JP6223723B2 - Ultrasound endoscope - Google Patents

Description

  The present invention relates to an ultrasonic endoscope, and more particularly to a side-view type ultrasonic endoscope suitable for examining changes in the biliary tract (bile duct).

  Patent Document 1 proposes an ultrasonic endoscope that can perform endoscopic retrograde pancreaticocholangiography (ERCP) and ultrasonic endoscope-guided puncture (FNA) with a single endoscope. ing. In this ultrasonic endoscope, a side-viewing optical observation unit and a first channel, a convex-type ultrasonic probe, and a second channel, which are arranged in order from the tip, are arranged in the body insertion portion. It is possible to perform ERCP by injecting contrast agent from the channel and observing the contrast image with the optical observation unit, and FNA by projecting the puncture needle from the second channel and puncturing under the ultrasonic tomogram It is said.

JP 2010-4945 A

  In the endoscope of Patent Document 1, a raising mechanism is provided at the opening portion of the second channel in the insertion portion in the body. The raising mechanism has a raising base that can be turned up and down around an axis orthogonal to the axis of the body insertion portion, and a puncture needle inserted through the second channel according to the angle of the raising base The protruding direction of the flexible linear treatment instrument can be changed. However, since the elevator is exposed to the side of the body insertion portion with almost no difference in height from the ultrasound probe, when the ultrasound probe is brought into contact with the treatment target site (affected site), the surrounding site is It is difficult to perform the raising operation by being pressed against the raising table, and there is a possibility that the protruding direction of the puncture needle is limited and accurate puncturing cannot be performed.

  The present invention is an ultrasonic endoscope having a side-view type optical observation unit based on the above problem awareness, and is a flexible projection that protrudes into an ultrasonic tomographic image at the time of ultrasonic image diagnosis using an ultrasonic probe. An object of the present invention is to obtain an ultrasonic endoscope in which the direction of a linear treatment instrument can be accurately set by a raising mechanism.

In the ultrasonic endoscope of the present invention, an ultrasonic probe for obtaining an ultrasonic tomographic image of an observation site is provided at the forefront of the insertion portion, and behind the ultrasonic probe, in the ultrasonic tomographic image of the ultrasonic probe. This is a configuration in which a forceps channel opening for projecting the flexible linear treatment instrument and a side-viewing type optical observation unit with an objective window facing in a direction substantially orthogonal to the axial direction of the insertion unit are provided. The forceps channel opening communicates with an elevator storage recess recessed in the insertion portion with the opening surface facing sideways, and an axis orthogonal to the ultrasound scanning plane by the ultrasonic probe is in the elevator storage recess. A raising base supported so as to be able to be tilted up and down is provided. The raising base storage recess includes a rear wall in which the forceps channel is opened, a pair of side walls located on both sides of the raising base, a bottom wall connecting the bottoms of the pair of side walls and facing the opening surface , and a pair of side walls. And a pair of side walls forming an elevator storage recess are formed up to the forefront of the insertion section excluding the ultrasonic probe, and the elevator storage recess of each side wall. The side intersecting with the opening surface of the insertion portion is substantially parallel to the axis of the insertion portion, and a cutout is formed on the front wall through which the flexible linear treatment instrument passes from the opening surface toward the bottom wall. And

  The raising base performs a raising operation from the bottom wall of the raising base storage recess toward the opening surface, and the pair of side walls are formed higher in the raising direction than the raising base in the state where the raising operation is performed. preferable.

The bottom of the notch formed in the front wall is preferably located closer to the bottom wall in the depth direction of the elevator storage recess than the portion of the ultrasonic probe that protrudes most in the elevator rising direction.

In the ultrasonic endoscope of the present invention, the ultrasonic probe is disposed at the distal end of the insertion portion, and the side-viewing optical observation portion and the forceps channel opening are disposed behind the ultrasonic probe, so that the ultrasonic probe is reliably treated. Ultrasonic image diagnosis can be performed in contact with a site, and the side of the insertion portion can be optically reliably observed. Further, a pair of side walls that are located on both sides of the elevator and constitute the elevator storage recess are formed up to the forefront of the insertion portion excluding the ultrasonic probe, and the opening surface of the elevator storage recess of each side wall By making the side intersecting with the axis of the insertion part substantially parallel to the axis of the insertion portion, when the ultrasonic probe is brought into contact with the treatment target site, it is possible to prevent the raising operation of the raising table from being limited by the peripheral site, The direction of the flexible linear treatment instrument can be accurately set by the raising mechanism. In addition, by forming a notch through which the flexible linear treatment instrument passes from the opening surface toward the bottom wall in the front wall of the elevator storage recess, the degree of freedom in the protruding direction of the flexible linear treatment instrument It became possible to raise.

1 is a front view showing an overall configuration of an ultrasonic endoscope to which the present invention is applied. It is the figure which looked at the insertion part front-end | tip of the ultrasonic endoscope shown in FIG. 1 from the observation direction of the optical observation part. It is the side view of the insertion part front-end | tip of the same ultrasonic endoscope which showed a part along the III-III line | wire of FIG. 2 as a cross section. FIG. 4 is a side view of the distal end of the insertion portion of the ultrasonic endoscope when the raising operation of the raising base is performed from the state of FIG. 3. It is the figure which looked at the insertion part front-end | tip of the same ultrasonic endoscope from the front-end | tip direction. It is the side view which showed a part as a cross section of the state which made the puncture needle which is a flexible linear treatment tool protrude from the insertion part front-end | tip of the same ultrasonic endoscope. It is a figure which shows the relationship between the ultrasonic image in the state of FIG. 6, and a puncture needle.

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

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

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

  2 to 7 show an embodiment of an ultrasonic endoscope according to the present invention. The distal end rigid portion 10 of the insertion portion 1 is provided with a convex type ultrasonic probe 30 at the foremost end portion, and a forceps raising mechanism 32 is provided in a raising base housing recessed portion 31 recessed behind the ultrasonic probe 30. The objective window 33 and the illumination window 34 are provided on the side portion of the elevator storage recess 31 so as to be displaced in the front-rear direction. An objective lens (not shown) constituting the observation optical system faces the objective window 33, and an image sensor unit (not shown) is provided behind the observation optical system. The image sensor unit is connected to an image signal cable (not shown). The illumination window 34 is connected to a light guide fiber (not shown). The image signal cable, the light guide fiber, and the ultrasonic signal cable 30 a (FIGS. 3 and 4) connected to the ultrasonic probe 30 are guided from the insertion unit 1 to the universal tube 3 through the operation unit 2. As is well known, the image signal cable is connected to a video processor (not shown) via the video connector 4, and the ultrasonic cable is not shown via the cable 5 and the ultrasonic signal connector 6. Connected to. The light guide fiber is connected to a light source device that supplies illumination light. The ultrasonic endoscope according to the present embodiment is a side view in which the objective window 33 and the illumination window 34 constituting the optical observation unit face in a direction substantially orthogonal to the axis of the distal end rigid portion 10 (insertion axis of the insertion portion 1). In this configuration, an ultrasonic probe 30 is provided in a type endoscope.

  An ultrasonic scanning plane by the ultrasonic probe 30 is a plane P shown in FIGS. 2 and 5, and an ultrasonic scanning angle by the ultrasonic probe 30 is shown as θ in FIGS. 3, 4, and 6.

  A forceps channel 40 (FIGS. 3 and 4) whose rear end portion is connected to the forceps insertion port 23 is inserted into the insertion portion 1 from the operation portion 2, and the distal end portion of the forceps channel 40 is shown in FIGS. As shown in FIG. 4, it communicates (opens) with an elevator storage recess 31 formed in the distal end rigid portion 10. The forceps channel 40 is made of a flexible metal pipe (for example, made of stainless steel), and the distal end portion of the forceps channel 40 that opens into the elevator housing recess 31 is an outlet-side straight line that is inclined with respect to the axis of the distal end rigid portion 10. It becomes the shape part 41.

  The forceps raising mechanism 32 has a raising base 32b pivotally mounted on an axis 32a orthogonal to the ultrasonic scanning plane P in the raising base accommodating recess 31 of the distal end rigid portion 10, and an ultrasonic scanning is provided on the raising base 32b. A V-groove 32c that is located in the plane P and is deepest in the plane is formed. The V-groove 32 c is located on the extension of the outlet-side linear portion 41 of the forceps channel 40. The raising / lowering operation mechanism of the raising base 32b provided in the operation part 2 is well-known, The illustration is abbreviate | omitted.

  The elevator storage recess 31 is a recess that is open and recessed toward the side of the distal end rigid portion 10 (the elevation direction of the elevator 32 b), and a rear wall 31 a that is orthogonal to the axial direction of the distal end rigid portion 10. The ultrasonic probe 30 is positioned in front of the pair of side walls 31b parallel to the coaxial line direction and located on both sides of the elevator base 32b, the bottom wall 31c connecting the bottoms of the pair of side walls 31b, and the bottom wall 31c. The front wall 31d that constitutes the most distal end portion of the tip hard portion 10 is removed, and the portion facing the bottom wall 31c is an opening surface 31f that opens toward the side of the tip hard portion 10. As shown in FIG. 3 and FIG. 4, each of the pair of side walls 31b has a side that intersects the bottom wall 31c and a side that intersects the opening surface 31f in parallel, and a height H ( 3 and 4) is the depth of the elevator storage recess 31 in the direction perpendicular to the axis of the distal end rigid portion 10. The distal end portion of the forceps channel 40 opens in the rear wall 31a, and the outlet-side linear portion 41 is obliquely provided so as to advance from the bottom wall 31c side to the opening surface 31f side as it approaches the rear wall 31a.

  In the direction perpendicular to the axis of the distal end rigid portion 10, when the side where the opening surface 31 f of the raising base storage recess 31 is formed is the upper side and the side where the bottom wall 31 c is formed is the lower side, the raising base 32 b is Then, a raising operation (FIG. 4) is performed from the lower side to the upper side around the shaft 32a. The depth of the elevator storage recess 31 in the vertical direction (height H of each side wall 31b) is such that the elevator 32b is tilted toward the bottom wall 31c as shown in FIG. 3 and the elevator 32b as shown in FIG. In any state where the raising operation is performed, the uppermost portion of the raising base 32b is not protruded upward from the raising base accommodating recess 31, and the both sides of the raising base 32b are always covered with the pair of side walls 31b. Has been. As shown in FIG. 3 and FIG. 4, the side where each side wall 31b intersects the opening surface 31f is parallel to the axial direction of the distal end rigid portion 10, and each side wall 31b in the axial direction of the distal end rigid portion 10 extends from the rear wall 31a. It extends to the position of the front wall 31d (the most distal end of the hard tip portion 10 excluding the ultrasonic probe 30). That is, the raising base accommodating recess 31 is formed at a depth that accommodates the entire raising base 32b in the range from the tip (opening) portion of the forceps channel 40 to the forefront of the distal rigid portion 10 excluding the ultrasonic probe 30. Has been.

  A notch 31 e is formed in the front wall 31 d of the elevator storage recess 31. The notch 31e is formed with a predetermined depth from the opening surface 31f (the outer peripheral portion of the distal end rigid portion 10) of the elevator base recess 31 toward the bottom wall 31c, and the depth of the notch 31e in this direction. Is indicated by A in FIG. The depth A of the notch 31e is set so that the bottom of the notch 31e is located behind the ultrasonic probe 30 and cannot be seen when the distal rigid portion 10 is viewed from the distal end side as shown in FIG. More specifically, as shown in FIG. 3 and FIG. 4, the ultrasonic signal cable 30 a is disposed below the raising table storage recess 31 in a positional relationship with the raising table storage recess 31, and has a forceps lifting mechanism. 32 does not interfere. The ultrasonic probe 30 is disposed at a point where the ultrasonic signal cable 30a is linearly extended, and the ultrasonic probe 30 is offset downward with respect to the center (axis) of the distal end rigid portion 10. The bottom of the notch 31e is positioned below the most protruding portion (vertex Q of the acoustic lens shown in FIG. 3) of the ultrasonic probe 30 offset downward. A vertical difference between the bottom of the notch 31e and the apex Q of the ultrasonic probe 30 is indicated by B in FIG.

  The ultrasonic endoscope having the above-described configuration is formed by a side-viewing optical observation unit that passes through the objective window 33 in a state where the insertion unit 1 is inserted into the body and the distal rigid portion 10 reaches a target position in the body cavity. Perform optical observations.

  Further, when performing ultrasonic diagnosis and treatment, the ultrasonic probe 30 is brought into contact with the affected area as shown in FIG. 6, and the ultrasonic waves from the ultrasonic probe 30 are emitted to the ultrasonic scanning plane P in FIGS. To obtain an ultrasonic tomogram. Then, as shown in FIG. 6, when the puncture needle S that is a flexible linear treatment instrument inserted from the forceps insertion port 23 of the operation unit 2 is guided from the outlet-side linear portion 41 of the forceps channel 40 to the raising base 32b, The direction is determined so that the puncture needle S supported on the V-groove 32c of the raising base 32b is positioned in the ultrasonic scanning plane P. As shown in FIG. 6, even if the side of the distal rigid portion 10 is covered with the vicinity of the affected area at this time, the pair of side walls 31 b extend to the forefront of the distal rigid portion 10 excluding the ultrasonic probe 30. Since the internal space of the raising base accommodating recess 31 is secured, the raising action of the raising base 32b can be performed smoothly without interfering with the affected part inside the raising base accommodating recess 31 (see FIG. 4). .

  The puncture needle S can be protruded in the vicinity of the ultrasonic probe 30 through the notch 31e formed in the raising base accommodating recess 31 according to the angle of the raising base 32b. Since the deepest portion of the V-groove 32c is located in the ultrasonic scanning plane P, when the raising base 32b is tilted up and down about the shaft 32a, the puncture needle S remains in the ultrasonic scanning plane P in the direction. Change. 6 shows the puncture needle S ideally located in the ultrasonic scanning plane P, and FIG. 7 shows a visual recognition example of the puncture needle S in the ultrasonic tomographic image U. In this way, if the puncture needle S is located in the ultrasonic tomographic image U, the puncture needle S is easily moved to the target site (for example, the lesioned part T in FIG. 7), and under the ultrasonic image. Necessary treatment can be taken. At this time, since the puncture needle S protrudes into the ultrasonic scanning plane P through the notch 31e, the puncture needle S in the ultrasonic scanning plane P is not restricted by the inner wall portion of the elevator base recess 31. Can be set.

  As described above, in the ultrasonic endoscope of the present embodiment, the distal end rigid portion 10 of the insertion portion 1 is provided with a side-viewing type optical observation portion, and the ultrasonic probe 30 is provided in front of the optical observation portion. A site such as the duodenal papilla can be observed by the optical observation unit, and an accurate ultrasonic diagnosis can be performed by reliably bringing the ultrasonic probe 30 into contact with the affected part.

  As described above, when the ultrasonic probe 30 is brought into contact with the affected part, the pair of side walls 31b constituting the raising base accommodating recess 31 prevents the periphery of the affected part and the forceps raising mechanism 32 from contacting each other. The raising operation can be performed smoothly, and the puncture needle S can reliably reach the lesioned part.

  Further, by forming the notch 31e in the raising base housing recess 31, the forceps raising mechanism 32 can be protected by the side wall 31b, and the degree of freedom in the protruding direction of the puncture needle S can be increased, and more accurate puncture can be performed. It is possible.

  Therefore, according to the configuration of the present embodiment, both endoscopic retrograde pancreatobiliary imaging (ERCP) and ultrasonic endoscopic guided puncture (FNA) are performed by a single ultrasonic endoscope. Furthermore, excellent performance can be obtained in each observation and treatment.

DESCRIPTION OF SYMBOLS 1 Insertion part 2 Operation part 3 Universal tube 4 Video connector 5 Cable 6 Ultrasonic signal connector 10 Tip rigid part 11 Bending part 12 Flexible tube 21 Operation knob 22 Suction button 23 Forceps insertion port 30 Ultrasonic probe 30a Ultrasonic signal cable 31 Elevator storage recess 31a Rear wall 31b Side wall 31c Bottom wall 31d Front wall 31e Notch 31f Opening surface 32 Forceps raising mechanism 32a Shaft 32b Elevator 32c V-groove 33 Objective window 34 Illumination window 40 Forceps channel 41 Exit side linear portion S Puncture Needle (flexible linear treatment instrument)

Claims (3)

An ultrasonic probe that obtains an ultrasonic tomographic image of the observation site is provided at the tip of the insertion part.
A forceps channel opening for projecting a flexible linear treatment instrument in the ultrasonic tomogram of the ultrasonic probe and an objective window in a direction substantially orthogonal to the axial direction of the insertion portion are provided behind the ultrasonic probe. A side-viewing optical observation unit
The forceps channel opening communicates with an elevator storage recess recessed in the insertion portion with the opening surface facing sideways, and an ultrasound scanning plane formed by the ultrasonic probe is disposed in the elevator storage recess. An elevator that is supported so that it can be raised and lowered around an orthogonal axis is disposed.
The elevator housing recess has a rear wall the forceps channel is opened, and a pair of side walls located on both sides of the elevator, a bottom wall opposite the bottom connecting the said opening surface of said pair of side walls, the Having a front wall connecting the front of the pair of side walls ;
The pair of side walls are formed up to the most advanced of the insertion portion excluding the ultrasound probe, and the opening surface and intersecting edges of each of the above side walls state, and are substantially parallel to the axis of the insertion portion,
An ultrasonic endoscope characterized in that a notch through which the flexible linear treatment instrument passes is formed in the front wall in a direction approaching the bottom wall from the opening surface . The ultrasonic endoscope according to claim 1, wherein the elevator is raised from the bottom wall of the elevator storage recess toward the opening surface,
The ultrasonic endoscope in which the pair of side walls are formed higher in the raising direction than the raising table in a state where the raising operation is performed. 3. The ultrasonic endoscope according to claim 1, wherein a bottom portion of the notch is more than a portion of the ultrasonic probe that protrudes most in a rising direction of the raising base in a depth direction of the raising base housing recess. An ultrasonic endoscope located near the bottom wall.

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