JP2010000307A - Endoscope and ultrasonic probe - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endoscope retaining a treatment instrument or the distal end of an ultrasonic probe in a predetermined projecting state by suppressing the treatment instrument or the ultrasonic probe inserted in a treatment instrument channel provided at an insertion section of the endoscope, from freely advancing/retracting in the axial direction of the treatment instrument channel or freely rotating about the axis. <P>SOLUTION: This endoscope 1 is provided with a plurality of treatment instrument insertion channels 12 and 15 in which the treatment instrument is inserted, in the interior of the endoscope insertion section 2. The first treatment instrument insertion channel 12 has a fixing portion that suppresses the axial rotation of the ultrasonic probe 40 inserted into the treatment instrument insertion channel 12 and its advancement in the treatment instrument insertion channel. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an endoscope including a plurality of treatment instrument channels, and an ultrasonic probe inserted into at least one of the plurality of treatment instrument channels.

  Conventionally, an elongated insertion portion is inserted into the body, and an internal organ or the like is displayed on a monitor screen by using an imaging device provided with a solid-state imaging device provided at the distal end of the insertion portion, for examination or treatment. Endoscopes that can be used are widely used. When in-vivo examination or the like is performed with this endoscope, a biopsy forceps is introduced into the body through a treatment instrument channel provided in the endoscope, and a living tissue is collected. In recent years, an endoscope including a plurality of treatment instrument channels is used for examination or treatment.

The ultrasonic probe can be used by being connected to an ultrasonic diagnostic apparatus, and can be inserted into a treatment instrument channel of an endoscope. The ultrasonic probe repeatedly transmits an ultrasonic pulse from the ultrasonic transducer provided in the transducer section into the living tissue, and the echo signal of the ultrasonic pulse reflected from the living tissue is provided in the same or different body. Receive with an ultrasonic transducer. The echo signal received by the ultrasonic transducer is constructed by, for example, an ultrasonic tomographic image, which is a two-dimensional visible image, and displayed on the screen of the display device. For example, Patent Document 1 discloses an endoscope that easily recognizes the positional relationship between an ultrasonic tomographic image obtained by an ultrasonic probe inserted into a treatment instrument channel and an endoscopic image. In FIG. 17 and FIG. 18 of Patent Document 1, a groove is provided in the probe sheath of the ultrasonic probe so that the ultrasonic probe does not rotate with respect to the endoscope, and a protrusion that fits into the groove on the distal end cover of the endoscope The structure in which the part is formed is shown. According to this configuration, when the endoscope is twisted to bring the ultrasonic probe into contact with the affected part, the ultrasonic probe follows the torsional motion of the endoscope well, and the operability is improved.
Japanese Patent Laid-Open No. 7-116166

  However, in the endoscope of Patent Document 1, the ultrasonic probe is movable forward and backward with respect to the axial direction of the endoscope. Therefore, when an ultrasonic tomographic image necessary for examination and treatment is displayed by bringing the transducer part of the ultrasonic probe into close contact with the body wall, the ultrasonic probe is retracted to obtain a stable ultrasonic image. It was difficult.

  The present invention has been made in view of the above circumstances, and the treatment instrument inserted into the treatment instrument channel provided in the insertion portion of the endoscope can freely advance and retreat in the axial direction of the treatment instrument channel and can be freely pivoted. An object of the present invention is to provide an endoscope that keeps the distal end portion of the treatment tool in a predetermined protruding state while suppressing rotation around.

  The endoscope of the present invention includes a plurality of treatment instrument insertion passages, and at least one treatment instrument insertion passage includes a fixing portion that suppresses rotation and advancement around the axis of the treatment instrument or ultrasonic probe to be inserted. Yes.

  According to the present invention, it is possible to prevent the treatment instrument inserted through the treatment instrument channel provided in the insertion portion of the endoscope from freely moving back and forth in the axial direction of the treatment instrument channel and freely rotating around the axis. Thus, an endoscope that holds the distal end portion of the treatment instrument in a predetermined protruding state can be realized.

  Embodiments of the present invention will be described below with reference to the drawings.

  1 to 17 relate to an embodiment of the present invention, FIG. 1 is a diagram illustrating the configuration of an endoscope system, FIG. 2 is a diagram illustrating the configuration of the distal end surface of the endoscope, and FIG. 3 is FIG. 4 is a cross-sectional view taken along line AA of FIG. 4, FIG. 4 is a view for explaining holes provided in the first channel base in the cross section taken along line BB in FIG. 3, and FIG. FIG. 6 is a diagram for explaining the holes provided in the first channel cap in the cross section taken along the line DD in FIG. 3, and FIGS. 7A, 7B, 7C, and 7D exemplify fixing portions. FIG. 8 is a diagram for explaining the ultrasonic probe, FIG. 9 is a diagram for explaining the outer shape of the engaging portion provided in the rigid portion at the EE line position in FIG. 8, and FIG. 10 is a position at the FF line in FIG. FIG. 11 is a perspective view for explaining the vibrator portion, and FIG. 12 is a strain view for explaining the outer shape of the engaging portion provided in the rigid portion. FIG. 13 is a diagram for explaining the relationship between the transducer unit and the operation wire in the bent state, FIG. 13 is a diagram for explaining the relationship between the transducer unit in the bent state and the operation wire, and FIG. FIG. 15 is a front view of the endoscope in which the treatment portion of the ultrasonic probe protrudes from the first treatment instrument insertion path, and FIG. 16 is a diagram of the endoscope system. FIG. 17 is a diagram for explaining the operation, and FIG. 17 is a diagram for explaining a state in which an ultrasonic probe having another configuration is disposed in the first treatment instrument insertion path of the endoscope.

  As shown in FIG. 1, an endoscope system 60 according to the present embodiment includes an endoscope 1 and an ultrasonic probe 40.

  Although the endoscope 1 will be described with reference to FIGS. 1 to 6, the endoscope to which the ultrasonic probe of the present invention is applied is not limited to the following configuration.

  An endoscope 1 shown in FIG. 1 includes an endoscope insertion portion 2 to be inserted into the body, an operation portion 3 provided on the proximal end side of the endoscope insertion portion 2, and an extension from the operation portion 3. And a universal cord 4 to be configured. An endoscope connector 5 is provided at the base end portion of the universal cord 4.

  The endoscope insertion portion 2 includes, in order from the distal end side, a hard distal end portion 2a, for example, a curved portion 2b that can be bent in the vertical and horizontal directions, and a long flexible endoscope flexible tube portion 2c. It is configured. The operation unit 3 also serves as a gripping unit. The operation unit 3 includes an up / down bending knob 3a for bending the bending portion 2b in the vertical direction, a left / right bending knob 3b for bending in the left / right direction, an air / water supply button 3c, and a suction button 3d. And a plurality of remote buttons 3e for instructing drive control and the like of the imaging device (see reference numeral 20 in FIG. 3) built in the distal end portion 2a.

  In addition, the operation section 3 is provided with treatment instrument insertion ports 3f and 3g that constitute base ends of a plurality of treatment instrument insertion passages (see reference numerals 12 and 15 in FIG. 3) described later.

  2, the observation window 22 of the objective optical unit 21 constituting the imaging device 20, for example, the illumination window 31 of the two illumination units 30, the air / water supply nozzle 32, and the second end surface 2d of the endoscope insertion portion 2 shown in FIG. A first tip opening 33 and a second tip opening 34 are provided.

  The opening portion of the first treatment instrument insertion passage is the first distal end opening 33, and the opening portion of the second treatment instrument insertion passage is the second distal opening 34.

  The bending portion 2b of the endoscope insertion portion 2 shown in FIG. 3 is configured by connecting a plurality of annular bending pieces 6 in a freely rotatable manner. The outer periphery of the plurality of bending pieces 6 is covered with a bending blade 7 formed in a tubular shape by weaving a thin wire or the like, and the outer periphery of the bending blade 7 is covered with a bending rubber 8 for ensuring watertightness. .

  For example, four wire guards (not shown) are provided on the inner peripheral surface of the bending piece 6 around the insertion portion axis at, for example, approximately 90 ° intervals, and bending operation wires (not shown) are inserted into the wire guards, respectively. ing. The distal end portion of each bending wire is fixed to the distal bending piece 6f.

  Each bending wire passes through a wire guard fixed to the bending piece 6 and extends into the operation unit 3, and its base end portion is connected to a bending operation mechanism unit (not shown) connected to the bending knobs 3 a and 3 b. Each is fixed.

  The distal end portion 2 a of the endoscope insertion portion 2 is mainly composed of the distal end rigid portion 11 and the distal end cover portion 18. The distal end hard portion 11 is formed in a cylindrical shape with a hard metal member such as stainless steel. A distal end cover portion 18 is fixed to the distal end side surface of the distal end hard portion 11, and a distal end bending piece 6f is fixed to the outer periphery of the proximal end portion.

  The distal end hard portion 11 is formed with a plurality of through holes 11a, 11b, and 11c having a center line parallel to the center axis of the distal end hard portion 11. The first through-hole 11a is, for example, a through-hole constituting the first treatment instrument insertion passage 12, and the first channel cap 13 is fixed thereto. A distal end portion of a flexible first channel tube 14 constituting the first treatment instrument insertion passage 12 is fixed to the proximal end portion of the first channel base 13. The 2nd through-hole 11b is a through-hole which comprises the 2nd treatment instrument insertion path 15, Comprising: The 2nd channel cap 16 is fixedly provided. A distal end portion of a flexible second channel tube 17 constituting the second treatment instrument insertion passage 15 is fixed to the proximal end portion of the second channel base 16.

  The third through hole 11c is a through hole for disposing the imaging device 20. The imaging device 20 includes an objective optical unit 21 and an imaging unit 23, and the objective optical unit 21 is fixed in the third through hole 11c. Reference numeral 24 denotes a signal cable that extends from the imaging unit 23 that constitutes the imaging device 20.

The imaging device 20 includes an imaging element that converts an optical image formed on the light receiving surface into an electrical signal.
In addition to the through holes 11a, 11b, and 11c, the distal end hard portion 11 has a through hole (not shown) constituting an air / water supply channel for supplying a liquid or gas to the air / water supply nozzle 32, or an illumination unit. A through hole (not shown) or the like for disposing 30 is formed.

  The tip cover portion 18 has a cylindrical shape, and a plurality of communication holes 18b, 18c, or 18d that respectively communicate with the through holes 11a, 11b, or 11c are formed in the bottom portion 18a. The first communication hole 18 b constitutes the first distal end opening 33 of the first treatment instrument insertion path 12. The second communication hole 18 c constitutes the second distal end opening 34 of the second treatment instrument insertion passage 15. The distal end portion of the objective optical unit 21 is disposed in the third communication hole 18d. The tip portion of the illumination unit 30 is disposed in a fourth communication hole and a fifth communication hole (not shown). An air / water supply nozzle 32 is disposed in the sixth communication hole.

  Various treatment instruments or ultrasonic probes can be inserted into both the first treatment instrument insertion path 12 and the second treatment instrument insertion path 15, but the first treatment instrument insertion path 12 is provided around the axis of the ultrasonic probe. A fixing portion that suppresses rotation and forward movement is provided.

  In the present invention, the fixing portion is not particularly limited as long as it suppresses the rotation and advance around the axis of the treatment instrument or the ultrasonic probe. As a method for realizing the function of the fixing portion, for example, a method (I) of narrowing the treatment instrument insertion passage toward the distal end, a method (II) of increasing the friction coefficient of the distal end of the treatment instrument insertion passage, or at least the insertion passage The method (III) etc. which provide the location which clamps the inserted treatment tool or ultrasonic probe in a part are mentioned. The methods (I) to (III) can be used in combination.

  Further, as a method for more effectively suppressing the rotation around the axis, the shape of the fixing portion and the shape of at least a part of the rigid portion of the treatment instrument or ultrasonic probe inserted through the treatment instrument insertion path are fitted to each other. A method of combining them into a non-cylindrical shape is mentioned. Details of the non-cylindrical shape will be described later.

The fixing part illustrated in FIGS. 2 to 3 is a combination of the above-described method (I) with a non-cylindrical shape. The first channel cap 13 fixed to the through hole 11a is formed with a hole 13a constituting a fixed portion. The base end side cross-sectional shape of the hole 13a is a circular round hole 19a as shown in FIG. On the other hand, as shown in FIG. 5, the tip side cross-sectional shape of the hole 13a provided in the first channel cap 13 is, for example, a pentagonal shape that is at least inscribed in the circle of FIG. An endoscope side fitting portion 19b is configured to suppress the rotation of the 40 around the probe longitudinal axis. As shown in FIG. 6, the cross-sectional shape of the intermediate portion of the hole 13a provided in the first channel cap 13 is configured as a pentagonal columnar transition hole 19c that fits within the circle of FIG.
The hole 13a of the first channel cap 13 is configured to gradually narrow and deform from the round hole 19a on the proximal end side toward the distal end side to be a pentagonal square hole at the distal end.

  In the present embodiment, the first channel cap 13 disposed in the first through hole 11a is disposed in a predetermined positional relationship with respect to the second through hole 11b. Specifically, when the first through-hole 11a is disposed in the first channel base 13, the first channel base is extended from one vertex 19d of the fixing portion 19b of the first channel base 13 shown in FIG. The imaginary line extension line 19L of the imaginary line 19f passing through the center 13C defines the arrangement position of the first channel cap 13 so as to pass through the center 11C of the second through hole 11b as shown in FIG. . Reference numeral 19g denotes a transducer part defining surface.

  Note that the fixing portion 19b is not limited to a pentagonal prism shape. The shape of the fixed part is preferably a non-true cylindrical shape that suppresses rotation. Examples of the non-true cylindrical shape include an elliptical column shape illustrated in FIG. 7A, a cashew nut column shape illustrated in FIG. 7B, and a semi-cylindrical shape illustrated in FIG. 7C. When the shape of a column made of a curve is adopted as the shape of the fixed portion, there is an advantage that the cleaning property is improved. In addition, when a cross-sectional shape such as a cashew nut pillar shape or a semi-cylindrical shape is employed, or when at least one side illustrated in FIG. 7D is different in length from the other side. When the polygonal column shape is adopted, there is an advantage that the orientation of the distal end of the treatment instrument or the ultrasonic probe with respect to the distal end portion of the endoscope when the treatment instrument or the ultrasonic probe protrudes can be physically determined.

The ultrasonic probe 40 will be described with reference to FIGS.
As shown in FIG. 1, the ultrasonic probe 40 includes a probe insertion portion 41 inserted into the first treatment instrument insertion passage 12, a probe operation portion 42 provided on the proximal end side of the probe insertion portion 41, A probe cord 43 extending from the probe operation unit 42 is provided.

  A probe connector 44 is provided at the proximal end portion of the probe cord 43 and can be detachably connected to the connector portion 45 a of the ultrasonic observation apparatus 45. The probe operation section 42 is provided with a holding section 42h that is fixed to the first treatment instrument insertion port 3f. By engaging the holding portion 42h of the ultrasonic probe 40 into the first treatment instrument insertion port 3f, the probe operation unit 42 is integrally fixed to the first treatment instrument insertion port 3f.

  As shown in FIG. 8, the probe operation unit 42 is provided with a slide lever 42 a to which a first operation wire 46 is connected. The slide lever 42a includes a slide portion 42b to which the second operation wire 47 is connected.

  The slide lever 42a is provided in a slide groove 42d elongated in the longitudinal axis direction provided in the probe operation section 42, and slides in the longitudinal axis direction.

  The slide portion 42b is disposed in the slide lever 42a and is configured to slide with respect to the longitudinal axis direction of the slide lever 42a. Reference numeral 42c denotes an urging member that urges the slide portion 42b and arranges the slide portion 42b at a predetermined position in the slide lever 42a.

  In the present embodiment, the urging member 42 c is a coil spring and urges the slide portion 42 b toward the probe insertion portion 41. Therefore, when the slide lever 42a is moved from the position indicated by the solid line to the probe cord 43 side as indicated by the arrow, the slide lever 42a and the slide portion 42b move integrally as indicated by the broken line. Accordingly, the first operation wire 46 and the second operation wire 47 are pulled with the movement of the slide lever 42a and the slide portion 42b.

  The slide portion 42b is provided with a knob (not shown). This knob protrudes from a long hole (not shown) parallel to the longitudinal axis formed on one side surface of the slide lever 42a, for example. By operating the knob 42a and moving the slide portion 42b toward the probe cord 43 against the urging force of the urging member 42c, the slide portion 42b moves relative to the slide lever 42a, and the second operation The wire 47 is pulled.

  The probe insertion portion 41 is configured by connecting a transducer portion 48, a rigid portion 49, and a probe flexible tube portion 50. Ultrasonic waves are transmitted from the transducer unit 48. The rigid portion 49 is provided with an engaging portion 51 for engaging with the hole 13a. On the distal end side of the engaging portion 51, there is a probe-side fitting portion 52 formed in a shape to be fitted to the fixed portion 19b. In the present embodiment, the outer shape of the probe-side fitting portion 52 is formed as a pentagonal fixing portion 52a as shown in FIG.

  On the other hand, the proximal end side of the engaging portion 51 is formed as a circular tube portion 52b as shown in FIG. The circle forming the tube portion 52b is formed larger than the fixed portion 52a so as to circumscribe at least the fixed portion 52a. And between the pipe part 52b and the fixing | fixed part 52a, it forms as the transition part 52c which engages in the transition hole 19c.

That is, the rigid portion 49 provided in the probe insertion portion 41 constituting the ultrasonic probe 40 is provided with the engaging portion 51 including the fixing portion 52a, the tube portion 52b, and the transition portion 52c. The engaging portion 51 has a circular base end portion and gradually narrows toward the distal end side, and has a pentagonal fixing portion 52a at the distal end portion. One plane indicated by reference numeral 52d of the fixing portion 52a is the same as that of the transducer portion 48. It is a defining surface 52d that defines the arrangement position.

  8, 11, and 12 rotate so that the angle between the rigid portion 49 and the vibrator portion 48 changes from the straight state to the bent state shown in FIG. 13. The tip of the part 49 is rotatably attached.

  Specifically, the guide pin 54 protrudes and is fixed to the upper part of the base end side of the pair of long side surfaces 48 a that rises from the ultrasonic transmission / reception unit 53 of the transducer unit 48 and is parallel to the longitudinal axis of the transducer unit 48. Yes.

  In addition, a notch recess 48 c serving as a cable outlet is provided on the upper surface 48 b of the transducer unit 48 facing the ultrasonic transmission / reception unit 53. A plurality of signal lines connected to a plurality of ultrasonic transducers (not shown) constituting the ultrasonic transmission / reception unit 53 of the transducer unit 48 are inserted into the signal cable 55 extending from the cutout recess 48c. . The upper surface 48b of the vibrator unit 48 is disposed in parallel to the defining surface 52d.

  A central portion of the upper surface 48b of the vibrator portion 48 is configured as a first fixing portion 48d to which the first operation wire 46 is fixed. The second operation wire 47 is fixed to the upper part of the proximal side short side surface 48e, which is one of the short side surfaces that rise from the ultrasonic wave transmitting / receiving unit 53 of the transducer unit 48 and intersect the longitudinal axis. The second fixing portion 48f is configured. The wires 46 and 47 are fixed to the vibrator portion 48 by adhesion, for example.

  A guide groove 49a in which a guide pin 54 provided in the vibrator portion 48 is slidably disposed is formed on the inner surface of the rigid portion 49 constituting the ultrasonic probe 40. On the leading end side of the guide groove 49a, there is provided a lock groove 49b that locks the guide pin 54 and is narrower than the width of the guide groove 49a.

  The signal cable 55 extending from the notch recess 48 c of the transducer part 48 is guided into the probe connector 44 through the probe insertion part 41, the probe operation part 42, and the probe cord 43.

  Note that the bundle of signal lines led out from the signal cable 55 is sealed in a watertight and airtight manner by a flexible rubber sheet film in the cutout recess 48c.

  The first operation wire extending from the center of the upper surface of the vibrator portion 48 and fixed to the slide lever 42a is in a fully extended state when the upper surface 48b of the vibrator portion 48 is parallel to the longitudinal axis. . At this time, the slide lever 42 a is located on the distal end side of the probe operation unit 42.

  On the other hand, the second operation wire 47 extending from the proximal side short side surface upper portion of the vibrator portion 48 and fixed to the slide portion 42b is slightly loosened.

Here, the operation of the probe operation unit 42 constituting the ultrasonic probe 40 will be described.
When the user bends the straight vibrator portion 48, the user moves the slide lever 42a in the direction of the arrow as shown by the broken line as shown by the solid line in FIG. Then, along with the movement of the slide lever 42a, the slide portion 42b is also moved, and the first operation wire 46 and the second operation wire 47 are pulled. Then, the guide pin 54 fixed to the vibrator portion 48 is moved downward in the drawing along the guide groove 49a by the pulling force of the first operation wire 46, and the upper surface 48b of the vibrator portion 48 is gradually inclined. To go. Further, the slack of the second operation wire 47 is gradually removed.

  When the slide lever 42a comes into contact with the proximal end wall 42e of the slide groove 42d, the first operation wire 46 and the second operation wire 47 are fully extended, and the rotation of the vibrator unit 48 is stopped. . At this time, the upper surface 48b of the vibrator portion 48 and the defining surface 52d of the hard portion 49 are bent substantially orthogonally. At this time, the guide pin 54 is engaged with the locking groove 49b and holds the vibrator portion 48 in a bent state. That is, the guide pin 54 and the locking groove 49 b constitute a locking portion that holds a bent state in which the upper surface 48 b of the vibrator portion 48 and the defining surface 52 d of the rigid portion 49 are orthogonal to each other.

  For example, the slide lever 42a is provided with a latching portion that protrudes by being biased by a spring, for example, and the latching portion is disposed in the latching hole by the biasing force substantially simultaneously with the slide lever 42a contacting the base end wall 42e. The slide lever 42a may be held by the probe operation unit 42.

  When the bent vibrator portion 48 is set to the original state shown in FIG. 8, the user moves the slide portion 42b in the direction of the arrow against the urging force of the urging member 42c. Then, as the slide portion 42b moves, the second operation wire 47 is pulled, and the guide pin 54 provided on the vibrator portion 48 moves toward the guide groove 49a against the engaging input of the locking groove 49b. Is done.

  Thereafter, the user moves the slide lever 42a toward the probe insertion portion 41. Then, along with the movement of the slide lever 42a, the slide part 42b is also moved, so that the first operation wire 46 and the second operation wire 47 are pushed out, and the vibrator part 48 is returned to the original state of FIG. Return.

The ultrasonic observation device 45 receives the drive control of a plurality of ultrasonic transducers arranged in the transducer unit 48 of the ultrasonic probe 40 and the echo signals output from these ultrasonic transducers. The ultrasonic tomographic image data for displaying the ultrasonic tomographic image is constructed. When the ultrasonic tomographic image data constructed by the ultrasonic observation device 45 is output to a display device (not shown), the ultrasonic tomographic image is displayed on the screen of the display device.
Further, the rotatable vibrator portion 48 prevents the ultrasonic probe 40 from moving backward in the bent state.

  The operation of the endoscope system 60 including the endoscope 1 and the ultrasonic probe 40 configured as described above will be described.

  In recent years, the endoscope system 60 of the present embodiment forms an opening on the wall surface of a luminal organ while observing an image by an endoscope introduced into the luminal organ through a natural opening such as an oral cavity and an anus. It can be used for a so-called NOTES procedure (Natural Orifice Translumenal Endoscopic Surgery) in which the endoscope is introduced into the abdominal cavity or the like through the opening to observe or treat the abdominal organ.

  Here, a procedure for introducing the endoscope 1 into the stomach and performing puncture into the jejunum via the stomach wall under the ultrasound endoscope guide by the transducer unit 48 provided in the ultrasound probe 40 will be described.

  First, the user displays an endoscopic image on a display device (not shown), and introduces the endoscope insertion portion 2 of the endoscope 1 from the oral cavity to the vicinity of the target site in the stomach.

  Next, the user inserts the probe insertion portion 41 of the ultrasonic probe 40 into the first treatment instrument insertion port 3 f and advances the transducer portion 48 toward the first distal end opening 33. Then, the vibrator portion 48 of the probe insertion portion 41 is guided into the hole 13 a of the first channel base 13.

  Thereafter, the position of the slide lever 42a provided in the probe operation unit 42 is confirmed, and the probe insertion unit 41 is further advanced. Then, the fixing portion 52a provided in the insertion portion 51 of the rigid portion 49 is fitted into the fixing portion 19b, and the holding portion 42h is inserted into the first treatment instrument insertion port 3f. This suppresses the transducer unit 48 from moving backward. Further, when the fixed portion 52a is fitted into the fixed portion 19b, the forward movement of the vibrator portion 48 and the rotation around the axis are suppressed.

  As a result, the probe operating unit 42 is integrally fixed to the first treatment instrument insertion port 3f, and the transducer is moved from the first distal end opening 33 of the first treatment instrument insertion passage 12 as shown in FIGS. The part 48 protrudes. At this time, since the defining surface 52d of the rigid portion 49 is in contact with the transducer unit defining surface 19g, the upper surface 48b of the transducer unit 48 is led out parallel to the transducer unit defining surface 19g.

  Here, the user operates the slide lever 42a to place the vibrator portion 48 in a predetermined bent state. Then, the upper surface 48b is disposed substantially parallel to the distal end surface 2d, and is set to be substantially the same direction as the observation direction of the ultrasonic transmission / reception unit 53 and the observation direction of the objective optical unit 21. In the bent state, the scanning surface 56 of the transducer part 48 passes through the center 11C of the second through hole 11b. In addition, the ultrasonic probe 40 is prevented from moving backward in the bent state.

  Thereafter, the user starts the search for the puncture route by bringing the ultrasonic transmission / reception unit 53 of the transducer unit 48 into close contact with the stomach wall 71 as shown in FIG. That is, the user confirms whether or not a blood vessel exists in the puncture route by observing an ultrasonic tomographic image displayed on the display device.

  After confirming that there is no blood vessel on the puncture route, the user measures the distance to the jejunum, sets the puncture distance based on the distance, and moves the puncture needle 72 toward the jejunum through the stomach wall 71. Insert. As a result, a puncture needle 72 (not shown) reaches the target site. At this time, since the scanning surface 56 of the transducer part 48 is set to pass through the second through-hole center 11C of the second through-hole 11b, the puncture needle to be inserted into the ultrasonic tomographic image An image is displayed.

  Thereafter, the user performs a gastrojejunostomy such as inserting a suturing device or the like via the puncture needle 72 and anastomosing the stomach and jejunum.

  In this way, the treatment instrument channel of the endoscope is gradually narrowed toward the distal end side, and a non-round fixing portion is provided at the distal end, while the non-round fixing is performed on the treatment instrument inserted into the treatment instrument channel. A fixing part is provided to be fitted to the part. Thereby, it can suppress that a treatment tool rotates the axis | shaft of a treatment tool by fitting a fixing | fixed part in a fixing part. In addition, when the fixing portion is fitted in the fixing portion, the treatment tool can be prevented from further advancing in the treatment instrument channel due to the transition portion coming into contact with the transition hole.

  Further, by making the treatment instrument an ultrasonic probe having a configuration in which the transducer part changes from a straight state to a bent state, an endoscope having two treatment instrument channels and an ultrasonic probe are combined to perform a surgery such as a NOTES technique. Surgery can be performed.

  In the ultrasonic probe of the present embodiment, a configuration is shown in which the vibrator portion 48 is rotated by operating the slide lever 42a and the slide portion 42b. However, the configuration may be such that the wires 46 and 47 are pulled by the driving force of the drive motor to rotate the vibrator portion 48, or a shape memory alloy or artificial muscle is used instead of the wires 46 and 47. .

  Moreover, in this embodiment, it is set as the structure which the vibrator | oscillator part of an ultrasonic probe rotates from a straight state to a bending state. However, the ultrasonic probe may be an ultrasonic probe 40 </ b> A in which a sector scanning type vibrator 73 formed of a silicon semiconductor substrate is disposed on the distal end surface of the rigid portion 49 as shown in FIG. 17.

  Other configurations are the same as those of the above-described embodiment, and the same members are denoted by the same reference numerals and description thereof is omitted.

According to this configuration, a probe operation unit that rotates the transducer unit from the ultrasonic probe can be eliminated. Other operations and effects are the same as those of the above-described embodiment.
Note that the advancement / retraction of the ultrasonic probe is performed by engaging the holding portion with the first treatment instrument insertion port and bringing the transition portion into contact with the transition hole. Moreover, a convex part may be provided instead of the transition part, and a contact part with which the convex part abuts may be provided instead of the transition hole. The contact portion is formed by forming a stepped hole, for example.

  The present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the spirit of the invention.

The figure explaining the composition of an endoscope system The figure explaining the structure of the front end surface of an endoscope AA line sectional view of FIG. The figure explaining the hole with which the nozzle | cap | die for 1st channels in the BB line cross section of FIG. 3 is provided. The figure explaining the hole with which the nozzle | cap | die for 1st channels in the CC sectional view of FIG. 3 is provided. The figure explaining the hole with which the nozzle | cap | die for 1st channels in the DD sectional view of FIG. 3 is provided. The figure explaining the fixed part of elliptical column shape The figure explaining the fixed part of cashew nut pillar shape The figure explaining the semicylindrical fixed part The figure explaining the fixed part of the polygonal column shape from which one side differs in length from other sides The figure explaining an ultrasonic probe The figure explaining the external shape of the engaging part with which the rigid part in the EE line position of FIG. 8 is provided. The figure explaining the external shape of the engaging part with which the rigid part in the FF line position of FIG. 8 is provided. A perspective view for explaining a vibrator unit The figure explaining the relationship between the vibrator part of a straight state, and an operation wire The figure explaining the relationship between the vibrator | oscillator part of a bending state, and an operation wire Side view illustrating a state in which the ultrasonic probe is disposed in the first treatment instrument insertion path of the endoscope Front view of the endoscope in which the treatment portion of the ultrasonic probe protrudes from the first treatment instrument insertion path Diagram for explaining the operation of the endoscope system The figure explaining the state which has arrange | positioned the ultrasonic probe of another structure in the 1st treatment tool insertion path of an endoscope.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Endoscope 2 Endoscope insertion part 2a Tip part 2b Curved part 2c Endoscope flexible tube part 2d End face 11 Tip hard part 11C 2nd through-hole center 11a 1st through-hole 11b 2nd through-hole 11c Third through hole 12 First treatment instrument insertion passage 13 First channel base 13C First channel base 13a Hole 14 First channel tube 15 Second treatment instrument insertion path 16 Second channel base 17 Second channel tube 18 End cover portion 18a Bottom portion 18b First communication hole 18c Second communication hole 18d Third communication hole 19L Virtual wire extension line 19a Round hole 19b Fixing portion 19c Transition hole 19d One vertex 19f Virtual line 19g Transducer portion defining surface 20 Imaging Device 21 Objective Optical Unit 22 Observation Window 23 Imaging Unit 24 Signal Cable 30 Illumination Unit 31 Illumination Window 32 Air / Water Supply Nozzle 33 1 tip opening 34 second tip opening 40 ultrasonic probe 40A ultrasonic probe 41 probe insertion portion 42 probe operating portion 42a slide lever 42b slide portion 42c biasing member 42d sliding groove 42e proximal end wall 42h holding portion 43 probe cord 44 probe Connector 45 Ultrasonic observation device 45a Connector portion 46 First operation wire 47 Second operation wire 48 Transducer portion 48 Moving element portion 48
48a Long side surface 48b Upper surface 48c Notch recess 48d First fixing portion 48e Proximal side short side surface 48f Second fixing portion 49 Hard portion 49a Guide groove 49b Locking groove 50 Probe flexible tube portion 51 Engagement portion 52 Probe side fitting Section 52a Fixing section 52b Pipe section 52c Transition section 52d Regulation surface 53 Ultrasonic transmission / reception section 54 Guide pin 55 Signal cable 56 Scan surface 60 Endoscope system 71 Stomach wall 72 Puncture needle 73 Sector scanning transducer

Claims (8)

It has a plurality of treatment instrument insertion passages,
The endoscope characterized in that at least one treatment instrument insertion path includes a fixing portion that suppresses rotation and advancement around the axis of the treatment instrument or ultrasonic probe to be inserted.   The endoscope according to claim 1, wherein the fixing portion is formed by constricting a treatment instrument insertion path toward a distal end.   The said fixing | fixed part makes the shape of a treatment tool insertion path into a non-true cylinder shape, and suppresses the rotation around the axis | shaft of the said treatment tool or the said ultrasonic probe, The Claim 1 or Claim 2 characterized by the above-mentioned. Endoscope. Including a vibrator part including an ultrasonic vibrator, and a rigid part to which the vibrator part is coupled,
The ultrasonic probe according to claim 3, further comprising a probe-side fitting portion that fits into the fixing portion when the rigid portion is inserted through the fixing portion of the endoscope according to claim 3.   The ultrasonic probe according to claim 4, wherein the endoscope-side fitting portion has a non-true cylindrical shape. The non-true cylindrical shape is
6. The ultrasonic probe according to claim 5, wherein the ultrasonic probe is one type selected from the group consisting of a prismatic shape, an elliptical column shape, a cashew nut column shape, and a semi-cylindrical shape. It is possible to change the angle formed by the vibrator part and the hard part,
The ultrasonic probe according to any one of claims 4 to 6, wherein a scanning direction of an ultrasonic wave transmitted from the transducer unit can be changed by changing the angle formed.   The ultrasonic probe according to claim 7, further comprising: a locking portion that fixes an angle formed by the rigid portion after changing an angle formed by the vibrator portion and the rigid portion.

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