DE3838396C2 - - Google Patents

Description

The invention relates to an arrangement for the localization of vessels and prognosis of bleeding according to the generic type handle of claim 1.

Based on a variety of endoscopic examinations in gastroin testinal tract has so far always had to be determined that despite safe If evidence of lesions is found in this area, no reliable statement can be made is whether and in what period there is bleeding from such lesions wait is. Also the detection of fresh bleeding in the lesions and the detection of stalks does not allow this statement either. In particular Above all, no forecast of the severity of the eventuality is to be expected the bleeding possible because there is no reliable knowledge about the size and The type of blood vessel that may be bleeding is possible. So there are currently no safe ones Right statement despite macroscopically endoscopically proven lesion bleeding over time of an expected bleeding and its extent or volume.

This remains an essential and crucial part of the expected statement of such an investigation unanswered, namely the answer to the Question whether and in what period of time the patient is potentially at risk of bleeding and therefore possibly under inpatient hospital conditions, possibly even in the intensive care unit is in need of monitoring, whether within the scope of the risk considering an immediate operation, or whether such measures are not necessary and conservative care among outpatients Conditions by the family doctor are sufficient.

As a consequence, the question of the current status of tech nik, d. H. are there procedures or at least concrete approaches that have a solution enable this problem or at least be expected in the foreseeable future. This must be answered with a clear no. So far there are only indi right indications that, depending on the experience of the examiner, diagnostic allow. Both the radiological and the endoscopic Examination procedures allow a statement about type, size and Localization of the lesions, thus certainly also via the topography of vessels eats that are in more or less direct area of the lesions but not a sufficiently reliable indication of whether bleeding is about to occur stands and if necessary what extent this bleeding can have. The crucial statement  the z. B. in the context of an emergency endoscopic examination ought to be asked, namely whether the patient is immediately in mortal danger, can only be answered indirectly or to a very limited extent. An additional limitation is the combination of the roentgenolo genetic or endoscopic procedures with other indirect methods such as Determination of the amount of blood available and the current circulatory situation possible, but the combination also provides the solution to our problem nation of the various processes known to date.

The currently most common method of performing vascular assessments is the Doppler sonography, the solution also does not make a decisive difference Step closer since this method is not sufficiently sensitive and precise and mostly only on the surface of the body and also here only to a limited extent Scope can be used. This applies even more to examinations routinely on site, d. H. for example inside the body directly in the immediate Area of the lesion and thus the expected bleeding. A solution about this At any rate, proceedings are not to be expected in the foreseeable future, if at all.

Double sensors with lasers, e.g. B. HeNe or semiconductor lasers in heterodyne mode and with an optical fiber optic coupling work and used for speed measurement and vibration analysis are known per se. That from the transmitting / receiving optics to the moving object focused and back-scattered laser light is according to the Doppler formula

f = fo ± (2 V / lambda) cos alpha
frequency shifted. The parameters mean:
f = electrical signal frequency of the laser sensor
fo = frequency distance between transmit and local oscillator laser beam
lambda = laser wavelength
v = speed of the object
alpha = angle between measuring and speed direction
f-fo = Doppler frequency

When measuring a vibrating object, this results in a Vibration frequency, frequency-modulated signal with the center frequency fo, its frequency spectrum after demodulation by a spectrum analyzer represented by the so-called FFT method (fast Fourier transform) can be.  

So far, no measurements of vascular pulsations have been made Doppler laser sensor has become known, but blood flow measurements. For example, For example, the article "An Instrument to Measure Cutanecus Blood Flow Using the Doppler Shift of Laser Light "by Watkins. Denis. Holloway. G. Allen in IEEE Transactions on Biomedical Engineering, Vol. BME-25, No. January 1, 1978, pages 28 to 33, a Doppler laser sensor for measuring blood flow in the capillaries of the skin, which has an optical fiber the sensor optics on the non-moving skin of the human Poor. Blood flow measurements are also taken into account Vessels of the eye and - invasively using a catheter - in veins mentioned. In the document DE 31 025 A1, the simultaneous Measurement of the two components of the speed vector of Scattering particles described in a flow field. Notes on the measurement of blood vessel vibrations and the one based thereon Possibility to localize and predict vascular bleeding are not included in these two writings.

The frequency spectra of such blood flow measurements correspond to Principle largely that known from Doppler sonography Spectra. A representation of the Doppler spectra is usual here with time as the abscissa, the Doppler frequency as the ordinate and their intensity as a gray value. Most often the highest Doppler frequencies also with high intensity, so that result in characteristic envelopes. For the momentary distribution a simpler representation of the Doppler spectrum is possible, e.g. B. with the frequency as the abscissa and its intensity as Ordinate.

Video endoscopes are also known devices. They are catheter-shaped, flexible instruments for partial insertion into internal cavities, the most controllable movable end for example have lighting and a taking lens, the image of which is either on site or after transport through an imaging glass fiber bundle to the other end of the endoscope on an image recording element, for. B. CCD element is imaged and observed on a video monitor. Often included these endoscopes also other externally controlled elements such as surgical Instruments, laser light-guiding glass fibers for coagulation etc., deflecting mirrors, Channels for flushing media etc.  

A decisive factor for the previous gap in the Diagnostics is the fact that the blood vessels run at different depths in the tissue. This surrounding tissue provides some protection under normal conditions especially against peptic persistence, which, however, z. B. by a Ulcer is gradually destroyed as the ulcer extends to the depth of the Tissue and thus can develop towards the vessel, it in one can also reach a defined point in time and through its peptic influences This then opens up, which is synonymous with acute bleeding for immediately life-threatening bleeding. Then the crucial requirement would be tion, namely a concrete statement about impending bleeding is only possible if an exact localization of the vessel and determination of the mechanical strength and the density of the tissue between the surface (including the surface of the lesion or ulcer base) and vessel surface would be possible. A further clarification of the statement would be possible if also the caliber of the vessel or the blood volume in the vessel including the differentiation whether an arterial or venous Vessel is present, could be determined. However, these statements can be made up to not become known examination procedures.

The task of Accordingly, the invention is to physically record these properties with an arrangement sen and thus enable a reliable diagnosis. This has to be different than with the currently usual and only feasible on the body surface Doppler sonographic methods, even using the smallest possible, punctiform flexibly derivable, do not depend on the direct support on the surface current measuring methods must be possible, but above all this must also be independent from a medium stored on the surface (e.g. liquid or air), in particular the air inflation of hollow organs, without which an endosko is not possible, a sonographic examination mostly makes impossible.

This task is accomplished by the measures set out in the claims solved in a reliable and effective manner, being in the subclaims Developments and refinements are shown.

The invention is in several embodiments in the following description and in the Figures of the drawing explained. It shows

Fig. 1 is a block diagram of an embodiment microscope with video Endo, Doppler laser sensor and computer with a picture-processing system, database and input and output units,

Fig. 2a shows the view of an overall image of the examination zone on the result of monitor blood vessel lesion and instantaneous visual field of the endoscope video display with the cursor,

FIG. 2b shows the plot of the instantaneous field of view of the video-endoscope with inserted Meßartanzeige,

Fig. 3a, b two embodiments of the patient end of the video endoscope, but only with representation of those components and beams that affect the Doppler laser sensor, namely
Fig. 3a with a foldable and rotatable deflection mirror for alternatively ven measuring the pulsation of the vessel surface and blood flow,
FIG. 3b having a rotatable beam splitter with associated folding mirror for the simultaneous measurement of both of pulsations as well as a deflection unit for scanning transversely of the blood vessel,

Fig. 4 shows an embodiment of the computer-side end of a video endoscope with the image transfer by which a conventional video endoscope is extended to the subject invention to the image pickup element through the fiber bundle, again only showing the essential to the invention components and optical paths and of those,

FIG. 5a is a time-dependent Doppler spectrum with the Doppler frequency as the ordinate and its intensity as a gray value,

Fig. 5b shows a current Doppler spectrum, that is, intensity as a function of frequency.

The following typical situation is the starting point for the following description:
The examiner observes the gastric ulcer of a patient with a video endoscope 40 ( FIG. 2a, b) and would like to assess the risk of bleeding in a blood vessel 10 affected by the ulcer.

From the multitude of possible assessment criteria, the pulsation of the blood flow, the pulsations of the blood vessel 10 and the surface 11 a caused by this covering the tissue layer 11 and the mechanical strength of the tissue 11 and the vessel 10 derived therefrom are selected, since a lesion 12 b these measured values will influence in a characteristic way. Furthermore, it is proposed to assess the position and strength of the damaged vessel section 10 b by comparing the measured values with those on an adjacent intact section 10 a of the blood vessel 10 and at different blood pressures.

For the measurement, the use of a Doppler laser sensor 60 in heterodyne operation is proposed, which is connected to a modified video endoscope 40 (FIGS . 3a, 3b, 4) and is supported by spectrum analyzer 62 , computer 70 and image processing system 80 ( FIG. 1) .

In the present application, the laser device 60 is coupled via a single-mode glass fiber 61 that runs through the video endoscope 40 to its sensor optics 66 at the patient end 40 a ( FIG. 3a). The measuring device 21, 22 is either in the endoscope direction, ie almost perpendicular 21 to the tissue surface 11 a to be examined, or obliquely to almost transverse 22 to the endoscope direction by means of a from the other end of the endoscope 40 ( FIG. 4) foldable and adjustable Deflecting mirror 50 . By rotating the deflecting mirror 50 , the measuring direction 22 is adjusted to the direction of the blood flow, ie the blood vessel 10 . The Doppler laser sensor 60 thus measures once the pulsation of the surface 10 c of the blood vessel 10 and once the pulsation of the speed of the blood flow in the blood vessel 10 , since - supported by multiple diversification - part of the laser light penetrates into the blood vessel 10 and, from the scattered moving blood cells, finally returned to the sensor optics 66 .

The examiner is supported in these measurements by audiovisual means. The respective measuring point 20 is by the visible in the endoscope monitor 71 laser light spot 20 a, the wavelength of which is in the sensitivity range of the video endoscope 40 , the measuring direction 22 by the z. B. displayed as arrow 20 c at a freely selectable position in the endoscope monitor 71 position of the deflecting mirror 50 . The type of measurement and, if appropriate, the measurement direction 22 are communicated to the computer 70 and the image processing system 80 by a folding sensor 54 a and a rotation sensor 53 a, which measure the folding state and the angle of rotation 23 c of the deflecting mirror 50 . The measured Doppler frequencies are transformed into the listening area by suitable frequency mixing and reproduced via the loudspeaker 65 .

The examination process proceeds as follows: the examiner selects a suitable measuring point 20 and the desired measuring direction 21 or 22 on the en doskopmonitor 71 . By moving the endoscope 40 , folding and unfolding and possibly turning the deflecting mirror 50 , he positions the laser light spot 20 a and possibly the measuring direction 22 accordingly. By assessing the acoustic signal according to pitch and volume, he can optimize the position of the measuring point 20 in the transverse direction to the blood vessel 10 and possibly the measuring direction 22 . When the settings with the maximum double frequency are selected, the location of maximum pulsation, ie the vibration amplitude of the blood vessel 10 or the tissue surface 11 a containing it, and the location and direction 10 e of the maximum flow rate of the blood are found. As a rule, these are the center of the surface 10 c of the blood vessel 10 (seen from the endoscope 40 ) as well as its center 10 e and flow direction. With this then fixed setting, the pulsation sought is observed over a full cardiac cycle and this is communicated to the computer 70 by switching on a measuring key 55 .

The examiner then performs these measurements pointwise along the vessel 10 through, wherein it extends from an intact vessel section 10a over the range of the lesion 12 b away at a turn intact vessel section 10 a "gropes", comparing the measured values obtained and evaluated. In general, the lesion 12 b should manifest itself through increased vascular pulsation with a simultaneous decrease in the systolic maximum of the blood flow rate as well as through further characteristic differences.

The examiner is also supported by automatic recording of the measurement data. The image processing system 80 recognizes the course of the blood vessel 10 , the data supplied by the examiner himself, ie the selected measuring points 20 and measuring directions 21 and 22 , which correspond to the course of the vessel, and possibly further inputs and data already stored being used. The obtained measurement values, that is, the extending over a cardiac cycle waveforms of the pulsations of the blood flow and vessel surface are c 10 thus associated with the respective measuring points, regardless of shooting distance 23 c and angles 23 d, and in an image data memory 73 with the corresponding coordinates and the values of blood pressure and pulse rate as well as the instantaneous time related to the cardiac period. For this purpose, the computer 70 is connected to blood pressure and pulse rate sensors 86, 87 attached to the patient and to a PLL circuit 88 , which determines this point in time with the signals of the time base 82 and the pulse rate sensor 87 , even if the cardiac cycle is irregular, the current time Heart rate determined and the ratio between the elapsed time since the last pulse beat to the current heart period.

The measured values are then subjected to a series of mathematical operations in the computer 70 with the aid of the spectrum analyzer 62 , which serve to evaluate these data and to display them in a suitable manner on a second monitor, the result monitor 72 . This evaluation includes z. B. the Fourier analysis of the pulsations of blood vessel 10 and blood flow, which are periodic processes with the cardiac cycle. From this, a number of characteristic functions and parameters, such as. B. the envelopes of the Doppler frequency / time profiles and the resulting relative amplitudes of the harmonics of the heart rate, that is, the Fourier coefficients derived. Further informative, time-dependent parameters are the values of the maximum, the middle and the most frequent Doppler frequencies as well as their relationships at any point in time of a cardiac cycle, e.g. B. their systolic, initial and end diastolic values.

The data processed in this way is displayed to the examiner on the result monitor for assessment. The almost stationary image 12 comprises the entire area 12 entered by the video endoscope 40 in the course of the examination. First, the timing of a fictitious cardiac cycle is shown, repetitively at a freely selectable rate. This image sequence is generated by the image processing system 80 by topographically correct and time-synchronized “piecing” of the recorded images together with the necessary image transformations for correcting the recording distance 23 c, recording angle 23 d (the latter if the recording direction deviates from the plumb line onto the surface of the tissue 11 ) and any other distortions of the examination area 12 z. B. performed by breathing or other movement of the patient. One or more time-dependent parameters described above, or one or more of their combinations and cross-correlations, which are freely selected by the examiner, are underlaid correctly in the image sequence, whereby the methods of false color representation are used (e.g. coding of two parameters by hue and color saturation).

However, a freely selectable still image of this image sequence can also be used with the corresponding parameters are displayed. Here too Desire the non-time-dependent parameters such as Fourier coefficients, maxima, Minima, average and most frequent values of the Doppler frequencies as well as others data obtained by separate calculations.

Furthermore, the time profiles of the Doppler spectra can also be faded in for a few selected measuring points 20 in each case. The result monitor 72 is finally used together with input media 75 such as keyboard and computer mouse for menu-controlled command input to computer 70 , image processing system 80 and output media 76 for documenting the results.

For the assessment, the examiner preferably selects those representations and parameters that experience shows show the most significant differences between intact area 12 a and lesion 12 b. Here he can also advantageously use the methods for contrast improvement that are successful in image processing 80 , such as, for example, B. Set thresholds, change the gray scale or other scale factors, etc. However, it is also supported by the computer 70 which, if desired, selects and displays the representation with the most significant differences from the measured data.

Even clearer differences are likely to arise if proposed one after the other with normal, increased, and if possible with vein compresses low blood pressure is measured and suitable parameter combination tions (difference and ratio values).  

The final assessment and all other knowledge about the patient are finally added to the total stock of previous patient data, including the normal values of healthy subjects. This database 74 is organized together with the computer 70, the input and output media 75/76 , the computer programs, the menu control and the image processing 80 as a knowledge-based expert system, which, on request, also suggests an assessment and, for. B. for control or teaching purposes a previous finding or similar cases in other patients and displays on both monitors 71, 72 . To assess the risk to the patient associated with bleeding, knowledge of the amount of blood transported and the type of blood vessel 10 (artery or vein) is required. It is proposed to use the maximum blood flow velocities measured on an intact piece of vessel 10 a at different blood pressures as well as their characteristic curves for arteries and veins. In the case of the laminar blood flow prevailing here, the amount of blood transported is determined relatively precisely by the flow rate, the latter being determined relatively well by the blood pressure and the diameter of the blood vessel 10 .

The maximum amount of backscatter displaced by the flowing blood cells is also used as a measure of the laser light absorption capacity, ie the thickness of the blood vessel 10 and the overlying tissue layer 11 , and taken into account by the examiner in the assessment, laser intensity and measuring distance 23 being kept constant or otherwise measured and taken into account. Finally, it is proposed to assess the mechanical strength of vessel 10 and tissue 11 according to the values of surface pulsation and mass or thickness of vessel 10 and tissue 11 determined in this way and to take them into account in the diagnosis.

To the examiner from the observation of not always well visible laser beam spot 20 a relieve, it is proposed tor at this point in Endoskopmoni 71 a suitable cursor, for example. B. Show circle. In the blood flow measurement of the measuring point is displayed d 20 by the tip of a cursor arrow 20th Whose Rich direction corresponds to the position of the deflecting mirror 50 , so indicates the measuring direction 22 .

For this purpose, the laser of the laser sensor 60 with a few Hz, z. B. 10 Hz, intensity modulated. An additional image evaluation unit 81 guides z. B. by means of a PLL circuit 83 , which receives the modulation signal as a reference signal, the position of the laser light spot 20 a in the monitor image 12 c. When the measuring key 55 is switched on, the cursor 20 remains stationary and the laser is operated unmodulated in order to avoid influencing the Doppler measurement.

The modulation frequency should clearly mark the laser light spot 20 a in the endoscope monitor 71 , and on the other hand should be as high as possible for automatic detection. A frequency mix of frame rate and integer fraction of it, therefore, is favorable. B. 25 Hz and 5 Hz. Thus, on the one hand, the maximum possible and a low modulation frequency that is clearly visible to the examiner is used, and on the other hand no undesirable beats occur.

A more complex, but more sensitive method is that a dichroic beam splitter 56 is connected upstream of the image recording camera 43 , which only deflects the laser wavelength to a second image recording camera 57 . From this, the image evaluation unit 81 recognizes the sought position of the laser light spot 20 a even without laser modulation.

In order to shorten the duration of the examination, it is proposed to carry out the measurement of the pulsation of the vessel surface 10 c and the blood flow simultaneously. Instead of the previous, single and foldable and rotatable deflecting mirror 50, a rotatable beam splitter 51 are arranged with a reflecting mirror 50 a in such a way here that the two directions of measurement, so far only alternatively selectable 21, 22 are now running in parallel. The combined Doppler spectrum obtained is broken down sufficiently well into the two corresponding components by interpreting the spectral components below a selectable frequency f * as being mainly due to the vascular pulsation and relating the components above to the blood flow rate. This is possible because in the cases considered here, the blood flow rate is significantly higher than the rate of pulsation of the vessel wall 10 c. It is advisable to create the almost perpendicular measuring beams 21, 22 so that they strike the working distance 23 of the endoscope 40 at a common measuring point 20 of the tissue surface 11 a. By observing this condition, the working distance 23 is then checked in turn.

In a further embodiment it is proposed to periodically deflect the measuring point 20 transversely to both measuring directions 21, 22 by means of an additional deflection unit 52 at the beam splitter 51 and here a corresponding Cur sensor symbol 21, 22 , z. B. crossbar 20 b corresponding length in the monitor image 12 c to be inserted. The freely selectable deflection area 20 b is preferably a multiple, for. B. three times the blood vessel diameter, the deflection frequency is chosen large against the heart rate and small against the Doppler frequency of the surface vibrations to be measured. This choice allows an accurate measurement of the surface vibration along the scan line almost simultaneously, ie in a small time interval with respect to the cardiac period. This means that one of the measuring points 20 no longer needs to be adjusted exactly to the center of the blood vessel 10 , and secondly the entire pulsating tissue surface 11 a is measured, so that the assessment of the lesion 12 b is further facilitated. For this purpose, the computer 70 calculates the vibration amplitudes of the vascular pulsation from the measured Doppler frequencies below half f * and displays them as contour lines on both monitors 71, 72 , so that the mechanical strength of the vessel 10 and the tissue layer 11 can be assessed.

The angle alpha between the measuring direction 21 or 22 and the speed vector entering the Doppler formula with the cosine is taken into account in the calculation of the data. For this purpose, the examiner may enter continuously estimated or otherwise determined angle values. With periodic scanning, the scanning angle corresponding to the respective deflection is taken into account arithmetically.

For documentation, as well as for control and teaching purposes, the computer 70 stores all of the images shown on the two monitors 71, 72 during the examination on two assigned video recorders 77, 78 after having provided them with a suitable identification code for targeted retrieval.

These measures create an arrangement that not only the examiner a reliable prognosis of a patient's risk of bleeding leaves, but also documents, stores and stores all measurement data for con reproduced trolling and teaching purposes, these and other entered or derives derived data from a database, which covers the total inventory Herergic patients and healthy subjects contains, and which finally as knowledge-based expert system is organized, the examiner largely supported and suggested a diagnosis.

Claims (30)

1. Arrangement for localizing vessels and for predicting bleeding using a video endoscope with monitor, a Doppler laser sensor connected to it by means of an optical fiber, which operates in heterodyne mode and is set up to measure blood flow in vessels, and a computer for data evaluation, characterized in that that the Doppler laser sensor ( 60 ) is connected by means of a single-mode optical fiber ( 61 ) to its sensor optics ( 62 ) arranged on the inside of the body ( 40 a) of the video endoscope ( 40 ), that with its almost punctiform measuring beam ( 21, 22 ) the surface of the blood vessel ( 10 ) visible in the endoscope monitor ( 71 ) perpendicular to the direction of flow ( 10 d) and diagonally or almost parallel to the direction of flow ( 10 d) in its course from undamaged ( 12 a) to damaged ( 12 b) and again to undamaged ( 12 a) area or the surface ( 11 a) of the overlying fabric layer ( 11 ) point by point it is scanned that the Doppler spectra are measured at each measuring point ( 20 ) over the duration of a cardiac cycle, from which a spectrum analyzer ( 62 ) and a computer ( 70 ) determine the pulsation of the wall ( 10 c) of the blood vessel ( 10 ) or the latter covering fabric layer ( 11 ) calculated and displayed on a result monitor ( 72 ), and that from the comparison of the measured values and the calculated values of the damaged area ( 12 b) with those of the undamaged areas ( 12 a) and with empirical values, a forecast of the probability of a Vascular bleeding is derived. 2. Arrangement according to claim 1, characterized in that the measured on an un-damaged piece of vessel ( 10 a) in the flow direction ( 10 d) maximum Doppler frequency and its time profile as a measure of the diameter of the vessel ( 10 ) and the amount of blood transported therein the type of vessel 10 ) are used, the laser intensity and working distance ( 23 ) being kept constant or otherwise determined and taken into account by calculation, and that the risk to the patient is assessed thereafter and according to the probability of vascular bleeding. 3. Arrangement according to claim 1 or 2, characterized in that the relative intensity of the received radiation from the Doppler laser sensor ( 60 ) measured with maximum Doppler shift, ie the blood flow as a measure of the laser light absorption capacity and thus the mass of the blood vessel wall ( 10 c) and an overlying fabric layer (11) is used and from this and from the measured pulsation of the vascular wall (10 c) and fabric layer (11) is judged to their mechanical stability. 4. Arrangement according to one of claims 1 to 3, characterized in that the measurements are carried out at different blood pressures and the measured values obtained and the values derived therefrom, in particular their values standardized to constant blood pressure and their differential and ratio values, are damaged ( 10 b) and undamaged ( 10 a) points of the blood vessel ( 10 ) are compared with each other and evaluated. 5. Arrangement according to one of claims 1 to 4, characterized in that at the inside of the body ( 40 a) of the video endoscope ( 40 ) one of its outer end ( 40 b) by means of a folding plate ( 54 ) can be folded in and out and by means of Rotary actuator ( 53 ) rotatable deflecting mirror ( 50 ) is arranged such that the measuring direction ( 21, 22 ) of the Doppler laser sensor ( 60 ) optionally in the endoscope direction, ie almost perpendicular ( 21 ) to the tissue surface to be examined ( 11 a), or approximate transverse to it ( 22 ) in the blood flow direction ( 10 d) is adjustable. 6. Arrangement according to one of claims 1 to 4, characterized in that on the inside of the body ( 40 a) of the video endoscope ( 40 ) a rotatable beam splitter ( 51 ) with a deflecting mirror ( 50 a) is arranged such that both measuring directions ( 21 , 22 ) of the Doppler laser sensor ( 60 ), ie in the direction of the endoscope ( 21 ) and ge approaching it transversely ( 22 ) and in the direction of blood flow ( 10 d) rotatable, are simultaneously active. 7. Arrangement according to claim 6, characterized in that the obtained combined Doppler spectrum broken down into the two corresponding components is by the spectral lying below a selectable frequency f * Portions interpreted as mainly due to vascular pulsation and the above components related to the blood flow rate be. 8. Arrangement according to one of claims 6 or 7, characterized in that the beam paths of the two measuring directions ( 21, 22 ) are designed such that they at a working distance ( 23 ) of the video endoscope ( 40 ) at a common measuring point ( 20 ) the examined surface ( 11 a) occur and that by observing this condition the observance of the working distance ( 23 ) is checked. 9. Arrangement according to one of claims 1 to 8, characterized in that a deflection unit ( 52 ) is arranged at the inside end ( 40 a) of the video endoscope ( 40 ) in the beam path of the Doppler laser sensor ( 60 ) such that the measuring point ( 20 ) is periodically deflected transversely to the blood flow direction ( 10 d), the freely selectable deflection area ( 20 b) preferably being a multiple of the diameter of the blood vessel ( 10 ) and the deflection frequency being large against the heart rate and small against the Doppler frequency of the measured Vascular pulsation or surface vibration is selected, and that the computer ( 70 ) from the Doppler measured with Doppler laser sensor ( 60 ) and spectrum analyzer ( 62 ) frequencies below f * the vibration amplitudes of the pulsation of the surface ( 10 c, 11 a) of the vessel ( 10 ) or fabric layer ( 11 ) calculated and represented as contour lines. 10. Arrangement according to one of claims 1 to 9, characterized in that the laser wavelength is in the sensitivity range of the video endoscope ( 40 ) and the laser power emitted on the measuring point ( 20 ) is sufficiently high so that the laser light spot ( 20 a) in Endoscope monitor ( 71 ) becomes visible and displays the measuring point ( 20 ). 11. The arrangement according to claim 5, characterized in that a folding sensor ( 54 a) and a rotation sensor ( 53 a) report the folding and angular position of the deflecting mirror ( 50 ) to the computer ( 70 ) and this by means of a symbol generator ( 84 ) the folding and possibly the angle of rotation direction by suitable symbols, e.g. B. as a circle or as an arrow ( 20 c) at a freely selectable location of the endoscope monitor ( 71 ). 12. The arrangement according to one of claims 1 to 11, characterized in that the measured Doppler spectra by means of a frequency mixer ( 64 ) and a suitable, supplied to this, from the verbun with the computer ( 70 ) which time base ( 82 ) derived frequency in the The listening area is transformed and reproduced via a loudspeaker ( 65 ). 13. Arrangement according to one of claims 1 to 12, characterized in that the laser of the laser sensor ( 60 ) when the measuring key ( 55 ) is switched off by the time base and a laser modulation unit ( 63 ) controlled by it with the highest possible, but by the user Easily recognizable modulation frequency is intensity-modulated that the computer ( 70 ) is connected to the image recording camera ( 43 ) of the video endoscope ( 40 ) and to an image evaluation unit ( 81 ), which it knows the modulated laser light spot ( 20 a) as a measuring point ( 20 ) interprets and communicates its coordinates to the computer ( 70 ), it being supported by a PLL circuit ( 83 ) assigned to it, which receives the modulation frequency as a reference. 14. Arrangement according to claim 13, characterized in that the laser of the Lasersen sensor ( 60 ) is modulated with a frequency mixture of image frequency and the examiner remarkable integer fraction thereof. 15. Arrangement according to one of claims 1 to 12, characterized in that before the image recording camera ( 43 ) of the video endoscope ( 40 ), a dichroic beam splitter ( 56 ) is connected upstream, which deflects only the laser wavelength to a second image recording camera ( 57 ) , and that the image evaluation unit ( 81 ) connected to it evaluates the position of the laser light spot ( 20 a) as a measuring point ( 20 ) and transmits its coordinates to the computer ( 70 ). 16. Arrangement according to one of claims 13 to 15, characterized in that the computer ( 70 ) by means of the symbol generator ( 84 ) at the respective measuring point ( 20 ) a suitable cursor, for. B. shows a circle or an arrow ( 20 d), which indicates the type of measurement and possibly the measuring direction ( 21 or 22 ) and the deflection area ( 20 b). 17. Arrangement according to one of claims 1 to 16, characterized in that the computer ( 70 ) is connected to an image processing system ( 80 ) which in the image ( 12 c) of the video endoscope ( 40 ) location, shape and course of the examined Blood vessel ( 10 ) recognizes, the selected measuring points ( 20 ) and measuring directions ( 21 and 22 ) communicated by switching on a measuring key ( 55 ) of the image processing system ( 80 ) and possibly including other inputs and supporting information used in image processing that the image processing system ( 80 ) has a body-fixed coordinate system of the examination area ( 12 ), with respect to the recording distance ( 23 c) and angle ( 23 d) of the taking lens ( 40 c) of the video endoscope ( 40 ), and patient movement, in which the pixels are created ( 12 c) the video endoscope ( 40 ), in particular the blood vessel ( 10 ) with its surroundings, the selected measuring points ( 20 ), types ( 21, 22 ) and directions gene ( 22 ) and the measurement data obtained are classified so that with each movement of the video endoscope ( 40 ), the new areas in the field of view ( 12 c) of their topography are added to the previously processed areas, so that finally an overall picture of the Under search area ( 12 ) arises, and that all this data is stored in an image data memory ( 73 ) according to its topography, ie under its coordinates as an image and data sequence in chronological order with respect to the heart period. 18. Arrangement according to one of claims 1 to 17, characterized in that the computer ( 70 ) carries out an analysis and evaluation of the measurement data and their results on the result monitor ( 72 ). 19. The arrangement according to claim 18, characterized in that the computer ( 70 ) by means of the spectrum analyzer ( 62 ) subjects the Doppler spectra of the pulsations of the blood vessel ( 10 ) and blood flow to a Fourier analysis, that all functions and parameters characteristic of the method, such as the envelope, Most frequent and mean value curves of the Doppler frequency / time profiles, the assigned Fourier coefficients, the values of the maximum, most frequent and mean Doppler frequencies at characteristic times, e.g. B. their systolic, initial and end diastolic values as well as experience-based characteristic combinations and cross-correlations of these functions and parameters are calculated and stored in the image data memory ( 73 ) with the corresponding pixel coordinates and in chronological order with respect to the cardiac period. 20. Arrangement according to one of claims 1 to 19, characterized in that the computer ( 70 ) on the result monitor ( 72 ) repeats the fictitious cardiac cycle image sequence of the overall image ( 12 ) repetitively in freely selectable running speed including still image and this optionally or several of the evaluated parameters or their combinations and cross-correlations superimposed correctly topographically, the methods of false color representation being used and the methods of image contrast improvement such as setting threshold values, changing the gray scale etc. being used. 21. The arrangement according to claim 20, characterized in that the computer ( 70 ) on the result monitor ( 72 ) overlays the contour lines of the pulsation of the vessel ( 10 ) and tissue layer ( 11 ). 22. Arrangement according to one of claims 20 or 21, characterized in that the computer ( 70 ) on the result monitor ( 72 ) superimposes the measured values obtained at different blood pressures and the values derived therefrom. 23. Arrangement according to one of claims 20 to 22, characterized in that the computer ( 70 ) represents that overlay with evaluated parameters etc., which shows the most significant differences between undamaged ( 12 a) and damaged ( 12 b) area of the overall image ( 12 ) display. 24. Arrangement according to one of claims 20 to 23, characterized in that the computer ( 70 ) in a freely selectable still image for some selected te measuring points ( 20 ) the temporal profiles of the Doppler spectra or their instantaneous distributions corresponding to the time of the still image. 25. Arrangement according to one of claims 20 to 24, characterized in that the computer ( 70 ) follows the image shown during the examination on both monitors ( 71, 72 ) provided with an identification code and retrievable on two assigned video recorders ( 77, 78 ) saves. 26. Arrangement according to one of claims 20 to 25, characterized in that the computer ( 70 ) input media ( 75 ) such as keyboard and mouse and an operating system for menu-controlled command input are assigned. 27. Arrangement according to one of claims 1 to 26, characterized in that all the measured values determined and data about the Patients in a database with the total stock of previous patient data finally added the normal values with scatter from healthy subjects will. 28. The arrangement according to claim 27, characterized in that the database ( 74 ) and computer ( 70 ) with input and output media ( 75, 76 ), computing and control programs, image processing ( 80 ), image data memory ( 73 ) and video recorder ( 77, 78 ) are organized as a knowledge-based expert system that suggests a result assessment to the examiner and shows the previously measured condition or similar cases of other patients. 29. Arrangement according to one of claims 1 to 28, characterized in that the respective angle alpha of the Doppler formula is taken into account arithmetically when evaluating the data, for which purpose angle values that are continuously estimated or otherwise determined in the course of the measurement may be given to the computer ( 70 ). inputs, with the deflection unit ( 52 ) activated, the angle corresponding to the current deflection is automatically calculated. 30. Arrangement according to one of claims 1 to 29, characterized in that the computer ( 70 ) with a blood pressure sensor ( 86 ) and a pulse sensor ( 87 ) is connected.