JP2013233272A - Ultrasonic endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To obtain an ultrasonic endoscope that can easily describe a treatment instrument of a flexible line shape in an ultrasonic tomographic image without relying on capability of an operator in the ultrasonic endoscope in which an ultrasonic probe that obtains an ultrasonic tomographic image of an observation region is disposed in an insertion part distal end, and a forceps channel to project the treatment instrument of a flexible line shape in an ultrasonic tomographic image of an ultrasonic probe is opened in the insertion part distal end.SOLUTION: An ultrasonic endoscope makes a forceps channel meander in a plane including an ultrasonic scanning plane of an ultrasonic probe near the opening.

Description

  The present invention relates to an ultrasonic endoscope.

  In an ultrasonic endoscope provided with an ultrasonic probe at the distal end portion of the body insertion portion, while observing an ultrasonic tomographic image acquired by the ultrasonic probe with an external ultrasonic observation device, for example, from a forceps channel to a flexible wire A treatment instrument (linear flexible element, for example, a puncture needle) is protruded, and its direction is adjusted with an elevator in the opening of the forceps channel to puncture the affected area and collect tissue.

JP 2010-4945 A

  In this ultrasonic endoscope, it is preferable that the puncture needle (particularly the tip thereof) is clearly depicted in the ultrasonic tomographic image. However, since the ultrasonic wave emitted from the ultrasonic probe is scanned in one plane, it is difficult to always position the puncture needle in this scanning plane, and at present, it depends largely on the skill of the operator. . That is, the inner diameter D of the forceps channel through which the puncture needle is inserted is formed sufficiently larger than the outer diameter d of the puncture needle (for example, d = D / 1.5 to D / 5). For this reason, in order to depict the tip in an ultrasonic tomographic image, it is necessary to rely on the skill of the surgeon, and the surgeon must be able to draw in the bending direction of the internal insertion portion (curved portion) or within the forceps channel. By operating the upper base, the tip of the puncture needle is depicted in the ultrasonic tomographic image.

  Based on the above problem awareness, the present invention allows a flexible linear treatment instrument such as a puncture needle protruding from a forceps channel opening to be easily depicted in an ultrasonic tomographic image without depending on the skill of the operator ( An object of the present invention is to obtain an ultrasonic endoscope that can position a flexible linear treatment instrument in an ultrasonic scanning plane.

  According to the present invention, when the forceps channel inner diameter D and the outer diameter d of the flexible linear treatment instrument are equal in size to the conventional example, The flexible linear treatment instrument that has passed through the channel is based on the knowledge that the bend is taken and located within the specific plane and protrudes from the channel opening. That is, when the forceps channel meanders in a specific plane and the flexible linear treatment instrument is passed through the meandering channel, the flexible linear treatment instrument projects from the forceps channel opening in a state of being located in the specific plane. To do.

  In the present invention, an ultrasonic probe for obtaining an ultrasonic tomographic image of an observation site is provided at the distal end of the insertion portion, and a flexible linear treatment instrument is projected from the ultrasonic tomographic image of the ultrasonic probe at the distal end of the insertion portion. In the ultrasonic endoscope in which the forceps channel is opened, the forceps channel is meandered in the plane including the ultrasonic scanning plane of the ultrasonic probe in the vicinity of the opening.

  The region where the forceps channel meanders is preferably provided with a specific length in the vicinity of the forceps channel opening. That is, even if the meandering portion is at the back of the forceps channel, the direction force effect of the flexible linear treatment instrument is likely to disappear before the exit. Further, by providing the forceps channel on the opening side of the meandering portion and providing a linear portion, it is possible to ensure the directionality of the flexible linear treatment instrument coming out of the forceps channel.

  Specifically, the meandering portion has, for example, an axial line in the ultrasonic scanning plane that connects the outlet-side linear portion and the inner linear portion that smoothly continues on the virtual extension of the outlet-side linear portion. It can comprise from the circular arc part which makes | forms.

  The straight line length of the meandering portion in the ultrasonic scanning plane is preferably less than four times the inner diameter of the forceps channel.

  Further, the meandering amount of the meandering portion is entirely covered from 30% by the inner wall of the meandering portion of the inner diameter contour of the outlet-side straight portion when the outlet-side straight portion is viewed from the axis on the forceps channel opening side. It is preferable to define as follows.

  The ultrasonic endoscope according to the present invention satisfies the case where d = D / 1.5 to D / 4, where D is the inner diameter of the forceps channel and d is the outer diameter of the flexible linear treatment instrument. It is suitable to apply.

  In one aspect of the ultrasonic endoscope of the present invention, the ultrasonic probe and the forceps channel opening are positioned in order from the front of the insertion portion, and the forceps channel opening has a forceps raising base disposed therein. Opened to the orthogonal wall of the raised storage recess.

  The present invention relates to an ultrasonic endoscope in which a forceps channel for projecting a flexible linear treatment instrument is opened in an ultrasonic tomogram of an ultrasonic probe at the distal end of an insertion portion. In FIG. 2, since the meandering is performed in the plane including the ultrasonic scanning plane of the ultrasonic probe, the direction of the flexible linear treatment instrument is corrected when passing through the meandering portion, and the flexible line is placed in the ultrasonic scanning plane. The treatment device can be projected. For this reason, without depending on the skill of the surgeon, the flexible linear treatment tool can be projected with high probability in the ultrasonic tomographic image, and the necessary treatment can be easily performed with the treatment tool.

1 is a plan view showing an overall configuration of an ultrasonic endoscope to which the present invention is applied. FIG. 2 is a partial cross-sectional plan view showing an enlarged distal end of an insertion portion of the ultrasonic endoscope shown in FIG. 1. It is sectional drawing which follows the III-III line of FIG. It is IV arrow line view of FIG. 3, Comprising: (A), (B) has shown different embodiment. It is a fragmentary sectional top view which shows the state which penetrated the puncture needle at the insertion part front-end | tip of FIG. It is sectional drawing which follows the VI-VI line of FIG. It is sectional drawing which follows the VII-VII line of FIG. FIG. 8 is a schematic diagram of an ultrasonic tomogram along the line VIII-VIII in FIG. 7. It is a fragmentary sectional view corresponding to FIG. 6 which expands and shows the insertion part front-end | tip of the conventional ultrasonic endoscope. It is sectional drawing which follows the XX line of FIG. It is a schematic diagram of the ultrasonic tomogram along the XI-XI line of FIG.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings. FIG. 1 shows the overall configuration of an ultrasonic endoscope to which the present invention is applied. The ultrasonic endoscope of the present embodiment includes a thin insertion portion 1 that is inserted into a patient's body, an operation portion 2 that is connected to the base of the insertion portion 1, and a universal tube that extends from the operation portion 2. 3 is provided with a video connector 4 provided at the tip of 3 and an ultrasonic signal connector 6 provided at the tip of a branch cable 5 extending from the video connector 4.

  The insertion portion 1 includes, in order from the front (in the order of insertion into the patient's body), a distal end rigid portion 10, a bending portion 11 that is bent by remote operation from the operation portion 2, and a flexible tube 12 having flexibility. have.

  In the operation unit 2, an operation lever 21 for bending the bending portion 11, a suction button 22 for sucking from the suction port of the distal end rigid portion 10, and a forceps insertion port 23 for inserting a flexible linear treatment instrument such as a puncture needle. Is provided.

  2 to 8 show an embodiment of an ultrasonic endoscope according to the present invention. As shown in FIGS. 2 and 3, the distal end rigid portion 10 of the insertion portion 1 is provided with an ultrasonic probe 30 at the front end portion thereof, and a forceps is raised on a slope portion 31 formed behind the ultrasonic probe 30. An upper mechanism 32 is provided, and an objective window 33 and an illumination window 34 are provided on the sides of the forceps raising mechanism 32 so as to be shifted in the front-rear direction. As is well known, the objective window 33 is connected to an objective lens and a CCD unit, and the CCD unit is connected to a CCD cable (not shown). The illumination window 34 is connected to a light guide fiber (not shown). The CCD cable, the light guide fiber, and an ultrasonic signal cable (not shown) connected to the ultrasonic probe 30 are guided from the insertion section 1 to the universal tube 3 through the operation section 2. As is well known, the CCD cable is connected to a video processor (not shown) via the video connector 4, and the ultrasonic cable is not shown via the branch cable 5 and the ultrasonic signal connector 6. Connected to. The light guide fiber is connected to a light source device that supplies illumination light. The inclined surface portion 31 is a plane that obliquely intersects the axis of the distal end rigid portion 10, and the present embodiment is a perspective type ultrasonic endoscope in which an objective window 33 and an illumination window 34 are provided on the inclined surface portion 31. Is applied.

  The ultrasonic scanning plane by the ultrasonic probe 30 is a plane P shown in FIGS. 2 and 3 (a direction orthogonal to the paper surface in FIG. 2 and a direction parallel to the paper surface in FIG. 3). The scanning angle of the sound wave is shown as θ in FIG.

  A forceps channel 40 having a rear end portion connected to the forceps insertion port 23 is inserted into the insertion portion 1 from the operation portion 2, and a distal end portion of the forceps channel 40 is located near (rearward) the forceps raising mechanism 32. It is open. The forceps channel 40 is made of a flexible resin pipe (for example, PTFE (polytetrafluoroethylene) tube), the axis of which is included in the ultrasonic scanning plane P, and in the ultrasonic scanning plane P. It has a meandering part (arc part) 42 located. That is, the forceps channel 40 appears linearly in FIG. 2 (it is linear when viewed from above and below), but its axis is located in the ultrasonic scanning plane P as is apparent from FIG. The outlet side linear portion 41, the meandering portion 42 in which the axis line following the outlet side linear portion 41 forms an arc, and the inner side linear portion 43 connected to the meandering portion 42 (in the left-right direction) Meander when seen from). In the conventional forceps channel 40 ′, as shown in FIG. 9, the meandering portion 42 does not exist and is smoothly connected from the outlet-side linear portion 41 to the inner linear portion 43.

  The forceps raising mechanism 32 has a raising base 32c pivotally mounted on an axis 32b orthogonal to the ultrasonic scanning plane P in an raising base accommodating recess 32a formed on the inclined surface portion 31 of the distal end rigid portion 10, and the raising base 32c. A V-groove 32d that is located in the ultrasonic scanning plane P and is deepest in the plane is formed. The V-groove 32 d is located on the extension of the outlet-side linear portion 41 of the forceps channel 40.

  The elevator storage recess 32a has an orthogonal wall 32a1 orthogonal to the axial direction of the distal end rigid portion 10, a pair of side walls 32a2 parallel to the coaxial line direction, and a bottom wall 32a3 connecting the bottoms of the pair of side walls 32a2. The distal end portion of the forceps channel 40 is open to the orthogonal wall 32a1. The outlet side linear portion 41 is slightly inclined in a direction approaching the center of the distal end rigid portion 10 with respect to the direction orthogonal to the orthogonal wall 32a1, and the inner linear portion 43 (virtual extension axis thereof) is orthogonal wall 32a1. Is orthogonal to (virtual extension plane). The raising / lowering operation mechanism of the raising base 32c provided in the operation part 2 is well-known, The illustration is abbreviate | omitted.

  In this embodiment, the degree of meandering (meandering amount) of the meandering portion 42 of the forceps channel 40 is determined as follows. Now, when the exit-side linear portion 41 of the forceps channel 40 is viewed on the axis line from the opening end to the orthogonal wall 32a1 of the raising base storage recess 32a, it is visible within the inner diameter contour 41w of the outlet-side linear portion 41 having the inner diameter D. The edge 42x of the meander portion 42 reaches at least 30% of the inner diameter contour 41w, and preferably reaches 80%. 4A and 4B show examples of the height (position) of the edge 42x visually recognized in the inner diameter contour 41w. It is also possible to set the meandering amount so large that the edge 42x does not appear in the inner diameter contour 41w.

  The meandering direction (protruding direction) of the meandering portion 42 is determined so that the puncture needle S is bent in a direction opposite to the raising direction of the puncture needle S by the raising base 32c. Further, the meandering length is defined as a forceps channel 40 (meandering portion 42), where L (FIG. 3) is a linear length (length in the axial direction of the distal end rigid portion 10) of the meandering portion 42 in the ultrasonic scanning plane P. ) Is preferably less than 4 times the inner diameter D. When it exceeds 4 times, the direction correction effect of the puncture needle S becomes thin. The lower limit of the length L is determined so that the puncture needle S can pass through the forceps channel 40 in consideration of the flexibility of the puncture needle S. In the above discussion, when the inner diameter of the forceps channel 40 is D and the outer diameter of the puncture needle S inserted through the forceps channel is d, d = D / 1.5 to D / 5 is satisfied as in the conventional case. It is a discussion when you do. In the conventional example shown in FIG. 9, d = about D / 2, and d = D / 1.5 to D / 5 are satisfied.

  The ultrasonic endoscope having the above configuration is used as follows. When performing ultrasonic diagnosis and treatment in a state where the insertion portion 1 is inserted into the body and the distal rigid portion 10 reaches the target position in the body cavity, the ultrasonic waves from the ultrasonic probe 30 are shown in FIG. An ultrasonic tomographic image is obtained by emitting to 3 ultrasonic scanning planes P. In this state, the puncture needle S inserted from the forceps insertion port 23 of the operation unit 2 is moved from the inner straight portion 43, the meandering portion 42 and the outlet-side straight portion 41 of the forceps channel 40 to the raising base 32c of the forceps raising mechanism 32. , The direction of the puncture needle S is corrected by the meandering portion 42 so as to be positioned in the ultrasonic scanning plane P, and the direction is determined by the outlet-side linear portion 41 to the V groove 32d of the forceps raising mechanism 32. Guided. It is practical that the length Z of the axis of the outlet-side linear portion 41 is not less than the inner diameter D of the forceps channel 40 and not more than the linear length L (FIG. 3) in the ultrasonic scanning plane P of the meandering portion 42. It is. If the length is less than the inner diameter D, the action of determining the direction of the puncture needle S cannot be expected. If the length exceeds L, the forceps channel 40 becomes unnecessarily long.

  That is, when the puncture needle S advances in the forceps channel 40 and reaches the meandering portion 42 from the inner straight portion 43, the upper wall of the inner straight portion 43 and the meandering portion 42 are shown in FIG. It is corrected so as to be in the scanning plane P in contact with the edge 42x, and goes out from the exit-side linear portion 41. Since the deepest portion of the V-groove 32d of the raising base 32c of the forceps raising mechanism 32 is located in the ultrasonic scanning plane P, when the raising base 32c is tilted about the shaft 32b, the puncture needle S is super The direction is changed while being located in the acoustic wave scanning plane P. FIG. 7 shows the puncture needle S ideally located in the ultrasonic scanning plane P, and FIG. 8 shows a visual recognition example of the puncture needle S in the ultrasonic tomographic image U. As described above, if the puncture needle S is located in the ultrasonic tomographic image, the puncture needle S can be easily moved to the target site and necessary treatment can be performed under the ultrasonic image.

  9 to 11 show a state in which the puncture needle S is inserted into a forceps channel 40 ′ that does not include the conventional meandering portion 42. Since the conventional forceps channel 40 'does not correct the direction of the puncture needle S, the puncture needle S is likely to come off from the ultrasonic scanning plane P as shown in FIG. FIG. 11 shows an example image of the puncture needle S depicted in the ultrasonic tomographic image U when the puncture needle S is bent and protrudes as shown in FIG. In the rendered image of FIG. 11, the portion where the puncture needle S crosses the ultrasonic scanning plane P is depicted, and the tip thereof is not depicted, so that accurate puncture (treatment) is difficult.

  In the above embodiment, only one meandering portion (arc portion) 42 of the forceps channel 40 is provided between the outlet-side straight portion 41 and the inner straight portion 43. However, a plurality of arc portions such as an S-shape, for example, are provided. May be lined up.

  Further, in the above embodiment, the present invention is applied to the embodiment in which the ultrasonic probe 30 is provided at the most distal portion of the insertion portion 1, but the present invention is not limited to the arrangement position of the ultrasonic probe 30. Can be applied to. In the above embodiment, the present invention is applied to a perspective ultrasonic endoscope. However, the present invention provides a flat portion parallel to the axis on the distal end rigid portion, and an objective lens on the flat portion. The present invention can also be applied to a side view type in which an illumination window is provided.

DESCRIPTION OF SYMBOLS 1 Insertion part 2 Operation part 3 Universal tube 4 Video connector 5 Branch cable 6 Ultrasonic signal connector 10 Tip rigid part 11 Bending part 12 Flexible tube 23 Forceps insertion port 30 Ultrasonic probe 31 Slope part 32 Forceps raising mechanism 32a Raising stand Storage recess 32a1 Orthogonal wall 32a2 Side wall 32a3 Bottom wall 32b Shaft 32c Raising base 32d V groove 40 Forceps channel 41 Outlet side linear part 41w Inner diameter contour 42 Meandering part 42x Edge 43 Inner linear part P Ultrasonic scanning plane S Puncture needle (possible Flexural element)

Claims (7)

An ultrasonic probe for obtaining an ultrasonic tomographic image of the observation site is provided at the distal end of the insertion portion, and a forceps channel for projecting the flexible linear treatment instrument into the ultrasonic tomographic image of the ultrasonic probe is provided at the distal end of the insertion portion. In the opened ultrasound endoscope,
An ultrasonic endoscope characterized in that the forceps channel meanders in a plane including an ultrasonic scanning plane of an ultrasonic probe in the vicinity of the opening. The ultrasonic endoscope according to claim 1, wherein the forceps channel has the meandering portion following the outlet-side linear portion connected to the opening. The ultrasonic endoscope according to claim 2, wherein the meandering portion connects the outlet-side linear portion and an inner linear portion that smoothly continues on a virtual extension of the outlet-side linear portion, An ultrasonic endoscope comprising an arc portion whose axis is an arc in an ultrasonic scanning plane. The ultrasonic endoscope according to any one of claims 1 to 3, wherein a linear length of the meandering portion in the ultrasonic scanning plane is less than four times an inner diameter of the forceps channel. . 5. The ultrasonic endoscope according to claim 2, wherein the meandering amount of the meandering portion is such that when the outlet-side linear portion is viewed from the opening-side axis, the outlet-side linear shape is as follows. An ultrasonic endoscope in which the inner diameter contour of the portion is determined to be entirely covered by 30% by the inner wall of the meandering portion. 6. The ultrasonic endoscope according to claim 1, wherein when the inner diameter of the forceps channel is D and the outer diameter of the flexible linear treatment instrument is d, d = D / 1.5 to D / 4 is satisfied. Ultrasound endoscope. The ultrasonic endoscope according to any one of claims 1 to 6, wherein the ultrasonic probe and the forceps channel opening are located in order from the front of the insertion portion, and the forceps channel opening is an internal part. An ultrasonic endoscope having an opening in an orthogonal wall of an elevator storage recess in which a forceps elevator is disposed.

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