JP4526298B2 - Ultrasound endoscope device - Google Patents

Description

The present invention relates to an ultrasonic endoscope apparatus , and more particularly to an ultrasonic endoscope apparatus that can be easily treated by suction.

  Conventionally, ultrasonic endoscopes have been widely used in the medical field. Ultrasound endoscopic suction biopsy or the like is performed in which the puncture needle protrudes from the affected area while the affected area is observed with an ultrasonic tomographic image, and the cells of the affected area are collected.

Specifically, the operator inserts an endoscope insertion portion having an ultrasonic probe at the distal end into a body cavity, transmits it from an ultrasonic transducer provided at the distal end of the ultrasonic probe, and reflects it from the living body. Various treatments are performed while viewing an image generated based on the received ultrasonic signal. FIG. 13 is a diagram for explaining the state of the conventional ultrasonic endoscopic suction biopsy. As shown in FIG. 13, when an ultrasound probe 101 is positioned so as to be close to an affected part, for example, the stomach wall 102, and an ultrasonic image is generated by the observation device, a lesion existing behind the stomach wall 102 and the stomach wall 102. The image of the unit 103 and the image of the puncture needle 104 provided at the distal end of the treatment instrument, for example, the endoscope are displayed on the monitor. Therefore, the surgeon can perform a biopsy or the like while observing images of the affected part 103 and the puncture needle 104 that are puncture targets (see, for example, Patent Document 1).
Japanese Patent Laid-Open No. 2002-268835

  However, when the target to be punctured is a stomach wall, it may be difficult to pierce even if an attempt is made to pierce the stomach wall by protruding the puncture needle from the distal end of the endoscope. In FIG. 13, as shown by a two-dot chain line, the puncture target is not fixed in the body cavity, or the organ in the body cavity is easily deformed. Will run away. Alternatively, since the endoscope is also flexible, if the puncture needle is protruded, the tip of the endoscope may escape due to the reaction, and the target may not be inserted even if the puncture needle is protruded. . As a result, it may not be easy to puncture the target with the puncture needle to reach the target position.

The present invention has been made in view of the above points, and in an ultrasonic endoscope apparatus , an ultrasonic wave capable of easily performing treatment with a treatment tool without escape of both a target organ and an insertion portion. An object is to provide an endoscope apparatus .

The ultrasonic endoscope apparatus of the present invention includes an insertion portion provided with an ultrasonic transducer, and a treatment instrument channel through which a treatment instrument can be inserted and communicated with a treatment instrument opening provided in the insertion section. The treatment instrument protrudes obliquely forward toward the distal end of the insertion shaft of the insertion portion, and the ultrasound endoscope window in which the observation optical system window and the illumination optical system window are also directed in the oblique direction ; , airtightly to the have a opening provided in the protruding direction of the ultrasonic emission direction and the treatment instrument of the ultrasonic vibrator, the insertion portion in a state where the the opening the treatment instrument opening communicating And a suction means for performing suction from the treatment instrument opening through the treatment instrument channel .

According to the ultrasonic endoscope apparatus of the present invention, it is possible to realize an ultrasonic endoscope apparatus that can easily perform treatment with a treatment tool without escape of both a target organ and an insertion portion.

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

(First embodiment)
FIG. 1 is a configuration diagram showing a configuration of an ultrasonic endoscope according to the first embodiment of the present invention. FIG. 2 is a perspective view showing a distal end cover for an endoscope insertion portion according to the present embodiment. FIG. 3 is a view for explaining a state in which the distal end cover of FIG. 2 is attached to the distal end of the endoscope insertion portion. FIG. 4 is a perspective view showing a state in which the distal end cover is attached to the ultrasonic probe and the treatment instrument protrudes.

  As shown in FIG. 1, the ultrasonic endoscope 1 is configured to include an operation unit 3 at the proximal end of an elongated insertion unit 2, and is connected to a light source device (not shown) from the side of the operation unit 3. The universal cord 4 is extended. Further, an ultrasonic cord 5 connected to an ultrasonic observation device (not shown) extends from the side of the operation unit 3. In the ultrasonic observation apparatus, there is provided a control device that performs drive control of the ultrasonic transducer of the ultrasonic probe disposed in the distal end main body 6 that is an endoscope distal end, which will be described later. The ultrasonic endoscope 1 according to the present embodiment is configured such that the ultrasonic scanning surface scans almost the measurement of the insertion portion 2.

  The insertion portion 2 is configured by connecting a distal end portion main body 6, a bending portion 7, and a flexible tube portion 8 in order from the distal end side. The flexible tube portion 8 has flexibility and constitutes from the proximal end of the bending portion 7 to the distal end of the operation portion 3. Further, the bending portion 7 is bent in a desired direction by operating a bending knob 9 provided in the operation portion 3.

  A treatment instrument insertion port 10 is formed on the distal end side of the operation unit 3. By inserting a treatment instrument such as a puncture needle from the treatment instrument insertion port 10, the insertion unit 2 passes through the treatment instrument channel communicating with the inside of the treatment instrument insertion port 10 from the treatment instrument protrusion of the distal end body 6. The treatment instrument is projected in a diagonally forward direction toward the distal end direction of the insertion shaft. The operation unit 3 is provided with a suction button 11 for performing a suction operation. A suction device 12 as a suction means and a connected suction tube 13 can be connected to the treatment instrument insertion port 10. A distal end cover 21 is detachably attached to the distal end portion of the insertion portion 2. Note that the distal end cover 21 may be fixed to the distal end portion of the insertion portion 2.

  As shown in FIG. 2, the distal end cover 21 according to the present embodiment includes an attachment opening 21 a that is an opening for attaching to the distal end main body 6 that is an ultrasonic probe, and a treatment portion that touches a treatment target portion. It has a cap shape having a side opening (hereinafter simply referred to as an opening) 22. As shown in FIG. 3, when the distal end cover 21 is fitted to the distal end portion main body 6, the opening 22 has a scanning surface 23 of the ultrasonic transducer provided in the distal end portion main body 6, and a treatment instrument. It is formed in a shape that does not cover the treatment instrument protrusion surface 25 including the treatment instrument protrusion 24 that is an opening. In other words, the opening 22 is provided in the ultrasonic radiation direction of the ultrasonic transducer and the protruding direction of the treatment instrument. On the treatment instrument protruding surface 25, an illumination optical system window 26 and an observation optical system window 27 are also provided obliquely forward. This is because an ultrasonic signal is emitted from the scanning surface 23 and a reflected wave is received, and a treatment tool, for example, the puncture needle 28 can protrude in the direction of the site to be treated, and further by an illumination optical system. This is because the illuminated region to be treated can be imaged by the imaging optical system. As shown in FIG. 4, when the distal end cover 21 is attached to the insertion portion 2, the distal end cover 21 is connected to the insertion portion 2 while the opening 22 and the treatment instrument protrusion 24 are in communication with each other. It is attached.

  As shown in FIG. 4, the treatment instrument protrusion 24 is formed so as to incline obliquely forward toward the proximal end side of the distal end portion body 6 so as to project a treatment instrument described later within the ultrasonic scanning range of the ultrasonic transducer. ing. Therefore, the treatment tool protruded from the opening of the treatment tool protrusion 24 passes through the fan-shaped ultrasonic scanning range by the ultrasonic vibrator.

  Furthermore, the opening surface of the opening portion 22 has a flat surface 22a substantially along the insertion direction of the insertion portion and a curved surface 22b substantially along the scanning surface of the ultrasonic transducer at the tip so that the opening surface can be easily adhered to the surface of the treatment target. Consists of. The shape of the opening surface of the opening portion 22 is a peripheral portion shape in which there is no unevenness in the peripheral portion of the opening surface in the direction orthogonal to the opening surface so as to be in close contact with the surface of the site to be treated.

  The material of the tip cover 21 is made of a synthetic resin having elasticity, preferably a soft plastic such as vinyl chloride, polyurethane, or fluororesin, or an elastic material, preferably rubber such as latex, silicon, isoprene, or neoprene. .

  The operation of the ultrasonic endoscope having the above configuration will be described. FIG. 5 is a view showing a state in which the opening of the distal end body is substantially in contact with the surface of the stomach wall. FIG. 6 is a diagram illustrating a state in which the stomach wall is sucked into the opening, the stomach wall is adsorbed to the opening of the tip body, and the adsorbed portion of the stomach wall is fixed to the tip body. FIG. 7 is a view showing a state in which the distal end side of the puncture needle protrudes outside from the treatment instrument protrusion port.

  First, the surgeon inserts the insertion portion 2 into a body cavity such as a patient's trachea while observing an endoscopic image displayed by an observation optical system displayed on a monitor of an endoscope apparatus (not shown). When the distal end main body 6 reaches a target position, for example, a desired position on the stomach wall, the insertion is stopped, and the opening 22 is substantially brought into contact with the treatment target site while operating the bending knob 9. As a result, the state shown in FIG. 5 is obtained, and the opening 22 of the distal end portion main body 6 is substantially in contact with the surface of the stomach wall 31.

  At this time, the treatment instrument is inserted in the treatment instrument channel halfway in advance. In this state, the surgeon operates the suction device 12 by pressing the suction button 11 of the operation unit 3, and operates the suction function via the suction tube 13 and the treatment instrument channel. As a result, as shown in FIG. 6, the stomach wall is sucked into the opening 22, the stomach wall 33 is adsorbed to the opening 22 of the distal end body 6, and the adsorbed portion of the stomach wall 31 is fixed to the distal end body 6. It will be in the state. That is, the internal space of the distal end cover 21 where the opening 22 and the treatment instrument protrusion 24 communicate with each other is sucked by the suction device 12 and becomes negative pressure, so that the stomach wall 33 is adsorbed to the opening 22.

In this fixed state, as shown in FIGS. 4 and 7, the surgeon projects the distal end side of the puncture needle 28 from the treatment tool projecting port 24 to the outside. Then, the puncture needle 28 is inserted from the stomach wall 31 into the lesion 32 that is the target site. Then, by sucking the puncture needle 28 from the proximal end side, it is possible to collect cells that are living tissue of the target site. If the suction operation is canceled, the fixed state by the suction of the opening 22 and the stomach wall 33 is released.

  Note that if suction is performed with the puncture needle 28 as a treatment tool inserted into the treatment tool channel, the suction force may be reduced. Therefore, as shown in FIG. 8, a suction-only channel 41 may be provided in the insertion portion 2 separately from the treatment instrument channel. FIG. 8 is a diagram for explaining a modification in which a suction-dedicated channel is provided in the insertion portion. Furthermore, as shown in FIG. 9, the suction channel 42 may be provided along the outer peripheral surface of the insertion portion 2 instead of providing the suction channel in the insertion portion 2. FIG. 9 is a view for explaining a modification in which a suction tube is provided along the outer peripheral surface of the insertion portion.

  In the above description, the opening 22 has a shape in which there is no unevenness in the peripheral portion of the opening surface in the direction orthogonal to the opening surface so that the opening portion 22 can easily adhere to the surface of the target site. In the orthogonal direction, some unevenness may be present in the peripheral portion of the opening surface according to the surface of the target part. In short, any shape that can be adsorbed by suction with respect to the target part may be used.

  Furthermore, in the above description, the opening 22 of the distal end cover 21 is provided so that the distal end cover 21 does not block the protruding direction of the treatment instrument and the ultrasonic scanning direction. In the case where the treatment is performed from another direction, it is only necessary that the opening 22 be formed so that the surface of the site to be treated can be sucked and fixed at least in the direction in which the treatment tool protrudes.

  Further, in the above-described embodiment, the distal end cover has a cap shape, but may have a tube shape extending to the proximal end portion of the insertion portion. That is, the tip cover may have a tube shape having a length that covers substantially the entire length of the insertion portion. In that case, it is set as the structure which keeps airtight with the insertion part 2 of an endoscope in the base end part.

  Furthermore, in the above-described example, the tip cover is detachable, but it may be formed integrally with the tip portion main body. In that case, it is formed of the same material as the tip body, for example, engineering plastic or stainless steel.

(Second Embodiment)
Next, a second embodiment of the present invention will be described. In addition, the same code | symbol is attached | subjected about the same component as 1st Embodiment, and description is abbreviate | omitted.
FIG. 10 is a perspective view showing a state in which the tip cover according to the present embodiment is attached to the ultrasonic probe.

  As shown in FIG. 10, the distal end surface of the distal end portion main body 60 of the ultrasonic endoscope according to the present embodiment has a curved scanning portion 61 projecting toward the distal end side of the insertion shaft of the insertion portion 2 and a treatment. It has a treatment instrument projecting surface 63 including an instrument projecting port 62. Further, the treatment instrument protruding surface 63 is also provided with an illumination optical system window 64 and an observation optical system window 65 facing forward in the insertion axis direction of the insertion portion 2.

  A tip cover 66 is attached to the tip side of the tip portion main body 60 so as to be fitted. A tip cover 66 is detachably attached to the tip of the insertion portion 2. Note that the distal end cover 66 may be fixed to the distal end portion of the insertion portion 2. The tip cover 66 has a cylindrical shape in which one end of the cylinder is cut off at a predetermined angle. The portion cut off at a predetermined angle is the tip side of the tip cover 66. Therefore, the opening surface of the opening 67 on the tip side of the tip cover 66 is substantially elliptical. Furthermore, the scanning unit 61 and the treatment instrument protruding port 62 are provided inside the distal end cover 55. The opening surface of the opening 67 has an ultrasonic radiation direction of the ultrasonic transducer of the scanning unit 61 and an illumination optical system. Are provided in the optical axis direction of each of the window 64 and the observation optical system window 65 and in the protruding direction of the puncture needle 28 as a treatment instrument. This is because the ultrasonic wave is emitted from the scanning surface of the scanning unit 62 and the reflected wave is received, and the treatment tool, for example, the puncture needle 28 can protrude in the direction of the treatment target region, and the illumination can be performed. This is because the region to be treated illuminated by the optical system can be imaged by the imaging optical system.

  The action of performing the suction operation by bringing the distal end of the insertion portion 2 of the ultrasonic endoscope 1 close to the target site to be treated is the same as the action in the first embodiment, and thus the description thereof is omitted.

  FIG. 11 is a diagram for explaining a state in which the distal end cover 66 is attached to the ultrasonic endoscope 1 according to the present embodiment and treatment is performed. FIG. 11 shows a state in which the gastric wall 31 as the target site is adsorbed to the distal end cover and the puncture needle 28 is inserted into the lesioned part 32.

  In the distal end portion of the ultrasonic endoscope 1 according to the second embodiment, the direction in which the puncture needle 28 is inserted substantially coincides with the insertion direction of the insertion portion 2. And the scanning part 61 and the treatment tool protrusion port 62 are arrange | positioned so that the puncture needle 28 which is a treatment tool may protrude in the ultrasonic scanning range R of the scanning part 62 shown with a dotted line in FIG. That is, the protruding direction of the treatment instrument is substantially parallel to the insertion axis of the ultrasonic endoscope 1, the optical axis of the observation optical system is also substantially parallel to the insertion axis, and the scanning range of the ultrasonic transducer is , Including a range including an extension line of the insertion axis.

  Accordingly, the opening 67 of the tip cover 66 abuts on the surface of the target site such as the stomach wall at an angle that is substantially orthogonal, so that the puncture needle 28 can be inserted at an angle that is nearly perpendicular to the target site. . As a result, when inserting into a lesion near the back of the stomach wall or the like, the insertion path from the surface of the stomach wall to the lesion 32 is shorter than in the case of the first embodiment. , The safety of the treatment is further improved.

  Furthermore, in the above-described example, the tip cover is detachable, but it may be formed integrally with the tip portion main body. In that case, it is formed of the same material as the tip body, for example, engineering plastic or stainless steel.

  In the example described above, the distal end cover 66 has a cylindrical shape, but may have a tube shape extending to the proximal end portion of the insertion portion 2 as shown in FIG. That is, the tip cover 66 may have a tube shape having a length that covers almost the entire length of the insertion portion, and may be slidably attached to the insertion portion 2. FIG. 12 is a view for explaining a modification in which the tip cover is formed into a tube shape. In that case, it has a structure which keeps airtight with the insertion part 2 of an endoscope in the base end part.

  Specifically, as shown in FIG. 12, a tube 71 that wraps around the insertion portion 2 is provided. The tube 71 extends to the vicinity of the insertion portion folding preventing portion 72 at the proximal end portion of the insertion portion 2. An O-ring-shaped packing member 73 is attached to a part of the inner peripheral surface of the tube 71 in order to maintain airtightness with the surface of the insertion portion 2. Here, the packing member 73 is provided at the end of the tube 71 on the proximal end side.

  Further, the packing member 73 is made of a fluorine-based rubber material that is an elastic member, and can slide on the surface of the insertion portion 2. Therefore, when observing the inside of the body cavity, the operator slides the tube 71 to the proximal end side so that the distal end portion of the tube 71 does not cover the periphery of the distal end portion main body 61, and the observation field by ultrasonic waves is increased. Can be wide. When performing treatment such as puncture, the tube 71 is slid to the distal end side, and the opening of the distal end portion of the tube 71 covers the periphery of the distal end portion main body 61 as shown in FIG. The stomach wall can be adsorbed to the opening surface by bringing the opening surface of the opening portion into contact with the opening surface. Therefore, the method of using the tip cover as described with reference to FIG. 11 is possible.

  In place of the packing member 73, a fastening member such as a band for fastening the tube 71 from the periphery may be used.

  Furthermore, the opening surface of the opening 67 of the tip cover 66 may be a surface that is substantially perpendicular to the insertion axis of the insertion portion 2.

  As described above, according to the second embodiment, since the puncture direction is substantially the same as the insertion direction of the insertion portion, treatment is easy.

  Although the two embodiments have been described above, in order to make the ultrasonic tomographic image clearer, for example, a liquid such as water is previously injected into a body cavity such as the stomach, and then the tip as described above. You may make it perform the treatment by the ultrasonic endoscope with a cover. Furthermore, in that case, water may be injected into the stomach through the treatment instrument channel.

  Moreover, the above description was demonstrated in the example of the ultrasonic endoscopic suction biopsy. Ultrasound endoscopic suction biopsy is a technique of collecting cells at a target site while observing a puncture needle and a puncture target displayed in an ultrasonic tomographic image. However, the present invention can be applied not only to ultrasonic endoscopic aspiration biopsy medical treatment, but also to treatment using a treatment tool such as a syringe.

  From the above embodiments, the items described in the following supplementary items are characterized.

(Additional item 1)
An ultrasonic endoscope having an insertion portion provided with an ultrasonic transducer and a treatment instrument channel through which a treatment instrument is inserted, and having an end cover member having an opening in the protruding direction of the treatment instrument Insert a sonic endoscope into the body cavity,
Abutting the distal end portion of the inserted ultrasonic endoscope to a site to be treated;
By sucking from the opening provided in the tip, the part is adsorbed to the opening of the cover,
A treatment method using an ultrasonic endoscope, wherein treatment is performed by causing a treatment tool to protrude from the opening or other opening provided at the distal end in a state where the portion is adsorbed.

1 is a configuration diagram showing a configuration of an ultrasonic endoscope according to a first embodiment of the present invention. It is a perspective view which shows the front-end | tip cover for endoscope insertion parts concerning the 1st Embodiment of this invention. It is a figure for demonstrating a mode that the front-end | tip cover of FIG. 2 is attached to the front-end | tip of an endoscope insertion part. It is a perspective view which shows the state which the front-end | tip cover was attached to the ultrasonic probe and the treatment tool protruded. It is a figure which shows the state which the opening part of the front-end | tip part main body substantially contact | abutted on the surface of the stomach wall. It is a figure which shows the state by which the stomach wall was suck | inhaled by the opening part, the stomach wall adsorb | sucked to the opening part of a front-end | tip part main body, and the part of the adsorbed stomach wall was fixed with respect to the front-end | tip part main body. It is a figure which shows the state which made the front end side of the puncture needle protrude outside from the treatment tool protrusion port. It is a figure for demonstrating the modification which provided the channel only for suction in the insertion part. It is a figure for demonstrating the modification which provided the tube for suction along the outer peripheral surface of an insertion part. It is a perspective view which shows the attachment state of the front-end | tip cover which concerns on the 2nd Embodiment of this invention to an ultrasonic probe. It is a figure for demonstrating a mode that a front-end | tip cover is attached to the ultrasonic endoscope concerning the 2nd Embodiment of this invention, and a treatment is performed. It is a figure for demonstrating the modification which made the front-end | tip cover the tube shape. It is a figure for demonstrating the mode of the conventional ultrasound endoscopic suction biopsy.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Ultrasonic endoscope, 2 insertion part, 3 operation part, 6 tip part main body, 7 bending part, 8 flexible tube part, 9 operation knob, 10 treatment tool insertion port, 11 suction button, 21 tip cover, 22 opening Section, 23 Scanning plane, 24 Treatment tool protrusion, 28 Puncture needle, 31 Stomach wall, 32 Lesion site agent Patent attorney Susumu Ito

Claims (3)

An insertion portion in which the ultrasonic transducers are provided, the treatment tool can be inserted, possess a treatment instrument channel which communicates with the treatment instrument opening provided in the insertion portion, the treatment instrument insertion of the insertion portion An ultrasound endoscope that protrudes obliquely forward toward the tip direction of the shaft, and the window of the observation optical system and the window of the illumination optical system are also directed in the oblique direction ;
The have a opening provided in the protruding direction of the ultrasonic emission direction and the treatment instrument of the ultrasonic transducer, the opening and the treatment instrument opening is airtightly into the insertion portion in a state of communicating A tip cover member ,
A suction means for performing suction from the treatment instrument opening through the treatment instrument channel;
An ultrasonic endoscope apparatus comprising: The ultrasonic endoscope apparatus according to claim 1, wherein the cover member is detachable from the insertion portion. The ultrasonic endoscope apparatus according to claim 1, wherein the cover member is fixed to a distal end of the insertion portion.

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