JP2012000194A - Medical system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To definitely measure states by means of ultrasonic waves before and after a medical treatment in a medical system for the treatment of a fetus or the like.SOLUTION: At the tip end of an endoscope 10, a plurality of vibrators 12 are provided circularly. Each vibrator 12 is provided in a posture slanting in a direction toward inside. Then, a plurality of ultrasonic beams are crossed at a point to be treated. A three dimensional blood flow speed vector relating to the blood flow at the treating point is calculated by using these vibrators 12. The tip point also includes an observation window 14A and a laser emission tube.

Description

  The present invention relates to a medical system, and more particularly to a system for treating a tissue to be treated under endoscopic vision in a body cavity.

  Examples of intrauterine fetal treatment include treatment of twin-to-twin transfusion syndrome. In that case, a treatment instrument equipped with an endoscope is inserted into the uterus, a laser is applied to the anastomotic blood vessel between identical twins on the common placenta, and the blood flow is blocked by the coagulation effect. . According to the blockage, it becomes possible to treat the blood circulation insufficiency of both infants due to the imbalance of the blood flow flowing between the twins. The therapeutic instrument utilized in that case has an optical fiber inserted into the forceps hole in addition to the endoscope. Specifically, an endoscope observation window and an optical fiber exit end are provided at the distal end of the treatment instrument. Patent Documents 1 and 2 below disclose devices for treating a tissue with a laser in a body cavity. Patent Document 2 describes a combination of an endoscope apparatus, a laser apparatus, and an ultrasonic apparatus, but does not perform blood flow observation.

Japanese Patent Laid-Open No. 4-17847 Japanese Patent No. 3255562

  In the intrauterine fetal treatment as described above, after the blood flow is coagulated and blocked by laser light, conventionally, the post-treatment state is observed by endoscopic observation. In observation, it is difficult to sufficiently confirm whether or not the blood flow is completely blocked. That is, it is difficult to reliably confirm the treatment result of the blood vessel in the treatment instrument used in the conventional intrauterine fetal treatment, in particular, an apparatus for treating the blood vessel. This problem can also be pointed out in body cavity treatment other than fetal treatment.

  An object of the present invention is to provide a system capable of appropriately observing a blood flow state when treating a blood vessel in a body cavity.

  The objective of this invention is providing the system which can confirm reliably that the blood flow does not flow into the blood vessel after coagulating the blood vessel in the intrauterine fetal treatment.

  The present invention is an instrument to be inserted into a body cavity, comprising: a therapeutic instrument including a therapeutic light irradiation unit and an ultrasonic measurement unit; and a signal processing unit that processes a reception signal from the ultrasonic measurement unit. And the ultrasonic measurement unit is configured by a plurality of transducers that are directed forward where the tissue to be treated exists, and the signal processing unit is configured based on a plurality of reception signals obtained by the plurality of transducers. And means for calculating a blood flow velocity based on the plurality of velocity components.

  According to the above configuration, the therapeutic instrument is provided with the ultrasonic measurement unit in addition to the therapeutic light irradiation unit, and can perform ultrasonic measurement before and after the treatment or during the treatment. The ultrasonic measurement unit has a plurality of transducers provided at different positions, and the blood flow velocity is calculated from a plurality of velocity components acquired by them. Since a plurality of transducers are provided, even if the ultrasonic beam formed by a specific transducer is orthogonal to the blood flow and cannot be observed in Doppler information, There is an advantage that Doppler information can be observed reliably. That is, blood flow can be reliably measured. Since a plurality of velocity components can be measured in a plurality of ultrasonic beam directions, a three-dimensional blood flow velocity vector can be calculated. In this case, since not only the flow speed information but also the flow direction can be specified, information useful for diagnosis can be provided. Since flow that is not optically visible can be observed by using ultrasonic measurement, for example, a blood flow state before treatment and a blood flow state after treatment can be easily and reliably diagnosed. The present invention can provide important information particularly for confirming the therapeutic effect.

  Desirably, the plurality of transducers are arranged in a ring shape on the distal end surface of the treatment instrument. Preferably, each of the vibrators is provided obliquely inward. An instrument to be inserted into the body is usually configured as a hard or soft rod-like body, and its tip is usually a circular surface, and it is desirable that a plurality of vibrators be arranged in a ring shape there. For example, an optical observation window or a channel opening (treatment light irradiation member) is provided in the inner inner area of the transducer array. According to such a configuration, it is possible to effectively use the space while separating the vibrators.

  Preferably, each of the vibrators forms an ultrasonic beam that passes through a predetermined treatment point located in front of the distal end surface, and the therapeutic light irradiation unit emits therapeutic light toward the predetermined therapeutic point. The distal end surface is further provided with an endoscopic observation window having an optical field of view including the predetermined treatment point. The predetermined treatment point may be fixedly set, or may be configured to be variable. Usually, a treatment point and a beam cross point are set at the same position on the center line of the observation visual field. For observation of blood flow, it is desirable to use the pulse Doppler method. Of course, the continuous wave Doppler method can also be used. It is also conceivable to observe the presence or absence of flow from the level of the echo signal. Although the ultrasonic measurement is intended for blood flow measurement, a configuration for forming a tomographic image and a three-dimensional image may be employed. Preferably, the therapeutic device is a fetal therapeutic device that is inserted into the uterus.

  An instrument according to the present invention is a therapeutic instrument used in a medical system for fetal treatment, and has a distal end portion provided with an endoscopic observation window, a therapeutic light irradiation unit, and an ultrasonic measurement unit. The ultrasonic measurement unit includes transducer arrays for measuring Doppler information arranged in an annular shape while facing forward where the tissue to be treated exists, and each transducer constituting the transducer array is obliquely inward It has a posture.

  ADVANTAGE OF THE INVENTION According to this invention, the system which can observe a blood-flow state appropriately at the time of the treatment of the blood vessel in a body cavity can be provided. Alternatively, it is possible to provide a system that can reliably confirm that blood flow does not flow in the blood vessel after coagulation of the blood vessel in the intrauterine fetal treatment.

It is a block diagram which shows suitable embodiment of the medical system which concerns on this invention. It is sectional drawing for demonstrating the structure of the front-end | tip of a treatment instrument. It is a figure for demonstrating the calculation of a three-dimensional blood-flow velocity vector.

  DESCRIPTION OF EXEMPLARY EMBODIMENTS Hereinafter, preferred embodiments of the invention will be described with reference to the drawings.

  FIG. 1 shows a preferred embodiment of a treatment system according to the present invention, and FIG. 1 is a block diagram showing the overall configuration thereof. The treatment system shown in the present embodiment is a system in which an endoscopic system and an ultrasound system are combined, and particularly a system used for treatment of a twin-to-fetus transfusion syndrome. Specifically, in order to block the anastomotic blood vessel on the placenta, a laser is irradiated on the blood vessel to coagulate or cauterize the blood vessel.

  The medical system according to the embodiment roughly includes a system main body and an endoscope 10 as a treatment instrument. The endoscope 10 is a rod-shaped instrument that is inserted into the body as will be described later, and a plurality of vibrators 12, an optical device 14, an optical fiber 16, and the like are provided at the distal end portion thereof. The plurality of transducers 12 constitute a ring-shaped transducer array as a whole, and each transducer 12 forms an ultrasonic beam and observes blood flow velocity components. Specifically, according to the ultrasonic Doppler method, an ultrasonic pulse is transmitted forward by each vibrator 12, and a reflected wave from the front is similarly received by the vibrator 12. As a result, a reception signal is obtained for each transducer 12. As will be described later, each vibrator 12 is provided inwardly and with a slightly inclined posture. This is to cross a plurality of ultrasonic beams at a predetermined point. It is desirable to adopt a time division method or a frequency division method so that acoustic interference does not occur between the vibrators.

  The optical device 14 is for realizing a function as a so-called endoscope. Specifically, an observation window is provided at the distal end portion of the endoscope 10. The center of the front field of view of the optical device 14 corresponds to the treatment site. The optical device 14 may be substantially constituted by a lens, or may correspond to an electrical device such as a camera. In the present embodiment, a lens as the optical device 14 is provided at the distal end portion, and an image passing therethrough is visually observed at the tail end portion of the endoscope 10. Of course, as described later, a camera 22 that converts such an optical image into an electrical signal may be provided. The optical fiber 16 functions as a therapeutic light irradiation means that is inserted into a channel (forceps hole) of the endoscope 10. Specifically, the distal end portion of the optical fiber 16 extends from an opening provided at the distal end portion. The blood vessel is coagulated or cauterized by extending forward and irradiating laser light in that state. An optical signal is given from the laser device 24 to the tail end side of the optical fiber 16. The irradiation point by the optical fiber 16 and the measurement points by the plurality of vibrators 12 coincide with each other, and such a predetermined point may be fixed in relation to the tip portion or may be variable. . The optical device 14 has a field of view that extends around such a point.

  Next, the system main body will be described. A transmission / reception unit 18 is provided corresponding to the plurality of transducers 12. The transmission / reception unit 18 functions as a transmission unit and a reception unit, supplies a transmission pulse at the time of transmission, and processes a received signal at the time of reception. The transmission / reception unit 18 may have functions as a transmission beam former and a reception beam former. That is, an ultrasonic beam may be formed by electronic control. In the present embodiment, each transducer 12 is composed of a single transducer, and an ultrasonic beam is formed in the normal direction of the surface by setting the wave transmitting / receiving surface inward.

  The blood flow vector calculation unit 20 is a module that executes processing such as detection and frequency analysis on each received signal. That is, velocity information, specifically, velocity components along the ultrasonic beam are calculated for each ultrasonic beam. Furthermore, the blood flow vector calculation unit 20 calculates a three-dimensional blood flow velocity vector based on a plurality of pieces of velocity information. The calculation result is displayed on the display unit 26. According to such calculation, it is possible to recognize the blood flow state before the treatment and the blood flow state after the treatment as an ultrasonic measurement result. Of course, ultrasonic measurement may be continued during treatment. In this way, there is an advantage that the state of treatment can be observed in real time.

  In this embodiment, as will be described later, the transducer array is formed in an annular shape, that is, ultrasonic waves are transmitted and received at a plurality of points. Even in the orthogonal relationship, it is possible to reliably observe Doppler information in one or more other transducers. Usually, if three or more vibrators are provided, a three-dimensional velocity vector can be obtained. However, in this embodiment, as will be described later, six or more, specifically seven vibrators are provided. Is provided.

  As described above, the optical device 14 is configured by a lens, a light guide member, and the like, and can perform optical observation by looking into the inside at the tail end side of the light guide member. An optical image may be captured by the camera 22 and the signal may be given to the display unit 26. The laser device 24 supplies therapeutic laser light to the optical fiber 16, and its output or power is controlled by the control unit 28. The control unit 28 includes a CPU and an operation program, and performs operation control of each configuration shown in FIG. You may make it link ultrasonic measurement and treatment. The input unit 30 is means for transmitting contents set by the user by the control unit 28.

  Next, the structure of the distal end portion of the endoscope 10 shown in FIG. 1 will be described with reference to FIG. (A) shows a longitudinal section of the distal end portion 32 of the endoscope 10, and (B) shows the distal end surface of the distal end portion. The distal end portion 32 includes the optical device 14 on the central axis, and the optical device 14 includes a lens 32. The left side when viewed from the lens 32 is a light guide. The front end surface of the lens 32 corresponds to the observation window 14A. A plurality of vibrators 12, specifically, seven vibrators 12 are provided around the observation window 14A. In the endoscope 10, a channel 38 is formed, and this channel 38 is a so-called forceps hole. In the present embodiment, the optical fiber 16 is inserted into the channel 38, and laser light is emitted from the tip surface 38A. The optical fiber 16 is movable in the front-rear direction, and the distal end surface 38A is guided to the affected part side during treatment as necessary. Of course, the optical fiber 16 may be fixedly disposed. A signal line 36 is connected to each vibrator 12.

  As shown in FIG. 2, each transducer 12 is provided obliquely inward so that each ultrasonic beam crosses at a predetermined point. That is, the normal line is provided obliquely so as to cross at a predetermined distance in front of the observation window 14A. In this embodiment, as shown in (B), the vibrator is removed from a part of the annular vibrator row, and the opening of the channel 38 is located there. According to such a configuration, it is possible to increase the space utilization efficiency of the tip surface. ,

FIG. 3 conceptually shows a method of calculating the three-dimensional blood flow velocity vector V. As described above, seven vibrators are provided in a ring shape, among which five vibrators are represented by A to E in FIG. The positions of other vibrators are not shown. A broken line extending from the position of each transducer represents the center line of the ultrasonic beam. They cross each other at a predetermined point O. The predetermined point O is a treatment site. As shown in the figure, a treatment point O is set on the blood vessel 40, and the blood flow vector V is observed using a plurality of ultrasonic beams. The treatment point O is an irradiation point of the laser beam at the same time, and also corresponds to the center point of the visual field of the observation window. Here, reference numeral 42 represents the direction of the three-dimensional blood flow velocity vector. Reference numerals 42a and 42b schematically represent velocity components observed at the position of the point A and velocity components observed at the position of the point B, respectively. In the present embodiment, seven velocity components V _a , V _b , V _c , V _d , V _e , V _f , and V _g are measured by seven vibrators, and three-dimensional blood is obtained as a vector synthesis result thereof. A flow velocity vector V is calculated.

  According to such a configuration, even if any of the ultrasonic beams is orthogonal to the blood flow, it is possible to reliably measure the velocity component using the other ultrasonic beams. In the present embodiment, the three-dimensional blood flow velocity vector is calculated. Of course, the blood flow velocity may be obtained as a scalar value, and if only the result of treatment is confirmed, only the presence or absence of the blood flow is determined. May be observed. However, if a three-dimensional blood flow vector is observed, there is an advantage that treatment can be performed appropriately because the state of the actual flow can be surely recognized before and after treatment.

  DESCRIPTION OF SYMBOLS 10 Endoscope, 12 vibrator | oscillator, 14 optical apparatus, 16 optical fiber, 20 blood flow vector calculating part, 24 laser apparatus, 28 control part.

Claims (6)

A device to be inserted into a body cavity, comprising a therapeutic light irradiation unit and an ultrasonic measurement unit;
A signal processing unit for processing a reception signal from the ultrasonic measurement unit;
Have
The ultrasonic measurement unit is composed of a plurality of transducers that are directed forward in which a tissue to be treated exists,
The signal processing unit
Means for calculating a plurality of velocity components based on a plurality of received signals obtained by the plurality of vibrators;
Means for calculating a blood flow velocity based on the plurality of velocity components;
A medical system characterized by comprising: The system of claim 1, wherein
The medical system, wherein the plurality of transducers are arranged in a ring shape on a distal end surface of the treatment instrument. The system of claim 2, wherein
A medical system, wherein each of the vibrators is provided obliquely inward. The system of claim 3, wherein
Each transducer forms an ultrasonic beam that passes through a predetermined treatment point located in front of the tip surface,
The therapeutic light irradiation unit irradiates therapeutic light toward the predetermined therapeutic point,
The medical system according to claim 1, further comprising an endoscopic observation window having an optical field of view including the predetermined treatment point on the distal end surface. The system according to any one of claims 1 to 4,
The medical system, wherein the therapeutic instrument is a fetal therapeutic instrument inserted into the uterus. A therapeutic instrument used in a medical system for fetal therapy,
It has a distal end portion provided with an endoscopic observation window, a therapeutic light irradiation unit, and an ultrasonic measurement unit,
The ultrasonic measurement unit has a transducer array for Doppler information measurement arranged in an annular shape while facing forward where the tissue to be treated exists.
Each of the transducers constituting the transducer array has an oblique inward posture.

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