope, a distal end portion of an insertion portion to be inserted into a body cavity is a distal end hard portion, and the distal end hard portion has an endoscope observation means including an illumination window and an observation window, and an ultrasonic transducer. And an ultrasonic observation means provided with. Here, there are mechanical scanning type, electronic scanning type, and the like as the ultrasonic transducers constituting the ultrasonic observation means. In the electronic linear scanning type ultrasonic transducer, a plurality of ultrasonic transducers are linearly arranged. To arrange
This ultrasonic transducer becomes long. For this reason, the illumination window and the observation window forming the endoscope observation means are provided on the tip surface of the hard tip portion, and the ultrasonic transducers forming the ultrasonic observation means are provided on the side surfaces of the hard tip portion.

A puncture device is used for observing the internal tissue condition by ultrasonic wave observing means, and injecting an injection solution, a contrast agent or the like into the affected area or performing drainage when the affected area is found. Although the puncture operation is performed from the inner wall of the body cavity, the puncture operation of this puncture tool is performed under the supervision of the ultrasonic observation means. For this reason, a puncture instrument insertion passage through which a puncture instrument as a treatment instrument is inserted is provided in the insertion portion. The puncture instrument insertion passage forms a passage with a flexible tube in the insertion portion, and the puncture implement passage is turned in the hard tip portion so that the puncture tool passage is connected to the puncture implement outlet formed on the side surface of the hard tip portion. Has become.

[0004]

As described above, it is necessary to bend the puncture instrument insertion passage in order to change the direction in the hard tip portion, and the puncture instrument inserted in the curved puncture instrument insertion passage is As long as it is flexible, there is no particular problem even if the bending angle is quite large. However, the puncture device has a puncture needle, and since the puncture needle is deeply pierced into the body from the inner wall of the body cavity, it is necessary to use a high-rigidity device in order to allow a smooth puncture operation. Moreover, the puncture angle of the puncture needle depends on the distance from the inner wall of the body cavity to the affected part, and in some cases, the puncture needle may have to be inserted at a considerably large angle. If a puncture tool with high rigidity is used, there is a drawback in that if the bending angle in the hard tip portion is too large, it cannot be projected from the puncture tool outlet.

On the other hand, in order to guide the treatment instrument insertion passage from the axial direction of the insertion portion in the desired direction from the side surface of the distal end hard portion, the treatment instrument raising base is located at a position close to the treatment instrument introduction portion in the treatment instrument insertion passage. There is also a structure in which the direction of the treatment instrument is changed by this treatment instrument raising base. However, in the case where there are many built-in parts in the insertion portion such as an ultrasonic endoscope, such treatment is performed. A raising stand cannot be provided.

The present invention has been made in view of the above points, and an object of the present invention is to extend a treatment instrument in the distal end hard portion at a shallow angle from the axial direction of the insertion portion. , It is to be able to raise to a desired angle when it is projected to a predetermined position.

[0007]

In order to achieve the above-mentioned object, the present invention provides an inspection mechanism on a hard distal end portion that constitutes the distal end of an insertion portion, and forms a treatment instrument outlet on the side surface portion thereof. Then, the treatment tool in which the hard portion is continuously provided on the distal end side of the soft portion, the direction is changed from the axial direction of the insertion portion, and the treatment tool is projected by a predetermined length from the treatment instrument outlet.
In the passage portion in the distal end hard portion, the treatment instrument inserted in the axial direction of the insertion portion bends at a shallow angle with respect to the axis line of the insertion portion, and guides it so as to be guided out from the treatment instrument outlet. It forms an inclined guide wall and a steeply inclined guide wall that faces the gently sloping guide wall and has an angle deeper than the gently sloping guide wall to raise the treatment instrument by a predetermined angle. Is not narrower than the width of the passage portion, and further, a stopper member having an outer diameter intermediate between the width of the passage portion and the width of the treatment instrument outlet is fixedly provided at the proximal end portion of the hard portion of the treatment instrument. What is done is the feature.

[0008]

When the treatment instrument is inserted into the treatment instrument insertion passage and enters the distal end hard portion, first, in the treatment instrument insertion passage, the treatment instrument advances along the gently sloping guide wall, and then from the treatment instrument outlet to the hard portion. Comes to the outside. Then, when the treatment tool projects from the treatment tool lead-out opening by a predetermined amount, the stopper member engages with the treatment tool lead-out opening, and the treatment tool is restricted from further projecting. When the treatment tool is pushed further out, the front side of the portion provided with the stopper member is bent and pushed into a position where it abuts against the steeply inclined guide wall, and the distal end side of the treatment tool rises up. In this way, by projecting the treatment instrument from the hard tip portion at a shallow angle, even if the tip portion of the treatment instrument is made of a hard member, it can be smoothly and smoothly projected from the treatment instrument outlet. Moreover, after the treatment tool is led out, the treatment tool is rotated about the treatment tool lead-out port,
The lead-out direction of the treatment tool can be adjusted to be a desired direction.

[0009]

Embodiments of the present invention will be described below with reference to the drawings. In addition, in this embodiment, an ultrasonic endoscope is shown as an in-vivo inspection apparatus in which the treatment tool is used. However, other than this, it can be configured as an endoscope, an ultrasonic probe, or the like. Although the puncture device is used, any other treatment device may be used as long as it is a treatment device that is hardened by a predetermined length at the tip portion.

First, FIG. 1 shows the entire structure of an ultrasonic endoscope, and FIG. 2 shows a cross section of its tip. In the figure, 1
Is an insertion part, 2 is a main body operation part, and 3 is a universal cord, respectively. The insertion part 1 is a flexible part that is bent along the insertion path from the part continuously connected to the main body operation part 2. An angle portion 5 which can be bent in a desired direction by a hand operation is provided at the tip portion of the flexible portion 4, and a tip hard portion 6 is successively provided at the tip of the angle portion 5.

As shown in FIG. 3, an endoscope observation means having an illumination window 10 and an observation window 11 is provided on the tip surface 6a of the hard tip portion 6. The illumination window 10 faces the illumination light emitting end of the light guide, the observation window 11 is provided with an objective lens, and a solid-state image pickup device as an image pickup means is provided at the image forming position of the objective lens. An endoscopic observation image is converted into an electric signal by the solid-state imaging device and taken out. Further, the treatment instrument insertion channel 12 for inserting a treatment instrument such as forceps is provided with the distal end surface 6a.
It is open to. Since these endoscope observation means and the treatment instrument insertion channel 12 are conventionally well known,
Detailed illustration and description thereof are omitted.

An ultrasonic transducer 20 is attached to the base end side of the portion where the endoscope observation means is attached. The ultrasonic transducer 20 is configured by arranging a large number of ultrasonic transducers in the axial direction of the distal end hard portion 6, and performs linear scanning (or convex scanning) electronically, for example, and the ultrasonic observation field of view The direction is a direction substantially orthogonal to the axis of the insertion portion 1. Before and after the position where the ultrasonic transducer 20 is disposed, concave grooves 21 and 22 for attaching a balloon are formed, and both ends of the cylindrical balloon 23 are attached to the concave grooves 21 and 22 to form a rubber ring. It is designed to be fixed by a fixing tool such as. In addition, the ultrasonic transducer 20 and the concave groove 22
An ultrasonic wave propagation medium such as degassed water is supplied to the position between and so as to be able to swell.

Reference numeral 30 denotes a puncture device, and as is clear from FIGS. 4 and 5, the puncture device 30 has a tube 32 inserted through an outer tube 31, and the tube 32 has a sharpened puncture needle. 33 is connected. Puncture needle 33
With the outer tube 31 covered with the outer tube 31, it is inserted into the puncture instrument insertion passage 34 which is provided by extending to the distal end hard section 6 through the flexible section 4 and the angle section 5 of the main body operation section 2 and the insertion section 1. ,
The tube 32 is led out from the treatment instrument lead-out port 35 for leading out the puncture instrument formed on the side surface of the distal end hard portion 6 and then the tube 32.
By pushing the puncture needle 33 into the body so as to push it out of the mantle tube 31.
The injection solution or the like can be pressure-fed or drained by suction while being protruded by a predetermined length from the tip of the. Here, the puncture needle 33 is composed of a hard pipe having a sharp tip and a predetermined length so that the puncture needle 33 can be smoothly inserted into a predetermined position in the body. The outer tube 31 has a flexible portion 31a formed of a flexible member at the base end side thereof, but has a hard portion 31b at least on the distal end side, which covers the puncture needle 33. A ring-shaped stopper member 31c is fitted and fixed to the base end of the hard portion 31b.

The puncture instrument insertion passage 34 is
The portion from the flexible portion 4 to the angle portion 5 is made of a flexible tube 36 having an inner diameter larger than that of the stopper member 31c, which is the maximum diameter portion of the treatment instrument 30, and extends in the axial direction of the insertion portion 1, but the distal end is hard. A direction changing passage 37 is bored inside the portion 6. The direction changing passage 37 is a passage having a circular cross section having an inner diameter that allows the stopper member 31c, which is the maximum diameter portion of the puncture device 30, to pass through at the connection portion to the flexible tube 36, and the width of the passage becomes constant as it goes forward. However, the wall portion on the upper surface side thereof is designed to spread in the vertical direction and has a relatively shallow angle θ _1, and a gently inclined guide wall 37 a that moves to the puncture device outlet 35. Has become. In addition, the wall portion on the lower surface side goes straight to a position beyond the transition portion of the wall portion on the upper surface side to the gently sloping guide wall 37a, and then is larger than the angle θ ₁ and the angle θ _{2 at} which the puncture needle 33 such as the affected area is inserted. It is a steeply inclined guide wall 37b for starting up. Further, the steeply inclined guide wall 37b is an inner gently inclined guide wall 37c having an angle θ ₁ substantially equal to that of the gently inclined guide wall 37a before reaching the puncture device outlet 35.

The puncture device outlet 35 is guided to the outside by guiding the puncture device 30 along the gently inclined guide wall 37a and the inner gently inclined guide wall 37c. It is long in the direction.
Then, a thin plate ring 38 is fitted in a portion of the distal end hard portion 6 where the treatment instrument lead-out port 35 is formed, and as shown in FIG. The treatment instrument outlet 35 at a position overlapping with
Have the same length in the axial direction and pass through the hard portion 31b of the outer tube 31 of the puncture device 30, but the stopper member 31c.
Is formed with an opening 38a having a width that cannot pass through.

This embodiment is constructed as described above. For example, the insertion portion 1 is inserted from the throat portion through the esophagus to the inside of the stomach in the body cavity, and the stomach is examined by the endoscope observation means. The ultrasonic inspection can be performed by operating the ultrasonic transducer 20 while performing the internal inspection. In addition, the puncture device 30 is inserted from the inner wall of the stomach into another organ such as the pancreas to inject an injection solution, a contrast agent, or the like,
You can do drainage.

In order to guide the distal end portion of the insertion portion 1 into the stomach for ultrasonic examination from the inner wall of the stomach, the balloon 23 is filled with the ultrasonic wave propagating medium and the balloon 23 is expanded. Let Then, the ultrasonic transducer 2 is attached to the inner wall of the stomach.
By facing 0 and sequentially driving the ultrasonic transducers constituting the ultrasonic transducer 20, ultrasonic information regarding the internal tissue slice is acquired. This ultrasonic information can be recognized as an ultrasonic image displayed on the monitor screen that constitutes the ultrasonic observation apparatus. By thus filling the balloon 23 with the ultrasonic wave propagation medium, the attenuation of the ultrasonic wave signal is suppressed.

When a disease is found in the pancreas or the like based on the ultrasonic image displayed on the monitor screen, the puncture device 30 is inserted from the inner wall of the stomach cavity toward the target such as the pancreas. The puncture device 30 is protruded from the puncture device outlet 35 through the flexible tube 36 and the direction changing passage 37 which form the puncture device insertion passage 34 provided in the insertion portion 1, and the outer tube of the puncture device 30 is protruded. Hard part 3 at 31
By pressing 1b against the stomach wall and pushing the tube 32 into the outer tube 31, the puncture needle 33 is projected from the tip of the tube 32 and inserted into the body, and is advanced toward the target to inject an injection solution or the like. Or do drainage. The puncture operation of the puncture needle 33 is performed under the supervision of an ultrasonic image.

Here, the puncture operation of the puncture device 30 is performed under the supervision of the ultrasonic image.
The optimum derivation angle of the puncture device 30 is determined from the relationship between the position of, the position of the puncture device outlet 35, and the position of the target. Generally, while ultrasonically observing the pancreas from the inner wall of the stomach, the proximal end portion of the ultrasonic transducer 20 is relatively close to the ultrasonic transducer 20 in order to make the axial length of the distal rigid portion 6 as short as possible. In order to guide the puncture device 30 through the puncture device outlet 35 provided at the position and reach the pancreas, the derivation angle of the puncture device 30 is about 30 with respect to the transmitting / receiving surface of the ultrasonic transducer 20.
It is preferable that the angle is °. On the other hand, the puncture device 30 is to be inserted into the body, and for this reason, at least the length that is led out from the puncture device outlet 35 and reaches the target must be formed of a hard member. As described above, it is extremely difficult, and even impossible, to change the angle of the puncture device 30 having a long hard portion in the hard end portion 6 by a large angle such as 30 °.

However, since the direction changing passage 37 provided in the distal end hard portion 6 guides the puncture device 30 at a shallow angle,
Since the gently sloping guide wall 37a and the inner gently sloping guide wall 37c are formed, as shown in FIG. 4, the puncture device 30 is once moved to a predetermined length with the gently sloping guide wall 37a and the inner gently sloping guide wall 37c as guides. It is led out from the treatment instrument lead-out port 35. When the puncture device 30 is pulled out by a predetermined length, the stopper member 31c provided on the outer tube 31 of the puncture device 30 opens the opening 3 of the ring 38.
8a is abutted and further protruding is restricted. When the puncture device 30 is still pushed in in this state, as shown in FIG. 5, the soft portion 31b located on the base end side of the portion where the stopper member 31c is provided is steeply inclined to the guide wall 31.
As a result, the part of the puncture device 30 on the tip side of the stopper member 31c rotates around the stopper member 31c and rises up by a predetermined angle. Thus, if the inclination angle θ ₁ of the gently inclined guide wall 37a and the inner gently inclined guide wall 37c is set to, for example, about 10 ° to 15 °, the distal end portion of the puncture device 30 made of a hard member will be smooth. Can be outsourced. Then, if the steeply inclined guide wall 31b is set to about 30 °, the puncture device 30 can be raised to have an angle necessary for directing the puncture device 30 toward the target.

In this state, the distal end surface of the hard portion 31b of the outer tube 31 of the puncture device 30 is pressed against the stomach wall, and then the puncture needle 33 is projected from the outer tube 31. Here, since the puncture needle 33 is a hard member at least for the length corresponding to the depth to reach the target, it can be inserted into this target very easily. Moreover, when the operation of inserting the puncture needle 33 is performed, it is necessary to hold the hard portion 31b of the outer tube 31 in a stable state so that the hard portion 31b does not swing or move axially during the operation. The stopper member 3 provided on the outer tube 31 is pushed in by pressing the soft portion 31a of the outer tube 31 and pressing it against the steeply inclined guide wall 37b.
Since 1c is pressed against the inner surface of the portion of the ring 38 where the opening 38a is formed and is fixed so as not to cause positional displacement, the hard portion 31b of the outer tube 31 is held in an extremely stable state.

In the above-mentioned embodiment, the ultrasonic examination apparatus for the upper digestive system of the stomach and the like and the part into which the puncture tool is inserted are the pancreas and the like, but the present invention is not limited to this. Needless to say Further, it goes without saying that the angle of the puncture device with respect to the ultrasonic transducer and the like are not limited to those described above.

[0023]

Since the present invention is constructed as described above, a puncture tool or other treatment tool formed of a rigid member for a predetermined length at the distal end portion can be directed from the axial direction of the insertion portion within the rigid distal end portion. When performing the operation of diverting and deriving it from the treatment instrument outlet provided on the side surface, it can be performed extremely smoothly without using a treatment instrument raising stand, etc., and it can be led out from the treatment instrument outlet at a shallow angle. After this, it is possible to raise it up to a larger angle, so it is possible to change the hard part of the treatment instrument by an extremely large angle with respect to the axis of the insertion part and then to guide it from the treatment instrument outlet. The treatment can be performed smoothly, and the operability of inserting the treatment instrument is significantly improved.

[Brief description of drawings]

FIG. 1 is an overall configuration diagram of an ultrasonic endoscope as an intracorporeal ultrasonic examination apparatus showing an embodiment of the present invention.

FIG. 2 is a cross-sectional view of the tip portion of FIG.

3 is an external view of the front end surface of FIG.

FIG. 4 is an operation explanatory view showing the insertion operation of the puncture device.

FIG. 5 is an operation explanatory view showing another operation state in the insertion operation of the puncture device.

FIG. 6 is a plan view of a main portion of a distal end portion of an insertion portion.

[Explanation of symbols]

 1 Insertion Part 6 Tip Hard Section 20 Ultrasonic Transducer 30 Puncture Tool 31 Outer Tube 31a Soft Section 31b Hard Section 31c Stopper Member 32 Tube 33 Puncture Needle 34 Puncture Tool Insertion Path 35 Treatment Tool Outlet 37 Direction Change Path 37a Gradient Guide Wall 37b Steeply inclined guide wall 37c Inside gently inclined guide wall 38 Ring 38a Opening

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Susumu Hiki 1385-1 Shimoishigami, Otawara-shi, Tochigi Stock company Toshiba Nasu factory

Claims (1)

[Claims] 1. A treatment instrument in which an inspection mechanism is provided on a distal end hard portion which constitutes the distal end of an insertion portion, and a treatment instrument lead-out port is formed on a side surface portion thereof so that a hard portion is continuously provided on the distal end side of a flexible portion. , In which the direction is changed from the axial direction of the insertion portion so as to project from the treatment instrument outlet by a predetermined length, the passage portion in the distal end hard portion is inserted in the axial direction of the insertion portion. A treatment instrument bends at a shallow angle with respect to the axis of the insertion portion, and a gently sloping guide wall that guides the treatment instrument to be guided out of the treatment instrument outlet. It forms a deeper angle and forms a steeply inclined guide wall for raising the treatment instrument by a predetermined angle,
Also, the width of the treatment instrument outlet is not narrower than the width of the passage portion,
Further, an in-vivo inspection characterized in that a stopper member having an outer diameter intermediate between the width of the passage portion and the width of the treatment instrument outlet is fixedly provided at the proximal end of the hard portion of the treatment instrument. Device treatment device insertion passage.