JP2003190170A - Ultrasonic diagnostic and treatment apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an apparatus capable of smoothly performing image diagnosis and medicine activation treatment. <P>SOLUTION: In addition to a transmitting/receiving part 32 for diagnosis for transmitting/receiving the ultrasonic waves of low output for image formation, a transmitting part 40 for treatment is provided for radiating the ultrasonic waves of a high energy density for medicine activation. A vibrator provided on the distal end of a catheter-like ultrasonic probe 10 is driven and controlled respectively by the transmitting/receiving part 32 for diagnosis in the case of diagnosis and by the transmitting part 40 for treatment in the case of treatment. The ultrasonic probe 10 is inserted into the body of a patient via the forceps channel of an endoscope. A diseased part is specified by ultrasonic image diagnosis and the ultrasonic waves of high power for medicine activation are radiated from the ultrasonic probe 10 to the diseased part. <P>COPYRIGHT: (C)2003,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a device for diagnosis and treatment using ultrasonic waves.

[0002]

2. Description of the Related Art Conventionally, as a method of diagnosing an initial cancer that has occurred in the digestive tract or the like, image diagnosis using an ultrasonic endoscope has been used. The ultrasonic endoscope is a broad-sense ultrasonic endoscope in which a catheter-shaped ultrasonic probe is provided on the optical endoscope, and a small-diameter ultrasonic endoscope designed to be inserted into the body cavity through the forceps port of the optical endoscope. There are catheter-shaped ultrasonic probes.
In any of these formats, the ultrasonic probe portion is generally constructed by rotatably inserting a torque wire having an ultrasonic transducer mounted on the side surface of the distal end portion into a catheter-shaped sheath tube. Then, the ultrasonic transducer is rotated by rotationally driving the torque wire. That is, an ultrasonic beam is emitted in the lateral direction of the sheath tube (that is, the radial direction) to perform radial scanning.

On the other hand, in recent years, studies have been conducted to treat cancer tissues by using a photoactive anticancer drug such as porphyrin. As an example thereof, there is already a method for guiding a laser fiber from a forceps port of an endoscope to irradiate a laser beam to a diseased part in the body to which an anticancer agent has been administered, and a device therefor.

Further, a method for activating a photosensitizing drug with ultrasonic waves is disclosed in Japanese Patent Laid-Open No. 08-245420 and Japanese Patent Laid-Open No. 11-504534. This method is for thrombolytic treatment, in which a photosensitizing drug is injected into a blood vessel, and the drug is activated only in the vicinity of the affected part by irradiating the affected part with ultrasonic waves instead of light. It suppresses the occurrence of side effects. In this conventional technique, a catheter-shaped ultrasonic probe having an ultrasonic transducer attached to its tip is inserted into a blood vessel and guided to the affected area, and ultrasonic waves are emitted from the oscillator toward the affected area.
Since the thrombus is located in front of the insertion direction when viewed from the catheter-shaped ultrasonic probe inserted into the blood vessel, the transducer is arranged so as to irradiate ultrasonic waves in the front direction of the catheter-shaped ultrasonic probe.

[0005]

The prior art of activating laser light with an optical laser fiber to activate an anti-cancer agent is as follows.
There were the following problems. First, since the irradiation spot of the laser beam is small and power control is not easy, it is difficult to uniformly irradiate the anticancer agent administration site having a certain width to activate the anticancer agent. Further, there is also a problem that the anticancer agent activating effect cannot be expected for the cancer tissue existing under the superficial mucosa which the laser beam does not reach. In addition, the affected area condition and the therapeutic effect can only be visually confirmed with an optical endoscope, and in order to know the affected area condition inside the surface layer, an ultrasonic probe or the like is inserted from the forceps port instead of the optical fiber for laser light irradiation. Work such as doing was necessary.

Further, Japanese Patent Laid-Open No. 08-245420 and Japanese Patent Publication No. 11-
Japanese Patent No. 504534 does not disclose a mechanism or a method for confirming a diseased part state and a therapeutic effect. Since the devices described in these publications are for treating blood vessels, they cannot be visually confirmed with an endoscope. Further, in this conventional technique, the ultrasonic generator does not include a mechanism for generating a tomographic image, and ultrasonic radiation is used exclusively for treatment.

The present invention has been made in view of the above problems, and an object of the present invention is to provide an apparatus capable of smoothly performing image diagnosis of an affected area and treatment by activating a drug.

[0008]

In order to achieve the above object, an ultrasonic diagnostic treatment apparatus according to the present invention includes an ultrasonic probe which is inserted into a body cavity and is capable of transmitting and receiving an ultrasonic beam, and the ultrasonic probe. A diagnostic control means for scanning an ultrasonic beam of a predetermined diagnostic power and generating a diagnostic image by an echo reception signal by this scanning, and a predetermined drug activation power higher than the diagnostic power for the ultrasonic probe. A treatment control unit for outputting an ultrasonic beam and a switching control unit for switching between the diagnosis control unit and the treatment control unit are provided.

In this configuration, by switching between the diagnostic control means and the therapeutic control means, it is possible to perform both image diagnosis and treatment by drug activation with one ultrasonic probe.

Further, an ultrasonic diagnostic treatment apparatus according to the present invention includes an endoscope device and a distal end portion of the endoscope device.
An ultrasonic probe capable of transmitting and receiving an ultrasonic beam; diagnostic control means for causing the ultrasonic probe to scan an ultrasonic beam of a predetermined diagnostic power; and a diagnostic control unit for generating a diagnostic image by an echo reception signal by this scanning; A therapeutic control means for outputting an ultrasonic beam of a predetermined drug activation power higher than the diagnostic power to the ultrasonic probe; a switching control means for switching between the diagnostic control means and the therapeutic control means; Equipped with.

With this configuration, it is possible to perform image diagnosis and treatment by drug activation with one ultrasonic probe, and by combining it with an endoscope, confirm the effect as soon as the treatment by ultrasonic irradiation is completed. It can be visually observed with an endoscope, and it can be monitored with an endoscope whether or not the ultrasonic probe is displaced from the affected area during ultrasonic irradiation.

[0012] In a preferred aspect of the present invention, the ultrasonic probe includes a probe shaft having an ultrasonic transducer mounted on a distal end portion thereof, and a sheath accommodating the probe shaft, and the probe shaft is rotated. Is capable of radial scanning with an ultrasonic beam, an opening is provided in the side surface of the distal end portion of the sheath, and the ultrasonic beam does not pass through the sheath when the output direction of the ultrasonic beam is in the range of the opening. It was output to.

According to this aspect, since the sheath is provided with the opening, the ultrasonic waves can reach the affected area without passing through the sheath at the time of ultrasonic wave irradiation for activating the drug, thereby wasting ultrasonic energy. It can be reduced.

In a further preferred aspect, the position of the opening is obtained based on the echo reception signal when the ultrasonic beam is radially scanned, and a guide display for adjusting the position of the opening is displayed together with the diagnostic image based on the information of the position of the opening. An aperture display means for displaying is provided.

In this aspect, a guide display related to the opening position (for example, a display showing the range of the opening and a therapeutic range by ultrasonic waves passing through the opening) is displayed together with the diagnostic image, so that the ultrasonic probe and the sheath can be displayed. It will help you to manipulate the to direct the opening to the affected area.

In another preferred aspect, the therapeutic control means obtains the position of the opening from the echo reception signal when the ultrasonic beam is radially scanned, and controls the rotation of the probe shaft, A direction adjusting means for adjusting the ultrasonic beam output direction to the calculated position of the opening is provided, and before the ultrasonic beam output period with the drug activation power is started, Positioning of the sound beam output direction is performed.

According to this structure, if the opening is directed toward the affected area, the output direction of the ultrasonic beam can be automatically adjusted in accordance with the opening, and the ultrasonic wave of the drug activation power is effectively applied to the affected area. Can be irradiated.

In a preferred aspect of the present invention, the treatment control means interrupts the output of the ultrasonic beam with the drug activation power at a predetermined timing even during the output period, and the direction adjusting means causes the ultrasonic beam to be output. The ultrasonic beam output direction is aligned with the aperture. It is possible to automatically calibrate the deviation from the opening of the vibrator during the output period.

In a further preferred aspect, at least a part of the periphery of the opening is provided with a marker having an ultrasonic reflectance higher than that of the sheath.

In this aspect, since the opening can be detected more clearly by providing the marker, the above-described guide display and beam direction alignment can be performed more accurately.

[0021] In still another preferred mode, an injection means for injecting a liquid into the sheath is provided, and the injected liquid is discharged from the opening.

In this aspect, the liquid injected into the sheath and discharged from the opening acts as an acoustic medium by being filled between the oscillator and the sheath, and also acts as a coolant for cooling the oscillator that has generated heat. .

In yet another preferred aspect, a sheath rotating mechanism for rotating the sheath is provided. In this aspect, the sheath can be rotated and the orientation of the opening can be adjusted.

[0024]

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.

[Outline] The ultrasonic diagnostic treatment apparatus of the present embodiment realizes image diagnosis using ultrasonic waves and activation of a drug using ultrasonic waves with one ultrasonic probe.

The ultrasonic diagnostic treatment apparatus of this embodiment has a mechanism for controlling the ultrasonic probe in two modes, a diagnostic mode and a therapeutic mode. In the diagnostic mode, the transducer is driven with a relatively low power for diagnostics (about several to several tens of mW) to transmit and receive ultrasonic waves to form a diagnostic image. In the treatment mode, the oscillator is driven with a strong power suitable for drug activation (for example, about 1 W, which is higher than the power at the time of diagnosis), and a strong ultrasonic wave is emitted to activate the drug accumulated in the affected part of the subject. . This realizes both diagnostic image generation and drug activation with one ultrasonic probe. Hereinafter, a detailed configuration of the device of the embodiment will be described.

[Device Configuration] First, the structure of the ultrasonic probe of the ultrasonic diagnostic treatment device of this embodiment will be described with reference to FIG. In FIG. 1, the forceps opening 2 of the endoscope distal end portion 22 is shown.
8 shows a state in which the tip of the ultrasonic probe 10 is projected from 8.

The ultrasonic probe 10 is constructed by inserting a probe shaft 14 having an ultrasonic transducer 16 mounted at its tip into a flexible sheath 12 made of resin or the like. The probe shaft 14 is made of, for example, a torque wire and is flexible, but the twist due to rotation is minimized. A signal cable connected to the ultrasonic transducer 16 passes through the probe shaft 14.

In this example, the ultrasonic transducer 16 has an ultrasonic wave transmitting / receiving surface as a side surface so as to transmit / receive an ultrasonic beam in the lateral direction of the ultrasonic probe 10 (that is, the direction perpendicular to the longitudinal direction of the probe 10). The probe shaft 14
It is attached to the tip. The sheath 12 has, for example, an outer diameter 2
The size of the ultrasonic transducer 16 is about 3 mm, and the ultrasonic wave transmitting / receiving surface of the ultrasonic transducer 16 is, for example, about 1 mm square.

An opening 12a is provided at the tip of the sheath 12. The opening 12a is provided at a position corresponding to the ultrasonic transducer 16 with the probe shaft 14 inserted up to the tip of the sheath 12. FIG. 2 is a diagram showing a state in which the opening 12a of the sheath 12 is viewed from the front. As shown in FIG. 2, the opening 12a has a sufficient size so that the entire ultrasonic wave transmitting / receiving surface of the ultrasonic transducer 16 is exposed to the outside (that is, not covered by the sheath 12). Thereby, in the state where the ultrasonic transducer 16 is aligned with the opening 12a, the ultrasonic wave emitted from the ultrasonic transducer 16 can be radiated to the outside without being attenuated by the sheath 12. In the treatment mode, ultrasonic waves are radiated with the opening 12a directed toward the diseased tissue 102 (see FIG. 1) of the body cavity wall 100 so that the energy of the ultrasonic waves can effectively reach the diseased tissue 102. ing. The shape of the opening 12a shown in FIG. 2 is an example, and basically the opening 12a 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 22 shown in FIG. 1 is a distal end portion of the insertion portion 21 extending from the endoscope operating portion 20. The illumination opening 24 and the observation opening 26 (see FIG. 1) of the endoscope distal end portion 22 are connected to the insertion portion 21 and the endoscope operation portion 20.
The light guides (optical fibers) for illumination passing therethrough and for observation and photographing 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 20a. In addition to the light guide, the insertion section 21 is provided with a forceps channel extending from the treatment instrument introducing section 20b to the forceps opening 28. The ultrasonic probe 10 of the present embodiment also passes through the forceps channel from the treatment instrument introducing portion 20b and projects from the forceps port 28.

The probe drive unit 10a includes a probe shaft 1
A motor for rotating the motor 4 and other rotating mechanisms are built-in. When the probe shaft 14 is rotated by this rotating mechanism, the ultrasonic transducer 16 provided at the tip is rotated, and radial scanning is realized. Probe driver 10a
Is connected to an ultrasonic diagnostic treatment apparatus main body (not shown) via a connection cord 10b, and rotationally drives the probe shaft 14 in accordance with a drive control signal from the main body. Also,
The signal cable connected to the ultrasonic transducer 16 is also connected to the main body through the inside of the connection cord 10b.

A sheath rotation operating portion 17 is provided near the probe driving portion 10a. The sheath rotation operating unit 17 is connected to the sheath 12, and the operator rotates the sheath rotation operating unit 17 to rotate the sheath 12. The sheath rotation operation portion 17 is for positioning the opening 12a at a desired rotation position.

A water injection tube 18 connected to a water injection mechanism (not shown) is connected to the probe driving section 10a. A liquid such as water or physiological saline is injected into the sheath 12 from the water injection mechanism via the water injection tube 18. This liquid injection is performed in order to remove the air from the inside of the sheath 12 (in particular, the front surface of the transducer) so that the ultrasonic waves are transmitted to the subject, and to cool the ultrasonic transducer 16.
The injected liquid is discharged from the opening 12a.

Next, the control mechanism of the apparatus of this embodiment will be described with reference to FIG. In the configuration shown in the figure, the other units except the ultrasonic probe 10 and the probe shaft rotation drive unit 42 are provided in the ultrasonic therapy diagnostic apparatus main body.

In this configuration, the ultrasonic probe 10
Are connected to the switch 30. The switch 30 is connected to the diagnostic transmission / reception section 32 and the therapeutic transmission section 40, and selectively switches both of them to the ultrasonic probe 10 under the control of the control section 46.

The diagnostic transmission / reception unit 32 has several mW to ten and several mW.
A drive signal of a diagnostic power of a certain degree is supplied to the ultrasonic probe 10 to excite the ultrasonic transducer 16, and the echo signal received by the ultrasonic transducer 16 is subjected to signal processing such as amplification, and the image forming unit 34. To enter. The image forming unit 34 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 36 and displayed on the display unit 38. The diagnostic transmission / reception unit 32, the image forming unit 34, the image memory unit 36, and the display unit 38 may have the same configuration as a general ultrasonic diagnostic apparatus.

The therapeutic transmitter 40 supplies the ultrasonic probe 10 with a drive signal having a power for activating the drug (eg, about 1 W) stronger than the diagnostic power to excite the ultrasonic transducer 16. On the other hand, the therapeutic transmitter 40 generates a drive signal for continuous wave transmission. By using a continuous wave, the energy density of the emitted ultrasonic waves can be increased. The frequency of ultrasonic waves for activating the drug is about 1 to several MHz. Of course, it is possible that the frequency of ultrasonic waves that are easily activated differs depending on the drug used, so it is also preferable to adopt a configuration in which the excitation frequency can be switched according to the drug.

The probe shaft rotation drive unit 42 is a mechanism for rotating the probe shaft 14, and is incorporated in the probe drive unit 10 a of the ultrasonic probe 10. The probe shaft rotation drive unit 42 is controlled by the control unit 46. In the diagnostic mode, radial scanning is realized by continuously rotating the probe shaft 14 at a predetermined rotation speed according to the image frame rate. Ultrasonic transducer 1 in treatment mode
The rotation of the probe shaft 14 is servo-controlled in order to align the ultrasonic wave transmitting / receiving surface of 6 in the direction of the opening 12a. The alignment process for the opening 12a will be described in detail later.

The aperture position detector 44 detects the position of the aperture 12a based on the echo reception signal acquired by the diagnostic transmitter / receiver 32 during the radial scanning. The detection of the opening position is performed based on the presence or absence of echo by the sheath 12. That is, during radial scanning, the direction of the ultrasonic beam is 1
Since there is no echo from the distance of the sheath 12 while it is within the range of 2a, for example, the sheath 12 in the echo reception signal is
It is possible to determine whether or not there is the opening 12a in the beam direction at that time by extracting the portion of the distance of with a gate and determining whether or not the level is higher than a predetermined threshold value. Information on the detected opening position is used for control when aligning the orientation of the ultrasonic transducer 16 with the opening 12a. Further, by superimposing and displaying the information of the opening position on the diagnostic image such as the B-mode tomographic image, it helps the operator when aligning the opening 12a itself toward the affected tissue.

The control unit 46 controls each unit of the present apparatus described so far in accordance with an operation instruction input by the operator from the operation unit 48, and causes an operation according to the instruction. The diagnosis mode and the treatment mode are also realized by the control of the control unit 46.

The water injection mechanism 50 is a mechanism for supplying a liquid such as water or physiological saline into the sheath 12. The supplied liquid is discharged from the opening 12a of the sheath 12.
By continuously supplying the liquid into the sheath 12 over the diagnostic mode and the treatment mode, an action as an acoustic medium and a cooling action of the ultrasonic transducer 16 are obtained, and
It is possible to prevent a substance outside the sheath 12 from flowing back into the sheath 12 through the opening 12a and prevent contamination of the ultrasonic transducer 16 and the like inside.

[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. In the following, a case of diagnosing and treating gastrointestinal cancer such as stomach and duodenum will be described as an example.

(1) Preparation For example, hematoporphyrin and its derivatives (so-called porphyrins) are known to accumulate in malignant tumors. For example, conventionally, 4 times after administration of hematoporphyrin.
After a lapse of a predetermined time such as 8 hours, an optical fiber was inserted into the stomach or the like, laser light was applied to the affected area to activate hematoporphyrin, and treatment was performed. In the present embodiment as well, similarly, a drug is administered to a patient in advance, and the timing when the drug accumulates in the affected area is estimated to execute diagnosis / treatment by the present device.

(2) Identification of Affected Area For diagnosis and treatment using the present apparatus, first, the target digestive tract is filled with water, physiological saline or the like, and then the insertion portion 21 of the endoscope is inserted from the mouth. Insert. Then, the affected area is visually identified through the optical system of the endoscope, the distal end portion of the ultrasonic probe 10 is brought close to the affected area, and the ultrasonic probe 10 is operated in the diagnostic mode to form a diagnostic image, indicate. From this diagnostic image, the operator can grasp not only the surface of the affected area but also the condition inside thereof, and can more accurately identify the affected area.

(3) Positioning of Sheath Opening When the affected area is specified by both the endoscope and the ultrasonic image in this way, the operator operates the sheath rotation operating section 17 to rotate the sheath 12 so that the opening 12a is affected. To face. The position of the opening 12a is adjusted by using an endoscope.
In addition to visually confirming the position of a, it can be performed while confirming the positional relationship between the opening 12a and the affected area on the diagnostic image of ultrasonic waves. That is, in the B-mode diagnostic image by radial scanning, the portion where the sheath 12 is present is displayed with high brightness, while the portion of the opening 12a has low brightness because there is no ultrasonic reflection, and the overall shape is "C". A sheath image 206 of is displayed. Therefore, the opening 12a can be aligned by operating the sheath rotation operating portion 17 to rotate the sheath 12 so that the open portion of the “C” -shaped cross section faces the affected area. Thus, in the case of an ultrasonic image, the affected area and the opening 12 are
Since it is easy to specify the relative positional relationship of a, the opening 12
The positioning of a can be performed.

In order to further facilitate the positioning of the opening 12a, the opening 12 is formed on the ultrasonic image as shown in FIG.
The opening position guide display 208 indicating a is displayed, and the rough treatment range in the treatment mode (effective range of drug activation)
It is also possible to display the treatment range guide display 210 indicating ".

Here, the exemplified opening position guide display 20 is shown.
Reference numeral 8 is a display showing both ends of the opening 12a. That is,
In the radial scanning, the beam direction at the time when the echo reception signal intensity at the distance of the sheath 12 passes a predetermined threshold value (threshold value for distinguishing the echo level of the sheath 12 from the echo level of the opening 12a) is set to the opening 12a. It is determined to be both ends of the image, and these are superimposed and displayed on the diagnostic image. Of course, the marker form of the illustrated opening position guide display 208 is an example, and other various display forms such as displaying the range of the opening 12a in color are conceivable. The opening position guide display 208 allows the operator to better understand the position and range of the opening 12a.

Also, an exemplary treatment range guide display 210.
Is a form of a broken line marker that encloses a treatment range assumed by ultrasonic irradiation in the treatment mode. This display is generated based on the detection result of the opening position. Of course, the display form of the treatment range guide display 210 is not limited to this.

According to such a display, for example, the affected tissue image 202 existing in the ultrasonic image surrounded by the normal tissue image 204 is located in front of the opening indicated by the opening position guide display 208 or in the treatment range guide display 210. By adjusting the position of the opening 12a by rotating the sheath 12 so that the opening 12a is included within the treatment range indicated by, the accurate alignment of the opening 12a can be performed.

When it is found that the ultrasonic transducer 16 is too far from the affected area by the treatment range guide display 210 or the like during this alignment, the ultrasonic wave is operated by operating the endoscope or the ultrasonic probe. The vibrator 16 can also be brought close to the affected area.

(4) Treatment by drug activation When the affected area is specified and the opening 12a is positioned with respect to the affected area, the operator switches the mode of the apparatus to the treatment mode by the operating section 48. When switched to the treatment mode, the control unit 46 controls the probe shaft rotation drive unit 42 to bring the ultrasonic beam from the ultrasonic transducer 16 toward the affected area, and in that state, fixes the probe shaft 14. In the alignment of the ultrasonic transducer 16, for example, the ultrasonic beam of diagnostic power is transmitted and received while rotating the probe shaft 14. The position of the opening 12a is determined by the opening position detection unit 44 from the echo reception signal at this time, and the ultrasonic transducer 16 is stopped at a position corresponding to approximately the center of the opening 12a. This control can be realized by using a servo mechanism. In this alignment, if the rotation speed of the probe shaft 14 is slower than that in the diagnostic image generation, alignment can be performed more easily and with high accuracy.

When the ultrasonic transducer 16 is aligned with the opening 12a, the controller 46 causes the switch 30 to move to the therapeutic transmitter 4.
Switching to 0, the ultrasonic transducer 16 is driven by the drive signal of the drug activation power. As a result, when the ultrasonic waves of about 1 W and several MHz emitted from the ultrasonic transducer 16 are applied to the affected tissue, the same drug activation action as that obtained when the laser light is applied is obtained. This one-time treatment period by activating the drug is performed over a predetermined time such as several tens of minutes.

(5) Confirmation of treatment effect When one treatment period is completed, the operator can switch the apparatus to the diagnosis mode to form a diagnosis image of the affected area. From this diagnostic image, it is possible to judge the therapeutic effect by confirming the condition of tumor atrophy and tissue degeneration due to the action of the drug. If the therapeutic effect is not sufficient, the therapeutic period is again conducted by ultrasonic irradiation of drug activation power, and the therapeutic effect is confirmed in the diagnostic mode. In this way, the treatment period and the confirmation of the treatment effect can be repeated until it is determined that the sufficient treatment effect is obtained. The therapeutic effect on the tissue surface can also be confirmed by visual confirmation with an endoscope.

Although a series of work procedures have been described above, the ultrasonic transducer 16 may be displaced from the direction of the opening during long-term treatment. Therefore, for example, one treatment period is divided into a plurality of sections, and the ultrasonic transducer 16 is aligned in the same manner as when the treatment mode is started by the control of the control unit 46 every time the ultrasonic irradiation of one section ends. By so doing, it is possible to suppress a decrease in treatment efficiency due to the displacement of the ultrasonic transducer 16.

In addition, when the patient or the movement of the digestive tract, the opening 1
2a and the ultrasonic probe 10 themselves may be displaced or separated from the affected area during the treatment mode. Such an event may occur, for example, when the operator monitors the endoscopic image during the treatment mode and finds a deviation of the opening 12a, etc., adjusts the position of the opening 12a under endoscopic observation, or switches to the diagnostic mode. This can be solved by switching and adjusting the position of the opening 12a while viewing the ultrasonic image.

When the treatment mode (4) is repeatedly executed a plurality of times while the endoscope is inserted into the patient's body, a diagnostic image generated for confirming the effect before the treatment and between the treatment modes. By storing this in the device and displaying it in chronological order in this device, it is possible to display in an easy-to-understand manner how the affected tissue changes as the treatment progresses.

The preferred embodiment of the present invention has been described above. As can be seen from this description, the device of the present embodiment is
In addition to the diagnostic transmission / reception unit 32 for forming a diagnostic image, a therapeutic transmission unit 40 for emitting ultrasonic waves of high energy density for drug activation is provided. Both activation treatments can be given. Since the ultrasonic probe 10 can be diagnosed and treated without removing it from the body, the transition from the identification of the affected area to the treatment and the transition from the treatment to the confirmation of the treatment effect can be performed smoothly. In addition, since ultrasonic waves have a greater reachable depth than laser light, it is possible to treat deeper areas than conventional drug activation treatment methods using laser light.

Further, in this embodiment, the ultrasonic probe 10 and the sheath opening 12a during the ultrasonic irradiation treatment are used by using the optical endoscope and the ultrasonic diagnostic treatment apparatus in combination.
The position shift of can be monitored with an endoscope, and it is possible to quickly deal with it.

In this embodiment, the opening 1 is formed in the sheath 12.
By providing 2a, the following various effects can be obtained.

First, since the ultrasonic waves are not blocked by the sheath 12 at the opening 12a, the ultrasonic energy in the treatment mode can be efficiently transmitted to the affected area by directing the opening 12a toward the affected area.

Further, from the water injection mechanism 50 to the ultrasonic probe 1
The cooling effect of the ultrasonic transducer 16 can be enhanced by discharging the liquid injected into the zero through the opening 12a. In particular, when high power for drug activation is used as in the present embodiment, the heat generation of the ultrasonic vibrator 16 can be a serious problem, but in the configuration of the present embodiment, the ultrasonic vibrator 1 is used.
A new cooling liquid (which is of course also an acoustic medium) can be supplied to 6 and a high cooling effect can be obtained.

Further, the opening 12a can be used as a reference for positioning the ultrasonic transducer 16 in the treatment mode, whereby the ultrasonic transducer 16 can be automatically positioned as described above. For this, of course, opening 1
Although it is necessary to position 2a toward the affected part, this can be performed relatively easily by hand while watching the diagnostic image as described above.

By providing the opening 12a with a marker made of a material such as metal that reflects ultrasonic waves better than the sheath 12, the opening position detection section 44 can more reliably determine the opening position. The marker is, for example, the opening 1
It may be provided in the form of an edge surrounding the periphery of 2a.

The embodiment described above is only one aspect of the present invention, and various modifications can be made within the scope of the technical idea of the present invention.

[0066]

As described above, according to the present invention,
Both ultrasound and drug activated therapy can be performed with one ultrasound probe. Further, in the present invention, by providing the opening at the tip of the sheath of the probe, it is possible to obtain effects such as improvement of ultrasonic irradiation efficiency and automation of positioning of the transducer during treatment.

[Brief description of drawings]

FIG. 1 is a diagram showing a configuration of a tip portion of an ultrasonic probe of an ultrasonic diagnostic treatment apparatus according to an embodiment.

FIG. 2 is a diagram showing a state in which an opening of a sheath 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 ultrasonic image obtained by radial scanning.

[Explanation of symbols]

10 ultrasonic probe, 12 sheath, 12a opening,
14 probe shaft, 16 ultrasonic transducer, 22 endoscope tip portion, 28 forceps port, 30 switching device, 32 diagnostic transceiver, 34 image forming unit, 36 image memory unit, 38
Display unit, 40 therapeutic transmission unit, 42 probe shaft rotation drive unit, 44 opening position detection unit, 46 control unit, 48 operation unit, 50 water injection mechanism.

   ─────────────────────────────────────────────────── ─── Continued front page    F-term (reference) 4C060 JJ11 JJ12 JJ13 JJ27 MM24                 4C061 HH51 WW16                 4C301 BB03 BB30 CC02 EE12 EE13                       FF04 FF14 FF21 GA01 GA06                       GA14 GC02 GC22 JC16                 4C601 BB05 BB09 BB12 BB14 BB24                       EE10 EE11 FE01 FF11 GA01                       GA06 GA11 GA14 GC01 GC02                       GC21 GC22 JC15 JC20 KK12

Claims (9)

[Claims] 1. An ultrasonic probe which is inserted into a body cavity and is capable of transmitting and receiving an ultrasonic beam; and an ultrasonic beam of a predetermined diagnostic power which is scanned by the ultrasonic probe, and a diagnostic image is obtained by an echo reception signal by this scanning. A diagnostic control means for generating the ultrasonic probe, a therapeutic control means for causing the ultrasonic probe to output an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power, the diagnostic control means, and the therapeutic control An ultrasonic diagnostic treatment apparatus, comprising: switching control means for switching the means. 2. An endoscope apparatus, an ultrasonic probe projecting from a distal end portion of the endoscope apparatus and capable of transmitting and receiving an ultrasonic beam, and scanning the ultrasonic probe with an ultrasonic beam having a predetermined diagnostic power. And a diagnostic control means for generating a diagnostic image by an echo reception signal by this scanning, and a therapeutic control means for causing the ultrasonic probe to output an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power. An ultrasonic diagnostic treatment apparatus comprising: a switching control unit for switching between the diagnostic control unit and the therapeutic control unit. 3. The ultrasonic probe includes a probe shaft having an ultrasonic transducer attached to a tip portion thereof, and a sheath that accommodates the probe shaft, and the ultrasonic beam is radially rotated by rotating the probe shaft. It is capable of scanning, and an opening is provided on the side surface of the distal end portion of the sheath, and the ultrasonic beam is output without passing through the sheath when the output direction of the ultrasonic beam is within the range of the opening. The ultrasonic diagnostic treatment apparatus according to claim 1 or 2. 4. An aperture display means for obtaining the position of the opening from an echo reception signal when the ultrasonic beam is radially scanned and displaying a guide display for adjusting the aperture position together with the diagnostic image based on the information of the opening position. The ultrasonic diagnostic treatment apparatus according to claim 3, further comprising: 5. The treatment control means obtains the position of the opening from an echo reception signal when the ultrasonic beam is radially scanned, and controls the rotation of the probe shaft to obtain the position of the opening. And an alignment means for aligning the output direction of the ultrasonic beam, the alignment of the output direction of the ultrasonic beam by the alignment means before starting the output period of the ultrasonic beam with the drug activation power. The ultrasonic diagnostic treatment apparatus according to claim 3, wherein 6. The therapeutic control means interrupts the output of the ultrasonic beam with the drug activation power at a predetermined timing even during the output period, and the direction adjusting means causes the ultrasonic beam to be directed to the opening. The ultrasonic diagnostic treatment apparatus according to claim 5, wherein alignment in the output direction is performed. 7. The ultrasonic diagnostic treatment apparatus according to claim 3, wherein a marker having an ultrasonic reflectance higher than that of the sheath is provided on at least a part of the periphery of the opening. 8. The ultrasonic diagnostic treatment apparatus according to claim 3, further comprising injection means for injecting a liquid into the sheath, wherein the injected liquid is discharged from the opening. 9. The ultrasonic diagnostic treatment apparatus according to claim 3, further comprising a sheath rotation mechanism that rotates the sheath.