JP4153731B2

JP4153731B2 - Electronic scanning ultrasound endoscope

Info

Publication number: JP4153731B2
Application number: JP2002176075A
Authority: JP
Inventors: 眞一宮本; 明子水沼; 研一仁科; 祐介市川
Original assignee: Olympus Corp
Current assignee: Olympus Corp
Priority date: 2002-06-17
Filing date: 2002-06-17
Publication date: 2008-09-24
Anticipated expiration: 2022-06-17
Also published as: JP2004016505A

Description

【０００１】
【発明の属する技術分野】
本発明は、観察光学系及び照明光学系を有する内視鏡観察部と、電子走査して超音波画像を得る超音波観察部とを備えた電子走査式超音波内視鏡に関する。
【０００２】
【従来の技術】
近年、体腔内に挿入可能な内視鏡の挿入部の先端側に超音波観察部を設け、この超音波観察部によって超音波断層画像を得られるようにするとともに、この内視鏡に設けた処置具挿通用チャンネルを通して体腔内に処置具を導いて、病変部の組織を採取する等の診断や処置を行える電子走査式或いは機械走査式の超音波内視鏡が実用化されている。
【０００３】
従来の超音波内視鏡では超音波観察部を先端面から突出させた構造であるため、観察光学系の観察視野を確保するために視野範囲を挿入方向に対して斜めの斜視光学系で構成していた。しかし、術者からは内視鏡観察を広範囲にわたって、できるだけ直視に近い状態で行いたいという要望があった。
【０００４】
そのため、機械走査式の超音波内視鏡では例えば特開２００１−２９２９９７号公報に示すように操作部を大型化させることなく、簡単な操作で超音波振動子部を挿入部の先端部から突没させて超音波検査を行える超音波内視鏡が示されている。
【０００５】
【発明が解決しようとする課題】
しかしながら、電子走査式の超音波内視鏡で、前記特開２００１−２９２９９７号公報の超音波内視鏡で示したように超音波観察部が突没する構造にすると、多数の圧電素子から延出している信号線の一部が断線して観察に支障を来すおそれがある。
【０００６】
また、機械走査式、電子走査式に関わらず、超音波内視鏡観察下で病変部の組織の採取を行う際、処置具挿通孔の導出口から病変部に向けて穿刺針を穿刺するとき、この穿刺針の突出量が大きくなると穿刺針の先端が超音波走査範囲から外れて、超音波画像として描出されなくなるおそれがあった。
【０００７】
本発明は上記事情に鑑みてなされたものであり、内視鏡観察部による観察と超音波観察部による観察を最良の状態で行える、使い勝手に優れた電子走査式超音波内視鏡を提供することを目的にしている。
【０００８】
【課題を解決するための手段】
本発明の電子走査式超音波内視鏡は、挿入部の先端部を構成する先端硬質部に、内視鏡挿入軸方向を照らす照明光学系及び直視する観察光学系を設けた内視鏡観察部と、複数の圧電素子を配列して挿入軸方向に対して略側方を超音波走査範囲とする超音波走査面を形成した超音波観察部と、処置具が突没可能に挿通される処置具開口とを具備する電子走査式超音波内視鏡において、前記処置具開口から突出する前記処置具の突出量の変化に伴い前記内視鏡観察部と、前記超音波観察部の超音波走査面との相対位置を変化させる観察部移動手段を設けている。
【００１４】
【発明の実施の形態】
以下、図面を参照して本発明の実施の形態を説明する。
図１ないし図１１は本発明の第１実施形態に係り、図１は電子走査式超音波内視鏡装置の構成を説明する図、図２は進退移動手段を有する超音波内視鏡の先端硬性部の構成を説明する図、図３は図２のＡ−Ａ線断面図、図４は中途部の一部にほぐした状態の素線が位置するイメージガイドを説明する図、図５は信号線を複数本ずつガイドチューブの外側に引き出して信号線の断線を防止する構成を説明する図、図６は内視鏡観察部の突出状態を説明する図、図７は超音波観察部の突出状態を説明する図、図８は電子走査式超音波内視鏡の他の構成の進退移動手段を説明する図、図９は電子走査式超音波内視鏡の別の構成の進退移動手段を説明する図、図１０は電子走査式超音波内視鏡のまた他の構成の進退移動手段を説明する図、図１１は電子走査式超音波内視鏡のまた別の構成の進退移動手段を説明する図である。
なお、図１１（ａ）は内視鏡観察状態を説明する図、図１１（ｂ）は超音波観察状態を説明する図である。
【００１５】
図１に示すように本実施形態の電子走査式超音波内視鏡装置（以下、超音波内視鏡装置と略記する）１は、電子走査式超音波内視鏡（以下、内視鏡と略記する）２と、照明光を供給する光源部（不図示）及び図示しない撮像素子の駆動及び受信信号の各種信号処理を行って内視鏡画像を生成する信号処理部を具備する内視鏡観察装置３と、後述する圧電素子の駆動及び受信信号の各種信号処理を行って超音波診断画像を生成する信号処理部を具備する超音波観察装置４と、この超音波観測装置４及び前記内視鏡観察装置３で生成された診断画像を表示するモニタ５とを備えて主に構成されている。
【００１６】
前記内視鏡２は、体腔内に挿入される細長の挿入部１１と、この挿入部１１の基端側に位置する操作部１２と、この操作部１２の側部から延出するユニバーサルコード１３とで主に構成されている。
【００１７】
前記ユニバーサルコード１３の基端部には前記内視鏡観察装置３の光源部に接続される内視鏡コネクタ１４が設けられている。この内視鏡コネクタ１４からは前記超音波観測装置４に電気的に接続される超音波コネクタ１５ａを有する超音波ケーブル１５が延出するとともに、前記内視鏡観察装置３の信号処理部に電気接続される図示しない電気コードが着脱自在に接続される電気コネクタ１４ａが設けられている。
【００１８】
前記挿入部１１は、先端側から順に硬質部材で形成した先端硬性部６、この先端硬性部６の基端側に位置する湾曲自在な湾曲部７、この湾曲部７の基端側に位置して前記操作部１２の先端側に至る細径かつ長尺で可撓性を有する可撓管部８を連設して構成されている。
【００１９】
前記先端硬性部６には、直視による内視鏡観察を行う観察光学系及び照明光学系を進退自在に構成した内視鏡観察部２０と、超音波を送受する複数の圧電素子を配列して構成した超音波走査面を有する進退自在な超音波観察部３０とが設けられている。
【００２０】
なお、前記操作部１２には前記湾曲部７を所望の方向に湾曲制御するアングルノブ１６、送気及び送水操作を行うための送気・送水ボタン１７ａ、吸引操作を行うための吸引ボタン１７ｂや、体腔内に導入する処置具の入り口となる処置具挿入口１８等の他に前記内視鏡観察部２０を進退移動させる内視鏡観察部用操作ノブ１９ａ及び前記超音波観察部３０を進退移動させる超音波観察部用操作ノブ１９ｂが設けられている。符号９は患者の口腔に配置されるマウスピースである。
【００２１】
図２及び図３に示すように前記先端硬性部６を構成する先端部材６ａには凸部６ｂが形成されており、この凸部６ｂの段付透孔６ｃに直視観察を行う内視鏡観察部２０が摺動自在に設けられるとともに、前記先端部材６ａに対して突出して挿入軸方向に対して略側方（本図では上側）を超音波走査範囲にした超音波観察部３０が摺動自在に設けられている。この構成のとき、前記内視鏡観察部２０の光学視野範囲の一部は前記超音波観察部３０によって遮られ、前記超音波観察部３０の超音波走査範囲の一部が前記凸部６ｂによって遮られる。
【００２２】
前記内視鏡観察部２０は、前記観察光学系２１及び照明光学系２２が配設される前記先端部材６ａに対して摺動自在な内視鏡本体部材（以下、内視鏡部本体と略記する）２３と、この摺動する内視鏡部本体２３と前記先端部材６ａとのあいだの水密を図る伸縮自在で蛇腹状部を設けたチューブ体で構成した水密部材２４と、前記内視鏡部本体２３の押し引き操作を行う進退移動手段である内視鏡本体操作チューブ２５とで主に構成されている。
【００２３】
前記内視鏡部本体２３は、回転することを防止するため断面形状を例えば略楕円形状に形成した摺動部２３ａと、断面形状を略円形に形成したパイプ形状部２３ｂとで構成されており、このパイプ形状部２３ｂには前記内視鏡本体操作チューブ２５の先端部が固設されている。
前記水密部材２４の先端部は、前記内視鏡部本体２３の摺動部２３ａの基端面に一体的に固定され、基端部は前記先端部材６ａに一体に固定されている。
【００２４】
前記内視鏡本体操作チューブ２５は、樹脂チューブ又はブレードを網み込んだ樹脂チューブによって構成されており、基端部は前記内視鏡観察部用操作ノブ１９ａに連結固定されるようになっている。この内視鏡本体操作チューブ２５内には前記観察光学系を構成するイメージガイドファイバ２６及び前記照明光学系を構成するライトガイドファイバ（不図示）が挿通している。そして、この内視鏡本体操作チューブ２５は、挿入部１１内に挿通配置された内視鏡用ガイドチューブ２７内を挿通している。
【００２５】
一方、前記超音波観察部３０は、前記先端部材６ａに対して摺動自在で超音波を送受する複数の圧電素子３１，…，３１を配列して構成した超音波走査面３２を設けた超音波本体部材（以下、超音波部本体と略記する）３３と、この超音波部本体３３と前記先端部材６ａとのあいだの水密を図る伸縮自在で蛇腹状部を設けたチューブ体で構成した水密部材３４と、前記超音波部本体３３の押し引き操作を行う進退移動手段である超音波本体操作チューブ３５とで主に構成されている。
【００２６】
前記超音波部本体３３は回り止めとなる平面部３３ａを設けた摺動部３３ｂを有し、この摺動部３３ｂの基端部、つまり超音波部本体３３の基端部に前記超音波本体操作チューブ３５の先端部が固定されている。この超音波本体操作チューブ３５の基端部は、前記操作部１２に設けた超音波観察部用操作ノブ１９ｂに連結固定されるようになっている。この超音波本体操作チューブ３５内には前記圧電素子３１から延出する信号線３６が挿通している。
【００２７】
なお、前記超音波本体操作チューブ３５は前記内視鏡本体操作チューブ２５と同様、樹脂チューブ又はブレードを網み込んだ樹脂チューブである。また、前記超音波本体操作チューブ３５は、挿入部１１内に挿通配置されている超音波用ガイドチューブ３７内を挿通している。さらに、前記水密部材３４の先端部は前記超音波部本体３３の所定面に一体に固定され、基端部は前記先端部材６ａの所定面に一体に固定されている。又、図２の符号７ａは湾曲駒、符号７ｂは外皮チューブ、図３の符号６ｄは前記平面部３３ａに対応する平面を有する超音波本体用透孔、符号６ｅは前記処置具挿入口１８から挿入された処置具が挿通する処置具チャンネルである。
【００２８】
図４に示すように前記内視鏡用ガイドチューブ２７の基端部は、前記操作部１２内に設けられているガイドチューブ固定部材４１に固設されている。前記内視鏡本体操作チューブ２５の基端部は、このガイドチューブ固定部材４１近傍で前記内視鏡観察部用操作ノブ１９ａに一体なスライド部材４２に固設されている。
【００２９】
そして，前記内視鏡本体操作チューブ２５内を挿通してこのスライド部材４２上に導かれたイメージガイドファイバ２６及び図示しないライトガイドファイバの中途部には、被覆部材の一部を剥してライトガイド素線をほぐして弛んだ状態にした素線弛み部２６ａが設けられている。このことよって、ライドガイド素線が切断されることなく前記内視鏡観察部２０が進退移動する構成になっている。
【００３０】
なお、前記観察光学系を固体撮像素子を設けて構成する際には、この固体撮像素子から延出する信号線に弛るみ部を持たせ、その弛み部を例えばスライド部材４２上に配置する。
【００３１】
一方、図５に示すように前記超音波観察部用操作ノブ１９ｂに連結固定される超音波本体操作チューブ３５の基端部には押し引き操作性を向上させる目的で樹脂部材等の充填材５１を封入している。また、前記超音波本体操作チューブ３５の側面部及びガイドチューブ３７の側面部には例えば千鳥状配置で複数のスリット３５ａ、３７ａが形成されている。これらスリット３５ａ、３７ａからは前記圧電素子３１から延出した信号線３６が複数本ずつ前記ガイドチューブ３７の外周側に弛んだ状態で引き出されている。なお、前記スリット３５ａとスリット３７ａとは略同位置に形成されており、スリット３７ａをスリット３５ａより細長に形成している。
【００３２】
上述のように構成した超音波内視鏡装置１の作用を説明する。
内視鏡観察を行う場合、前記操作部１２に設けられている内視鏡観察部用操作ノブ１９ａを所定の方向に手元操作する。すると、この内視鏡観察部用操作ノブ１９ａの回動動作に伴って前記スライド部材４２、内視鏡本体操作チューブ２５が前方側に移動される。このことよって、図６の矢印に示すように内視鏡観察部２０を構成する内視鏡部本体２３が前方側に移動して突出した状態になる。この突出動作のとき、前記イメージガイドファイバ２６及びライトガイドファイバはスライド部材４２上で弛んだ状態になっているので、前記イメージガイドファイバ２６及びライトガイドファイバに負荷がかからない状態で、前記内視鏡部本体２３は挿入軸方向にスムーズに移動する。
【００３３】
そして、前記内視鏡部本体２３が所定の位置まで突出することによって、観察光学系２１の光学視野範囲が前記超音波観察部３０によって遮られることなく良好な内視鏡観察状態なる。
【００３４】
一方、超音波観察を行う場合には、前記操作部１２に設けられている超音波観察部用操作ノブ１９ｂを所定方向に手元操作する。すると、この超音波観察部用操作ノブ１９ｂの回動動作に伴って前記超音波本体操作チューブ３５が前方側に移動する。そして、図７の矢印に示すように超音波観察部３０を構成する超音波部本体３３が前方側に移動して突出状態になる。このことによって、超音波観察部３０に設けられている超音波走査面３２の超音波走査範囲が前記内視鏡観察部２０や凸部６ｂによって遮られることなく良好な超音波観察を行える。
【００３５】
なお、前記信号線３６は、スリット３５ａ、３７ａから引き出されて弛んだ状態になっているので、この信号線３６に負荷がかからない状態で、前記超音波部本体３３は挿入軸方向にスムーズに移動する。
【００３６】
このように、先端硬性部に直視観察を行う内視鏡観察部を摺動自在に設けるとともに、複数の圧電素子を配列して構成した超音波走査面を有する超音波観察部を摺動自在に設け、操作部に内視鏡観察部用操作ノブ及び超音波観察部用操作ノブを設けることによって、適宜、内視鏡観察部用操作ノブ又は超音波観察部用操作ノブを操作して内視鏡観察部又は超音波観察部を進退移動して挿入軸方向の位置を変化させることによって、最良の光学視野範囲又は超音波走査範囲を確保して良好な内視鏡観察及び超音波観察を行うことができる。
【００３７】
また、内視鏡観察部から延出するライトガイドファイバ及びイメージガイドファイバの中途部に素線弛み部を設ける構成、或いは撮像素子から延出する信号線を弛ませる構成、超音波観察部から延出する信号線を超音波本体操作チューブのスリット及びガイドチューブのスリットから引き出して弛んだ状態にすることによって、内視鏡観察部及び超音波観察部を挿入を軸方向に進退移動させたときファイバ類及び信号線が断線させることを確実に防止することができる。
【００３８】
なお、本実施形態においては内視鏡観察部２０と超音波観察部３０とをそれぞれ挿入部軸方向に対して進退自在な構成としたが、図８に示すように超音波観察部３０Ａを先端面から所定量突設させた状態で固定して、内視鏡観察部２０Ａだけを進退移動させる構成にしてもよい。この構成のとき、前記摺動部２３ａを段付透孔６ｃ内に収納状態にすることによって、前記超音波観察部３０Ａに設けた超音波操作面３２の超音波走査範囲が確保され、前記内視鏡観察部２０Ａを突出状態にすることによって光学視野範囲が前記超音波観察部３０によって遮られることがなくなる。このことによって、内視鏡観察部２０Ａを適宜突没させることによって、光学視野範囲又は超音波走査範囲を確保して所望の観察を行うことができる。
【００３９】
なお、この実施形態においては、前記内視鏡部本体２３のパイプ形状部２３ａに周り止め用の平面部を設けることによって摺動部２３ａが回転することを防止している。
【００４０】
また、図９に示すように超音波観察部３０Ｂが配置される段部６ｆを形成するように長めに形成した凸部に内視鏡観察部２０Ｂを固定状態にし、超音波観察部３０Ｂだけを進退移動させる構成にしてもよい。この構成によれば、超音波観察部３０Ｂを突出させることによって超音波操作面３２の超音波走査範囲が確保され、超音波観察部３０Ｂを段部６ｆ内に引き戻し配置することによって観察光学系２１の光学視野範囲が確保される。このことによって、超音波観察部３０Ｂを適宜突没させて、光学視野範囲又は超音波走査範囲を確保して所望の観察を行うことができる。
【００４１】
さらに、上述した実施形態においては内視鏡観察部及び超音波観察部の進退操作を、操作部に設けた内視鏡観察部用操作ノブ、超音波観察部用操作ノブの手元操作によって行う構成にしていたが、図１０に示すように例えば空気等の流体の注入及び排出を行う流体チューブ６１及びシリンダ部６２と、ピストン部６３となる超音波部本体３３Ａとを設けて進退移動手段を構成するようにしてもよい。
【００４２】
加えて、本実施形態においては前記超音波部本体３３Ａの進退移動の際に前記圧電素子３１からそれぞれ延出している信号線３６が断線することを防止するため、シリンダ部６２を構成する円筒部材６４の内部空間を信号線配置空間とし、この空間部内に前記信号線３６をほぐして弛ませた状態で螺旋状にまとめて収納する。そして、この信号線３６のひとまとめに構成した先端側部を前記円筒部材６４に固定して操作部方向に延出する。なお、ほぐした信号線３６を用いる代わりに、螺旋状に形成したフレキシブル基板を用いる構成にしてもよい。
【００４３】
このことによって、シリンダ６２内に流体を注入することによって超音波部本体３３Ａが突出するように前方側に移動し、このシリンダ６２内の流体を排出することによって超音波部本体３３Ａが基端側に戻るように移動する。つまり、流体の注入或いは排出を適宜行うことによって前記超音波部本体３３Ａを進退移動させて光学視野範囲又は超音波走査範囲を確保して所望の観察を行うことができる。
【００４４】
又、前記内視鏡観察部、超音波観察部の進退を、操作部に設けた操作ノブや、流体の注入／排出で行う代わりに、図１１（ａ）に示すように先端部材６ａ内に超音波部本体３３Ｂを収納する本体収納空間７０を形成し、この本体収納空間７０に配置される超音波部本体３３Ｂにラック７１を設け、先端部材６ａの所定位置に前記ラック７１に噛合するギア７２を配置してラックピニオン部を設けるとともに、処置具チャンネル７３に挿通されるシース部材７４の外周面の所定位置に前記ラックピニオン部のギア７２に噛合する噛合部７４ａを設けて進退移動手段を構成するようにしてもよい。
【００４５】
このことによって、図１１（ｂ）に示すように前記シース部材７４の先端部を処置具開口から突出させるように移動させることにより、このシース部材７４に設けられている噛合部７４ａが前記ギア７２を回転させる。すると、このギア７２の回転に伴って、前記ラック７２が前方側に移動して超音波観察部３０Ｃが内視鏡先端面から突出した状態になる。一方、この状態で前記シース部材７４を処置具チャンネル７３内に納めるように引き戻し操作を行うことにより、前記ラック７２が基端側に移動して超音波観察部３０Ｃが本体収納空間７０内に収納される。
【００４６】
このように、ラックピニオン部を構成するギア７２に噛合する噛合部７４ａを設けたシース部材７４を適宜突没動作することによって、前記超音波本体部３３Ｂを進退移動させて、光学視野範囲又は超音波走査範囲を確保して所望の観察を行うことができる。
【００４７】
本実施形態においては、前記ラックピニオン部を構成するラック７１とギア７２との間にスリップ機構を設けている。このスリップ機構は、例えば軸部７５ａに対して所定の弾性力で軸支されるスリップギア７５で構成したものである。このスリップギア７５は、前記超音波観察部３０Ｃが例えば体腔内の体壁や粘膜等に接触してラック７１の移動抵抗が所定状態より増大しているときには、前記シース部材７４を突出させて超音波観察部３０Ｃを移動させようとしても、ギア７２の回転がラック７２へ伝達されることを阻止するように作用する。
【００４８】
このことにより、前記超音波観察部３０Ｃが体壁や粘膜等に接触している状態のとき、超音波観察部３０Ｃがさらに突出して体壁等に傷をつける不具合の発生が確実に防止される。
【００４９】
図１２ないし図１４は本発明の第２実施形態にかかり、図１２は回動手段を有する超音波内視鏡の先端硬性部の構成を説明する図、図１３は超音波内視鏡の作用を説明する図、図１４は超音波観察部の回動と穿刺ラインの修正方法を説明する図である。
【００５０】
なお、図１２（ａ）は長手方向の断面図、図１２（ｂ）は図１２（ａ）のＢ−Ｂ線断面図、図１４（ａ）は画面上に表示される超音波観察部を示す図、図１４（ｂ）は画面上に表示される超音波観察部を示す図である。
【００５１】
本実施形態の電子走査式の超音波内視鏡では、前記第１実施形態で示したように内視鏡観察部又は超音波観察部の少なくとも一方を挿入軸方向に対して進退移動させる代わりに、図１２（ａ）及び図１３に示すように超音波観察部３０Ｄを矢印Ａ、Ｂに示すように回動させて上側であった超音波走査範囲を前方上側に変化させる構成にしている。
【００５２】
そのため、前記図１１（ａ）、（ｂ）に示したラックピニオン部を構成していたラックの代わりに前記超音波観察部３０Ｄを構成する超音波部本体３３Ｂの所定位置に第２のギア７７を一体的に設けてこの超音波部本体３３Ｂを回動させる構成にしている。なお、前記超音波観察部３０Ｄは先端面から突出した構成であり、その他の構成は前記図１１（ａ），（ｂ）に示した構成と同様であり、同部材には同符合を符して説明を省略する。
【００５３】
上述のように超音波内視鏡２Ａを構成したことによって、図１３に示すように前記シース部材７４の先端部を処置具開口から突出させるように移動させることにより、このシース部材７４に設けられている噛合部７４ａが前記ギア７２を回転させ、このギア７２の回転が前記スリップギア７５を介して前記第２のギア７７に伝達される。
【００５４】
すると、超音波観察部３０が一点鎖線に示した状態から実線に示す状態まで回転するとともに、超音波走査範囲も一点鎖線で示す上方向から実線で示す前方上方向に変化する。また、観察光学系の光学視野範囲も二点鎖線に示す範囲から実線に示す範囲に広がる。このことによって、例えば前記シース部材７４から破線に示すように穿刺針７８を突出させたとき、この穿刺針７８の先端部７８ａを確実に超音波操作範囲内に位置させた状態で病変部の組織の採取を行える。
【００５５】
一方、この状態で前記シース部材７４を処置具チャンネル７３内に納めるように引き戻し操作することにより、前記第２のギア７７が逆方向に回転して超音波観察部３０Ｄの超音波走査範囲及び観察光学系の光学視野範囲が直線に示した状態から元の一点鎖線及び二点鎖線に示す状態に戻る。
【００５６】
このように、ギア７２に噛合する噛合部７４ａを設けたシース部材７４を適宜突没動作することにより、第２のギア７７を設けた超音波部本体が回動して、観察光学系の光学視野範囲による広範囲の直視観察や、超音波走査範囲を上側から前方上側に変化させての観察を行うことができる。
【００５７】
ところで、前記第２実施形態においては超音波観察部３０Ｄが回動することにより、この超音波観察部３０Ｄの超音波走査範囲が上側から前方上側への変化等に伴って穿刺ラインを変化させる必要がある。
【００５８】
そのため、符号７９に示す回動角度検出手段として例えば歪みゲージ等を設け、この歪みゲージの抵抗値の変化を基に、前記内視鏡観察装置３又は超音波観測装置４に設けられている図示しない演算処理部で回動量を算出し、その算出した回動量に基づいて穿刺ラインの修正を行ったり、或いは、図１４（ａ）、（ｂ）に示すようにモニタ５の画面５ａ上に表示される超音波観察部３０Ｄの上面の見え方を基に、前記内視鏡観察装置３に設けられている画像処理部及び前記演算処理部で回動量を算出し、その算出した回動量に基づいて穿刺ラインの修正を行う。
【００５９】
尚、本発明は、以上述べた実施形態のみに限定されるものではなく、発明の要旨を逸脱しない範囲で種々変形実施可能である。
【００６０】
［付記］
以上詳述したような本発明の上記実施形態によれば、以下の如き構成を得ることができる。
【００６１】
（１）挿入部の先端部を構成する先端硬質部に、内視鏡挿入軸方向を照らす照明光学系及び直視する観察光学系を設けた内視鏡観察部と、複数の圧電素子を配列して挿入軸方向に対して略側方を超音波走査範囲とする超音波走査面を形成した超音波観察部とを具備する電子走査式超音波内視鏡において、
前記内視鏡観察部と、前記超音波観察部の超音波走査面との相対位置を変化させる観察部移動手段を設けた電子走査式超音波内視鏡。
【００６２】
（２）前記観察部移動手段は、前記内視鏡観察部又は前記超音波観察部の少なくとも一方を、挿入軸方向に移動させる進退移動手段である付記１に記載の電子走査式超音波内視鏡。
【００６３】
（３）前記内視鏡観察部又は前記超音波観察部は、
前記先端硬質部に対して摺動自在で前記観察光学系及び照明光学系又は前記超音波走査面が配設される本体部材と、
この本体部材と前記先端硬質部とのあいだの水密を図る伸縮自在な水密部材と、
を具備する付記１に記載の電子走査式超音波内視鏡。
【００６４】
（４）前記進退移動手段は、前記本体部材の基端部に先端部が固定されて押し引き操作を行う操作チューブである付記２又は付記３に記載の電子走査式超音波内視鏡。
【００６５】
（５）前記進退移動手段は、シリンダ内に配置されたピストンとなる前記本体部材を進退させる流体を供給又は吸引する流体チューブである付記２又は付記３に記載の電子走査式超音波内視鏡。
【００６６】
（６）前記操作チューブ内に、前記超音波観察部の圧電素子から延出する信号線が挿通する付記４又は付記５に記載の電子走査式超音波内視鏡。
【００６７】
（７）前記操作チューブ内に、前記内視鏡観察部の観察光学系を構成する撮像素子から延出する信号線又はイメージガイドファイバ及び照明光学系を構成するライトガイドファイバが挿通する付記４又は付記５に記載の電子走査式超音波内視鏡。
【００６８】
（８）前記操作チューブに、これらチューブ内を挿通する前記信号線又はガイドファイバが断線することを防止する断線防止手段を設けたことを特徴とする付記６又は付記７に記載の電子走査式超音波内視鏡。
【００６９】
（９）前記断線防止手段は、前記信号線又はガイドファイバを外周側に導く、前記チューブの中途部に配列した透孔である付記８に記載の電子走査式超音波内視鏡。
【００７０】
（１０）前記断線防止手段は、前記信号線又はライトガイドファイバをほぐした弛み部である付記８に記載の電子走査式超音波内視鏡。
【００７１】
（１１）前記水密部材は、伸縮自在な弾性部材で形成したチューブ体である付記３に記載の電子走査式超音波内視鏡。
【００７２】
（１２）前記水密部材は、蛇腹状部を設けたチューブ体である付記３に記載の電子走査式超音波内視鏡。
【００７３】
（１３）前記進退移動手段を、前記超音波観察部を構成する本体部材の基端側に設けたラックピニオン部と、このラックピニオン部の歯車に噛合する噛合部を外周面に設けた処置具とで構成する付記２又は付記３に記載の電子走査式超音波内視鏡。
【００７４】
（１４）前記処置具はシース部材であり、このシース部材の先端部外周面に前記噛合部を設けた付記１３記載の電子走査式超音波内視鏡。
【００７５】
（１５）前記観察部移動手段は、前記超音波観察部を前記観察光学系の観察方向に対して回動させる回動手段である付記１に記載の電子走査式超音波内視鏡。
【００７６】
（１６）前記回動手段は、前記超音波観察部を構成する本体部材の基端側に一体に設けた第２歯車部とこの歯車に噛合する歯車と、この歯車に噛合する噛合部を外周面に設けた処置具である付記１５に記載の電子走査式超音波内視鏡。
【００７７】
（１７）前記処置具の突出量の変化に伴い、前記超音波観察部を構成する本体部材が回動する付記１６に記載の電子走査式超音波内視鏡。
【００７８】
（１８）前記歯車と歯車との間にスリップ機構を設けた付記１６記載の電子走査式超音波内視鏡。
【００７９】
（１９）前記超音波観察部に回動角度検出手段を設けた付記１６に記載の電子走査式超音波内視鏡。
【００８０】
（２０）前記回動角度検出手段は歪みゲージである付記１９に記載の電子走査式超音波内視鏡。
【００８１】
【発明の効果】
以上説明したように本発明によれば、内視鏡観察部による観察と超音波観察部による観察を最良の状態で行える、使い勝手に優れた電子走査式超音波内視鏡を提供することができる。
【図面の簡単な説明】
【図１】図１ないし図１１は本発明の第１実施形態に係り、図１は電子走査式超音波内視鏡装置の構成を説明する図
【図２】進退移動手段を有する超音波内視鏡の先端硬性部の構成を説明する図
【図３】図２のＡ−Ａ線断面図
【図４】中途部の一部にほぐした状態の素線が位置するイメージガイドを説明する図
【図５】信号線を複数本ずつガイドチューブの外側に引き出して信号線の断線を防止する構成を説明する図
【図６】内視鏡観察部の突出状態を説明する図
【図７】超音波観察部の突出状態を説明する図
【図８】電子走査式超音波内視鏡の他の構成の進退移動手段を説明する図
【図９】電子走査式超音波内視鏡の別の構成の進退移動手段を説明する図
【図１０】電子走査式超音波内視鏡のまた他の構成の進退移動手段を説明する図
【図１１】電子走査式超音波内視鏡のまた別の構成の進退移動手段を説明する図
【図１２】図１２ないし図１４は本発明の第２実施形態にかかり、図１２は回動手段を有する超音波内視鏡の先端硬性部の構成を説明する図
【図１３】超音波内視鏡の作用を説明する図
【図１４】超音波観察部の回動と穿刺ラインの修正方法を説明する図
【符号の説明】[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an electronic scanning ultrasonic endoscope including an endoscope observation unit having an observation optical system and an illumination optical system, and an ultrasonic observation unit that electronically scans to obtain an ultrasonic image.
[0002]
[Prior art]
In recent years, an ultrasonic observation unit is provided on the distal end side of an insertion portion of an endoscope that can be inserted into a body cavity, and an ultrasonic tomographic image can be obtained by the ultrasonic observation unit, and the endoscope is provided on the endoscope. 2. Description of the Related Art An electronic scanning or mechanical scanning ultrasonic endoscope that can perform diagnosis and treatment such as taking a treatment tool into a body cavity through a treatment tool insertion channel and collecting a tissue of a lesioned part has been put into practical use.
[0003]
The conventional ultrasonic endoscope has a structure in which the ultrasonic observation part protrudes from the distal end surface, so that the visual field range is composed of a perspective optical system oblique to the insertion direction in order to secure the observation visual field of the observation optical system Was. However, there has been a request from the surgeon to perform endoscopic observation over a wide range in a state as close to direct view as possible.
[0004]
For this reason, in a mechanical scanning ultrasonic endoscope, for example, as shown in Japanese Patent Laid-Open No. 2001-292997, the ultrasonic transducer unit protrudes from the distal end of the insertion unit with a simple operation without increasing the size of the operation unit. An ultrasonic endoscope that can be immersed and can be subjected to ultrasonic examination is shown.
[0005]
[Problems to be solved by the invention]
However, when an electronic scanning ultrasonic endoscope has a structure in which the ultrasonic observation section protrudes and retracts as shown in the ultrasonic endoscope of JP-A-2001-292997, it extends from a large number of piezoelectric elements. There is a possibility that a part of the signal line that goes out may be broken and hinder observation.
[0006]
Whether to puncture the puncture needle from the outlet of the treatment instrument insertion hole toward the lesion when collecting tissue of the lesion under ultrasound endoscopy regardless of mechanical scanning or electronic scanning If the protruding amount of the puncture needle becomes large, the tip of the puncture needle may be out of the ultrasonic scanning range and may not be drawn as an ultrasonic image.
[0007]
The present invention has been made in view of the above circumstances, and provides an electronic scanning ultrasonic endoscope excellent in usability in which observation by an endoscope observation unit and observation by an ultrasonic observation unit can be performed in the best state. It is aimed at that.
[0008]
[Means for Solving the Problems]
The electronic scanning ultrasonic endoscope according to the present invention is an endoscope observation in which an illumination optical system for illuminating the endoscope insertion axis direction and an observation optical system for direct viewing are provided on the distal end hard portion constituting the distal end portion of the insertion portion. And an ultrasonic observation unit in which a plurality of piezoelectric elements are arranged to form an ultrasonic scanning surface in which an ultrasonic scanning range is set substantially lateral to the insertion axis direction. A treatment instrument opening through which the treatment instrument can be inserted and retracted; In an electronic scanning ultrasonic endoscope comprising: Along with a change in the protruding amount of the treatment tool protruding from the treatment tool opening Observation unit moving means for changing a relative position between the endoscope observation unit and the ultrasonic scanning surface of the ultrasonic observation unit is provided.
[0014]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
1 to 11 relate to a first embodiment of the present invention, FIG. 1 is a diagram for explaining the configuration of an electronic scanning ultrasonic endoscope apparatus, and FIG. 2 is a front end of an ultrasonic endoscope having an advancing / retreating means. FIG. 3 is a cross-sectional view taken along the line AA in FIG. 2, FIG. 4 is a diagram illustrating an image guide in which a strand is loosened in a part of the middle portion, and FIG. FIG. 6 is a diagram illustrating a configuration in which a plurality of signal lines are pulled out to the outside of the guide tube to prevent disconnection of the signal lines, FIG. 6 is a diagram illustrating a protruding state of the endoscope observation unit, and FIG. 7 is a diagram of the ultrasonic observation unit. FIG. 8 is a diagram for explaining a protruding state, FIG. 8 is a diagram for explaining an advance / retreat means of another configuration of the electronic scanning ultrasonic endoscope, and FIG. 9 is an advance / retreat means of another configuration of the electronic scanning ultrasonic endoscope. FIG. 10 is a diagram for explaining the advancing / retreating means of another configuration of the electronic scanning ultrasonic endoscope, and FIG. Is a diagram illustrating a forward and backward movement means of yet another configuration of the scanning ultrasonic endoscope.
FIG. 11A is a diagram for explaining the endoscope observation state, and FIG. 11B is a diagram for explaining the ultrasonic observation state.
[0015]
As shown in FIG. 1, an electronic scanning ultrasonic endoscope apparatus (hereinafter abbreviated as an ultrasonic endoscope apparatus) 1 of the present embodiment is an electronic scanning ultrasonic endoscope (hereinafter referred to as an endoscope). 2) and an endoscope including a light source unit (not shown) for supplying illumination light and a signal processing unit for driving an imaging device (not shown) and performing various signal processing of received signals to generate an endoscopic image. An ultrasonic observation apparatus 4 including an observation apparatus 3, a signal processing unit that generates a diagnostic ultrasound image by performing various signal processing of a piezoelectric element and a received signal, which will be described later, and the ultrasonic observation apparatus 4 and the internal And a monitor 5 for displaying a diagnostic image generated by the endoscope observation apparatus 3.
[0016]
The endoscope 2 includes an elongated insertion portion 11 that is inserted into a body cavity, an operation portion 12 that is located on the proximal end side of the insertion portion 11, and a universal cord 13 that extends from a side portion of the operation portion 12. And is mainly composed.
[0017]
An endoscope connector 14 that is connected to a light source unit of the endoscope observation apparatus 3 is provided at a base end portion of the universal cord 13. An ultrasonic cable 15 having an ultrasonic connector 15 a electrically connected to the ultrasonic observation device 4 extends from the endoscope connector 14, and the signal processing unit of the endoscope observation device 3 is electrically connected. An electrical connector 14a to which an electrical cord (not shown) to be connected is detachably connected is provided.
[0018]
The insertion portion 11 is located on the distal end side of the bending portion 7, the distal end rigid portion 6 formed of a hard member in order from the distal end side, the bendable bending portion 7 located on the proximal end side of the distal end rigid portion 6. Thus, a flexible tube portion 8 having a small diameter, a long length, and flexibility reaching the distal end side of the operation portion 12 is continuously provided.
[0019]
The distal end rigid portion 6 includes an endoscope observation unit 20 configured to freely move an observation optical system and an illumination optical system that perform endoscope observation by direct viewing, and a plurality of piezoelectric elements that transmit and receive ultrasonic waves. An ultrasonic observation unit 30 having a configured ultrasonic scanning surface and capable of moving back and forth is provided.
[0020]
The operation unit 12 includes an angle knob 16 for controlling the bending of the bending unit 7 in a desired direction, an air / water supply button 17a for performing air supply and water supply operations, a suction button 17b for performing a suction operation, In addition to the treatment instrument insertion port 18 serving as the entrance of the treatment instrument introduced into the body cavity, the endoscope observation section operation knob 19a for moving the endoscope observation section 20 forward and backward and the ultrasonic observation section 30 are advanced and retracted. An ultrasonic observation section operation knob 19b to be moved is provided. Reference numeral 9 denotes a mouthpiece placed in the oral cavity of the patient.
[0021]
As shown in FIGS. 2 and 3, the distal end member 6a constituting the distal end rigid portion 6 is formed with a convex portion 6b, and endoscopic observation in which direct observation is performed in the stepped through hole 6c of the convex portion 6b. A portion 20 is provided slidably, and an ultrasonic observation portion 30 that protrudes from the distal end member 6a and has an ultrasonic scanning range in a substantially lateral direction (upper side in the figure) with respect to the insertion axis direction slides. It is provided freely. In this configuration, a part of the optical field range of the endoscope observation unit 20 is blocked by the ultrasonic observation unit 30, and a part of the ultrasonic scanning range of the ultrasonic observation unit 30 is formed by the convex part 6b. Blocked.
[0022]
The endoscope observation unit 20 is an endoscope main body member (hereinafter abbreviated as an endoscope main body) that is slidable with respect to the distal end member 6a on which the observation optical system 21 and the illumination optical system 22 are disposed. 23), a watertight member 24 constituted by a tube body having a telescopic and bellows-like portion for achieving watertightness between the sliding endoscope main body 23 and the tip member 6a, and the endoscope It is mainly composed of an endoscope main body operation tube 25 which is an advancing / retracting means for pushing and pulling the main body 23.
[0023]
The endoscope section main body 23 is configured by a sliding section 23a having a cross-sectional shape formed in, for example, a substantially elliptical shape, and a pipe-shaped section 23b having a cross-sectional shape formed in a substantially circular shape in order to prevent rotation. The distal end portion of the endoscope body operation tube 25 is fixed to the pipe-shaped portion 23b.
The distal end portion of the watertight member 24 is integrally fixed to the proximal end surface of the sliding portion 23a of the endoscope portion main body 23, and the proximal end portion is integrally fixed to the distal end member 6a.
[0024]
The endoscope main body operation tube 25 is configured by a resin tube or a resin tube in which a blade is meshed, and a base end portion is connected and fixed to the endoscope observation unit operation knob 19a. Yes. An image guide fiber 26 constituting the observation optical system and a light guide fiber (not shown) constituting the illumination optical system are inserted into the endoscope main body operation tube 25. The endoscope main body operation tube 25 is inserted through the endoscope guide tube 27 inserted in the insertion portion 11.
[0025]
On the other hand, the ultrasonic observation unit 30 is provided with an ultrasonic scanning surface 32 configured by arranging a plurality of piezoelectric elements 31,..., 31 that are slidable with respect to the tip member 6a and that transmit and receive ultrasonic waves. A watertight structure composed of a sonic body member (hereinafter abbreviated as an ultrasonic body) 33 and a tube body provided with a telescopic and bellows-like portion for achieving watertightness between the ultrasonic body 33 and the tip member 6a. The member 34 is mainly composed of an ultrasonic body operation tube 35 which is an advancing / retreating movement means for pushing and pulling the ultrasonic body 33.
[0026]
The ultrasonic unit main body 33 has a sliding portion 33b provided with a flat surface portion 33a that serves as a detent. The ultrasonic main body 33 is located at the base end of the sliding portion 33b, that is, at the base end of the ultrasonic unit main body 33. The tip of the operation tube 35 is fixed. The base end portion of the ultrasonic body operation tube 35 is connected and fixed to an ultrasonic observation unit operation knob 19 b provided in the operation unit 12. A signal line 36 extending from the piezoelectric element 31 is inserted into the ultrasonic body operation tube 35.
[0027]
The ultrasonic body operation tube 35 is a resin tube or a resin tube in which blades are meshed, like the endoscope body operation tube 25. The ultrasonic body operation tube 35 is inserted through an ultrasonic guide tube 37 that is inserted into the insertion portion 11. Further, the distal end portion of the watertight member 34 is integrally fixed to a predetermined surface of the ultrasonic body main body 33, and the proximal end portion is integrally fixed to a predetermined surface of the distal end member 6a. 2 is a bending piece, 7b is an outer tube, 6d is a through hole for an ultrasonic body having a plane corresponding to the flat portion 33a, and 6e is from the treatment instrument insertion port 18. A treatment instrument channel through which the inserted treatment instrument is inserted.
[0028]
As shown in FIG. 4, the proximal end portion of the endoscope guide tube 27 is fixed to a guide tube fixing member 41 provided in the operation portion 12. The proximal end portion of the endoscope main body operation tube 25 is fixed to a slide member 42 that is integral with the endoscope observation portion operation knob 19 a in the vicinity of the guide tube fixing member 41.
[0029]
Then, a part of the covering member is peeled off in the middle portion of the image guide fiber 26 and the light guide fiber (not shown) inserted through the endoscope main body operation tube 25 and guided onto the slide member 42. A strand slack portion 26a is provided in which the strand is loosened and loosened. Thus, the endoscope observation unit 20 is configured to move forward and backward without cutting the ride guide element wire.
[0030]
When the observation optical system is configured by providing a solid-state image sensor, a signal line extending from the solid-state image sensor is provided with a slack portion, and the slack portion is disposed on the slide member 42, for example.
[0031]
On the other hand, as shown in FIG. 5, a filler 51 such as a resin member is provided at the proximal end portion of the ultrasonic body operation tube 35 connected and fixed to the ultrasonic observation portion operation knob 19b for the purpose of improving the push-pull operability. Is enclosed. A plurality of slits 35 a and 37 a are formed in a staggered arrangement on the side surface of the ultrasonic body operation tube 35 and the side surface of the guide tube 37, for example. A plurality of signal lines 36 extending from the piezoelectric element 31 are led out from the slits 35a and 37a in a slack state toward the outer peripheral side of the guide tube 37. The slit 35a and the slit 37a are formed at substantially the same position, and the slit 37a is formed to be longer than the slit 35a.
[0032]
The operation of the ultrasonic endoscope apparatus 1 configured as described above will be described.
When performing endoscopic observation, the endoscope observation unit operation knob 19a provided in the operation unit 12 is operated by hand in a predetermined direction. Then, the slide member 42 and the endoscope main body operation tube 25 are moved to the front side in accordance with the turning operation of the operation knob 19a for the endoscope observation unit. As a result, as shown by the arrow in FIG. 6, the endoscope body 23 constituting the endoscope observation section 20 moves forward and protrudes. At the time of this projecting operation, the image guide fiber 26 and the light guide fiber are in a slack state on the slide member 42, so that the endoscope is in a state where no load is applied to the image guide fiber 26 and the light guide fiber. The body part 23 moves smoothly in the direction of the insertion axis.
[0033]
Then, the endoscope main body 23 protrudes to a predetermined position, so that the optical field range of the observation optical system 21 is not obstructed by the ultrasonic observation unit 30 and a good endoscope observation state is obtained.
[0034]
On the other hand, when performing ultrasonic observation, the operation knob 19b for ultrasonic observation part provided in the said operation part 12 is hand-operated in a predetermined direction. Then, the ultrasonic body operation tube 35 moves to the front side in accordance with the turning operation of the ultrasonic observation unit operation knob 19b. Then, as shown by the arrows in FIG. 7, the ultrasonic unit main body 33 constituting the ultrasonic observation unit 30 moves forward and enters a protruding state. Thereby, it is possible to perform good ultrasonic observation without the ultrasonic scanning range of the ultrasonic scanning surface 32 provided in the ultrasonic observation unit 30 being obstructed by the endoscope observation unit 20 or the convex portion 6b.
[0035]
Since the signal line 36 is pulled out from the slits 35a and 37a and is in a relaxed state, the ultrasonic wave body 33 moves smoothly in the insertion axis direction without applying a load to the signal line 36. To do.
[0036]
In this way, an endoscope observation part that performs direct-view observation at the distal end rigid part is slidably provided, and an ultrasonic observation part having an ultrasonic scanning surface configured by arranging a plurality of piezoelectric elements is slidable. By providing the operation knob for the endoscope observation section and the operation knob for the ultrasonic observation section in the operation section, the endoscope can be operated by appropriately operating the operation knob for the endoscope observation section or the operation knob for the ultrasonic observation section. By moving the mirror observation part or ultrasonic observation part back and forth to change the position in the insertion axis direction, the best optical field of view range or ultrasonic scanning range is ensured and good endoscopic observation and ultrasonic observation are performed. be able to.
[0037]
In addition, a light guide fiber extending from the endoscope observation unit and a configuration in which a wire slack portion is provided in the middle of the image guide fiber, or a configuration in which a signal line extending from the image sensor is slackened, extending from the ultrasonic observation unit. When the insertion line is moved forward and backward in the axial direction by pulling out the outgoing signal line from the slit of the ultrasonic body operation tube and the slit of the guide tube to make it loose, the fiber is It is possible to reliably prevent the type and signal lines from being disconnected.
[0038]
In the present embodiment, the endoscope observation unit 20 and the ultrasonic observation unit 30 are configured to be able to advance and retreat with respect to the axial direction of the insertion unit. However, as shown in FIG. A configuration may be adopted in which only a predetermined amount of projection from the surface is fixed and the endoscope observation unit 20A is moved forward and backward. In this configuration, by placing the sliding portion 23a in the stepped through hole 6c, an ultrasonic scanning range of the ultrasonic operation surface 32 provided in the ultrasonic observation portion 30A is secured, and the inner portion By making the endoscope observation part 20A project, the optical field of view is not blocked by the ultrasonic observation part 30. Thus, by appropriately projecting and sunk the endoscope observation unit 20A, it is possible to ensure the optical visual field range or the ultrasonic scanning range and perform desired observation.
[0039]
In this embodiment, the sliding portion 23a is prevented from rotating by providing a flat portion for preventing rotation on the pipe-shaped portion 23a of the endoscope portion main body 23.
[0040]
Further, as shown in FIG. 9, the endoscope observation unit 20B is fixed to a long convex portion so as to form a step portion 6f on which the ultrasonic observation unit 30B is arranged, and only the ultrasonic observation unit 30B is provided. It may be configured to move forward and backward. According to this configuration, the ultrasonic scanning range of the ultrasonic operation surface 32 is secured by projecting the ultrasonic observation unit 30B, and the observation optical system 21 is arranged by pulling back the ultrasonic observation unit 30B in the stepped portion 6f. Is ensured. Accordingly, the ultrasonic observation unit 30B can be appropriately projected and retracted to ensure a desired optical field of view or ultrasonic scanning range and perform desired observation.
[0041]
Furthermore, in the above-described embodiment, a configuration in which the endoscope observation unit and the ultrasound observation unit are advanced and retracted by hand operation of the operation knob for the endoscope observation unit and the operation knob for the ultrasound observation unit provided in the operation unit. However, as shown in FIG. 10, for example, a fluid tube 61 and a cylinder portion 62 for injecting and discharging a fluid such as air, and an ultrasonic body 33A serving as a piston portion 63 are provided to constitute an advance / retreat means. You may make it do.
[0042]
In addition, in this embodiment, in order to prevent the signal lines 36 extending from the piezoelectric elements 31 from being disconnected when the ultrasonic body 33A moves forward and backward, a cylindrical member constituting the cylinder 62 is provided. The internal space 64 is used as a signal line arrangement space, and the signal line 36 is loosened and loosened in this space portion and stored together in a spiral shape. Then, the distal end side portion of the signal line 36 configured in a lump is fixed to the cylindrical member 64 and extends in the direction of the operation portion. Instead of using the loosened signal line 36, a configuration may be used in which a flexible substrate formed in a spiral shape is used.
[0043]
As a result, by injecting fluid into the cylinder 62, the ultrasonic body 33A moves forward so as to protrude, and by discharging the fluid in the cylinder 62, the ultrasonic body 33A becomes proximal. Move back to. That is, by appropriately injecting or discharging the fluid, the ultrasonic body 33A can be moved forward and backward to ensure an optical field of view range or an ultrasonic scanning range, and desired observation can be performed.
[0044]
Further, instead of performing the advancement / retraction of the endoscope observation unit and the ultrasonic observation unit by an operation knob provided in the operation unit or injection / discharge of a fluid, as shown in FIG. A main body storage space 70 for storing the ultrasonic unit main body 33B is formed, a rack 71 is provided in the ultrasonic unit main body 33B disposed in the main body storage space 70, and a gear that meshes with the rack 71 at a predetermined position of the tip member 6a. 72 is provided to provide a rack and pinion portion, and a meshing portion 74a that meshes with the gear 72 of the rack and pinion portion is provided at a predetermined position on the outer peripheral surface of the sheath member 74 that is inserted into the treatment instrument channel 73. You may make it comprise.
[0045]
As a result, as shown in FIG. 11 (b), the distal end portion of the sheath member 74 is moved so as to protrude from the treatment instrument opening, whereby the meshing portion 74 a provided in the sheath member 74 is moved to the gear 72. Rotate. Then, with the rotation of the gear 72, the rack 72 moves forward and the ultrasonic observation unit 30C protrudes from the distal end surface of the endoscope. On the other hand, by performing a pull back operation so that the sheath member 74 is accommodated in the treatment instrument channel 73 in this state, the rack 72 is moved to the proximal end side and the ultrasonic observation unit 30C is accommodated in the main body accommodating space 70. Is done.
[0046]
In this way, the ultrasonic body 33B is moved forward and backward by appropriately projecting and retracting the sheath member 74 provided with the meshing portion 74a that meshes with the gear 72 constituting the rack and pinion portion, so that the optical field of view range or Desired observation can be performed while ensuring the acoustic wave scanning range.
[0047]
In the present embodiment, a slip mechanism is provided between the rack 71 and the gear 72 constituting the rack and pinion portion. This slip mechanism is composed of, for example, a slip gear 75 that is pivotally supported by a predetermined elastic force with respect to a shaft portion 75a. When the ultrasonic observation unit 30C comes into contact with, for example, a body wall or mucous membrane in a body cavity and the movement resistance of the rack 71 is increased from a predetermined state, the slip gear 75 protrudes the sheath member 74 to Even if the sound wave observation unit 30 </ b> C is moved, the rotation of the gear 72 is prevented from being transmitted to the rack 72.
[0048]
Thus, when the ultrasonic observation unit 30C is in contact with the body wall, mucous membrane, and the like, it is possible to reliably prevent the occurrence of a problem that the ultrasonic observation unit 30C further protrudes and damages the body wall or the like. .
[0049]
FIGS. 12 to 14 relate to the second embodiment of the present invention, FIG. 12 is a diagram for explaining the configuration of the distal end rigid portion of the ultrasonic endoscope having a rotating means, and FIG. 13 is an operation of the ultrasonic endoscope. FIG. 14 is a diagram for explaining the rotation of the ultrasonic observation unit and the method for correcting the puncture line.
[0050]
12A is a longitudinal sectional view, FIG. 12B is a sectional view taken along the line BB of FIG. 12A, and FIG. 14A is an ultrasonic observation section displayed on the screen. FIG. 14B is a diagram showing an ultrasonic observation unit displayed on the screen.
[0051]
In the electronic scanning ultrasonic endoscope of this embodiment, instead of moving at least one of the endoscope observation unit and the ultrasonic observation unit forward and backward with respect to the insertion axis direction as shown in the first embodiment, As shown in FIGS. 12A and 13, the ultrasonic observation unit 30 </ b> D is rotated as indicated by arrows A and B to change the upper ultrasonic scanning range to the front upper side.
[0052]
Therefore, the second gear 77 is placed at a predetermined position of the ultrasonic body 33B constituting the ultrasonic observation part 30D instead of the rack constituting the rack and pinion part shown in FIGS. 11 (a) and 11 (b). Are integrally provided to rotate the ultrasonic body 33B. The ultrasonic observation unit 30D has a configuration protruding from the distal end surface, and the other configuration is the same as the configuration shown in FIGS. 11A and 11B, and the same reference numerals are used for the same members. The description is omitted.
[0053]
By configuring the ultrasonic endoscope 2A as described above, the distal end portion of the sheath member 74 is moved so as to protrude from the treatment instrument opening as shown in FIG. The meshing portion 74 a rotates the gear 72, and the rotation of the gear 72 is transmitted to the second gear 77 through the slip gear 75.
[0054]
Then, the ultrasonic observation unit 30 rotates from the state indicated by the one-dot chain line to the state indicated by the solid line, and the ultrasonic scanning range also changes from the upper direction indicated by the one-dot chain line to the upper front direction indicated by the solid line. The optical field of view of the observation optical system also extends from the range indicated by the two-dot chain line to the range indicated by the solid line. As a result, for example, when the puncture needle 78 is projected from the sheath member 74 as shown by the broken line, the tissue of the lesioned part is in a state where the distal end portion 78a of the puncture needle 78 is reliably positioned within the ultrasonic operation range. Can be collected.
[0055]
On the other hand, when the sheath member 74 is pulled back so as to be accommodated in the treatment instrument channel 73 in this state, the second gear 77 rotates in the reverse direction and the ultrasonic scanning range and the observation of the ultrasonic observation unit 30D. The state of the optical field of view of the optical system returns from the state shown by the straight line to the state shown by the original one-dot chain line and two-dot chain line.
[0056]
In this way, by appropriately projecting and retracting the sheath member 74 provided with the meshing portion 74a that meshes with the gear 72, the ultrasonic unit main body provided with the second gear 77 rotates, and the optical of the observation optical system It is possible to perform wide-range direct-view observation based on the visual field range and observation by changing the ultrasonic scanning range from the upper side to the front upper side.
[0057]
By the way, in the said 2nd Embodiment, it is necessary to change the puncture line with the change etc. of the ultrasonic scanning range of this ultrasonic observation part 30D from the upper side to the front upper side by rotating the ultrasonic observation part 30D. There is.
[0058]
Therefore, for example, a strain gauge or the like is provided as the rotation angle detection means indicated by reference numeral 79, and the endoscope observation apparatus 3 or the ultrasonic observation apparatus 4 is provided based on a change in the resistance value of the strain gauge. The rotation amount is calculated by the calculation processing unit, and the puncture line is corrected based on the calculated rotation amount, or displayed on the screen 5a of the monitor 5 as shown in FIGS. 14 (a) and 14 (b). The rotation amount is calculated by the image processing unit and the arithmetic processing unit provided in the endoscope observation apparatus 3 based on how the upper surface of the ultrasonic observation unit 30D is viewed, and based on the calculated rotation amount Correct the puncture line.
[0059]
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.
[0060]
[Appendix]
According to the embodiment of the present invention as described above in detail, the following configuration can be obtained.
[0061]
(1) An endoscope observation part provided with an illumination optical system for illuminating the endoscope insertion axis direction and an observation optical system for direct viewing, and a plurality of piezoelectric elements are arranged on the distal end hard part constituting the distal end part of the insertion part. In an electronic scanning ultrasonic endoscope comprising an ultrasonic observation section formed with an ultrasonic scanning surface having an ultrasonic scanning range substantially lateral to the insertion axis direction,
An electronic scanning ultrasonic endoscope provided with observation unit moving means for changing a relative position between the endoscope observation unit and an ultrasonic scanning surface of the ultrasonic observation unit.
[0062]
(2) The electronic scanning ultrasonic endoscope according to appendix 1, wherein the observation unit moving unit is an advancing / retreating unit that moves at least one of the endoscope observation unit or the ultrasonic observation unit in an insertion axis direction. mirror.
[0063]
(3) The endoscope observation unit or the ultrasonic observation unit is
A main body member that is slidable with respect to the hard tip portion and on which the observation optical system and the illumination optical system or the ultrasonic scanning surface is disposed;
A stretchable watertight member for watertightness between the main body member and the hard tip portion;
The electronic scanning ultrasonic endoscope according to appendix 1, comprising:
[0064]
(4) The electronic scanning ultrasonic endoscope according to appendix 2 or appendix 3, wherein the forward / backward moving means is an operation tube having a distal end portion fixed to a proximal end portion of the main body member and performing a push-pull operation.
[0065]
(5) The electronic scanning ultrasonic endoscope according to appendix 2 or appendix 3, wherein the advancing / retreating means is a fluid tube that supplies or sucks a fluid for advancing and retracting the main body member serving as a piston disposed in the cylinder. .
[0066]
(6) The electronic scanning ultrasonic endoscope according to appendix 4 or appendix 5, wherein a signal line extending from the piezoelectric element of the ultrasound observation unit is inserted into the operation tube.
[0067]
(7) Supplementary note 4 or the signal line or image guide fiber extending from the image sensor constituting the observation optical system of the endoscope observation unit and the light guide fiber constituting the illumination optical system are inserted into the operation tube The electronic scanning ultrasonic endoscope according to appendix 5.
[0068]
(8) The electronic scanning super-mode according to appendix 6 or appendix 7, wherein the operation tube is provided with a disconnection prevention means for preventing the signal line or guide fiber inserted through the tubes from being disconnected. Sonic endoscope.
[0069]
(9) The electronic scanning ultrasonic endoscope according to appendix 8, wherein the disconnection preventing means is a through hole arranged in the middle of the tube that guides the signal line or the guide fiber to the outer peripheral side.
[0070]
(10) The electronic scanning ultrasonic endoscope according to appendix 8, wherein the disconnection preventing means is a slack portion obtained by loosening the signal line or the light guide fiber.
[0071]
(11) The electronic scanning ultrasonic endoscope according to appendix 3, wherein the watertight member is a tube body formed of a stretchable elastic member.
[0072]
(12) The electronic scanning ultrasonic endoscope according to appendix 3, wherein the watertight member is a tube body provided with a bellows-like portion.
[0073]
(13) A treatment instrument in which the advancing / retreating means is provided on the outer peripheral surface with a rack and pinion portion provided on the base end side of the main body member constituting the ultrasonic observation portion and a meshing portion that meshes with a gear of the rack and pinion portion. The electronic scanning ultrasonic endoscope according to Supplementary Note 2 or Supplementary Note 3, wherein
[0074]
(14) The electronic scanning ultrasonic endoscope according to appendix 13, wherein the treatment instrument is a sheath member, and the engagement portion is provided on an outer peripheral surface of a distal end portion of the sheath member.
[0075]
(15) The electronic scanning ultrasonic endoscope according to appendix 1, wherein the observation unit moving unit is a rotation unit that rotates the ultrasonic observation unit with respect to an observation direction of the observation optical system.
[0076]
(16) The rotating means includes a second gear portion integrally provided on the base end side of the main body member constituting the ultrasonic observation portion, a gear meshing with the gear, and a meshing portion meshing with the gear. The electronic scanning ultrasonic endoscope according to appendix 15, which is a treatment tool provided on a surface.
[0077]
(17) The electronic scanning ultrasonic endoscope according to supplementary note 16, wherein a main body member constituting the ultrasonic observation unit rotates in accordance with a change in the protrusion amount of the treatment instrument.
[0078]
(18) The electronic scanning ultrasonic endoscope according to appendix 16, wherein a slip mechanism is provided between the gears.
[0079]
(19) The electronic scanning ultrasonic endoscope according to appendix 16, wherein a rotation angle detection unit is provided in the ultrasonic observation unit.
[0080]
(20) The electronic scanning ultrasonic endoscope according to appendix 19, wherein the rotation angle detecting means is a strain gauge.
[0081]
【The invention's effect】
As described above, according to the present invention, it is possible to provide an easy-to-use electronic scanning ultrasonic endoscope capable of performing observation by the endoscope observation unit and observation by the ultrasonic observation unit in the best state. .
[Brief description of the drawings]
FIG. 1 to FIG. 11 relate to a first embodiment of the present invention, and FIG. 1 is a diagram for explaining the configuration of an electronic scanning ultrasonic endoscope apparatus.
FIG. 2 is a diagram for explaining a configuration of a distal end rigid portion of an ultrasonic endoscope having an advancing / retreating means.
3 is a cross-sectional view taken along line AA in FIG.
FIG. 4 is a diagram for explaining an image guide in which an unwound element wire is located in a part of a midway portion;
FIG. 5 is a diagram for explaining a configuration for preventing signal lines from being disconnected by drawing a plurality of signal lines to the outside of the guide tube;
FIG. 6 is a diagram illustrating a protruding state of the endoscope observation unit
FIG. 7 is a diagram for explaining a protruding state of an ultrasonic observation unit
FIG. 8 is a view for explaining a forward / backward moving means of another configuration of an electronic scanning ultrasonic endoscope;
FIG. 9 is a view for explaining a forward / backward moving means of another configuration of the electronic scanning ultrasonic endoscope;
FIG. 10 is a view for explaining an advancing / retreating means of still another configuration of the electronic scanning ultrasonic endoscope.
FIG. 11 is a diagram for explaining an advancing / retreating means of another configuration of the electronic scanning ultrasonic endoscope;
FIGS. 12 to 14 are related to a second embodiment of the present invention, and FIG. 12 is a diagram for explaining the configuration of the distal end rigid portion of the ultrasonic endoscope having a rotating means.
FIG. 13 is a diagram for explaining the operation of an ultrasonic endoscope;
FIG. 14 is a diagram for explaining a method of correcting the rotation of the ultrasonic observation unit and the puncture line
[Explanation of symbols]

Claims

An endoscope observation part provided with an illumination optical system for illuminating the endoscope insertion axis direction and an observation optical system for direct viewing, and a plurality of piezoelectric elements arranged on the distal end hard part constituting the distal end part of the insertion part, and an insertion axis In an electronic scanning ultrasonic wave, comprising an ultrasonic observation section having an ultrasonic scanning surface having an ultrasonic scanning range approximately lateral to the direction, and a treatment instrument opening through which the treatment instrument can be projected and retracted In the endoscope,
Observation unit moving means is provided for changing a relative position between the endoscope observation unit and the ultrasonic scanning surface of the ultrasonic observation unit in accordance with a change in the protruding amount of the treatment tool protruding from the treatment tool opening. An electronic scanning ultrasonic endoscope characterized by the above.

When the movement resistance of at least one of the endoscopic observation unit or the ultrasonic observation unit is increased from a predetermined state, the observation unit moving means is at least one of the endoscopic observation unit or the ultrasonic observation unit. The electronic scanning ultrasonic endoscope according to claim 1, further comprising a slip mechanism that prevents transmission of a driving force to the robot.

The observation unit moving means includes a meshing portion provided on an outer peripheral surface of the treatment instrument, and a meshing portion of the endoscopic observation unit or the ultrasonic observation unit that is meshed with the meshing unit and interlocked with the protrusion and depression of the treatment tool. The electronic scanning ultrasonic endoscope according to claim 1, further comprising a gear portion that moves at least one of the gear portions.

The observation unit moving means advances the ultrasonic observation unit relative to the endoscope observation unit in the insertion axis direction according to the protrusion of the treatment tool from the treatment tool opening. The electronic scanning ultrasonic endoscope according to any one of claims 1 to 3.

The observation unit moving means advances the ultrasonic observation unit so that the ultrasonic scanning range moves in the protruding direction of the treatment tool according to the protrusion of the treatment tool from the treatment tool opening. The electronic scanning ultrasonic endoscope according to claim 4.

The observation unit moving means rotates the ultrasonic observation unit relative to the observation direction of the endoscope observation unit according to the protrusion of the treatment tool from the treatment tool opening. The electronic scanning ultrasonic endoscope according to any one of claims 1 to 3.

The observation unit moving means rotates the ultrasonic observation unit so that the ultrasonic scanning range is tilted in the protruding direction of the treatment tool according to the protrusion of the treatment tool from the treatment tool opening. The electronic scanning ultrasonic endoscope according to claim 6, wherein: