JP2003088527A - Ultrasonic diagnostic device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To facilitate to take a measure such as treatment to an affected part specified by the diagnosis with a catheter-like ultrasonic probe. SOLUTION: The catheter-like ultrasonic probe 10 is covered with an over sheath 20, and inserted into a body cavity of subject. When an affected tissue 102 is specified by diagnosis using the probe 10, the probe 10 is pulled out from the over sheath 20, and the over sheath 20 is left in the patient body. For treatment, a laser probe, for example, is inserted to the left over sheath 20, whereby the laser probe can be extended to the affected tissue 102 along the over sheath 20 to perform the treatment.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic diagnostic apparatus equipped with a catheter-shaped probe, and more particularly to a technique for ultrasonic diagnosis and its cooperation with subsequent medical treatment and other treatments.

[0002]

2. Description of the Related Art Conventionally, as a diagnostic method for diagnosing an initial cancer that has occurred in the bronchus, a catheter-shaped thin ultrasonic probe is inserted into the bronchus from the forceps port of an endoscope to transmit and receive ultrasonic waves. An ultrasonic image diagnostic method of forming a tomographic image of a region of interest by this is used. The small-diameter ultrasonic probe used in this diagnostic method is composed of a catheter-shaped sheath tube, a torque wire rotatably inserted therein, and a transducer provided on the side surface of the distal end portion of the torque wire. By rotating the torque wire, the transmitting and receiving directions of the ultrasonic beam are rotated to realize radial scanning.

Since the endoscope itself has a thickness of about 10 mm in outer diameter, it is impossible to insert even a thin peripheral bronchus. On the other hand, the small-diameter ultrasonic probe has an outer diameter of 2 to 3 m.
Since it is as thin as about m, insert it into a fairly thin peripheral bronchus,
Since it can be diagnosed, it is an effective diagnostic means.

On the other hand, a large-scale thoracotomy has been conventionally performed for the treatment of bronchial cancer. However, since thoracotomy is a high risk for physically weak patients such as the elderly, a laser fiber or a drug injection catheter is guided from the forceps mouth of the endoscope to the affected area, and laser irradiation or drug application is used to guide the affected area. There is a demand for an endoscopic treatment method such as the treatment of.

[0005]

When this endoscopic treatment method is applied to a thin bronchial portion into which an endoscope cannot be inserted, there arises a problem of how to identify the affected area. The small-diameter ultrasonic probe described above is the solution for this. That is, a radial scanning tomographic image is formed while the probe is gradually advanced to the inside of the bronchus, and the tip position of the probe when cancer tissue appears in the tomographic image can be specified as the position of the affected area.

However, even if the affected area can be identified by using the small-diameter ultrasonic probe, the small-diameter ultrasonic probe is removed from the forceps opening for treatment, and a new treatment tool such as a laser probe is newly inserted from the forceps opening. Need to be inserted into the bronchi. At this time, if the small-diameter ultrasonic probe is removed, there arises a problem that the position information of the affected area that has been specified in detail is lost.

In this case, it is not impossible to leave the tip position of the small-diameter ultrasonic probe as an image by X-ray photography and guide the therapeutic instrument to the affected area while referring to it.
In this case, it becomes necessary to take X-rays many times to confirm whether or not the treatment tool is in the correct position. In addition, since the bronchus have many branches, trial and error is required to correctly guide the treatment tool to the position of the affected part, which is very troublesome.

The case of diagnosing and treating bronchial cancer has been described above, but the same applies to the case of diagnosing blood vessels and other body cavities with a small-diameter ultrasonic probe and treating the affected area specified by this diagnosis. Problems can occur.

The present invention has been made to solve such a problem, and a treatment tool for subsequent treatment or the like can be easily guided to the position of the affected area specified by the diagnosis by the ultrasonic probe. It is an object to provide an ultrasonic diagnostic apparatus.

[0010]

To achieve the above object, an ultrasonic diagnostic apparatus according to the present invention comprises a catheter-shaped ultrasonic probe and an oversheath into which the probe can be removably inserted. After ultrasonic diagnosis is performed with the probe inserted in the oversheath inserted in the subject, the oversheath remains in the subject so that only the probe can be removed. Other catheter-like instruments can be inserted and processed.

With this configuration, after the affected area is identified by ultrasonic diagnosis, only the ultrasonic probe is removed to leave the oversheath in the subject, and the oversheath allows the treatment tool for the subsequent treatment. Can be guided to the affected area.

In a preferred aspect of the present invention, a marker member made of a material that is less likely to transmit X-rays than biological tissue is provided at the tip of the oversheath.

According to this aspect, the tip of the oversheath left inside the subject can be easily identified by X-ray photography, and the position of the affected area can be easily confirmed.

In another preferred embodiment, an opening is provided at the distal end of the oversheath, so that treatment such as drug application to the affected area can be performed through this opening.

Further, in this aspect, the position of the opening is detected from the echo reception signal when the ultrasonic beam is scanned by the probe, the opening position display is generated based on the detection result, and the diagnosis is performed by the ultrasonic beam scanning. By providing the aperture display means for displaying the image together with the image, the position of the aperture can be easily confirmed on the diagnostic image, and the operation of directing the aperture to the affected area becomes easy.

By providing a marker member having a higher acoustic impedance than that of the oversheath in at least a part of the periphery of the opening of the oversheath, the ultrasonic reflection of the marker member can be strengthened and the opening It becomes easy to detect automatically.

Further, the present invention provides an oversheath into which a catheter-shaped ultrasonic probe can be removably inserted and which has a marker member made of a material which is less likely to transmit X-rays than a living tissue at its tip. is there.

[0018]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention (hereinafter referred to as embodiments) will be described below with reference to the drawings.

[Device Configuration] First, the structure of the ultrasonic probe of the ultrasonic diagnostic apparatus of this embodiment will be described with reference to FIG. FIG. 1 is a partial cross-sectional view showing a state in which the tip of the ultrasonic probe 10 inserted into the oversheath 20 projects from the forceps port 38 of the endoscope tip 32.

The ultrasonic probe 10 has a catheter-shaped body constructed by covering a probe shaft 14 having a transducer 16 mounted on a cap portion 18 at its tip with a flexible sheath 12 made of resin or the like. It has an insertion part. The probe shaft 14 is composed of, for example, a torque wire,
It is flexible, but twisting with rotation is minimized. A signal cable connected to the vibrator 16 passes through the probe shaft 14.

In this example, the transducer 16 directs its ultrasonic wave transmitting / receiving surface to the side surface so as to transmit / receive the ultrasonic beam toward the side surface of the ultrasonic probe 10 (that is, the direction perpendicular to the longitudinal direction of the probe 10). It is attached to the tip of the probe shaft 14 in a closed posture. The sheath 12 has, for example, an outer diameter of 2 to 3 m
The transducer 16 has an ultrasonic wave transmitting / receiving surface of, for example, 1 m.
The size is about m square. The sheath 12 is a closed type,
The inside thereof is filled with a liquid such as water to propagate ultrasonic waves.

In the illustrated state at the time of diagnosis, the ultrasonic probe 10 is inserted into the subject while being inserted into the oversheath 20. The oversheath 20 is a catheter-shaped tube made of resin or the like, and has a built-in mesh made of metal or the like to secure its strength. The over sheath 20 is the ultrasonic probe 10.
Has an inner diameter slightly larger than that of the catheter portion.

The oversheath 20 and the ultrasonic probe 10 are constructed as separate bodies, and the probe 10 can be freely inserted into the oversheath 20 and the oversheath 2.
Can be removed from zero. Therefore, after the ultrasonic diagnosis, the oversheath 20 is left inside the body, and the probe 10
By removing from the oversheath 20, a treatment tool such as a laser probe or a catheter for drug injection can be inserted into the oversheath 20 and guided to the affected tissue 102 of the tube wall 100 of the subject.

An opening 22 is provided on the side surface of the distal end portion of the oversheath 20. The opening 22 is provided at a position corresponding to the transducer 16 in a state where the probe 10 is inserted to the tip of the oversheath 20. This opening 2
2 is a treatment instrument such as a laser probe for treating the affected tissue 10
It becomes a window when treating 2.

FIG. 2 is a view showing a state in which the opening 22 of the oversheath 20 is viewed from the front. As shown in FIG.
The periphery of the opening 22 is framed by a marker 24. The marker 24 has a higher acoustic impedance than the oversheath 20 and is made of a material that is less likely to transmit X-rays than biological tissue. This material is, for example, a metal material, and in particular, platinum can be said to be a suitable material because it has little influence on the living body.

In general, when ultrasonic waves travel from a low acoustic impedance region to a high acoustic impedance region, reflection occurs, and the intensity of this reflection increases as the difference between the acoustic impedances of these regions increases. Therefore, since the acoustic impedance of the marker 24 is higher than that of the oversheath 20, the marker 24 is more likely to reflect ultrasonic waves than the oversheath 20. As a result, the edge of the opening 22 is emphasized by the ultrasonic reflection by the marker 24 in the scanning with the ultrasonic beam, so that the position of the opening 22 is easily detected (the opening detection process will be described later).

On the other hand, by using, as the material for the marker 24, a material that is less likely to transmit X-rays than living tissue, the marker 24 can be easily confirmed in the X-ray image, and the position of the tip portion of the oversheath 20 can be confirmed. It can be easy to grasp.

The marker shape shown in FIG. 2 and the like is merely an example, and the marker 24 does not need to be provided so as to frame the entire circumference of the opening 22. For example, if markers are provided at both ends A (see FIG. 2) of the opening 22 in the circumferential direction of the oversheath 20, the markers can be detected according to the radial scanning of the ultrasonic beam.

Further, in this example, one marker 24 has two properties, that is, a property of easily reflecting ultrasonic waves and a property of hardly transmitting X-rays. However, there is also a mode in which these properties are realized by separate markers. It is possible. For example, a marker that acoustically emphasizes the edge of the opening 22 is provided on the edge of the opening 22, and a marker for indicating the tip of the oversheath 20 on the X-ray image is provided on the dome-shaped portion of the tip of the oversheath 20. And so on. By the way, when the opening 22 can be specified by the difference in echo level between the opening 22 and the oversheath 20, it is not always necessary to provide a marker for acoustically enhancing the edge of the opening 22. It is desirable to provide such a marker as it is not sufficient.

In the example of FIG. 2, the shape of the opening 22 is circular, but this is merely an example, and the opening 22 may have any shape.

FIG. 3 is a view showing the outer appearance of the entire probe portion of the apparatus of this embodiment. The endoscope distal end portion 32 shown in FIG. 1 is the distal end portion of the insertion portion 31 extending from the endoscope operating portion 30. The illumination opening 34 and the observation opening 36 (see FIG. 1) of the endoscope distal end portion 32 include the insertion portion 31 and the endoscope operation portion 30.
The light guides (optical fibers) for illumination and observation / photographing that pass through the inside are respectively connected, and these light guides further extend to a light source unit, a processor and the like (not shown) through the connection cord 30a. In addition to the light guide, the insertion section 31 is provided with a forceps channel extending from the treatment instrument introducing section 30b to the forceps opening 38. The ultrasonic probe 10 and the oversheath 20 of the present embodiment also pass through the forceps channel from the treatment instrument introducing portion 30b, and the forceps port 38.
Stick out from.

The probe driving section 10a is a part of the ultrasonic probe 10, and has a motor for rotating the probe shaft 14 and other rotating mechanisms built therein. When the probe shaft 14 is rotated by this rotating mechanism, the vibrator 16 provided at the tip is rotated, and radial scanning is realized. The probe driving unit 10a is connected to an ultrasonic diagnostic apparatus body (not shown) via a connection cord 10b,
The probe shaft 14 is rotationally driven according to the drive control signal from the main body. The signal cable connected to the vibrator 16 is also connected to the main body through the inside of the connection cord 10b.

The oversheath rotation operation section 26 is attached to the oversheath 20 shown in FIG. 1 and the like, and the operator rotates the operation section 26 to rotate the oversheath 20. By this rotation operation, the opening 22
Can be positioned in the desired rotational position. The oversheath rotation operating portion 26 has a hole communicating with the inside of the oversheath 20, and the catheter portion of the ultrasonic probe 10 is inserted into the oversheath 20 through this hole.

A water injection tube 28 connected to a water injection mechanism (not shown) is connected in the vicinity of the oversheath rotation operation section 26. A liquid is injected into the oversheath 20 from the water injection mechanism via the water injection tube 28.
This liquid injection is mainly performed in order to facilitate the transmission of ultrasonic waves to the subject by filling the liquid from the front surface of the transducer of the probe 10. The injected liquid is the opening 2
Emitted from 2. As the liquid to be injected, one that does not have a bad influence on the living body is used. When diagnosing and treating the bronchus, an anesthetic such as xylocaine is used as the liquid to be injected, and by continuously injecting this at a small flow rate, ultrasonic transmission is improved and the target site is treated. Anesthesia can be performed.

Next, the control mechanism of the apparatus of this embodiment will be described with reference to FIG. In the illustrated configuration, the other units except the ultrasonic probe 10 and the probe shaft rotation drive unit 48 are basically provided in the ultrasonic diagnostic apparatus main body.

In this configuration, the transmitter / receiver 40 has a length of several meters.
A drive signal having a diagnostic power of about W to a little over 10 mW is supplied to the ultrasonic probe 10 to excite the transducer 16, and the echo signal received by the transducer 16 is subjected to signal processing such as amplification, thereby forming an image forming unit. To 42. The image forming unit 42 performs a process for generating a diagnostic image such as a B-mode tomographic image based on the echo signal. The diagnostic image is generated on the image memory unit 44. This diagnostic image is displayed on the display unit 46 after being overlaid with an aperture marker display (details will be described later) generated by the aperture position marker generation unit 54.

The probe shaft rotation driving section 48 is a mechanism for driving the probe shaft 14 to rotate, and is used for the ultrasonic probe 1.
No. 0 is incorporated in the probe driver 10a shown in FIG. The probe shaft rotation drive unit 48 is controlled by the control unit 50, and when a diagnostic image is generated, the probe shaft 14 is continuously rotated at a predetermined rotation speed according to the image frame rate to realize radial scanning.

The aperture position detector 52 detects the position of the aperture 22 based on the echo reception signal acquired by the transmitter / receiver 40 during the radial scanning. The detection of the opening position is performed based on the presence or absence of echo by the oversheath 20. That is, during radial scanning, the direction of the ultrasonic beam is the aperture 2
Since there is no echo from the distance of the oversheath 20 while it is in the range of 2, for example, the portion of the distance of the oversheath 20 in the echo reception signal is extracted by the gate and whether the signal level is higher than a predetermined threshold value or not. By determining whether or not the beam direction at that time is the portion of the oversheath 20 or the portion of the opening 22. Further, in this embodiment, since the marker 24 is provided on the opening 22, the opening 22 can be clearly detected by the strong echo by the marker 24.

The information on the detected opening position is used in the operation of directing the opening 22 toward the affected tissue 102. That is, the information on the opening position is transmitted to the opening position marker generating unit 54 via the control unit 50, the opening position marker generating unit 54 generates the image of the marker indicating the opening position, and the diagnostic image of the image memory unit 44. Superimpose on. FIG. 5 is a diagram schematically showing a diagnostic image displaying a marker provided in the opening. In this example, markers 208 are shown at both ends of the opening portion of the oversheath image 206. This marker 208
Is an actual image appearing in a diagnostic image (for example, a tube wall image 200 or an affected part image 202 which is an image of a living tissue part, a sheath image 204 which is an image of the sheath 12 or an oversheath image 206 which is an image of the oversheath 20). It is displayed in a display form (shape, pattern, color, etc.) that can be distinguished from. Of course, the display form of the marker 208 in FIG. 5 is merely an example, and other various display forms such as displaying the range of the opening 22 in color are conceivable. The operator operates the oversheath rotation operating unit 26 while checking the direction of the opening 22 with the marker 208 on the diagnostic image, and turns the opening 22 toward the affected area.

Returning to the explanation of FIG. 4 again, the operation panel 56
Is a means for receiving a user's instruction input to the ultrasonic diagnostic apparatus, and is provided with buttons indicating various functions and modes of the apparatus, a keyboard for data input, and the like.

The water injection mechanism 60 is a mechanism for injecting a liquid for acoustic matching or the like into the oversheath 20,
The oversheath 20 is inserted through the water injection tube 28 described above.
It is connected to the.

[Working Procedure Example] The configuration of the apparatus of this embodiment has been described above. Next, an example of a work procedure for diagnosis and treatment using this device will be described. Hereinafter, a case of diagnosing and treating the bronchus will be described as an example.

During diagnosis and treatment using this apparatus, the operator first inserts the insertion portion 31 of the endoscope from the patient's mouth and aims at the target site while checking the endoscopic image and the like. The endoscope tip portion 32 is advanced. When reaching the thin bronchus through which the endoscope tip portion 32 does not pass, the ultrasonic probe 10 inserted into the oversheath 20 is advanced. At this time, the water injection mechanism 60 is operated to inject a liquid such as xylocaine and ensure acoustic matching with the wall of the bronchial tube, while the ultrasonic probe 10 is radially scanned with the ultrasonic beam to form a diagnostic image. The operator advances and retracts the ultrasonic probe 10 and the oversheath 20 while observing this diagnostic image, and specifies the affected area.

When the affected area is specified, the operator next turns the oversheath 20 with the oversheath rotating operation section 26 while checking the direction of the opening 22 on the diagnostic image, and opens the opening 2
Point 2 to the affected area.

When the adjustment of the direction of the opening 22 is completed, the oversheath 20 is left and only the ultrasonic probe 10 is removed. By leaving the oversheath 20, the positional information of the affected area is saved. Since the marker 24 that is less likely to transmit X-rays than the body tissue is provided at the distal end of the oversheath 20, X-ray imaging can be performed as necessary to confirm the position of the affected area. By securing the strength of the oversheath 20 with a metal mesh or the like, it is possible to prevent the oversheath 20 from being crushed even when the probe or the like is removed.

In this state, a treatment tool used for the next treatment is inserted from the root of the oversheath 20 and advanced to the tip.
For example, a catheter for drug application is applied to the affected area, and a laser probe is inserted into the oversheath 20 to ablate the affected tissue with a laser beam.
In this case, since the oversheath 20 continues to the affected part position, the distal end of the treatment tool can naturally reach the affected part position simply by inserting the treatment tool. And
When the tip of the treatment tool reaches the tip of the oversheath 20, a predetermined treatment with the treatment tool is performed. For example, in the case of applying a drug, when the drug is injected from the inserted catheter, at this time, since the opening 22 faces the affected area, the drug is applied to the opening 2
Reach the affected area via 2. Further, in the case of laser treatment, laser light is emitted from the laser probe to the affected area through the opening 22. In this case, it is necessary to output the laser light in the direction of the opening 22, but this can be realized by providing a mirror 29 for reflecting the laser light in the oversheath 20, as shown in FIG. 6, for example. In this case, for example, the laser source 72 at the tip of the laser probe 70 emits laser light in the axial direction of the probe 40, that is, in the right direction in FIG. 6, and reflects the laser light in the direction of the opening 22 in the emitting direction forward. A mirror 29 is provided.

Whether or not the treatment tool has reached the tip of the oversheath 20 can be known from the fact that the treatment tool has stuck to the tip of the oversheath 20 and cannot move any further, and if necessary, X-ray photography is possible. You can also check.

When the treatment or other treatment is completed in this manner, the treatment tool is removed from the oversheath 20, and the ultrasonic probe 10 is inserted again into the oversheath 20 to reach the affected area position to form a diagnostic image. It is also possible to confirm the therapeutic effect. Then, if necessary, a treatment tool for treatment or the like can be inserted again into the oversheath 20 to perform treatment.

Then, when it is judged that the desired therapeutic effect is obtained, the oversheath 20 and the endoscope are removed from the patient, and a series of diagnosis / treatment work is completed.

The apparatus configuration of the preferred embodiment of the present invention and the method of using the apparatus have been described above. As can be seen from this description, according to the present embodiment, the oversheath 20 can be left inside the patient after ultrasonic diagnosis.
This oversheath 20 can store the positional information of the affected area. That is, when a treatment such as a medical treatment is performed on the affected area, if a treatment tool for that purpose is inserted into the oversheath 20, the position of the affected area can be naturally reached.
This is very convenient in the case of a branched trachea such as a bronchus. In addition, if the oversheath 20 is left, the ultrasonic probe 10 and other treatment tools can be easily inserted / removed, so that the cycle of treatment and effect confirmation is repeated, or laser light is irradiated after the drug is applied to the affected area. It is also easy to take complex measures such as.

Further, since the marker 24 which is less likely to transmit X-rays than the body tissue is provided at the tip of the oversheath 20, whether the position of the affected part is confirmed by X-ray photography or whether the laser probe or the like has reached the affected part. It becomes easy to confirm.

The opening 2 is formed on the side surface of the oversheath 20.
By providing 2, the opening 22 can be directed toward the affected part on the side of the body cavity of the diagnosis / treatment target, and various treatments such as laser light treatment can be performed through the opening 22.

Further, since the means for detecting the position of the opening 22 and displaying the marker display showing the opening 22 on the diagnostic image is provided, the work of aligning the opening 22 in the direction of the affected area becomes easy.

In the example described above, the opening 22 is provided on the side surface of the oversheath 20, but instead of this, as shown in FIG. It is also possible to provide an opening (tip opening 22A in FIG. 7) that opens toward the direction). In this case, a marker 24A that is less likely to transmit X-rays than living tissue may be provided along the periphery of the tip opening 22A. In this case, the ultrasonic diagnosis can be performed, for example, with the tip of the ultrasonic probe 10 protruding from the tip opening 22A. A treatment such as a laser treatment after the ultrasonic diagnosis is performed assuming that the affected area exists ahead of the marker 24A. In this case, a treatment tool for treatment or the like is projected from the distal end opening 22A and the treatment tool is rotated, whereby treatment such as treatment can be performed on the entire circumference of the body cavity wall at that position. At this time, the positional relationship between the distal end portion of the treatment tool for medical treatment and the marker 24A can be confirmed by X-ray photography or the like. The opening edge 23 that is the edge of the tip opening 22A is
In order to protect the wall of the body cavity tissue, it has a rounded shape, and preferably the opening edge 23 is made of a flexible material. In addition, at an appropriate position on the side surface of the sheath 12 of the probe 10,
Protrusion 12 caught on opening edge 23 of oversheath 20
By providing a and inserting the ultrasonic probe 10 until the protrusion 12a is caught by the opening edge 23, a fixed relationship is established between the position of the affected part captured in the ultrasonic image and the position of the marker 24A. You can have it. By providing similar side projections on the side surface of the catheter of the treatment tool for treatment such as laser treatment, it is possible to accurately perform treatment such as treatment on the affected area determined by ultrasonic diagnosis.

In the above example, the diagnosis and treatment of the bronchus is taken as an example, but it is clear that the device of this embodiment can be applied to the diagnosis and treatment of body cavities and lumens other than the bronchus.

[0056]

As described above, according to the present invention,
After the ultrasonic diagnosis, the oversheath can be left in the patient's body, and a treatment tool such as a medical treatment can be inserted into the oversheath to guide it to the position of the affected part. Furthermore, pull out the treatment tool inserted from the oversheath,
Other treatment tools and ultrasonic probes can be inserted, and complex treatments and treatments and their effect confirmation can be easily performed.

[Brief description of drawings]

FIG. 1 is a partial cross-sectional view showing a configuration of a tip portion of a portion to be inserted into a body cavity in an apparatus according to an embodiment.

FIG. 2 is a diagram showing a state in which the opening of the oversheath is viewed from the front.

FIG. 3 is a diagram showing an external appearance of the entire probe portion of the apparatus of the embodiment.

FIG. 4 is a functional block diagram showing a control mechanism of the apparatus of the embodiment.

FIG. 5 is a diagram schematically showing an image displayed on a display unit.

FIG. 6 is a cross-sectional view showing an example of an oversheath incorporating a mirror for reflecting laser light.

FIG. 7 is a cross-sectional view showing another example of the oversheath.

[Explanation of symbols]

10 ultrasonic probe, 12 sheath, 14 probe axis, 16 transducer, 20 oversheath, 22 opening, 24 marker, 32 endoscope tip part, 38 forceps port,
40 transmitter / receiver, 42 image forming unit, 44 image memory unit, 46 display unit, 48 probe axis rotation drive unit, 50
Control part, 52 Opening position detecting part, 54 Opening position marker generating part, 56 Operation panel, 60 Water injection mechanism.

Claims (7)

[Claims] 1. An ultrasonic diagnostic system comprising: a catheter-shaped ultrasonic probe; and an oversheath into which the probe can be removably inserted. Ultrasonic diagnosis is performed with the probe inserted into the oversheath inserted into a subject. After that, the oversheath remains in the subject so that only the probe can be removed, and another catheter-like device can be inserted into the remaining oversheath to perform processing. 2. The ultrasonic diagnostic apparatus according to claim 1, wherein a marker member made of a material that is less likely to transmit X-rays than biological tissue is provided at the tip of the oversheath. 3. The ultrasonic diagnostic apparatus according to claim 1, wherein an opening is provided at the tip of the oversheath. 4. The position of the opening is detected from an echo reception signal when the ultrasonic beam is scanned by the probe, an opening position display is generated based on the detection result, and is displayed together with a diagnostic image by ultrasonic beam scanning. The ultrasonic diagnostic apparatus according to claim 3, further comprising opening display means. 5. The ultrasonic diagnostic apparatus according to claim 4, wherein a marker member having an acoustic impedance higher than that of the oversheath is provided on at least a part of the periphery of the opening of the oversheath. . 6. The ultrasonic diagnostic apparatus according to claim 3, further comprising an oversheath rotating mechanism that rotates the oversheath, and the orientation of the opening can be adjusted by rotating the oversheath. 7. An oversheath in which a catheter-shaped ultrasonic probe can be removably inserted, and a marker member made of a material which is less likely to transmit X-rays than a living tissue is provided at a distal end portion.