JP2011206428A - Intracoelomic insertion type ultrasonic examination device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To elongate a curved part in order to gently bend a connection pipe and to prevent the interference with another member arranged in an insertion part.SOLUTION: The connection pipe 23, of which leading end part is inserted in and fitted to the treatment device insertion passage 22 formed to the leading end body 4 constituting a leading end hard part 2c, is formed into a curved shape and extended into the leading end ring 5 constituting the curved part 2b in a backward warped state to be backward warped from the state almost coming into contact with the inner surface of the leading end ring 5. A treatment device insertion tube 24 is connected to the upward warped region of the connection pipe 23 and a cutting squeeze part 31, to which the leading end of a curving operation wire 30 is fastened, is provided to the lower position of the upward warped region.

Description

  The present invention relates to an intracorporeal-type ultrasonic inspection apparatus such as an ultrasonic endoscope that is inserted into a body cavity of a subject and inspects the state of a body tissue.

  An intracorporeal-insertion-type ultrasonic inspection apparatus having a configuration in which an insertion portion is provided continuously with a main body operation portion and an ultrasonic transducer is provided at a distal end hard portion at the distal end of the insertion portion is disclosed in Patent Document 1, for example. As it is, it has been widely used conventionally. Here, in patent document 1, it comprises as an ultrasonic endoscope which provided the endoscope observation mechanism in addition to the ultrasonic observation mechanism which consists of an ultrasonic transducer, and an ultrasonic transducer has many ultrasonic vibrations. The elements are arranged in a convex curve shape in the axial direction, and the ultrasonic transducer is driven by an electronic scanning type.

  As a result of ultrasonography, if it is determined that there is a potential lesion in the body, the body tissue will be collected using a puncture instrument and the tissue cells will be examined closely. Treatment such as injecting drugs into the body may also be performed. For this purpose, at the distal end portion of the insertion portion into the body cavity, the treatment instrument outlet is opened at a position closer to the base end side than the arrangement portion of the ultrasonic transducer, and the entire length of the insertion portion is passed from the treatment instrument outlet. A treatment instrument insertion channel leading to the main body operation unit is provided.

  Here, when operating the puncture treatment instrument, it is necessary to always monitor the puncture treatment instrument. In an ultrasonic endoscope, before the puncture treatment instrument is inserted into the inner wall of the body cavity, the position of at least the tip of the puncture treatment instrument can be confirmed by the endoscope observation mechanism. After insertion, the ultrasonic observation mechanism is used for observation. For this reason, as described in Patent Document 1, the ultrasonic endoscope has a large number of ultrasonic vibrations so that the distal end hard portion of the insertion portion has a convex arc shape toward the distal end side in the axial direction of the insertion portion. An ultrasonic transducer is configured by disposing a child, and an illumination window and an observation window constituting an endoscope observation mechanism are formed on the proximal end side, and the endoscope is disposed on the proximal end side from these ultrasonic observation mechanisms. The treatment instrument outlet is formed in the vicinity of the observation mechanism.

  Here, the observation field of view by the ultrasonic observation mechanism is obliquely forward of the distal hard portion, and the treatment instrument derived from the treatment instrument outlet, particularly the puncture treatment instrument, is derived obliquely forward. Further, the treatment instrument outlet is opened at the side surface of the distal end body. For example, the endoscope observation mechanism is at the rear position of the treatment instrument outlet and the observation field of view is obliquely forward. It is configured as a perspective type.

  The treatment instrument outlet is an outlet of the treatment instrument insertion path, and the treatment instrument insertion path is formed in the distal end portion main body constituting the distal end hard portion. The insertion portion has a structure in which a bending portion and a flexible portion are sequentially connected to the distal end hard portion, and a treatment instrument insertion tube having flexibility in the bending direction is provided inside the bending portion and the flexible portion. ing. When the treatment instrument insertion tube is connected directly to the treatment instrument passage formed in the distal end body, the connection strength is not sufficient, so a metal connection pipe is provided and the distal end side of this connection pipe is treated. It is inserted into the instrument passage, and a treatment instrument insertion tube is fitted on the proximal end side. Therefore, a treatment portion insertion channel is constituted by the treatment instrument insertion tube, the connection pipe, and the treatment instrument insertion passage.

  Here, in the insertion portion, the treatment instrument insertion tube extends in the axial direction of the insertion portion within a portion from the flexible portion to the bending portion. On the other hand, when the treatment instrument is derived from the treatment instrument outlet, it is derived obliquely forward. For this reason, the treatment instrument insertion passage is inclined with respect to the axis of the insertion portion. Therefore, the treatment instrument insertion tube extending in the axial direction of the insertion portion is changed in direction and transferred to the treatment instrument insertion passage. The connection pipe not only functions to connect the treatment instrument insertion tube and the treatment instrument insertion passage, but also serves to change the direction of the treatment instrument insertion path. For this purpose, the connection pipe is constituted by a bent pipe having a curved shape.

Japanese Patent Laid-Open No. 11-276589

  By the way, the connection pipe is bent after being led out from the distal end portion main body constituting the distal end hard portion, and is bent inside the narrow insertion portion. Since the puncture treatment instrument has a sharp needle tip at the tip, it is composed of a hard member for a predetermined length. Therefore, it is desirable from the viewpoint of insertion operability of the puncture treatment instrument that the bending curvature of the connection pipe be as large as possible. However, since the treatment instrument insertion path is provided in an oblique direction, the connecting pipe is connected to the treatment instrument insertion path in the vicinity of the intermediate position in the cross section of the distal end hard portion from the leading end body. . Therefore, the bending angle of the connecting pipe cannot be made very gentle. For this reason, in Patent Document 1, the connection pipe is extended to the position of the tip ring located at the forefront of the bending portion, and led to a position almost in contact with the inner surface of the tip ring, thereby reducing the curvature of the bending portion. I try to plan.

  By the way, the bending portion is bent by remote operation, and in order to perform this bending operation, a bending operation wire is provided, and the distal end of the bending operation wire is fixed to the tip ring. The distal end fixing of the bending operation wire is usually performed by means such as soldering by providing an inwardly cut and drawn portion on the inner surface of the tip ring, and inserting the bending operation wire into the cut and drawn portion. Therefore, when the connecting pipe is extended to a position very close to the inner surface of the tip ring, the position interferes with the cut-off portion. For this purpose, it is necessary to arrange the cut-off portion at a position displaced by a predetermined amount in the circumferential direction of the tip ring.

  The bending operation wire needs to extend linearly within the bending portion, and when the distal end portion is attached to a position bent with respect to another wire fixing portion, the bending operation wire is pulled to bend the bending portion. In this case, the operability of the bending operation is deteriorated, for example, the operation load is increased. On the other hand, it is conceivable to dispose the connection pipe at a position shifted in the circumferential direction. However, in this case, the tip portion may be thickened. In particular, in an ultrasonic inspection apparatus that must pass through a very narrow region in a body cavity, such as an endoscopic endoscope for bronchi, it is intended to reduce the diameter and ensure operability. Becomes very important.

  The present invention has been made in view of the above points. The object of the present invention is to lengthen the curved portion in order to gently bend the connecting pipe without increasing the diameter of the distal end portion of the insertion portion. In addition, it is to prevent interference with other members disposed in the insertion portion.

  In order to achieve the above-described object, the present invention provides a hard tip at the tip of the bending portion, and a plurality of ultrasonic transducers are arranged linearly or in a curved shape in the axial direction on the hard tip. And an intracorporeal ultrasonic inspection apparatus provided with a treatment instrument outlet opening at a side surface position proximal to the ultrasonic transducer, wherein the distal end main body of the distal rigid portion is provided. A treatment instrument insertion passage leading to the treatment instrument outlet is formed, and a treatment tool insertion connection pipe is inserted into the treatment instrument insertion passage, and the connection pipe is led out from at least the treatment instrument insertion passage. This is characterized in that the portion that is bent is mounted in a reverse warped state, and the treatment instrument insertion tube is connected to the warped portion of the connection pipe.

  As an intracorporeal insertion type ultrasonic inspection apparatus, it may be configured to provide only an ultrasonic transducer at the distal end hard portion of the insertion portion, but an ultrasonic endoscope provided with an endoscope observation mechanism having an illumination portion and an observation portion. It can also be configured as a mirror. When configured as an ultrasonic endoscope, an endoscope observation mechanism is provided in the vicinity of the treatment instrument outlet of the hard tip portion, and the observation field of view by the endoscope observation mechanism is obliquely forward. As a result, after the puncture treatment instrument has been led out from the treatment instrument outlet and before being inserted into the body, the tip of the puncture treatment instrument was observed by the endoscope observation mechanism and inserted into the body. After that, it will be observed by the ultrasonic observation mechanism.

  The connection pipe is inserted into the treatment instrument insertion passage. From the viewpoint of the stability of the connection pipe and the like, it is desirable to extend the tip of the connection pipe to the position of the treatment instrument outlet. Although the site | part pulled out from the front-end | tip part main body to the base end side becomes a curved shape, it is good also as a straight state in a treatment tool insertion path, and can also make the whole connection pipe into a curved shape. In this case, the treatment instrument insertion path is also curved. And since a connection pipe is arrange | positioned in a reverse curvature state, an intermediate part becomes the lowest position, it will bend back from this position, and a base end side will come to warp. By positioning the warped portion above the fastening portion at the distal end of the bending operation wire of the bending portion, no interference occurs therebetween.

  In the distal hard portion of the insertion part of the intracorporeal ultrasonic examination apparatus, the space between the treatment instrument insertion path for leading the treatment instrument obliquely forward and the treatment instrument insertion tube extending in the axial direction of the insertion part The length of the curved portion of the connecting pipe for connecting and changing the direction of the passage can be increased and bent gently, and interference with other members disposed in the insertion portion can be prevented.

1 is an external view of a distal end portion of an insertion portion of an intracorporeal insertion type ultrasonic examination apparatus according to the present invention configured as an ultrasonic endoscope. FIG. It is a principal part front view of FIG. It is a top view of the tip hard part in an insertion part. It is AA sectional drawing of FIG. It is a longitudinal cross-sectional view of a connection pipe. It is explanatory drawing which shows the mutual relationship of the bending direction of the bending part of an insertion part by the structure of this invention, and the derivation | leading-out direction of an ultrasonic observation mechanism, an endoscope observation mechanism, and a treatment tool.

    Hereinafter, embodiments of the present invention will be described with reference to the drawings. In the present embodiment, an intracorporeal insertion type ultrasonic inspection apparatus configured as an ultrasonic endoscope is shown. However, the present invention is not limited to an ultrasonic endoscope, and may be configured not to include, for example, an endoscope observation unit.

  In FIG. 1, 1 is a main body operation part, 2 is an insertion part in a body cavity. The insertion portion 2 includes a flexible portion 2a, a bending portion 2b, and a distal end hard portion 2c in order from the continuous connection side to the main body operation portion 1. The longest site | part of the insertion part 2 is the soft part 2a, and the bending part 2b is comprised so that bending operation can be carried out in a desired direction.

  As shown in FIGS. 2 to 4, the distal end hard portion 2c has a distal end portion main body 4 made of a hard member. The distal end portion of the distal end portion main body 4 has an ultrasonic observation mechanism at its most distal end portion. An ultrasonic transducer 10 is provided. Here, the ultrasonic transducer 10 is composed of a large number of ultrasonic transducers arranged in the axial direction of the distal end hard portion 2c, and the arrangement thereof has a convex curved surface shape, whereby electronic convex scanning is performed. . Accordingly, the ultrasonic observation region when the ultrasonic transducer 10 is operated is in the direction and range indicated by the symbol S in FIG.

  Further, a rising surface 11 is formed on the proximal end side from the position where the ultrasonic transducer 10 is disposed in the distal end body 4. As apparent from FIG. 1, the rising surface 11 is provided with a pair of illumination windows 12 and 12 and an observation window 13 provided between the illumination windows 12 and 12. The mechanism is configured. The exit end of the light guide faces the illumination window 12 constituting the endoscope observation mechanism. As is clear from FIG. 4, a lens barrel 14 equipped with an objective optical system is attached to the observation window 13, and the optical path of the objective optical system is bent 90 degrees by a prism 15. A solid-state imaging device 16 is provided at the image forming position obtained by converting. The solid-state imaging device 16 is mounted on a substrate 17, and a predetermined number of cables 18 are connected to the substrate 17, and the cables 18 are connected to the universal cord (not shown) from the insertion unit 2 through the main body operation unit 1. )). The observation region by the endoscope observation mechanism is directed obliquely forward indicated by the symbol F in FIG.

  In the present embodiment, in the distal end portion body 4, a portion between the mounting portion of the ultrasonic transducer 10 and the rising surface 11 provided with the endoscope observation means is formed as a flat portion 19, and a treatment instrument is provided on the flat portion 19. The outlet 20 is open. The treatment instrument outlet 20 is an outlet portion of the treatment instrument in the treatment instrument insertion channel 21. From the treatment instrument outlet 20, the treatment instrument outlet 20 is inserted into the body to collect cells and collect chemicals. A puncture treatment instrument for performing treatment such as injection is also derived. Accordingly, the treatment instrument insertion channel 21 includes a treatment instrument insertion path 22 formed in the distal end portion main body 4 of the distal end rigid portion 2c, a connection pipe 23 into which the distal end side is inserted into the treatment instrument insertion path 22, and the connection pipe. The treatment instrument insertion tube 24 is fitted to the proximal end portion of the reference numeral 23. The treatment instrument outlet 20 is located on the proximal end side from the position where the ultrasonic transducer 10 is disposed, but is not necessarily positioned forward from the position where the endoscope observation mechanism is disposed. If it is in the vicinity of the mechanism, it can be opened at an arbitrary position.

  Here, the derivation direction of the treatment instrument from the treatment instrument insertion channel 21 is an arrow A direction in FIG. Accordingly, when the puncture treatment instrument is led out from the treatment instrument outlet 20, it immediately enters the observation region F by the endoscope observation mechanism through the observation window 13, and the ultrasonic transducer 10 directly or via a balloon. When the puncture treatment instrument is inserted into the body tissue while being in contact with the inner wall of the body cavity, the puncture treatment instrument enters the ultrasonic observation region S. Therefore, the puncture treatment instrument is always placed under monitoring by either the endoscope observation mechanism or the ultrasonic observation mechanism.

  The treatment instrument insertion channel 21 includes a treatment instrument insertion tube 24 at the site of the flexible portion 2 a and the bending portion 2 b in the insertion portion 2, and the treatment instrument insertion tube 24 extends in the axial direction of the insertion portion 2. When reaching the distal end hard portion 2 c, the treatment instrument insertion channel 21 moves to the treatment instrument insertion passage 22, and this treatment instrument insertion passage 22 opens in the flat portion 19 of the distal end portion main body 4 and extends in the axial direction of the insertion portion 2. It is not facing, but is inclined diagonally forward. Therefore, the connection pipe 23 is curved in order to smoothly transition from the treatment instrument insertion tube 24 extending in the axial direction to the treatment instrument insertion passage 22 extending obliquely forward. The treatment instrument insertion path 22 extends obliquely downward, and the connection pipe 23 extends to the position of the treatment instrument outlet 20 in the treatment instrument insertion path 22 or a position closest thereto. The other end of the connection pipe 23 protrudes from the base end side of the distal end portion body 4 by a predetermined length in the direction of the curved portion 2b.

  As shown in FIG. 5, the entire connection pipe 23 is curved in a generally arcuate shape. A partial notch 25 is provided at the distal end of the connection pipe 23, and the notch 25 abuts on a step 26 formed in the treatment instrument insertion path 22. Therefore, the connection pipe 23 has most of the end surface portions except for the portion of the notch portion 25 located substantially on the same plane as the plane portion 19. That is, when the connection pipe 23 is inserted into the treatment instrument insertion passage 22 to a position where the notch 25 and the stepped portion 26 come into contact with each other, there is a difference in height between the end surface of the connection pipe 23 and the surface of the flat portion 19. The insertion length is adjusted so as not to occur.

  Thus, the inner wall surface of the treatment instrument insertion passage 22 is almost entirely covered with the connection pipe 23 that is a metal member. Therefore, even if the distal end portion body 4 is formed of a synthetic resin, the treatment instrument inserted through the treatment instrument insertion channel 21, particularly the puncture treatment instrument, does not contact the treatment instrument insertion passage 22 provided in the distal end portion body 4. In this way, it is derived from the treatment instrument outlet 20. As a result, the inner surface of the treatment instrument insertion path 22 is not scraped off by the needle tip of the puncture treatment instrument. Here, when the distal end portion body 4 including the treatment instrument insertion passage 22 is scraped off, the surface becomes rough, and filth and residues are likely to remain, and even after washing, they cannot be completely removed. There is. However, if the entire circumference of the tip of the connection pipe 23 is flush with the plane part 19, the edge of the connection pipe 23 may partially protrude from the plane part 19 or be lower than the plane part 19 depending on the assembly accuracy and the like. There is a risk that variations may occur. Therefore, the notch 25 of the connection pipe 23 is brought into contact with the stepped portion 26 described above, whereby the connection pipe 23 can be positioned easily and accurately. In addition, although the site | part of the level | step-difference part 26 is not covered with the connection pipe 23, if the height of the level | step-difference part 26 is made smaller than the thickness of the connection pipe 23, it will be damaged by the needle point of the puncture treatment tool which passes this site | part. Never happen.

  As described above, the bent connection pipe 23 is attached to the treatment instrument insertion path 22 in a reverse warped state. That is, the part derived | led-out from the rear-end part of the treatment tool insertion path 22 is extended diagonally downward, and will be warped from the middle. Then, the treatment instrument insertion tube 24 is inserted into the warped proximal end portion.

  As is apparent from FIG. 4, the distal end main body 4 constituting the distal end hard portion 2c is fitted with the distal end ring 5 of the curved rings constituting the curved portion 2b. The curved portion 2b is connected. Then, the connection pipe 23 connected to the treatment instrument insertion path 22 extends obliquely downward and is guided to a position where it substantially contacts the inner surface of the distal end ring 5 and is warped from this position. As a result, the connection pipe 23 rises by the height indicated by T in FIG.

  By the way, the bending portion 2b connected to the distal end hard portion 2c is bent by a remote operation. As the bending direction, the bending operation can be performed in at least four directions of up and down, preferably up and down and left and right. For this bending operation, the main body operation unit 1 is provided with a bending operation lever 6, and a pulley (not shown) is connected to the bending operation lever 6. A pair of operation wires are wound around the pulley, and when the bending operation lever 6 is operated, the bending operation wires are pushed and pulled, and the bending portion 2b is bent. In the case of bending in four directions, two sets of bending operation mechanisms including a lever and a pulley are provided coaxially. The bending portion 2b that is bent by pushing and pulling the bending operation wire has a node ring structure in which the bending rings are sequentially connected by the pivoting pins. Among these curved rings, the most advanced one is the tip ring 5 shown in FIG. 4, and the portion from the curved portion 2 b to the hard tip portion 2 c is covered with a stretchable cover rubber 6 and a cover rubber 7.

  In FIG. 4, a bending operation wire 30 that bends the bending portion 2 b in the vertical direction is indicated by reference numeral 30. The pair of upper and lower bending operation wires 30 are pulled out from a pulley connected to the bending operation lever 6 and extended from the flexible portion 2a to the bending portion 2b in the insertion portion 2, and the distal end portion thereof is a distal end constituting the bending portion 2b. It is fixed to the ring 5. For this purpose, a cutting end portion 31 is formed on the tip ring 5 in the vertical direction. The end portions of the bending operation wires 30 are inserted into the cutting end portion 31 and fixed by means such as soldering. ing. Accordingly, the cut-and-drawn portion 31 functions as a fastening portion at the tip of the bending operation wire 30. The fixing of the distal end portion of the bending operation wire 30 is not limited to the cut-and-drawn portion 31. In short, a fastening portion is provided on the inner surface of the distal end ring 5, and the distal end of the bending operation wire 30 is attached to the fastening portion. It will be fixed. Accordingly, the fastening portions of the bending operation wires 30 protrude inward from the inner surface of the tip ring 5. No special member is provided on the front side of the fastening portion of the tip ring 5.

  As described above, in order to smoothly transition from the treatment instrument insertion tube 24 extending in the axial direction to the treatment instrument insertion path 22 extending obliquely forward, the distal end main body 4 is directed toward the proximal end side. The connecting pipe 23 protruding in this manner is extended so as to bend obliquely downward. By increasing the radius of curvature of the curved portion, the transition of the treatment instrument is performed smoothly. In particular, the puncture treatment instrument has a distal end portion made of a hard member, and increasing the radius of curvature at the bent portion of the treatment instrument insertion channel 21 so as to bend it gently is important for the insertion operability of the treatment instrument. is important. The curvature radius of the curved portion of the connection pipe 23 from the treatment instrument insertion path 22 is regulated at a position where the connection pipe 23 comes into contact with the inner surface of the distal end ring 5. The connection pipe 23 is warped from this position, and is a warped part that is lifted from the inner surface of the tip ring 5 by the amount of the warp.

  As shown in FIG. 6, when the bending portion 2 b in the insertion portion 2 is set to have a vertical line V and a horizontal line H with respect to the center, the bending portion 2 b is bent vertically. The movement is along the line V. In addition, when the bending operation wire of the left-right direction is also provided, the movement along the horizontal line H can also be performed now. Thus, in the case of bending in the left-right direction, the movement is along the horizontal line H. That is, if the vertical plane V-V is set as a vertical plane including the vertical line V, the operability of the insertion unit 2 determines the center of the endoscope observation visual field F by the observation window 13 and the ultrasonic transducer 10. It is desirable that the center of the ultrasonic observation region S is aligned in the direction of the vertical plane VV or is close to the vertical plane VV. At the same time, it is further desirable that the treatment instrument lead-out direction by the treatment instrument insertion channel 21 is the vertical plane V-V direction so that the treatment instrument is directed toward the center of the ultrasonic observation region S. Further, in addition to the above, when the bending operation lever 6 is operated, it is most desirable that the bending direction in the vertical direction is the vertical line V direction. In order to maximize the radius of curvature of the connection pipe 23 in the treatment instrument insertion channel 21 after satisfying these conditions, the position of the connection pipe 23 abuts against the inner surface of the tip ring 5 or Extend to a very close position.

  However, it is necessary that the connection pipe 23 does not interfere with the cut-and-drawn portion 31 that fixes the distal end of the bending operation wire 30. If the distal end ring 5 is long, and the cut-out portion 31 protruding toward the inner surface of the distal end ring 5 is arranged at a position sufficiently separated from the connection pipe 23 in the axial direction, the treatment instrument insertion tube 24 is provided. It will be arranged at the position of the cut-off / drawing portion 31. Since the treatment instrument insertion tube 24 is flexible in the bending direction, mutual interference can be prevented by shifting the treatment instrument insertion tube 24 in the lateral direction. However, since the tip ring 5 is a hard ring, the length of the hard portion at the tip of the insertion portion 2 becomes long, and the operability for insertion into the body cavity is deteriorated.

  By bending the base end side portion of the connection pipe 23, even if the connection pipe 23 is in contact with the inner surface of the tip ring 5 at the portion before the warp, the height T is changed to the tip ring 5 by the warp. It can be set to a position higher than the height of the provided cut and drawn part 31. Therefore, the connection pipe 23 can pass through the upper portion of the cut-and-drawn portion 31 that is the fastening portion at the tip of the bending operation wire 30. In addition, in order to avoid interference between the connection pipe 23 and the cut-off portion 31, it is not necessary to make the tip ring 5 longer than necessary.

  As described above, by bending the bending portion 2b in the insertion portion 2 in the vertical direction in the vertical direction, the operability of the bending operation is improved and the observation constituting the endoscope observation mechanism is achieved. Since the center of the window 13, the treatment instrument outlet 20 and the ultrasonic transducer 10 is on or close to the vertical line V, the puncture treatment instrument derived from the treatment instrument outlet 20 Before the needle is inserted, the needle tip of the puncture treatment device is ultrasonically observed after the puncture treatment device has been inserted into the body, and is substantially at the center position of the observation region F by the endoscope observation mechanism. It can be captured at the approximate center of the field of view. Therefore, the operability of the puncture treatment instrument is greatly improved, and the safety of the treatment performed using the puncture treatment instrument is further improved.

DESCRIPTION OF SYMBOLS 1 Main body operation part 2 Insertion part 2c Tip hard part 4 Tip part main body 5 Tip ring 10 Ultrasonic transducer 12 Illumination window 13 Observation window 19 Plane part 20 Treatment tool outlet 21 Treatment tool insertion channel 22 Treatment tool insertion path 23 Connection pipe 24 Treatment instrument insertion tube 30 Bending operation wire 31 Cutting section

Claims (5)

A tip hard portion is provided at the tip of the bending portion, and an ultrasonic transducer in which a plurality of ultrasonic transducers are arranged linearly or in a curved shape in the axial direction is provided at the tip hard portion. A body cavity insertion type ultrasonic inspection apparatus provided with a treatment instrument outlet opening at a side surface position on the base end side,
A treatment instrument insertion passage leading to the treatment instrument outlet is formed in the distal end portion main body of the distal rigid portion, and a treatment pipe insertion connection pipe is inserted into the treatment instrument insertion path,
The connecting pipe has a curved shape at least at a portion led out from the treatment instrument insertion passage, and is attached in a reverse warped state,
A body cavity insertion type ultrasonic examination apparatus characterized in that a treatment instrument insertion tube is connected to the warped part of the connection pipe. The lead-out portion of the connection pipe from the distal end main body to the proximal end side is configured to be reversed after being brought closest to the inner wall surface at the most advanced ring of the curved portion or its front position. The intracavitary ultrasonic examination apparatus according to claim 1 or 2. The bending portion is characterized in that a fastening portion of a wire for bending operation is provided on the inner surface of the most advanced ring, and the warped portion of the connection pipe is arranged at an upper position of the fastening portion. The intra-body-cavity insertion-type ultrasonic inspection apparatus according to claim 2. The intra-body-cavity insertion-type ultrasonic examination apparatus according to any one of claims 1 to 3, wherein the connection pipe extends to a position of the treatment instrument outlet of the treatment instrument insertion path. The distal rigid portion is provided with an endoscope observation mechanism having an observation field obliquely forward at a position closer to the base end side than the ultrasonic transducer mounting portion. The ultrasonic transducer mounting portion and the endoscope observation mechanism are provided. The treatment instrument lead-out port of the treatment instrument insertion path is opened and provided at a position near the attachment part of the endoscope observation mechanism including a position between the attachment part and the attachment part. Intrabody cavity type ultrasonic examination apparatus.

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