JP6833310B2 - Endoscope system - Google Patents

Description

The present invention relates to an endoscopic system that cauterizes tissue.

It is known that the reaction of allergic rhinitis such as pollinosis is mainly caused by the inferior turbinate in the nasal cavity shown in FIG. 1 (see Patent Document 1). In recent years, a technique for suppressing an allergic reaction by coagulating and inactivating the tissue on the surface of the inferior turbinate by cauterization has been adopted.

Cauterization of the surface of the nasal mucosa is performed under a microscope using an argon plasma coagulator (hereinafter, abbreviated as a cautery device). In a cautery apparatus, plasma (also called an argon beam) is generated by passing a high-frequency current while ejecting highly conductive argon gas from the tip of a treatment probe.

Since the argon beam has a low current density and is uniform, there is little concern that the structure is carbonized or excessively burned unlike a laser device, and the structure can be uniformly solidified.

However, when the tissue of the inferior turbinate is coagulated using a rigid endoscope for otolaryngology, the operator inserts the endoscope and the treatment probe separately into the nasal cavity for treatment.

Specifically, the surgeon displays an endoscopic image of the inferior turbinate on the monitor screen of the endoscopic system, and while observing the image, inserts a treatment probe into the nasal cavity to the test site. The tissue is coagulated by irradiating with an argon beam.

The surface area of the tissue of the inferior turbinate is larger than the irradiation range of the argon beam. Therefore, the surgeon repeatedly performs the operation of moving the endoscope and the procedure of irradiating the test site with an argon beam from the treatment probe.

Special Table 2002-508214

However, skill is required in the technique of repeatedly performing the operation of moving the endoscope and the coagulation treatment with the treatment probe and coagulating the tissue of the inferior turbinate without burning.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide an endoscopic system that evenly coagulates a wide range of test sites using a treatment probe while observing with an endoscope. There is.

In the endoscopic system of one aspect of the present invention, a cauterizing energy generating unit that generates ablation energy for coagulating the test site with a predetermined site including the lower nasal concha in the nasal cavity of the subject as the test site. A generator having a ablation control unit that controls irradiation of the ablation energy, and a ablation energy that is connected to the generator and generated in the ablation energy generation unit under the control of the ablation control unit. A cauterizing probe that irradiates the inspection site, a light source device that supplies white light that illuminates the test site including the site to be ablated, and excitation light for generating fluorescence from the tissue of the test site, and the light source device. Illumination optical system that irradiates white light and excitation light from the test site toward the test site, white light imaging system that images white light from the test site, and fluorescence generated from the tissue of the test site. An endoscope having a built-in imaging device having a fluorescence imaging system, and an image processing unit that processes an image signal output from the imaging device to generate and output a white light observation image and a fluorescence observation image of the test site. A region identification processing unit that sets a predetermined reference region and a region of interest corresponding to a portion to be ablated in the fluorescence observation image, and a ablation determination unit that discriminates a cauterized state in the test portion and generates a discrimination signal. A video processor including a control unit including a function of receiving a discrimination signal from the ablation discrimination unit and outputting an instruction signal to the generator, and the region identification processing unit comprises the fluorescence observation image. The reference region is set by pre-extracting a part of the region included in the above to set the region of interest, and by pre-extracting a part of the region different from the part of the region included in the fluorescence observation image. The reference region is newly set each time the region of interest is newly set, and the ablation determination unit is the same as the reference region in the fluorescence observation image set in the region identification processing unit. Based on the respective brightness values related to the region of interest, the cauterized state of the portion to be ablated corresponding to the region of interest is discriminated, and when the portion is ablated, the discrimination signal is output, and the control unit outputs the discrimination signal. , An instruction signal relating to the completion of ablation is output to the ablation control unit in the generator based on the determination signal.

According to the present invention, it is possible to realize an endoscopic system that evenly coagulates a wide range of test sites by using a treatment probe while observing with an endoscope.

Anatomical chart explaining the nose Diagram illustrating an endoscopic system Diagram explaining the fixture The figure explaining the mounting part main body and the lid member which constitute the mounting part of a mounting tool. The figure explaining the probe holding part of a fitting The figure explaining the mounting tool which can be assembled by arranging the engaging convex part between a mounting part main body and a lid member. The figure explaining the relationship between the insertion part of an endoscope and the probe body of a cautery probe, and the inferior turbinate. It is a figure seen from the direction of the arrow Y4B of FIG. 4A, and is the figure explaining an example of a plurality of cauterized regions necessary for cauterizing the entire test site of the inferior turbinate. The figure explaining the white light observation image including the test image and the treatment image displayed on the screen. The figure explaining the state which switched the screen display from the white light observation image shown in FIG. 5A to the fluorescence observation image. It is a fluorescence observation image displayed on the screen. The figure explaining the cauterization completion image displayed in the fluorescence observation image displayed on the screen. The figure explaining the state which switched the screen display from the fluorescence observation image shown in FIG. 5D to the white light observation image. The screen display is a diagram in which the white light observation image shown in FIG. 5E is switched to the fluorescence observation image, and a diagram for explaining the setting positions of the new reference region and the attention region. The figure explaining the screen which further displayed the cauterization completion image in addition to the cauterization completion image. A diagram showing a state in which a cauterization of a row of ablation regions in the Y-axis direction is completed, and a diagram illustrating a procedure for moving the treatment portion of the probe body. The figure explaining the coagulation treatment completion state of the inferior turbinate which cauterized all the cautery areas The figure which shows the ablation completion image which coagulation processing was done evenly The figure which shows the ablation completion image where solidification unevenness occurred The figure explaining the endoscope which has a plurality of image pickup devices, for example, three. The figure explaining the endoscopic image obtained by three image pickup apparatus of the endoscope of FIG. 7A. The figure explaining the radiation port identification part Further, a diagram illustrating a video processor having an identification unit discriminating unit for determining the presence or absence of a radiation port identification unit.

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
In each of the drawings used in the following description, the scale may be different for each component in order to make each component recognizable on the drawing. Further, the present invention is not limited to the number of components, the shape of the components, the ratio of the sizes of the components, and the relative positional relationship of each component shown in these figures.

The endoscope system will be described with reference to FIG.
The endoscope system 1 includes an endoscope 2, a light source device 3, a video processor 4, a cauterization system 5, and a display device 6. Reference numeral 7 is a mounting tool, and the mounting tool 7 has a mounting portion 7a and a probe holding portion 7b.
Reference numeral 8 is a nasal cavity, reference numeral 8a is an image of the inferior turbinate, reference numeral 8ai is an image of a part of the inferior turbinate, and reference numeral 56i is a probe tip image.

In the present embodiment, the light source device 3 supplies illumination light to the endoscope 2.
The light source device 3 includes a white light generation unit 31, an excitation light generation unit 32, dichroic mirrors 33 and 34, a condenser lens 35, and a light source control unit 36.

The white light generating unit 31 is configured to include, for example, an LED that emits a wide band of white light. A lamp such as a xenon lamp may be used instead of the LED. The excitation light generation unit 32 is configured to include, for example, an LED that emits light (excitation light) in a predetermined wavelength band including the excitation wavelength of autofluorescence of the subject tissue.

For example, the first dichroic mirror 33 transmits the white light emitted from the white light generating unit 31 and guides it to the condensing lens 35 side, and reflects the excitation light emitted from the excitation light generating unit 32 toward the condensing lens 35 side. It has the optical characteristics to make it.

On the other hand, the second dichroic mirror 34 has, for example, an optical characteristic of reflecting the excitation light emitted from the excitation light generating unit 32 toward the first dichroic mirror 33.

The condensing lens 35 collects the light incident on the first dichroic mirror 33 and emits it to the end face of the light guide fiber bundle 27.

The light source control unit 36 controls the white light generation unit 31 and the excitation light generation unit 32 according to the illumination light control signal output from the video processor 4.
Then, the white light generating unit 31 and the excitation light generating unit 32 are switched to a lighting state or an extinguishing state according to the control signal output from the light source control unit 36. Further, the white light generation unit 31 and the excitation light generation unit 32 generate white light or excitation light in an amount of light according to the control signal output from the light source control unit 36.

That is, the light source control unit 36 sets the observation mode of the endoscope 2 to the white light observation mode of supplying white light to the light guide fiber bundle 27 according to the illumination light control signal output from the video processor 4, and the excitation light. Is switched to the fluorescence observation mode for supplying the light guide fiber bundle 27.

The endoscope 2 shown in FIG. 2 extends from the insertion portion 21 which is rigid and has a circular outer shape, the elongated and tubular operation portion 22 provided on the base end side of the insertion portion 21, and the side portion of the operation portion 22. It is equipped with a universal code 23 to be issued.
The endoscope 2 has a built-in image pickup device 11 that constitutes an image pickup section on the tip end side of the insertion section 21. In the present embodiment, the viewing direction of the imaging device 11 is set to be orthogonal to the direction of the insertion portion longitudinal axis 21a.

The illumination window (not shown) and the observation window 24 of the illumination optical system that irradiates the test site with white light and fluorescence are provided at predetermined positions on the side peripheral surface, which is the side surface on the tip side of the insertion portion 21. There is. The imaging device 11 includes a white light imaging system 12, a fluorescence imaging system 13, an observation window 24, a dichroic prism 25, an excitation light cut filter 26, a circuit board (not shown), a signal line 18, and the like.
Have,

The white light imaging system 12 captures the reflected light of white light as the return light incident through the observation window 24 in the white light observation mode. The fluorescence imaging system 13 images fluorescence as return light incident through the observation window 24 in the fluorescence observation mode.

The dichroic prism 25 has a spectral characteristic that reflects white light while transmitting fluorescence. Then, the return light incident through the observation window 24 is divided into two optical axes orthogonal to each other by the dichroic prism 25.
The excitation light cut filter 26 has a spectral characteristic that cuts the wavelength band of the excitation light emitted from the light source device 3.

The white light image pickup system 12 includes a first imaging optical system 14 which is an optical system for white light and a first image pickup element 15 which is an image pickup element for white light. The first imaging optical system 14 forms an image of white light reflected by the dichroic prism 25.

The first image sensor 15 is composed of, for example, a color CCD provided with a primary color system or complementary color system color filter on the imaging surface. The first image sensor 15 is configured to perform an image pickup operation in response to an image sensor drive signal output from the video processor 4, captures white light imaged by the first image pickup optical system 14, and captures the image. An image pickup signal corresponding to the white light is generated and output.

The fluorescence imaging system 13 includes an excitation light cut filter 26, a second imaging optical system 16 which is an imaging optical system for fluorescence, and a second imaging element 17 which is an imaging element for fluorescence. The second imaging optical system 16 forms an image of fluorescence transmitted through the dichroic prism 25 and the excitation light cut filter 26.

The second image sensor 17 is composed of, for example, a highly sensitive monochrome CCD. The second image sensor 17 is configured to perform an image pickup operation according to an image sensor drive signal output from the video processor 4, and images the fluorescence imaged by the second image pickup optical system 16 and captures the image. An image pickup signal corresponding to fluorescence is generated and output.

Reference numeral 19 is a signal processing circuit. The signal processing circuit 19 performs predetermined signal processing (correlation double sampling processing, gain adjustment processing, A / D conversion processing, etc.) on the imaging signal output from the first imaging element 15, and second. Similarly, signal processing is performed on the image pickup signal output from the image pickup element 17. Then, the signal processing circuit 19 outputs the white light image signal and the fluorescence image signal that have undergone predetermined signal processing to the video processor 4 to which the electric cable (see reference numeral 28 in FIG. 1) is connected.

The operation unit 22 also serves as a grip portion, and switches 22a, 22b, etc. are provided on the side portions thereof. The plurality of switches 22a, 22b, etc. function as a freeze switch that generates a freeze signal, a release switch that generates a release signal when taking a picture, an observation mode changeover switch, and the like.
In the present embodiment, the first switch 22a is an observation mode changeover switch.

In the universal cord 23, a light guide fiber bundle 27 for transmitting illumination light constituting an illumination optical system, a signal line extending from switches 22a, 22b, etc. (not shown), a signal line extending from an image pickup apparatus 11, etc. Is inserted.

An endoscope connector 23c is provided at the base end of the universal cord 23. The universal cord 23 is detachable from the light source device 3 via the endoscope connector 23c.

Reference numeral 28 is an electric cable, and has an electric wire for transmitting a signal output from the switches 22a, 22b, etc., a signal input to the image pickup device 11, a signal output from the image pickup device 11, and the like. The electric cable 28 has a first connector 28c1 and a second connector 28c2 at each end. The first connector 28c1 is detachable from the endoscope connector 23c, and the second connector 28c is detachable from the video processor 4.

The endoscope is not limited to an electronic endoscope having a rigid insertion portion, and may be an electronic endoscope having a soft insertion portion. Further, the endoscope may be a so-called optical viewing tube in which a relay lens is arranged in the insertion portion, or a so-called fiberscope in which an image guide fiber is arranged in the insertion portion. In the case of an optical viewing tube or a fiberscope, the camera unit is provided with an imaging device 11 having a white light imaging system and a fluorescence imaging system in the eyepiece.

The video processor 4 mainly includes an image sensor driving unit 41, an image signal input unit 42, an area identification processing unit 43, a cauterization discrimination unit 44, an image processing unit 45, and a control unit 46. ..

The image pickup device drive unit 41 is configured to include, for example, a driver circuit or the like. Further, the image sensor drive unit 41 generates and outputs an image sensor drive signal according to the control of the control unit 46.

The image signal input unit 42 includes, for example, a buffer memory or the like, stores images sequentially output from the signal processing circuit 19 for one frame, and outputs the stored images to the control unit 46 for each frame. Further, the image signal input unit 42 outputs the white light image accumulated in the white light observation mode to the image processing unit 45 one frame at a time according to the control of the control unit 46. Further, the image signal input unit 42 outputs the fluorescence image accumulated in the fluorescence observation mode to the area identification processing unit 43 and the image processing unit 45 one frame at a time according to the control of the control unit 46.

The region identification processing unit 43 performs labeling processing on the fluorescent images sequentially output one frame at a time from the image signal input unit 42 according to the control of the control unit 46, so that the reference included in the fluorescent image is included. Make the area and the area of interest (corresponding to the ablation area) identifiable. Further, the region identification processing unit 43 outputs the labeled fluorescent image to the ablation determination unit 44.

The cauterization determination unit 44 includes, for example, an arithmetic processing circuit. Further, the ablation determination unit 44 pays attention to the brightness value of each pixel included in the reference region of the fluorescence image sequentially output from the area identification processing unit 43 for one frame at a time according to the control of the control unit 46, and the attention of the fluorescence image. Based on the brightness value of each pixel included in the region, an arithmetic process is performed to calculate an arithmetic value indicating the fluorescence intensity ratio of the region of interest with respect to the reference region. Further, the cauterization determination unit 44 outputs the calculated value obtained as the processing result of the above-mentioned arithmetic processing to the image processing unit 45 in response to the control of the control unit 46.

The image processing unit 45 includes, for example, an image processing circuit for performing predetermined image processing. Further, the image processing unit 45 performs predetermined image processing on the white light image sequentially output one frame at a time from the image signal input unit 42 in the white light observation mode in accordance with the control of the control unit 46 to obtain white color. Generate an optical observation image. Then, the generated white light observation image is output to the display device 6.

In addition, the image processing unit 45 performs predetermined image processing on the fluorescent images sequentially output one frame at a time from the image signal input unit 42 in the fluorescence observation mode in accordance with the control of the control unit 46 to observe the fluorescence. Generate an image. Then, the generated fluorescence observation image is output to the display device 6.

Further, the image processing unit 45 responds to the control of the control unit 46 based on the fluorescence image output from the region identification processing unit 43 and the calculated value output from the cauterization discrimination unit 44 in the fluorescence observation mode. , Performs a process of visualizing and displaying the fluorescence generation state of the region of interest with respect to the reference region.

In other words, in the fluorescence observation mode, the control unit 46 extracts a reference region and a region of interest from the fluorescence image output from the image signal input unit 42, and generates fluorescence in the region of interest with respect to the extracted reference region. The area identification processing unit 43, the ablation determination unit 44, and the image processing unit 45 are controlled to display the state as visualized information on the display device 6.

In the present embodiment, the operator operates the observation mode changeover switch 22a to switch from the white light observation mode to the fluorescence observation mode and from the fluorescence observation mode to the white light observation mode.

Further, the control unit 46 includes, for example, a CPU or the like, and generates an illumination control signal that emits illumination light corresponding to the observation mode according to an instruction signal from the observation mode changeover switch (hereinafter, referred to as a mode switch) 22a. And output to the light source control unit 36.

The cauterization system 5 includes a probe drive device 9 which is a generator, and a cauterization probe 50 which is a treatment probe that can be attached to and detached from the probe drive device 9.

The probe driving device 9 generates ablation energy for coagulating the tissue of the test site. The probe drive device 9 includes a compressed gas source 91 filled with argon gas, a pressure regulator 92 for adjusting the pressure of the argon gas supplied from the compressed gas source 91, a high frequency power supply 93 for generating a high frequency current, and a cauterization control. It has a part 94 and.

The cauterization control unit 94 controls the pressure regulator 92 and the high frequency power supply 93. The pressure regulator 92 supplies the pressure-adjusted argon gas to the cauterization probe 50. The high frequency power supply 93 supplies the generated high frequency current to the ablation probe 50.

The cauterization probe 50 includes a probe main body 51, a treatment portion 52, and a flexible tube body 53. The probe body 51 is a rigid, insulating tube having a predetermined diameter and length.

The treatment portion 52 is located on the distal end side of the probe main body 51 and has a distal end opening. The tip opening is a radiation port for radiating an argon beam, which is energy for cauterization. The treatment portion 52 is bent laterally with respect to the longitudinal axis of the probe main body 51.

The flexible tube body 53 has an insulating property and extends from the proximal end side of the probe body 51. A probe connector 53c is provided at the base end of the flexible tube body 53. The cauterization probe 50 is attached to and detachable from the probe driving device 9 via the probe connector 53c.

A gas tube 54 is inserted and arranged in the probe main body 51 and the flexible tube body 53. A high frequency cable 55 is inserted in the gas tube 54.

By connecting the probe connector 53c to the probe drive device 9, the gas tube 54 communicates with the pressure regulator 92, and the high frequency cable 55 is electrically connected to the high frequency power supply 93.
A high frequency electrode 56 is arranged near the tip opening of the treatment portion 52. A high frequency cable 55 is connected to the high frequency electrode 56.

A foot switch (not shown) is connected to the probe driving device 9. When the foot switch is turned on, argon gas is discharged toward the test site and a high frequency current is supplied to the high frequency electrode 56. As a result, an argon beam is irradiated from the treatment portion 52 toward the test site of the inferior turbinate 8a.

Although not shown, the front panel of the probe drive device 9 is provided with a flow rate setting unit for setting the flow rate of argon gas, a current setting unit for setting an output value of high-frequency current, and the like. The irradiation range can be adjusted by appropriately setting the argon gas flow rate and high-frequency current value.

Further, the proximal end side of the probe main body 51 is arranged in a probe insertion hole (see reference numeral 7n in FIG. 3A) described later in the mounting tool 7.
Reference numeral 57 is a protrusion. The protruding portion 57 projects from the vicinity of the treated portion 52 of the probe main body 51 in the bending direction of the treated portion 52. The tip of the protrusion 57 is formed as a hemisphere that contacts the surface of the inferior turbinate 8a.

Therefore, by arranging the hemispherical portion of the protrusion 57 on the surface of the inferior turbinate 8a, the distance from the tip opening of the treatment portion 52 to the surface of the inferior turbinate 8a is defined as a predetermined distance. That is, the protruding length of the protruding portion 57 is set to an optimum distance for cauterization by an argon beam.
The optimum distance is obtained by a preliminary experiment, simulation, or the like based on various parameters such as the flow rate of argon gas and the output value of high-frequency current.

The mounting tool 7 shown in FIGS. 2 and 3A is a rigid member made of resin or metal, and has a mounting portion 7a and a probe holding portion 7b as described above.
The probe holding portion 7b is slidably arranged in the engaging groove 7g of the mounting portion 7a.
Reference numeral 7g is an engagement groove, and reference numeral 7h is an insertion portion insertion hole.

As shown in FIG. 3B, the mounting portion 7a has a mounting portion main body 7c and a lid member 7d, and can be mounted and removed by screwing, for example.

The mounting portion main body 7c is a stepped member and has a large diameter portion 7e and a small diameter portion 7f, and a first annular shape having an engaging groove 7g on a stepped surface between the large diameter portion 7e and the small diameter portion 7f. A groove 7g1 is formed.

The large diameter portion 7e is formed with an insertion portion insertion hole 7h in which the insertion portion 21 is arranged. A male screw is formed on the outer peripheral surface of the small diameter portion 7f.

The lid member 7d is an annular member, and a second annular groove 7g2 serving as an engaging groove 7g is provided on one surface of the lid member 7d which is abutted against the stepped surface. The lid member 7d has a through hole 7i, and a female screw screwing with the male screw of the small diameter portion 7f is formed on the inner peripheral surface of the through hole 7i.

As shown in FIG. 3C, the probe holding portion 7b has a holding portion main body 7k and an engaging convex portion 7m. The holding portion main body 7k is formed with a probe insertion hole 7n in which the probe main body 51 is arranged in a predetermined loose fitting state. The probe insertion hole 7n is, for example, a long hole, and is elongated in the direction of the central axis of the insertion portion insertion hole 7h.

The engaging convex portion 7m has a spherical portion 7q on the tip end side and a cylindrical portion 7r on the holding portion main body 7k side. The outer diameter of the spherical portion 7q is set to be larger than the outer diameter of the cylindrical portion 7r.

Here, the assembly of the fitting 7 will be described with reference to FIG. 3D.
As shown in FIG. 3D, the engaging convex portion 7m of the probe holding portion 7b is arranged in the first annular groove 7g1 of the mounting portion main body 7c. In this state, the probe holding portion 7b and the lid member 7d are screwed together. As a result, the engaging convex portion 7m is slidably arranged between the mounting portion main body 7c and the lid member 7d without falling off, and the mounting portion 7a is provided with the slidable probe holding portion 7b. The tool 7 is configured.

Here, the treatment of allergic rhinitis using the endoscope system 1 of this example will be described.
At the start of the procedure, the surgeon arranges the insertion portion 21 of the endoscope 2 in 7h of the attachment 7, and arranges the probe main body 51 in the probe insertion hole 7n of the attachment 7.

At the beginning of the procedure, the operator first turns on the light source device 3, the video processor 4, the display device 6, and the probe drive device 9. Then, the white light observation image is displayed on the screen 6a of the display device 6.

Here, the operator inserts the insertion portion 21 and the probe body 51 into the nasal cavity 8 as shown in FIG. 4A while observing the white light observation image displayed on the screen 6a. As can be seen in the figure, the inferior turbinate 8a is wider than one cauterized region CA with an argon beam.

Therefore, in order to evenly cauterize the inferior turbinate 8a, it is necessary to repeatedly cauterize with an argon beam. Then, as shown in FIG. 4B, the inferior turbinate 8a is removed by cauterizing all the cauterized regions CA01, CA02, CA03, CA04, CA11, ..., CA15, CA21, ..., CA24, ... CA61, CA62, CA63, CA64. Can coagulate evenly.

Therefore, the surgeon repeatedly cauterizes, for example, from the back of the inferior turbinate 8a in the Y-axis direction, and then moves the insertion portion 21 and the probe body 51 toward the hand side (X-axis direction), and then Y again. The cauterization treatment is repeated in the opposite direction of the axis, and the above-mentioned cauterization regions CA01 and ... CA64 are provided.

The number of cauterization region CAs is not limited to the above, and can be changed by appropriately setting the size of the cauterization region CA.

In performing cauterization, the operator advances the probe body 51 as shown by the broken line in FIG. 4A. Then, as shown in FIG. 5A, the test site image (hereinafter abbreviated as the test image) 8bi of the test site 8b of the inferior turbinate 8a and the treatment section image 52i of the treatment section 52 are displayed on the screen 6a. ..

While observing the screen 6a, the surgeon arranges the treated portion image 52i at a desired position in the test image 8bi after considering the cauterization region CA01 by the argon beam.

Here, the operator operates the mode switch 22a to change the white light observation image on the screen 6a into a fluorescence observation image. Then, as shown in FIG. 5B, the fluorescence image 8bf of the test site is displayed on the screen 6a. At this time, the treatment unit 52 is not displayed as the treatment unit fluorescence image in the fluorescence observation image.

Next, the operator operates an input I / F (not shown) provided on the front panel of the video processor to compare the reference region Ar treated as the reference of the fluorescence generation state with the fluorescence generation state. An instruction is given to set each of the attention area Ai to be treated as.

The control unit 46 performs a process for extracting a reference region and a region of interest from the fluorescence image output from the image signal input unit 42 in accordance with the instruction input from the input I / F.

Then, after extracting the reference region Ar1 and the attention region Ai1, the control unit 46 controls the region identification processing unit 43 and cauterization determination to obtain information indicating the current fluorescence intensity ratio of the attention region Ar1 to the reference region Ai1. This is performed on the unit 44 and the image processing unit 45.

As a result, the area identification processing unit 43 sets the reference area Ar1 and the area of interest Ai1 shown on the screen 6a of FIG. 5C. When the ablation determination unit 44 determines that the fluorescence brightness of the attention region Ai1 is, for example, 10% or less (described as a threshold value) with respect to the fluorescence brightness of the set reference region Ar1, the control unit 46 Is set to output a first signal for notifying the completion of cauterization, which is a discrimination signal. Based on a predetermined instruction signal output from the control unit 46, the image processing unit 45 displays the fluorescence of the region of interest Ai1 on the screen 6a below the threshold value regardless of the fluorescence observation image display state or the white light observation image display state. It is set to perform the superimposition processing of displaying the attention region Ai1 whose brightness has decreased, for example, in white and notifying the region.

The reference region Ar and the region of interest Ai of this embodiment are set as pixel regions having one or more pixels, respectively.

The surgeon then operates the footswitch. Then, the argon beam is irradiated from the treatment unit 52 toward the region of interest Ai1. As a result, the region of interest Ai1 is cauterized with the irradiation of the argon beam.

As the cauterization progresses, the brightness of the region of interest Ai1 decreases. Then, when the ablation determination unit 44 determines that the brightness of the region of interest Ai1 is equal to or lower than the threshold value, the ablation determination unit 44 outputs a first signal to the control unit 46.

At the same time as receiving the first signal, the control unit 46 outputs an instruction signal to the image processing unit 45 and the probe driving device 9. That is, the control unit 46 instructs the image processing unit 45 to perform the superimposition processing, while instructing the ablation control unit 94 of the probe driving device 9 to stop the ablation energy output.

As a result, the irradiation of the argon beam to the region of interest Ai1 is stopped, and as shown in FIG. 5D, for example, a white cauterization completion image CA01i for notifying that the cauterization of the region of interest Ai1 has been completed is displayed on the screen 6a. ..

The operator recognizes that the cauterization of the region of interest Ai set in the test site 8b has been completed by displaying the white cauterization completion image CA01i on the screen 6a.
The cauterization completion image CA01i corresponds to the cauterization region CA01 of FIG. 4B.

After that, the operator operates the mode switch 22a to change the fluorescence observation image on the screen 6a to a white light observation image in order to move to the next treatment.

Then, as shown in FIG. 5E, the test image 8bi, the treated portion image 52i, and the white cauterization completed image CA01i are displayed on the screen 6a.

In this state, the operator moves the probe holding portion 7b of the mounting tool 7 along the engaging groove 7g of the mounting portion 7a in order to obtain the cauterization region CA02. As a result, as shown in FIG. 5E, the treatment portion image 52i is moved from the position shown by the solid line to the position of the hatched solid line.

Here, the operator operates the mode switch 22a to change the white light observation image on the screen 6a to the fluorescence observation image, and also operates the input I / F to perform a new reference region Ar2 and a region of interest Ai2. And, respectively, are instructed to set.
The control unit 46 performs the above-described processing according to the instruction input from the input I / F.

As a result, the area identification processing unit 43 sets the reference area Ar2 and the attention area Ai2 shown on the screen 6a of FIG. 5F, while the cauterization determination unit 44 and the image processing unit 45 are set in the same manner as described above.

The surgeon then operates the footswitch. Then, the argon beam is irradiated from the treatment unit 52 toward the region of interest Ai2, and the region of interest Ai2 is cauterized. Then, when the brightness of the region of interest Ai2 becomes equal to or less than the threshold value from the cauterization determination unit 44, the first signal is output to the control unit 46.

Then, as described above, the control unit 46 receives the first signal and at the same time instructs the image processing unit 45 to perform superimposition processing, while stopping the energy output to the cauterization control unit 94 of the probe driving device 9. Give instructions.

As a result, the irradiation of the argon beam to the region of interest Ai2 was stopped, and in addition to the ablation completion image CA01i as shown in FIG. 5G, the cauterization of the ablation region CA02, which is the region of interest Ai2, was completed on the screen 6a. The cauterization completion image CA02i to be announced is displayed.

By displaying the cauterization completion image CA02i on the screen 6a, the operator recognizes that the cauterization of the new area of interest Ai2 set in the test site 8b has been completed.

After that, the operator repeats the above-mentioned procedure to move the probe holding portion 7b to complete the cauterization of the cauterization regions CA03 and CA04 in the Y-axis direction as shown in FIG. 5H.

Next, the operator moves the insertion portion 21 and the probe main body 51 from the position shown by the broken line to the hand side shown by the solid line. After that, the Confucian scholar repeatedly performs the above-mentioned movement operation, mode switching operation, instruction by input I / F, treatment operation, and the like to complete the cauterization in the order of the cauterization areas CA15, ..., CA11.

Then, the operator repeatedly performs these operations to cauterize the cauterized regions CA01, CA02, ..., CA63, and CA64 as shown in FIG. 5I, and complete the coagulation treatment of the inferior turbinate 8a.

After the coagulation process is completed, the operator switches between the white light observation image and the fluorescence observation image to confirm the presence or absence of coagulation unevenness and coagulation loss of the inferior turbinate 8a.
Here, when the solidification process is performed evenly, the cauterization completion images CA01i, CA02i, ..., CA63i, CA64i are displayed on the screen 6a without any gap as shown in FIG. 6A.

On the other hand, when solidification unevenness occurs, as shown in FIG. 6B, a gap 6s1 is displayed between the cauterization completed image CA35i and the cauterization completed image CA33i on the screen 6a, for example, the lower left of the screen 6a. A gap 6s2 is displayed in the corner.
Therefore, uneven solidification can be easily found.

When the operator confirms the uneven coagulation, the operator performs the above-mentioned cauterization treatment on the voids 6s1 and 6s2 to eliminate the uneven coagulation.

In this way, by using the endoscope 2 that can obtain the fluorescence observation image and the white light observation image, it is possible to easily confirm the presence or absence of coagulation unevenness after the completion of the coagulation treatment.

Further, it is determined that the brightness of the region of interest is equal to or less than the predetermined brightness with respect to the brightness of the reference region to the video processor 4 to which the endoscope 2 that can obtain the fluorescence observation image and the white light observation image is connected. At the same time, after the determination, the ablation determination unit 44 is provided to output the first signal for notifying the completion of the ablation to the control unit 46. In addition, the control unit 46 is configured to receive the first signal and at the same time output an instruction signal instructing the probe driving device 9 to stop the energy output.

As a result, a plurality of cauterized regions, which are regions of interest, can be uniformly cauterized without being over-baked. In the above-described embodiment, the threshold value is set to the fluorescence of the reference region Ar1 with respect to the fluorescence of the region of interest Ai1. The brightness of is set to 10% or less. However, the threshold is not limited to 10 percent or less, and may be more or less.

Further, at the same time as receiving the first signal from the control unit 46, the image processing unit 45 is notified of the ablation completion site on the screen 6a regardless of the fluorescence observation image display state or the white light observation image display state, for example, white ablation completion. It is configured to output an instruction signal instructing the process of superimposing images.
As a result, the surgeon can visually recognize the cauterization completion image displayed on the screen, recognize the completion of cauterization in the region of interest, and confirm the plurality of cauterization completion images displayed on the screen to obtain the unburned residue. It is possible to solve the problem and perform the cauterization treatment more reliably.

In the above-described embodiment, the endoscope 2 has one imaging device 11 built in the tip side of the insertion portion 21. However, as shown in FIG. 7A, a plurality of, for example, three imaging devices 11 may be provided on the tip end side of the insertion portion 21 of the endoscope 2.

Here, all three imaging devices are imaging devices 11, and are described as a first imaging device 11, a second imaging device 11A, and a third imaging device 11B.

The observation windows 24 included in the imaging devices 11, 11A, and 11B are arranged in a row in the longitudinal direction along the longitudinal axis of the insertion portion 21.

In this configuration, the image signal input unit 42 of the video processor 4 is a white light image signal that is output from the image pickup devices 14 and 17 of the image pickup devices 11, 11A and 11B, respectively, and signal-processed by the respective signal processing circuits 19. And the fluorescent image signal is output.

Then, the image processing unit 45 generates a white light observation image synthesized by performing predetermined image processing on the white light images sequentially output from the image signal input unit 42 and outputs the combined white light observation image to the display device 6, and also outputs the image signal input unit. The fluorescence images sequentially output from 42 are subjected to predetermined image processing to generate a composite fluorescence observation image and output to the display device 6. As a result, the display shown in FIG. 7B having a horizontally long screen as compared with the display device 6. On the screen 6b of the device 6A, a test image 8bi imaged by the first image pickup device 11, the second image pickup device 11A, and the third image pickup device 11B and having a wide observation range is displayed.

As a result, after the coagulation process is completed, the operator performs an operation of switching between the white light observation image and the fluorescence observation image without repeating the operation of moving the insertion portion 21A of the endoscope 2A significantly, and the inferior turbinate. It is possible to quickly confirm the presence or absence of solidification unevenness and solidification loss in 8a.

In the above-described embodiment, the treatment unit is displayed on the screen in the white light observation image, and then the treatment unit 52 is switched to the fluorescence observation image to irradiate the argon beam from the treatment unit 52. In this configuration, the argon beam is irradiated when the foot switch is operated in a state where the treatment unit 52 is moved to a position not displayed on the screen.

For the purpose of solving this problem, the treatment unit 52 is provided with a radiation port identification unit 58 as shown in FIG. 8A.

The radiation port identification unit 58 is, for example, a paint that emits fluorescence different from autofluorescence, and is a coloring unit provided on an inclined surface facing the observation window 24. In a state where the fluorescence image 58f of the radiation port identification unit 58 is displayed on the screen 6a, the radiation port of the treatment unit 52 faces the test site.

In this configuration, as shown in FIG. 8B, the video processor 4 includes an image sensor driving unit 41, an image signal input unit 42, an area identification processing unit 43, an ablation determination unit 44, an image processing unit 45, and a control unit 46. Further, an identification unit discrimination unit 47 for determining the presence or absence of the radiation port identification unit 58 is provided.

The identification unit discrimination unit 47 identifies the presence or absence of the fluorescence image 58f of the emission port identification unit 58 in which the brightness value of each pixel included in the reference region Ar of the fluorescence image and the predetermined intensity ratio are different, and recognizes the fluorescence image 58f. A second signal is output to the control unit 46 in this state.

When the second signal is input, the control unit 46 outputs an instruction signal for permitting the cauterization control unit 94 of the probe drive device 9 to irradiate the argon beam with the operation of the foot switch.
In other words, the cauterization control unit 94 controls the control unit 46 to stop the irradiation of the argon beam at the same time as the input of the instruction signal permitting the argon beam to be irradiated is stopped.

According to this configuration, since the output of the second signal from the identification unit discrimination unit 47 is stopped and the irradiation of the argon beam is stopped at the same time, the treatment unit 52 is moved to a position that is not displayed on the screen by any chance. It is possible to solve the problem of irradiating the argon beam when the foot switch is operated under the condition.

The present invention is not limited to the above-described embodiments, and various modifications can be made without departing from the gist of the invention.

1 ... Endoscope system 2 ... Endoscope 3 ... Light source device 4 ... Video processor 5 ... Ablation system 6 ... Display device 6a ... Screen 7 ... Mounting tool 7a ... Mounting part 7b ... Probe holding part 7c ... Mounting part body 7d ... Lid member 7e ... Large diameter part 7f ... Small diameter part 7g ... Engagement groove 7g1 ... First annular groove 7g2 ... Second annular groove 7h ... Insertion part insertion hole 7i ... Through hole 7k ... Holding part body 7m ... Engagement convex part 7n ... Probe insertion hole 7q ... Spherical part 7r ... Cylindrical part 8 ... Nasal cavity 8a ... Inferior turbinate 8b ... Test site 8bf ... Test site fluorescent image 8bi ... Test site image (test image)
9 ... Probe drive device 11 ... Imaging device 12 ... White light imaging system 13 ... Fluorescence imaging system 14 ... First imaging optical system 15 ... First imaging element 16 ... Second imaging optical system
17 ... Second image sensor 18 ... Signal line 19 ... Signal processing circuit 21 ... Insert
21a ... Insertion section longitudinal axis 22 ... Operation section 22a ... Observation mode selector switch
23 ... Universal cord 23c ... Endoscope connector 24 ... Observation window
25 ... Dichroic prism 26 ... Excitation light cut filter
27 ... Light guide fiber bundle 28 ... Electric cable 28c ... Connector 31 ... White light generator 32 ... Excitation light generator 33 ... First dichroic mirror 34 ... Second dichroic mirror 35 ... Condensing lens 36 ... Light source control unit 41 ... Image sensor Element drive unit 42 ... Image signal input unit 43 ... Area identification processing unit 44 ... Caulking discrimination unit 45 ... Image processing unit 46 ... Control unit 47 ... Identification unit discrimination unit 50 ... Caulking probe 51 ... Probe body 52 ... Treatment unit 52i ... Treatment Part image 53 ... Flexible tube body 53c ... Probe connector 54 ... Gas tube 55 ... High frequency cable 56 ... High frequency electrode 56i ... Probe tip image 57 ... Projection 58 ... Radiation port identification part 58f ... Fluorescent image 91 ... Compressed gas Source 92 ... Pressure regulator 93 ... High frequency power supply 94 ... Caulking control unit

Claims (7)

A cauterization energy generation unit that generates ablation energy for coagulating the test site with a predetermined site including the inferior turbinate related to the nasal cavity of the subject as the test site, and a cauterization that controls irradiation of the cauterization energy. A generator with a control unit,
A cauterization probe connected to the generator and irradiating the test site with the ablation energy generated in the ablation energy generation unit under the control of the ablation control unit.
A light source device that supplies white light that illuminates the test site including the site to be cauterized and excitation light for generating fluorescence from the tissue of the test site.
An illumination optical system that irradiates white light and excitation light from the light source device toward the test site, a white light imaging system that images white light from the test site, and fluorescence generated from the tissue of the test site. An endoscope with a built-in imaging device having a fluorescence imaging system for imaging
An image processing unit that processes an image signal output from the imaging device to generate and output a white light observation image and a fluorescence observation image of the test site, a predetermined reference region in the fluorescence observation image, and ablation. The area identification processing unit that sets the region of interest corresponding to the portion, the ablation discrimination unit that discriminates the ablation state in the test portion and generates a discrimination signal, and the generator that receives the discrimination signal from the ablation discrimination unit. A video processor including a control unit including a function of outputting an instruction signal to
Equipped with
The region identification processing unit extracts a part of the region included in the fluorescence observation image in advance to set the region of interest, and at the same time, another part different from the part of the region included in the fluorescence observation image. The reference region is set by extracting the region of the above in advance, and the reference region is newly set each time the region of interest is newly set.
The cauterization discrimination unit cauterizes a portion to be cauterized corresponding to the region of interest based on the respective brightness values of the reference region and the region of interest in the fluorescence observation image set in the region identification processing unit. When the state is discriminated and the site is cauterized, the discriminant signal is output.
The endoscope system is characterized in that the control unit outputs an instruction signal relating to the completion of cauterization to the cauterization control unit in the generator based on the discrimination signal. Based on the discrimination signal generated by the cauterization discrimination unit, the image processing unit superimposes an image indicating the completion of cauterization of the portion to be cauterized corresponding to the region of interest on the white light observation image, and the subject The endoscopic system according to claim 1, wherein the cauterized region can be recognized in the image of the inspection site. When the cauterization control unit receives an instruction signal relating to the completion of cauterization of the portion to be ablated corresponding to the region of interest from the control unit of the video processor, the ablation control unit generates the ablation energy generated by the ablation energy generation unit. The endoscopic system according to claim 1, wherein the endoscopic system is stopped. The endoscope system according to claim 1, wherein the endoscope has a long insertion portion, and an observation window of the imaging device is arranged on a side surface of the insertion portion. The endoscope system according to claim 4, wherein a plurality of the imaging devices are arranged in the insertion portion, and the observation windows are arranged in a row in the longitudinal direction of the insertion portion. The endoscope system according to claim 1, wherein a radiation port identification unit for notifying a radiation port is provided on a side surface of a treatment unit included in the ablation probe. The video processor further includes an identification unit discriminating unit that determines the presence or absence of the radiation port identification unit.
When the ablation control unit of the generator receives an instruction signal from the control unit of the video processor to notify that the radiation port identification unit is included in the image output from the image processing unit, the ablation control unit receives the ablation. The endoscopic system according to claim 6, wherein the probe can irradiate the test site with cauterizing energy.

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