JP5989457B2 - Ultrasound endoscope - Google Patents

Description

  The present invention relates to an ultrasonic endoscope.

FIG. 12 shows a conventional example of an ultrasonic endoscope.
The ultrasonic endoscope includes an operation unit, an insertion unit extending from the operation unit and having a portion excluding the distal end portion having flexibility, an ultrasonic probe provided on a surface of the distal end portion of the insertion portion, and a distal end of the insertion portion. And a treatment instrument insertion passage formed in the insertion portion, the end opening of which is formed in the inclined surface.
As shown in the figure, the distal end of the insertion portion is covered with a rubber balloon covering the ultrasonic probe, and the internal space of the balloon (between the ultrasonic probe and the inner surface of the balloon) is filled with water. .
After inserting the insertion part of the ultrasonic endoscope into the intestinal tract and bringing the balloon into contact with the wall of the intestinal tract, when the ultrasonic wave is transmitted from the ultrasonic probe, the ultrasonic endoscope (through the ultrasonic diagnostic device) An ultrasonic image is displayed on the connected CRT monitor.
Further, the surgeon protrudes the distal end of the puncture needle (treatment tool) inserted into the treatment instrument insertion path from the proximal end opening (not shown) formed in the insertion portion from the end opening (inclined surface), so that the CRT Treatment with a puncture needle can be performed while looking at the monitor.

Japanese Patent No. 3869707 JP 2006-204465 A JP 2004-105289 A

  However, when the inner diameter of the intestinal tract is larger than the outer diameter of the insertion portion, the balloon is separated from the wall of the intestinal tract, and there is a possibility that an ultrasonic image cannot be displayed on the CRT monitor.

  Further, when performing an ultrasonic diagnosis using a balloon, the balloon may be ruptured by a puncture needle or the like, so it would be ideal if an ultrasonic diagnosis without such a risk could be performed.

  An object of the present invention is to provide an ultrasonic endoscope capable of performing an ultrasonic diagnosis while reliably maintaining a contact state of an ultrasonic probe or a balloon with respect to an observation target.

In one aspect of the ultrasonic endoscope of the present invention, the ultrasonic probe provided on the surface of the distal end portion of the insertion portion extending from the operation portion, and the circumferential position around the axis line of the insertion portion are the ultrasonic probe. At least one of a storage recess formed on the surface of the tip portion and a storage position stored in the storage recess, the axial position of which is different from that of the ultrasonic probe. A protruding member projecting in a direction having a moving component in a direction opposite to that of the ultrasonic probe as the portion escapes from the storage recess, and a pressing member movable to the inner space of the insertion portion Operating means that is linked to the pressing member via means and moves the pressing member between the retracted position and the protruding position, and when the pressing member is not subjected to external force, Located in the storage position, Deformed when subjected to external force from the linking mechanism by work a shape memory member to move to the protruding position, and characterized in that.
In another aspect, the ultrasonic endoscope of the present invention has an ultrasonic probe provided on the surface of the distal end portion of the insertion portion extending from the operation portion, and a position in the circumferential direction around the axis of the insertion portion. At least one of a storage recess formed on the surface of the tip portion and a storage position stored in the storage recess, the axial position of which is different from that of the ultrasonic probe. A protruding member projecting in a direction having a moving component in a direction opposite to that of the ultrasonic probe as the portion escapes from the storage recess, and a pressing member movable to the inner space of the insertion portion Operating means that is linked to the pressing member via means and moves the pressing member between the retracted position and the protruding position, and when the pressing member is not subjected to external force, Located in the protruding position and operated by the above operating means. Said the linkage means is deformed when subjected to an external force a shape memory member to move to the retracted position, it is characterized by the.

  The circumferential position of the storage recess is opposite to the ultrasonic probe, and when the pressing member moves from the storage position to the protruding position, the pressing member is opposite to the ultrasonic probe. You may project toward.

Some of the shape-memory member, the distal portion being relatively immovably supported on the axial direction with respect to said linkage means, be an operation wire for connecting the shape memory member and the operation means Good.

The ultrasonic endoscope of the present invention is provided with a pressing member that operates in accordance with the operation of the operating means at the distal end portion of the insertion portion provided with the ultrasonic probe.
When the pressing member is positioned at the storage position, the pressing member is positioned in the storage recess formed on the surface of the distal end portion of the insertion portion, and therefore the pressing member does not protrude outward from the surface of the insertion portion. Therefore, the insertion portion can be smoothly inserted into and removed from the body cavity or the like of the subject.
Then, after the distal end of the insertion portion has reached a desired position such as a body cavity, the operating member is operated to move the pressing member to the protruding position and press the pressing member against a part of the body cavity wall. By the reaction force received from the part, the ultrasonic probe comes into contact with another part (for example, an affected part) of the body cavity wall, and this contact state is maintained. Therefore, it is possible to reliably perform ultrasonic diagnosis without covering the distal end portion of the insertion portion with a balloon (covering the ultrasonic probe).
When the balloon is put on the distal end of the insertion portion, the balloon can be reliably brought into contact with a part of the body cavity wall (for example, the affected part), so that ultrasonic diagnosis using the balloon can be performed reliably. It becomes possible.

1 is an external view showing an embodiment of an ultrasonic endoscope to which the present invention is applied. It is a bottom view of the tip hard part of an insertion part. It is a side view which fractures | ruptures and shows a part of hard tip part of an insertion part. It is a front view of the tip hard part of an insertion part. It is a bottom view similar to FIG. 2 when a pressing member moves to a protrusion position. It is a side view similar to FIG. 3 when a pressing member moves to a protrusion position. It is a side view which shows the state which inserted the insertion part in the intestinal tract. It is a bottom view similar to FIG. 2 of a modification. It is a vertical side view of the tip hard part of another modification. It is the vertical side view similar to FIG. 9 when the pressing member of another modification moves to a protrusion position. It is typical sectional drawing of the tip hard part of another modification. It is a side view similar to FIG. 7 of a prior art example.

Hereinafter, an embodiment of the present invention will be described with reference to FIGS.
An ultrasonic endoscope 10 shown in FIG. 1 includes an operation unit 11, an insertion unit 12 extending forward from the operation unit 11, a universal tube 13 extending from the operation unit 11 to the opposite side of the insertion unit 12, and an ultrasonic wave. The tube 14 for image transmission, the connector part 13a provided in the edge part of the universal tube 13, and the connector part 14a provided in the edge part of the tube 14 for ultrasonic image transmission are provided. The connector portion 13a is connected to a processor (image processing device / light source device, not shown), and the connector portion 14a is connected to an ultrasonic diagnostic device (not shown). Both the ultrasonic diagnostic apparatus and the processor are connected to a CRT monitor (not shown).
The insertion portion 12 is formed with a bending portion 17 that bends in the vertical direction and the left-right direction in accordance with the rotation operation of the bending operation lever 15 provided in the operation portion 11. The flexible tube portion 18 is bent by a direct operation of the practitioner.
A portion of the insertion portion 12 closer to the distal end than the bending portion 17 is a distal hard portion 19 (tip portion) made of hard resin. An inclined surface 20 that is inclined with respect to a plane orthogonal to the axis of the insertion portion 12 is formed in the latter half of the distal end hard portion 19, and an objective lens, an illumination lens, and the like (not shown) are provided on the inclined surface 20. It is. An ultrasonic probe 23 positioned immediately before the inclined surface 20 is formed on the surface (lower surface in FIG. 1) of the front half portion of the distal end hard portion 19.

  As shown in FIG. 1, a treatment instrument insertion port projection 11 a for inserting a flexible puncture needle A (treatment instrument) projects from the front end of the operation unit 11. A cap 11b is detachably attached to the end opening of 11a. A treatment instrument insertion tube 26 (see FIG. 1) extending from the treatment instrument insertion port projection 11a toward the distal end hard section 19 is disposed inside the insertion section 12. The distal end of the treatment instrument insertion tube 26 is open at the inclined surface 20. The puncture needle A inserted into the treatment instrument insertion tube 26 from the treatment instrument insertion port protrusion 11a can protrude outward from the distal end opening (inclined surface 20) of the treatment instrument insertion tube 26.

As shown in FIGS. 2 to 7, a storage recess 28 is provided on the surface (upper surface in FIG. 1) of the front half portion of the distal end hard portion 19. The storage recess 28 and the ultrasonic probe 23 have the same position in the axial direction of the insertion portion 12, while the circumferential positions around the axis of the insertion portion 12 are shifted from each other by 180 °.
At the front end portion of the storage recess 28, the front end of the pressing member 30, which is a plate material formed of a shape memory material, extends in the width direction (vertical direction in FIGS. 2 and 5) of the distal end hard portion 19 ( (Not shown). On the other hand, the rear end of the pressing member 30 is supported so as to be slidable in the longitudinal direction (front-rear direction) of the storage recess 28 with respect to the inner surface of the storage recess 28.
A front end of an operation wire 32 having flexibility but high rigidity is fixed to the rear end portion of the pressing member 30. The front end portion of the operation wire 32 is located in the storage recess 28, and the portion excluding the front end of the operation wire 32 is disposed in the internal space of the insertion portion 12 and the internal space of the operation portion 11. The operation wire 32 is slidably supported in the front-rear direction by support means (not shown) which is a fixing member provided in the internal space of the insertion portion 12. As shown in FIG. 1, an operation lever 34 that is movable between a non-operation position (solid line position) and an operation position (virtual line position) is fixed to the operation unit 11. The inner end of the operation lever 34 is located in the operation unit 11, and the rear end of the operation wire 32 is connected to the inner end of the operation unit 11. When the operating lever 34 is located at the non-operating position, no external force is applied to the pressing member 30, and the pressing member 30 has a linear shape as shown in FIGS. Is done. The position of the pressing member 30 at this time is the storage position (the position in FIGS. 2 to 4). On the other hand, when the operation lever 34 is moved to the operation position side, this moving force is transmitted to the operation wire 32, and the operation wire 32 slides forward with respect to the insertion portion 12. Then, since a forward pressing force is applied from the front end of the operation wire 32 to the rear end of the pressing member 30, the rear end of the pressing member 30 slides forward with respect to the storage recess 28. Therefore, the pressing member 30 is deformed so that the portions excluding the front and rear ends gradually bulge upward (see reference numerals 30A and 30B in FIG. 7), and when the operation lever 34 reaches the operation position, The portions excluding both front and rear ends of the pressing member 30 protrude greatly upward from the upper surface of the distal end hard portion 19. The position of the pressing member 30 at this time is a protruding position (the position shown in FIGS. 5 and 6 and the position indicated by reference numeral 30 in FIG. 7). When the operation lever 34 is returned to the non-operation position, the pressing force applied to the pressing member 30 from the operation wire 32 disappears, so that the pressing member 30 returns to the retracted position in a linear state.

Next, endoscopy using the ultrasonic endoscope 10 will be described.
The operation lever 34 is positioned at the non-operation position (the pressing member 30 is positioned at the retracted position), the connector portion 13a is connected to the processor, and the connector portion 14a is connected to the ultrasonic diagnostic apparatus, and the insertion portion 12 is inserted into the intestine (stomach / duodenum) B from the mouth of the subject. At this time, since the entire pressing member 30 located at the storage position is stored in the storage recess 28, the pressing member 30 does not protrude outside the distal end hard portion 19. Therefore, the insertion portion 12 can be smoothly inserted into the intestinal tract B. As shown in the drawing, the outer diameter of the insertion portion 12 is thinner than the inner diameter of the intestinal tract B, so that a gap is formed between the insertion portion 12 and the intestinal tract B.
When the operating lever 34 is moved to the operating position when the distal end hard portion 19 reaches a desired position in the intestinal tract B, the pressing member 30 moves to the protruding position and protrudes while the operating lever 34 is positioned at the operating position. Held in position. When the pressing member 30 moves to the protruding position, the pressing member 30 presses the upper wall of the intestinal tract B, and the reaction force received by the pressing member 30 from the upper wall moves the entire distal end hard portion 19 downward. Therefore, the ultrasonic probe 23 is in close contact with the lower wall of the intestinal tract B, and this close contact state is maintained. Accordingly, when an ultrasonic wave is transmitted from the ultrasonic probe 23 in this state, the state inside the lower wall of the intestinal tract B is displayed as an ultrasonic image on the CRT monitor, so that the ultrasonic diagnosis can be executed reliably.
Further, after removing the cap 11b from the treatment instrument insertion port projection 11a, the puncture needle A is inserted into the treatment instrument insertion tube 26 from the treatment instrument insertion port projection 11a, and the distal end portion of the puncture needle A protruding from the inclined surface 20 is connected to the intestinal tract B. Since the tip of the puncture needle A pierced into the lower wall is displayed as an ultrasonic image on the CRT monitor, the practitioner can appropriately perform the treatment with the puncture needle A. . And since the adhesion state (fixed state) of the ultrasonic probe 23 and the wall of the intestinal tract B is maintained, the sniping ability of the puncture needle A with respect to the wall of the intestinal tract B becomes good.
When the operation lever 34 is returned to the non-operation position after the treatment is completed, the pressing member 30 is brought into a linear state and returned to the storage position. As a result, since the ultrasonic probe 23 is separated upward from the lower wall of the intestinal tract B, and the entire pressing member 30 is stored in the storage recess 28, the practitioner moves the insertion portion 12 from the intestinal tract B to the outside of the mouth. It can be pulled out smoothly.

As mentioned above, although this invention was demonstrated using the said embodiment, this invention can be implemented, giving various deformation | transformation.
For example, as in the modification shown in FIG. 8, instead of the pressing member 30 made of a plate material, a pressing member 36 configured by arranging a plurality of wires (seven in FIG. 8) extending in the front-rear direction may be used. good. Each wire constituting the pressing member 36 is constituted by a linear shape memory material having a circular cross section. Similar to the pressing member 30, the front end portion of the pressing member 36 is attached to the front end portion of the storage recess 28 via a rotation shaft (not shown) extending in the width direction of the distal end hard portion 19. The rear end of the member 36 is supported so as to be slidable in the longitudinal direction (front-rear direction) of the storage recess 28 with respect to the inner surface of the storage recess 28. When the operating lever 34 is in the non-operating position, no external force is applied to the pressing member 36, so that the pressing member 36 has a linear shape and is entirely stored in the storage recess 28. The position of the pressing member 30 at this time is the storage position shown in FIG. On the other hand, when the operation lever 34 is moved to the operation position side, this moving force is applied from the operation wire 32 to the rear end of the pressing member 36, and the rear end of the pressing member 36 is forward of the storage recess 28. Therefore, the pressing member 36 moves to a projecting position (not shown) that is deformed so that portions excluding the front and rear ends bulge upward.
Since the pressing member 36 of this modification also performs the same operation as the pressing member 30, it is possible to exhibit the same operational effects as in the above embodiment.

  By configuring the pressing members 30 and 36 with a shape memory material, the pressing members 30 and 36 are located when the operation lever 34 is located at a non-operation position (a position corresponding to the “operation position” in the above embodiment). When the operating lever 34 is moved to the operating position (a position corresponding to the “non-operating position” in the above embodiment) so as to be positioned at the protruding position, the pressing wire 32 is pulled backward, thereby pushing the pressing member. 30 and 36 may be located at the storage position.

Moreover, you may implement in the aspect of the modification shown in FIG. 9, FIG.
A storage hole 38 that penetrates the outer wall of the rigid distal end portion 19 of the ultrasonic endoscope 10 (upper surface in FIG. 1) is drilled in such a manner that the position in the front-rear direction coincides with the ultrasonic probe 23. It is set up. A support member 39 as a fixing member is provided in the internal space of the distal end hard portion 19, and a first bracket 40 and a second bracket 41 are fixed side by side on the upper surface of the support member 39. The first bracket 40 is connected to the lower end of the first link 44 so as to be rotatable about a rotation axis extending in the width direction of the distal end hard portion 19, and is formed in the second bracket 41 and extends in the front-rear direction. A rotating slide pin 46 extending in the width direction of the distal end hard portion 19 provided at the lower end of the second link 45 is fitted in the hole 42 so as to be rotatable about its own axis and slidable. Furthermore, the center part of the 1st link 44 and the 2nd link 45 is mutually connected by the connection pin 47 extended in the width direction of the front-end | tip hard part 19 so that rotation is possible. On the other hand, the upper end portion of the second link 45 extends in the width direction of the distal end hard portion 19 with respect to the third bracket 50 fixed to the inner surface (lower surface) of the pressing member 49 that is a plate material having the same shape as the storage hole 38. It is connected so that it can rotate around the rotation axis. A fourth bracket 51 located behind the third bracket 50 is fixed to the inner surface of the pressing member 49, and the second elongated hole 52 formed in the fourth bracket 51 extending in the front-rear direction has a second A rotating slide pin 53 extending in the width direction of the distal end hard portion 19 provided at the upper end portion of one link 44 is fitted so as to be rotatable about its own axis and slidable.
The first link 44 and the second link 45 constituting the parallel link can move between the shortened position shown in FIG. 9 and the extended position shown in FIG. It is urged toward the shortened position by a rotational urging force of an urging means (not shown) provided therebetween.
When the first link 44 and the second link 45 are positioned at the shortened position, the pressing member 49 closes the storage hole 38 and is in a storage position (position in FIG. 9) where its outer surface is continuous with the surface of the distal end hard portion 19. When the first link 44 and the second link 45 are positioned at the extended position, the pressing member 49 is positioned at the protruding position (the position in FIG. 10) protruding upward from the storage hole 38.
Further, the operation lever 34 is attached to the operation portion 11 in the same manner as the embodiment of FIGS. 1 to 7, and both front and rear ends of the operation wire 32 are connected to the rotary slide pin 46 and the operation lever 34. When the operating lever 34 is in the non-operating position, no external force is applied from the operating wire 32 to the rotary slide pin 46, so the first link 44 and the second link 45 are in the shortened position and the pressing member 49 is in the retracted position. Located in. On the other hand, when the operation lever 34 is moved to the operation position side, this moving force is applied from the operation wire 32 to the rotary slide pin 46, and the rotary slide pin 46 slides forward in the first long hole 42 (similarly). Since the rotary slide pin 53 slides forward in the second long hole 52), the first link 44 and the second link 45 move to the extended position, and the pressing member 49 moves to the protruding position.
Since the pressing member 49 of this modification also performs the same operation as that of the pressing member 30, it is possible to exert the same effect as the above embodiment.

  9 and 10, the urging means is configured to move and urge the first link 44 and the second link 45 to the extended position, and the operation lever 34 is in the non-operation position (see FIGS. The first link 44 and the second link 45 are positioned at the extended position when the position is at the “operation position” in the embodiment of FIG. 7 (the pressing member 49 is positioned at the protruding position). And when the operation lever 34 is moved to the operation position (a position corresponding to the “non-operation position” in the embodiment of FIGS. 1 to 7), the first link 44 and the second link 45 are moved to the shortened position. It may be positioned (the pressing member 49 is positioned at the storage position).

  Furthermore, in the above-described embodiment and each modification, the ultrasonic endoscope 10 is used without covering the distal end portion (ultrasonic probe 23) of the insertion portion 12 with a balloon (not shown) made of an elastic material (for example, silicon rubber). However, the ultrasonic endoscope 10 may be used by covering the distal end portion (ultrasonic probe 23) of the insertion portion 12 with a balloon while avoiding the pressing members 30, 36, and 49. In this case, water is filled in the space formed between the front half portion of the distal end hard portion 19 and the balloon, and the balloon is placed in the intestinal tract B while utilizing the pressing force from the pressing members 30, 36, 49 to the wall of the intestinal tract B. The ultrasonic wave generated by the ultrasonic probe 23 is applied to the wall of the intestinal tract B through the water in the balloon.

Moreover, in the said embodiment and each modification, although the circumferential direction position of the ultrasonic probe 23 and the pressing members 30, 36, and 49 is shifted 180 degrees, the pressing members 30, 36, and 49 with respect to the ultrasonic probe 23 The circumferential position (angle) may be another position (angle). That is, if the position (angle) when the direction when the ultrasonic probe 23 side is viewed from the axis of the insertion part 12 (hard tip 19) is set as the reference direction is larger than 90 ° and smaller than 180 °, another position (angle) (See FIG. 11). However, in this case, it is necessary to incline the deformation direction (moving direction) of the pressing members 30, 36, 49 from the storage position to the protruding position in a range larger than 90 ° and smaller than 180 ° with respect to the reference direction.
Even in such a modified example, the deformation direction of the pressing members 30, 36, 49 has an upward movement component (a movement component in the direction opposite to the ultrasonic probe 23), so that the same effect as the above embodiment is expected. it can. In particular, if the pressing members 30, 36, and 49 are formed at a plurality of locations (for example, two locations P1 and P2 in FIG. 11), the force that presses the ultrasonic probe 23 against the body cavity wall or the like increases.
Further, after forming one pressing member 30, 36, 49 at a position 180 ° away from the ultrasonic probe 23, another pressing member 30, 36, 49 is separated from the ultrasonic probe 23 within a range larger than 90 ° and smaller than 180 °. The members 30, 36, 49 may be formed.

DESCRIPTION OF SYMBOLS 10 Ultrasonic endoscope 11 Operation part 11a Treatment instrument insertion port protrusion 11b Cap 12 Insertion part 13 Universal tube 13a Connector part 14 Ultrasonic image transmission tube 14a Connector part 15 Bending operation lever 17 Bending part 18 Flexible tube part 19 Tip Hard part (tip part)
20 Inclined surface 23 Ultrasonic probe 26 Treatment instrument insertion tube 28 Storage recess 30 Pushing member 32 Operation wire (linkage means)
34 Control lever (control means)
36 Pushing member 38 Storage hole 39 Support member 40 First bracket 41 Second bracket 42 First long hole 44 First link 45 Second link 46 Rotating slide pin 47 Connection pin 49 Pushing member 50 Third bracket 51 Fourth bracket 52 Second long hole 53 Rotating slide pin A Puncture needle (treatment instrument)
B Intestinal tract (stomach / duodenum)

Claims (4)

An ultrasonic probe provided on the surface of the distal end portion of the insertion portion extending from the operation portion;
A storage recess formed on the surface of the distal end portion, wherein the circumferential position around the axis of the insertion portion is different from that of the ultrasonic probe, and the axial position is matched with the ultrasonic probe. ,
Pushing that is movable between a storage position stored in the storage recess and a protruding position in which at least a part escapes from the storage recess and protrudes in a direction having a moving component in the opposite direction to the ultrasonic probe. Members,
Operating means for linking with the pressing member via a linking means provided in the internal space of the insertion portion, and for moving the pressing member between the retracted position and the protruding position;
Equipped with a,
The pressing member is a shape memory member that is located at the retracted position when no external force is applied, and is deformed and moved to the protruding position when an external force is received from the linkage means by operation of the operating means.
An ultrasonic endoscope characterized by that. An ultrasonic probe provided on the surface of the distal end portion of the insertion portion extending from the operation portion;
A storage recess formed on the surface of the distal end portion, wherein the circumferential position around the axis of the insertion portion is different from that of the ultrasonic probe, and the axial position is matched with the ultrasonic probe. ,
Pushing that is movable between a storage position stored in the storage recess and a protruding position in which at least a part escapes from the storage recess and protrudes in a direction having a moving component in the opposite direction to the ultrasonic probe. Members,
Operating means for linking with the pressing member via a linking means provided in the internal space of the insertion portion, and for moving the pressing member between the retracted position and the protruding position;
Equipped with a,
The pressing member is a shape memory member that is located at the protruding position when no external force is applied, and is deformed and moved to the retracted position when an external force is received from the linkage means by operation of the operating means.
An ultrasonic endoscope characterized by that. The ultrasonic endoscope according to claim 1 or 2 ,
The circumferential position of the recess for storage is opposite to the ultrasonic probe;
An ultrasonic endoscope in which the pressing member protrudes toward the opposite side of the ultrasonic probe when the pressing member moves from the retracted position to the protruding position. The ultrasonic endoscope according to any one of claims 1 to 3 ,
A part of the shape memory member is supported so as not to move relative to the tip portion in the axial direction .
It said linkage means includes an ultrasonic endoscope, which is a manipulation wire for connecting the shape memory member and the operating means.

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