JP2014155638A - Ultrasonic therapy device and ultrasonic therapy system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To locally cauterize only an affected site even in the portion influenced by a body motion.SOLUTION: An ultrasonic therapy device 1 comprises an ultrasonic irradiation part 5 that irradiates a living body with a converged ultrasonic wave W; marker position measurement means 6, 10 that measure the position of a marker M disposed in the living body; and a control unit 10 that controls the ultrasonic irradiation part 5 on the basis of the position of the marker M measured by the marker position measurement means 6, 10. When the position of the marker M coincides with the position of the focus of the ultrasonic wave W, the control unit 1 makes the ultrasonic irradiation part 5 output the ultrasonic wave, and the position of the marker M does not coincide with the position of the focus of the ultrasonic wave W, the control unit 1 makes the ultrasonic irradiation part 5 stop outputting the ultrasonic wave W.

Description

  The present invention relates to an ultrasonic therapy apparatus and an ultrasonic therapy system.

  2. Description of the Related Art Conventionally, there has been known an ultrasonic therapy apparatus that uses focused ultrasound focused on a focal point and cauterizes an affected area under an endoscope (see, for example, Patent Document 1). The focused ultrasound acts locally on the focal point at a position away from the exit surface. Using this feature, it is possible to treat a site where it is difficult to directly introduce the device by irradiating focused ultrasound from other organs in the vicinity through other tissues such as cavity walls. it can.

JP-A-10-127678

However, in the ultrasonic treatment apparatus of Patent Document 1, when the affected part moves due to the body movement of an organ such as peristaltic movement, the focus position of the focused ultrasound is shifted from the affected part. Therefore, the ultrasonic wave is limited to only the affected part. There is an inconvenience that it is difficult to act.
The present invention has been made in view of the above-described circumstances, and provides an ultrasonic treatment apparatus and an ultrasonic treatment system capable of limitedly measuring only an affected part even in a region affected by body movement. For the purpose.

In order to achieve the above object, the present invention provides the following means.
The present invention provides an ultrasonic irradiation unit that emits focused ultrasonic waves to a living body, a marker position measuring unit that detects a position of a marker disposed on the living body, and the marker detected by the marker position measuring unit And a control unit that controls the ultrasonic irradiation unit based on the position of the ultrasonic wave, and the control unit controls the ultrasonic irradiation unit when the position of the marker coincides with the position of the focal point of the ultrasonic wave. Is output, and when the position of the marker does not coincide with the position of the focal point of the ultrasonic wave, the ultrasonic therapy apparatus stops the output of the ultrasonic wave by the ultrasonic wave irradiation unit.

According to the present invention, the ultrasonic wave emitted from the ultrasonic irradiation unit toward the living body can be focused on the focal point at a position away from the ultrasonic irradiation unit, and the living tissue can be cauterized at the focal point.
In this case, the position of the marker arranged on the living body is measured by the marker position measuring means, and the ultrasonic irradiation is performed so that the ultrasonic wave is emitted only when the measured marker position matches the position of the focal point of the ultrasonic wave. The unit is controlled by the control unit. Therefore, by arranging a marker in the affected area, only the affected area can be cauterized in a limited manner even in a region where the relative position between the affected area and the focal point of the ultrasonic wave tends to change due to the influence of body movement.

In the said invention, you may provide the marker arrangement | positioning means which arrange | positions the said marker to the said biological body.
By doing in this way, both arrangement | positioning of a marker and cauterization of a tissue can be performed using the same apparatus, and a procedure can be simplified.

Moreover, in the said invention, you may provide the ultrasonic imaging part which acquires the ultrasonic image of the area | region containing the position where the said marker is arrange | positioned by the said marker arrangement | positioning means.
By doing in this way, even the affected part located inside the surface of the tissue can be easily confirmed by the ultrasonic image, and the marker can be accurately arranged on the affected part.

Moreover, in the said invention, the said marker arrangement | positioning means may be provided with the injection needle.
By doing in this way, a marker can be easily arrange | positioned to the affected part located inside the surface of a structure | tissue. In this case, the marker is preferably a fluid.

In the above invention, the marker has magnetism, and the marker position measuring means detects the magnetic field from the magnetic sensor that detects the magnetic field generated by the marker and the strength of the magnetic field detected by the magnetic sensor. And a position calculation unit that calculates the position of.
By doing in this way, the position of the marker can be measured with a simple configuration even from a distant position.

The present invention also provides an ultrasonic treatment system comprising the ultrasonic treatment apparatus described above and an elongated guide member inserted into the living body, wherein the guide member comprises the marker fixed to the tip. .
According to the present invention, the ultrasonic wave emitted from the ultrasonic irradiation unit toward the living body can be focused on the focal point at a position away from the ultrasonic irradiation unit, and the living tissue can be cauterized at the focal point.
In this case, by inserting a guide member into the living body and placing a marker on the affected part, only the affected part is limited even in a part where the relative position between the affected part and the ultrasonic focus is likely to change due to the influence of body movement. Can be cauterized.

  According to the present invention, there is an effect that only the affected part can be limitedly scaled even in a part affected by body movement.

1 is a block diagram showing an overall configuration of an ultrasonic therapy apparatus according to a first embodiment of the present invention. It is a figure which shows the structure of the front-end | tip part of the insertion part with which the ultrasonic therapy apparatus of FIG. 1 is provided. It is a flowchart explaining the usage method of the ultrasonic therapy apparatus of FIG. It is a flowchart explaining the ultrasonic emission operation | movement of the ultrasonic therapy apparatus of FIG. It is a figure which shows the state of the insertion part in step S1 of the flowchart of FIG. It is a figure which shows the state of the insertion part in step S3 of the flowchart of FIG. It is a figure which shows the state of the insertion part in step S4 of the flowchart of FIG. It is a partial block diagram which shows the modification of the ultrasonic therapy apparatus of FIG. It is a block diagram which shows the whole structure of the ultrasonic treatment apparatus and ultrasonic treatment system which concern on the 2nd Embodiment of this invention. It is a figure which shows the structure of the front-end | tip part of the catheter with which the ultrasonic therapy system of FIG. 9 is provided. It is a flowchart explaining the usage method of the ultrasonic treatment system of FIG. It is a figure which shows the state of the insertion part in step S11 of the flowchart of FIG. It is a figure which shows the state of the insertion part in step S13 of the flowchart of FIG. It is a figure which shows the state of the insertion part in step S16 of the flowchart of FIG.

(First embodiment)
Hereinafter, an ultrasonic therapy apparatus 1 according to a first embodiment of the present invention will be described with reference to FIGS. 1 to 8.
The ultrasonic therapy apparatus 1 according to the present embodiment is configured based on an ultrasonic endoscope apparatus capable of acquiring both an in-vivo optical image and an ultrasonic image, and as shown in FIG. It has an elongated insertion portion 2 that has flexibility and is inserted into the body, and an external device 3 that is disposed outside the body.

  In addition, the ultrasonic treatment apparatus 1 includes an injection needle (marker arrangement means) 4 inserted into a channel 2 a penetratingly formed in the insertion portion 2 in the longitudinal direction, and an ultrasonic wave provided at the distal end portion of the insertion portion 2. An irradiation unit 5, a marker detection unit (marker position measuring means) 6, an endoscope imaging unit 7, and an ultrasonic imaging unit 8 are provided. The distal end opening 2b of the channel 2a, the ultrasonic irradiation unit 5, the marker detection unit 6, the endoscope imaging unit 7 and the ultrasonic imaging unit 8 are the same in the circumferential direction of the insertion unit 2 as shown in FIG. Is provided.

  The injection needle 4 penetrates in the longitudinal direction from the distal end to the proximal end, and has a through hole through which a magnetic fluid is supplied as the marker M. As the marker M, for example, a liquid containing a complex of magnetite particles or dextran and magnetic particles is used. The injection needle 4 is provided in the channel 2a so that the distal end can be projected and retracted from the distal end opening 2b of the channel 2a.

  The ultrasonic irradiation unit 5 has an emission surface 5 a provided on the outer peripheral surface of the insertion unit 2. The ultrasonic irradiation unit 5 generates an ultrasonic wave W and emits it from the emission surface 5a when a drive voltage is applied from the ultrasonic drive unit 9 included in the external device 3. Here, the emission surface 5 a is formed in a curved surface that is recessed with respect to the outer peripheral surface of the insertion portion 2. The ultrasonic wave W emitted from the emission surface 5a is focused on a focal point F away from the emission surface 5a by a focal length determined according to the curvature of the emission surface 5a. At the focal point F, the energy density of the ultrasonic wave W increases locally and the temperature rises, so that the tissue is locally cauterized.

  The marker detection unit 6 detects a magnetic field B generated by the marker M arranged on the living body. Specifically, the marker detection unit 6 includes magnetic sensors (not shown) such as Hall sensors provided at a plurality of different positions in the vicinity of the emission surface 5 a of the ultrasonic irradiation unit 5. In each position, a set of three magnetic sensors that detect magnetic fields B in different directions are arranged. Each magnetic sensor outputs a voltage corresponding to the strength of the magnetic field B generated by the marker M to the control unit (position calculation unit) 10 provided in the external device 3.

The endoscope imaging unit 7 irradiates the living body with illumination light supplied from the light source 11 provided in the external apparatus 3 to take an optical image of the living body, and the video system 12 in which the external apparatus 3 includes the obtained optical image information. Output to.
The ultrasound imaging unit 8 includes an ultrasound probe (not shown), irradiates the living body with ultrasound for image acquisition from the ultrasound probe, and reflects the ultrasound for image acquisition reflected on the living body. A wave (echo) is detected by an ultrasonic probe, and a signal of the detected echo is output to the video system 12.

  In the video system 12, an optical image of the living body is generated from the optical image information, an ultrasonic image of the living body is generated from the echo signal, and the generated optical image and ultrasonic image are connected to the external device 3. 20 is displayed. Here, the endoscope imaging unit 7 and the ultrasonic imaging unit 8 are provided so as to photograph the needle tip of the injection needle 4 protruding from the distal end opening 2b of the channel 2a. The ultrasonic imaging unit 8 is provided so as to capture a range including the focal point F of the ultrasonic wave W emitted from the ultrasonic irradiation unit 5.

  The control unit 10 provided in the external device 3 controls the emission of the ultrasonic wave W by the ultrasonic wave irradiation unit 5 based on the output voltage of each magnetic sensor received from the marker detection unit 6. Reference numeral 13 denotes an AD converter that converts the voltage output from the magnetic sensor into a digital value.

  Specifically, the control unit 10 calculates the position of the marker M using the magnitude of the voltage received from each magnetic sensor. Magnetic sensors present at different positions with respect to the marker M output different voltages. Therefore, the control part 10 can obtain | require the relative position of the marker M with respect to the output surface 5a from a difference of the voltage which the magnetic sensor of each position output.

  Then, when the calculated position of the marker M coincides with the position of the focal point F of the ultrasonic wave W, the control unit 10 instructs the ultrasonic driving unit 9 to output a driving voltage. On the other hand, when the calculated position of the marker M does not coincide with the position of the focal point F of the ultrasonic wave W, the control unit 10 instructs the ultrasonic drive unit 9 to stop outputting the drive voltage.

Next, the operation of the ultrasonic therapy apparatus 1 configured as described above will be described by taking as an example the case of treating an affected area present in the pancreas Y from the stomach X through the stomach wall.
FIG. 3 shows a procedure of treatment using the ultrasonic therapy apparatus 1. In order to treat an affected part existing in the pancreas Y using the ultrasonic therapy apparatus 1 according to the present embodiment, an operator first displays an endoscopic image acquired by the endoscope imaging unit 7 on the monitor 20. While observing, the insertion portion 2 is inserted into the stomach X, and as shown in FIG. 5, the distal end portion of the insertion portion 2 is disposed at a position facing the pancreas Y through the stomach wall (step S1). Then, the surgeon specifies the position of the affected part by observing the ultrasonic image of the pancreas Y acquired by the ultrasonic imaging unit 8 on the monitor 20 (step S2).

  Next, as shown in FIG. 6, the surgeon projects the tip of the injection needle 4 from the tip opening 2b of the channel 2a, punctures the tip of the needle into the stomach wall and pancreas Y, and places the tip of the specified affected part. Deploy. In this state, the surgeon injects the marker M into the affected area by supplying the marker M from the proximal end to the through hole of the injection needle 4 (step S3). The marker M injected into the affected area stays in the affected area for a sufficiently long time. Thereafter, the surgeon removes the injection needle 4 from the channel 2a.

Next, the operator turns on a switch (not shown), for example, to start emission of the ultrasonic wave W from the ultrasonic irradiation unit 5 and start cauterization of the affected part as shown in FIG. S4).
FIG. 4 is a flowchart showing the ultrasonic emission operation of the ultrasonic therapy apparatus 1. When the surgeon instructs the emission of the ultrasonic wave W, first, the magnetic field B generated by the marker M is detected by the marker detection unit 6 (step S41), and the control unit 10 applies the detected magnetic field B to the emission surface 5a. The position of the marker M is calculated (step S42).

  Then, the control unit 10 compares the position of the marker M with the position of the focal point F (step S43), and when the two positions coincide, the ultrasonic wave W is emitted from the ultrasonic irradiation unit 5 (step S44). When the positions do not match, the emission of the ultrasonic wave W is stopped (step S45). The surgeon confirms that the affected part has been sufficiently cauterized using, for example, an ultrasonic image, and then ends the emission of the ultrasonic wave W (step S46), and removes the insertion part 2 from the stomach X (step S5). .

  Thus, according to the present embodiment, the position of the marker M injected into the affected area is detected, and the ultrasonic wave W is applied to the living body only when the position of the focal point F of the ultrasonic wave W matches the position of the marker M. It is irradiated to. Therefore, for example, even in a situation where the relative position between the emission surface 5a and the affected part is easily changed by the peristaltic movement of the stomach X and the relative position between the focal point F and the affected part is not stable, the ultrasonic wave W is limited to the affected part. There is an advantage that the affected part can be cauterized by acting to prevent the ultrasonic wave W from acting on a part other than the affected part.

  In the present embodiment, a distance adjusting unit that adjusts the distance between the marker M and the emission surface 5a is provided, and the control unit 10 adjusts the distance so that the distance from the emission surface 5a to the marker M coincides with the focal length. May be controlled. In this way, when the distance between the focal point F and the marker M changes due to the movement of the living body, the focal point F and the marker M are operated by operating the distance adjusting means so as to cancel the change in the distance. The distance between the two can be kept constant, and the affected area can be cauterized efficiently.

  For example, as shown in FIG. 8, the distance adjusting means includes a balloon 15 provided around the emission surface 5 a, and a fluid supply unit (not shown) that supplies fluid to the balloon 15 and discharges fluid from the balloon 15. It consists of. The control unit 10 causes the fluid supply unit to supply fluid to the balloon 15 when the distance from the emission surface 5a to the marker M is greater than the focal length. Thereby, as shown in the figure, the distance between the emission surface 5a and the marker M can be extended to the focal length.

(Second Embodiment)
Next, an ultrasonic therapy apparatus 1 according to a second embodiment of the present invention and an ultrasonic therapy system 100 including the same will be described with reference to FIGS. 9 to 14. In the present embodiment, the configuration different from the first embodiment will be mainly described, and the configuration common to the first embodiment will be denoted by the same reference numerals and the description thereof will be omitted.

  As shown in FIG. 9, the ultrasonic therapy system 100 according to the present embodiment is different from the ultrasonic therapy apparatus 1 in place of injecting the liquid marker M as means for placing the marker M in the affected area. The main difference from the first embodiment is that a body catheter (guide member) 14 is employed. Specifically, the ultrasonic therapy system 100 includes a catheter 14 having a solid marker M made of a magnetic material at the tip instead of the injection needle 4 and the ultrasonic imaging unit 8.

  The catheter 14 is sufficiently smaller in diameter than the insertion portion 2 of the ultrasonic therapy apparatus 1 and can be inserted into the pancreatic duct Y ′ where it is difficult to insert the insertion portion 2. As shown in FIG. 10, the marker M is provided so as to cover the outer peripheral surface of the distal end portion of the catheter 14. The marker M is made of ferrite, for example. The catheter 14 can be inserted into the channel 30 a of the endoscope 30 and is guided to a desired position in the body using the endoscope 30.

  Next, with respect to the action of the ultrasonic therapy apparatus 1 and the ultrasonic therapy system 100 configured as described above, the affected area existing in the pancreas Y is treated from the inside of the stomach X through the stomach wall as in the first embodiment. A case will be described as an example.

  FIG. 11 shows a procedure of treatment using the ultrasonic therapy apparatus 1. In order to treat the affected part existing in the pancreas Y using the ultrasonic therapy apparatus 1 and the ultrasonic therapy system 100 according to the present embodiment, the operator first inserts the endoscope 30 into the duodenum Z, and FIG. As shown in FIG. 4, the distal end of the endoscope 30 is arranged in the vicinity of the fatter papilla (step S11). Then, the surgeon specifies, as an affected part, a part of the pancreatic duct Y ′ that is constricted by a tumor or the like by endoscopic retrograde pancreatography (ERP) (step S12).

  That is, the surgeon inserts the catheter 14 inserted through the channel 30a of the endoscope 30 up to the fatter nipple and further into the pancreatic duct Y ′ from the fatter nipple, and passes the X-ray contrast medium through the catheter 14 into the pancreatic duct Y ′. Supply in. The surgeon can identify the stenotic site of the pancreatic duct Y ′ that is the affected part by observing the X-ray image of the pancreas Y acquired by the X-ray imaging apparatus 40 on the monitor 20.

  Next, the surgeon inserts the distal end portion of the catheter 14 into the affected part while observing the X-ray image (step S13), and removes the endoscope 30 from the body while the catheter 14 is left in that position (step S14). ). Next, as shown in FIG. 13, the surgeon inserts the insertion portion 2 into the stomach X in the same manner as in the first embodiment (step S15), and inserts the distal end portion of the insertion portion 2 through the stomach wall into the pancreas. It arrange | positions in the position which opposes the affected part in Y. Here, for the positioning of the distal end portion of the insertion portion 2 in the stomach X, the detection result of the magnetic field B from the marker M by the marker detection portion 6 is used. For example, the voltage output from the magnetic sensor is displayed on the monitor 20, and the surgeon places the distal end portion of the insertion portion 2 at a position where the voltage on the monitor 20 becomes sufficiently large.

  Next, the surgeon starts cauterization of the affected area as shown in FIG. 14 in the same manner as in step S4 of the first embodiment (step S16). Thereby, the ultrasonic therapy apparatus 1 cauterizes the affected part according to step S41 to step S46 described in the first embodiment. After the cauterization of the affected part is completed, the operator removes the insertion part 2 and the catheter 14 from the body (step S17).

  As described above, according to the present embodiment, the position of the marker M arranged in the affected area is detected, and the ultrasonic wave W is applied to the living body only when the position of the focal point F of the ultrasonic wave W matches the position of the marker M. It is irradiated to. Therefore, for example, even in a situation where the relative position between the emission surface 5a and the affected part is easily changed by the peristaltic movement of the stomach X and the relative position between the focal point F and the affected part is not stable, the ultrasonic wave W is limited to the affected part. There is an advantage that the affected part can be cauterized by acting to prevent the ultrasonic wave W from acting on a part other than the affected part. Furthermore, according to the present embodiment, there is no need to puncture the stomach wall and pancreas Y with the injection needle 4, and there is an advantage that the marker M can be placed on the affected area with less invasiveness.

DESCRIPTION OF SYMBOLS 1 Ultrasonic therapy apparatus 2 Insertion part 2a Channel 2b Tip opening 3 External apparatus 4 Injection needle (marker arrangement means)
5 Ultrasonic irradiation unit 6 Marker detection unit (position measurement means)
7 Endoscopic imaging unit 8 Ultrasonic imaging unit 9 Ultrasonic drive unit 10 Control unit (position measuring means, position calculating unit)
11 Light source 12 Video system 13 AD converter 14 Catheter (guide member)
DESCRIPTION OF SYMBOLS 15 Balloon 20 Monitor 30 Endoscope 40 X-ray imaging apparatus 100 Ultrasonic treatment system B Magnetic field F Focus M Marker W Ultrasound X Stomach Y Pancreas Y 'Pancreatic duct Z Duodenum

Claims (7)

An ultrasonic irradiation unit that irradiates a living body with focused ultrasonic waves;
Marker position measuring means for measuring the position of the marker placed on the living body;
A control unit for controlling the ultrasonic irradiation unit based on the position of the marker measured by the marker position measuring means,
The control unit causes the ultrasonic irradiation unit to output the ultrasonic wave when the position of the marker coincides with the focal position of the ultrasonic wave, and the position of the marker does not coincide with the focal position of the ultrasonic wave. An ultrasonic therapy apparatus that sometimes stops output of the ultrasonic waves by the ultrasonic irradiation unit.   The ultrasonic therapy apparatus according to claim 1, further comprising marker placement means for placing the marker on the living body.   The ultrasonic therapy apparatus according to claim 2, further comprising an ultrasonic imaging unit that acquires an ultrasonic image of a region including a position where the marker is arranged by the marker arranging unit.   The ultrasonic therapy apparatus according to claim 2, wherein the marker placement unit includes an injection needle.   The ultrasonic therapy apparatus according to claim 2, wherein the marker is a fluid. The marker has magnetism;
The said marker position measurement means is provided with the magnetic sensor which detects the magnetic field which the said marker generate | occur | produces, and the position calculation part which calculates the position of the said marker from the strength of the magnetic field detected by this magnetic sensor. Item 6. The ultrasonic therapy apparatus according to any one of Items 5. The ultrasonic therapy apparatus according to claim 1;
An elongated guide member inserted into the living body,
An ultrasonic therapy system, wherein the guide member includes the marker fixed to the tip.

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