JPH0747027B2 - Ultrasound endoscope - Google Patents

Description

Description: TECHNICAL FIELD The present invention relates to an ultrasonic endoscope that is inserted into a human body cavity to perform optical observation of the lumen and ultrasonic examination of the surrounding area. The present invention relates to a tip structure of an ultrasonic endoscope having an ultrasonic guided puncture function of puncturing a tomographic examination region with a puncture needle and safely performing puncture while confirming the position of the puncture needle with an ultrasonic tomographic image.

[Prior Art] Ultrasonic guided puncture from inside a body cavity causes ultrasonically guided puncture from the surface of the body to interfere with other organs, such as the pancreas, to minute lesions that are difficult to detect by ultrasonic diagnosis from the surface of the body. Development of an ultrasonic endoscope capable of performing ultrasonic guided puncture is desired because it can cope with difficult organs.

As one of the inventions to date that makes this possible, there is JP-A-56-158646. This is because an ultrasonic probe is provided in the lateral direction at the tip of the insertion part, and a puncture needle outlet for inserting and retracting the puncture needle in the direction to be inspected is arranged in parallel with the ultrasonic probe. A guide mechanism for adjusting the angle of the needle is provided.

As another method, an ultrasonic probe, a puncture needle outlet, an objective lens of an observation optical system, an illumination lens, and the like are collectively provided on the tip end face of the insertion portion, so that the insertion path of the puncture needle is oriented in the insertion direction. It is also conceivable that they are provided substantially along with each other, which allows a smooth protrusion of the puncture needle and allows the puncture needle to be caught within the ultrasonic scanning range of the ultrasonic probe.

[Problems to be Solved by the Invention] However, none of the above-described inventions relating to an ultrasonic endoscope having an ultrasonic guided puncture function have been realized so far and have not been embodied.

For example, in ultrasonically guided puncture aiming at the pancreas from the stomach where ultrasonically guided puncture with an ultrasonic endoscope is considered effective, a puncture depth of about 3 cm is required. The need for a depth of about 3 cm means that the length of the puncture needle also needs to be about 3 cm, and since it must be possible to puncture straightly, it must have a certain degree of rigidity.

If the insertion passage is bent with a small curvature, the rigid long puncture needle will be caught and cannot be inserted. Therefore, at least the insertion passage in the vicinity of the outlet of the puncture needle needs to be a long insertion passage having a small curvature.

In the example of JP-A-56-158646, the outlet of the puncture needle is provided in the longitudinal direction of the ultrasonic probe, that is, the electronic linear type ultrasonic probe, provided in the distal end portion of the insertion portion in the lateral direction. They are installed side by side. In the electronic linear type, the ultrasonic tomographic range is determined by the length of the ultrasonic probe, so if the tomographic range is widened, the tip becomes longer and it becomes difficult to insert it into the human body.
It is common to use an ultrasonic probe of about 3 cm. When the outlet of the puncture needle is arranged side by side in the longitudinal direction of the ultrasonic probe of about 3 cm, it is necessary to provide a long conduit with a small curvature through which a longer puncture needle can be inserted from the outlet.
In the above example, the length is about 3 cm, and the total length of the tip is at least about 6 cm, which makes insertion into the human body extremely difficult. In addition, if a guide mechanism or the like for adjusting the angle of the puncture needle is provided, the size is further increased, and it is actually extremely difficult to bend the rigid puncture needle to adjust the angle, and even if it can be bent, the resistance is large. The reality is that it cannot be inserted. In addition, even if there is no guide mechanism, it is necessary to make the puncture needle that is inserted along the long axis direction of the insertion part project in the lateral direction of the tip part because it has a small curvature insertion path if it is bent in a short length. Therefore, there is a problem that the puncture needle is caught and cannot be inserted, and if the puncture needle is bent at a gentle inclination so that the puncture needle can be inserted, a long insertion passage is required and the tip becomes long.

Furthermore, if the projection is made at a gentle angle so as to enable smooth projection, a so-called electronic linear type ultrasonic probe may be provided in the lateral direction of the tip end of the ultrasonic scanning. Since the range is only the lateral direction,
As a characteristic of the ultrasonic diagnostic apparatus, the puncture needle passes through a short-distance portion where it is difficult to obtain a good tomographic image, and when the puncture needle is further advanced, it is out of the scanning range, and the position of the puncture needle cannot be properly grasped.

On the other hand, in the method of collectively providing the ultrasonic probe, the puncture needle outlet, the objective lens of the observation optical system, the illumination lens, etc. on the tip end face of the insertion part, the puncture needle outlet is on the tip end face. Since the insertion passage is provided almost along the insertion direction, this allows the puncture needle to project smoothly and allows the puncture needle to project within the ultrasonic scanning range, but it requires a small volume. Even a sector-type ultrasonic probe requires a size of about 10 mm square, and the diagonal length of a 10 mm square is about 14 mm or more. Therefore, the outlet, the objective lens, and the illumination lens are arranged side by side. If it is installed, there is a problem that the tip portion becomes even larger and the insertion into the human body becomes difficult.

The present invention has been made in view of the above problems, and the puncture needle can be smoothly projected without enlarging the tip portion, and ultrasonic waves that can confirm the puncture needle satisfactorily in an ultrasonic tomographic image It is intended to provide an ultrasonic endoscope capable of performing guide puncture.

[Means for Solving the Problems] The ultrasonic endoscope of the present invention is characterized by an elongated human body insertion part, and a tip block provided at the tip part of the human body insertion part.
An ultrasonic probe in which a large number of ultrasonic transducers are arranged in a convex shape from the tip of the tip block to one side surface, and is located on the transmitting / receiving surface side of the ultrasonic probe in front of the ultrasonic probe. An opening surface having at least an objective lens and an illumination lens of an observation optical system provided on the outer surface of the tip block, and an outlet on an extension line of a scanning line by the ultrasonic probe of the opening surface, An insertion path of a puncture needle that is opened along a plane including an ultrasonic scanning surface by an ultrasonic probe, and is formed so as to connect the opening surface and the rear end surface of the tip block, The ultrasonic probe is provided so that the tip side of the ultrasonic scanning range is wider on the opposite side surface where the ultrasonic probe is provided at the same angle as or more than the angle of the puncture needle protruding from the insertion passage, At least the tip of the puncture needle that allows insertion It is it has to have a length that can accommodate the quality unit.

[Operation] In the ultrasonic endoscope of the present invention, the ultrasonic probe is a so-called convex type ultrasonic probe in which a large number of ultrasonic transducers are arranged in a convex shape. Compared to the linear type ultrasonic probe, it has an ultrasonic scanning range equal to or greater than that of the linear type ultrasonic probe, and the ultrasonic probe part is shortened, and a long insertion passage that can accommodate a long puncture needle is installed in front of this. Even so, it is possible to collect them all while having a relatively short tip length and a wide ultrasonic scanning range. Also, because the opening surface of the observation optical system etc. is provided in front of the ultrasonic probe, the ultrasonic probe and the endoscope function of the observation optical system etc. do not exist in the same cross section, so the diameter is relatively small. The endoscope functions such as the ultrasonic probe and the observation optical system are housed in. Further, since the puncture needle insertion path connects the opening surface and the rear end surface of the tip block and is longer than the length of the puncture needle, the puncture needle is smoothly ejected without a great resistance. Further, since the distal end of the ultrasonic tomographic range by the ultrasonic probe is provided so as to be wider on the side opposite to the ultrasonic probe provided side in the same direction as the protruding direction of the puncture needle or more, When the needle is inserted, the puncture needle can be properly captured in the ultrasonic tomographic image from a short distance to a long distance.

[Embodiment] An embodiment of the present invention will be described below with reference to the drawings.

FIG. 4 is an overall configuration diagram of the present invention.
An insertion section 4 including a bending section 2 and a flexible tube section 3, an operation section 9 including a bending operation section 5, an air / water supply / suction operation section 6, a channel opening 7, an eyepiece section 8, and an air / water supply / suction line. And a cord 10 through which a signal line passes, and a connector section 11 for connecting the present apparatus and an ultrasonic observation apparatus or a light source apparatus (not shown).

The tip portion 1 will be described with reference to FIG. 1 which is a detailed side sectional view of the tip portion 1, FIG. 2 which is also a plan view thereof, and FIG. 3 which is a view of FIG.

The tip portion 1 has a tip block 12, and the tip portion of the tip block 12 is provided with a so-called convex type ultrasonic probe 13 in which a large number of ultrasonic transducers are arranged in a convex shape. Explaining the mounting state of the ultrasonic probe 13 in detail, a large number of ultrasonic transducers are arranged in a convex shape from the tip of the tip block 12 to one side surface. The tip side end (A in FIG. 1) of the scanning range is parallel to (B in FIG. 1) or wider than the protruding direction of the puncture needle protruding from the tip block described later, that is, in the tip block 12, It is provided so as to widen in the direction of the side opposite to the one side where the acoustic wave oscillators are arranged, that is, in the direction of arrow C in FIG.

On the outer surface of the tip block located on the transmitting and receiving surface side of the ultrasonic probe before this ultrasonic probe 13, an opening surface 14 is provided that is cut so as to become deeper toward the tip side,
The opening surface 14 is provided with an objective lens 15 of an observation optical system, an illumination lens 16, an air / water supply nozzle 17 for cleaning the lens surface, and a suction port 18 for sucking air or body fluid in the body cavity. . Further, a lead-out port 22 of the puncture needle insertion passage 21 for projecting the puncture needle 20 is provided on the extension line of the scanning line 19 by the ultrasonic probe on the opening surface 14.

The puncture needle insertion passage 21 is opened in the tip block 12 along the same plane as the ultrasonic scanning surface 35 of the ultrasonic probe 13, and the other end is opened to the rear end surface of the tip block 12. The length of the puncture needle to be used is equal to or longer than the tip hard portion 23 and is straightened. A flexible puncture needle insertion tube 24 is connected to the opening on the rear end surface of the tip block 12. Reference numeral 25 is a connection pipe for connecting the puncture needle insertion tube 24 to the opening. Note that the length of the puncture needle in the puncture needle insertion passage is equal to or greater than the hard end of the puncture needle.
It goes without saying that the length may be not only the length in the tip block 12 but also the length including the connecting pipe.

26 is a signal cable of the ultrasonic probe 13, 27 is an objective lens 15
Image transmission fiber bundle that transmits the light condensed by the eyepiece to the eyepiece, 28
Is a light transmission fiber bundle for irradiating light into the body cavity through the illumination lens 16. The observation optical system including the objective lens 15 and the like is provided so that the projected puncture needle enters the visual field range. Reference numeral 29 denotes an air / water supply conduit communicating with the air / water supply nozzle 17. 30 is a suction channel communicating with the suction port 18. The suction channel 30 and the suction port 18 may be omitted by sharing the puncture needle insertion passage as the suction passage.

Reference numeral 31 is a stopper for preventing the puncture needle 20 from accidentally protruding. The stopper 31 is normally closed and can be opened by pulling the stopper release wire 32.

Reference numeral 33 is a bending piece that supports the tip block 12 and connects a plurality of pieces to form a bending tube, and bends in four directions by pulling or loosening a wire (not shown) by operating the bending operation section 5. Guide the tip 1. Reference numeral 34 is an outer cover of a curved portion made of a rubber-like elastic body.

In the present device configured as described above, the bending portion is often bent when the human body is used for insertion, and it is difficult to insert a long puncture needle afterwards, so it is difficult to insert the device before insertion. Puncture needle insertion passage in the tip block 12
The tip hard portion 23 is stored in 21. After inserting the human body, optical observation and ultrasonic scanning are performed to catch the target to be punctured in the ultrasonic slice, and then the stopper release wire 32 is pulled and the stopper is pulled.
31 is opened, and the puncture needle 20 is pushed in and projected. The protruding puncture needle is first confirmed in the visual field of the observation optical system and then inserted into the human body tissue, and this time, it is confirmed in the ultrasonic tomographic image. And even if the needle is deeply inserted, the end on the tip side of the ultrasonic tomographic range is wider than the protruding direction of the puncture needle, so it is firmly caught within the ultrasonic tomographic range even at the deep part and the position of the puncture needle is dismissed. can do.

Although the puncture needle is used in the above embodiment, the present invention is not limited to this, and the same effect can be obtained even if a treatment tool such as biopsy forceps is used. In the examination of the stomach wall by the gastric degassed water filling method performed by putting water in the stomach, the same effect as that of the puncture needle can be obtained when biopsying the surface tissue after confirming the internal structure of the stomach wall. Obtainable.

Further, although the image transmission fiber bundle is used for the observation optical system in the present embodiment, a CCD image pickup device may be provided at the tip, and in this case, the eyepiece portion of the operation portion is unnecessary. Furthermore, although the flexible tube portion is provided in the insertion portion, the bending portion and the tip portion may be connected to a hard rod portion.

[Effects of the Invention] As described in detail above, in the ultrasonic endoscope of the present invention, an ultrasonic wave in which a plurality of ultrasonic transducers are arranged in a convex shape from the distal end to one side face in the distal end block of the insertion portion distal end By providing the probe, the ultrasonic probe part is shortened, and even if a long insertion passage that can accommodate a long puncture needle is installed in front of this, the ultrasonic operation is wide with a relatively short tip length. It can be grouped together while having a range, and because the opening surface of the observation optical system etc. is provided in front of the ultrasonic probe, the ultrasonic probe and the endoscope function of the observation optical system etc. are in the same cross section. Therefore, the ultrasonic probe and the endoscope function such as the observation optical system can be accommodated with a relatively small diameter.

In addition, since the puncture needle insertion path connects the opening surface and the rear end surface of the tip block and is longer than the length of the puncture needle, the puncture needle can be smoothly ejected without incurring great resistance. . Further, since the tip end of the ultrasonic tomographic range by the ultrasonic probe is provided so as to be wider on the side opposite to the ultrasonic probe provided side in the same direction as the protruding direction of the puncture needle or more, When the needle is inserted, the puncture needle can be captured well in the ultrasonic tomographic image from a short distance to a long distance.

Therefore, it is possible to smoothly eject the puncture needle without enlarging the tip portion, and furthermore, it is possible to ultrasonically guide the puncture needle in the ultrasonic tomographic image and perform ultrasonic guided puncture. It will be possible to provide a mirror.

[Brief description of drawings]

FIG. 1 is a detailed side sectional view of a tip portion of an embodiment of the present invention. FIG. 2 is a detailed plan view of the tip portion of the embodiment of the present invention. FIG. 3 is a view on arrow A of FIG. FIG. 4 is an overall configuration diagram of an embodiment of the present invention. 12 …… Tip block 13 …… Ultrasonic probe 14 …… Opening surface 21 …… Puncture needle insertion passage 22 …… Outlet port 23 …… Hard tip section

Claims (1)

[Claims] 1. An elongated human body insertion portion having a bendable portion, and a tip block provided at a tip portion of the human body insertion portion,
An ultrasonic probe in which a large number of ultrasonic transducers are arranged in a convex shape from the tip of the tip block to one side surface, and is located on the transmitting / receiving surface side of the ultrasonic probe in front of the ultrasonic probe. An opening surface having at least an objective lens and an illumination lens of an observation optical system provided on the outer surface of the tip block, and an outlet on an extension line of a scanning line by the ultrasonic probe of the opening surface, An insertion path of a puncture needle formed in the tip block so as to connect the opening surface and the rear end surface of the tip block, which is opened along a plane including an ultrasonic scanning surface by an ultrasonic probe, The ultrasonic probe has an ultrasonic scanning range on the side opposite to the side where the distal end of the ultrasonic scanning range is equal to or greater than the angle of the puncture needle protruding from the insertion passage. It is provided to be wide, and the insertion passage is at least An ultrasonic endoscope, characterized in that it has a length to accommodate the distal end rigid portion of the puncture needle to pass.