JP4864603B2 - Ultrasound endoscope - Google Patents

Description

  The present invention relates to an ultrasonic endoscope.

In the medical field, endoscopes are used for examination and diagnosis of the digestive tract and the like.
Such an endoscope has an insertion portion flexible tube to be inserted into the lumen, transmits ultrasonic waves to the distal end portion of the insertion portion flexible tube toward the test portion, and 2. Description of the Related Art An ultrasonic endoscope having an ultrasonic probe that receives ultrasonic waves reflected from a detection unit and having a treatment instrument insertion channel through which a treatment instrument is inserted is known inside an insertion portion flexible tube. .

  In this ultrasonic endoscope, an ultrasonic probe including an image of an affected area is obtained by bringing an ultrasonic probe inserted into the lumen into contact with a mucosal surface near the affected area (test area) and transmitting and receiving ultrasonic waves. Obtain a tomographic image. Then, while observing this ultrasonic tomographic image, the treatment tool is projected from the distal end of the treatment instrument insertion channel, and the treatment is performed by adjusting the projecting direction so that the distal end of the treatment instrument reaches the target affected area.

  Here, in the adjustment of the protruding direction of the treatment tool, a treatment tool raising piece is provided in the vicinity of the treatment tool protrusion of the treatment tool insertion channel so as to be in contact with the treatment tool. Is performed by the practitioner remotely operating the operating lever.

  With such an ultrasonic endoscope, a tomographic image of the test part can be obtained, so it is possible to observe the part of the digestive tract wall or the shadow of the organ that is difficult to observe with an optical endoscope, It is expected as a means for performing treatment (for example, excision of a lymph node that is a shadow of the stomach) on these sites.

  By the way, for example, in the treatment of the site behind the organ, by using a plurality of treatment tools, such as performing treatment on a target site with an appropriate treatment tool while lifting the organ with forceps, You can do it better.

  Therefore, an ultrasonic endoscope provided with a plurality of treatment instrument insertion channels so that a plurality of treatment instruments can be mounted has been proposed (see, for example, Patent Document 1).

  Here, in the ultrasonic endoscope having a plurality of treatment instrument insertion channels as described above, when there are a plurality of treatment instruments to be raised, a separate treatment instrument raising piece is provided for each treatment instrument. These are configured to be remotely operated by separate operation levers.

  However, in the configuration in which separate treatment tool raising pieces are provided for each treatment tool in this way, even when the protruding directions of a plurality of treatment tools are simultaneously changed to the same direction, a treatment is performed on the affected area with a plurality of treatment tools. A plurality of operation levers must be operated while performing the operation, and the operation becomes very complicated.

  In addition, it is difficult to operate the plurality of operation levers in exactly the same manner, and there is a difference in the angle at which the treatment instruments are operated, and the distance between the distal ends of the treatment instruments varies.

  Here, for example, when the procedure of incising the shadowed part of the organ while lifting the organ with forceps is performed while raising the forceps and the electric knife, the distance between the forceps and the electric knife changes. If this happens, the organ moves up and down, and the site to be incised appears and disappears, and the incision position is shifted by the electric knife.

  In addition, the configuration of the electric knife mounted on the ultrasonic endoscope has a working electrode and a counter electrode, and the working electrode and the counter electrode serve as the first treatment tool and the second treatment tool. The system of the type that is attached to the can be considered. The electric knife having such a configuration can apply a high voltage between the electrodes and can obtain a large amount of heat as compared with an electric knife having one electrode attached to the body surface.

  However, when the incision is performed while performing a raising operation with such an electric knife, if the distance between the electrodes varies, the amount of heat generated between the electrodes varies, and the incision can be performed stably. There is a concern that it may not be possible, or that the electrodes contact each other and short-circuit.

JP 2004-154300 A

  It is an object of the present invention to change the projecting direction of a plurality of treatment tools simultaneously and at the same angle, reduce the burden on the practitioner, and perform complex treatment efficiently and safely. It is to provide an endoscope.

Such an object is achieved by the present inventions (1) to (8) below.
(1) an insertion portion flexible tube to be inserted into the lumen;
An ultrasonic probe that is provided at the distal end of the insertion tube and that transmits and receives ultrasonic waves;
Ultrasound endoscopy having a plurality of treatment instrument insertion channels provided inside the insertion section flexible tube and capable of inserting a plurality of treatment instruments for performing treatment on the test portion in the lumen. A mirror,
A treatment instrument raising piece provided with a plurality of insertion portions through which the plurality of treatment instruments protruding from the distal end side opening can be inserted, and rotating the treatment instrument raising piece , the protrusion direction of the plurality of treatment instrument projecting from the distal end opening of the treatment instrument insertion channel, have a treatment instrument raising means for varying simultaneously and at the same angle,
The ultrasonic endoscope , wherein each of the insertion portions has a different distance from a rotation center of the treatment instrument raising piece .

  Thereby, the projection directions of the plurality of treatment tools can be changed at the same angle at the same time, the burden on the practitioner can be reduced, and a complex treatment can be performed efficiently and safely. A mirror is obtained.

(2) The ultrasonic endoscope according to (1) , wherein at least one of the plurality of insertion portions is a hole through which the treatment tool can be inserted.

  Thereby, since the protrusion direction of the treatment tool can be reliably regulated in all directions of up, down, left and right by the hole, the treatment tool can be surely reached the target position.

(3) The ultrasonic endoscope according to (1) or (2) , wherein at least one of the plurality of insertion portions is a groove through which the treatment tool can be inserted.

  As a result, when the ultrasonic endoscope is cleaned, the cleaning liquid can be efficiently distributed to the grooves, so that the grooves can be reliably cleaned.

(4) an insertion portion flexible tube to be inserted into the lumen;
  An ultrasonic probe that is provided at the distal end of the insertion tube and that transmits and receives ultrasonic waves;
  Ultrasound endoscopy having a plurality of treatment instrument insertion channels provided inside the insertion section flexible tube and capable of inserting a plurality of treatment instruments for performing treatment on the test portion in the lumen. A mirror,
  A treatment instrument raising means for changing the protruding direction of the plurality of treatment instruments protruding from the distal end side opening of the plurality of treatment instrument insertion channels simultaneously and at the same angle;
  The plurality of treatment tools protruding from the plurality of treatment tool insertion channels are all disposed such that their axes are positioned in a plane for scanning the ultrasonic waves of the ultrasonic probe. Endoscope.
Thereby, each of the plurality of treatment tools can be surely displayed on the ultrasonic tomographic image. Thereby, the practitioner can surely visually recognize the behavior of the plurality of treatment tools on the ultrasonic tomographic image. As a result, reliable treatment can be performed on the portion to be examined.

(5) an insertion portion flexible tube to be inserted into the lumen;
  An ultrasonic probe that is provided at the distal end of the insertion tube and that transmits and receives ultrasonic waves;
  Ultrasound endoscopy having a plurality of treatment instrument insertion channels provided inside the insertion section flexible tube and capable of inserting a plurality of treatment instruments for performing treatment on the test portion in the lumen. A mirror,
  A treatment in which the protruding directions of the plurality of treatment tools protruding from the distal-side openings of the plurality of treatment instrument insertion channels are changed simultaneously and at the same angle along the ultrasonic scanning surface of the ultrasonic probe. An ultrasonic endoscope comprising a raising unit.
Thereby, the process of changing the protruding direction of the plurality of treatment instruments can be surely visually confirmed on the ultrasonic tomographic image.

(6) The device according to any one of (1) to (5), further including: an operation lever that remotely operates the treatment instrument raising piece; and a wire that transmits movement of the operation lever to the treatment tool raising piece. Ultrasound endoscope.
Thereby, the practitioner can easily and reliably perform the turning operation of the treatment instrument raising piece.

(7) At least two of the plurality of treatment tools constitute a pair of electrodes,
The ultrasonic endoscope according to any one of (1) to (6) , wherein the two treatment tools function as an electric knife by applying a voltage between the pair of electrodes.

  Thereby, since the heat generated between the electrodes can be kept constant by keeping the separation distance between the electrodes constant, the test portion can be incised at a constant depth, and each It is possible to prevent a short circuit from occurring due to contact between the treatment instruments.

(8) The ultrasonic endoscope according to any one of (1) to (7) , including an imaging component that observes the inside of the lumen as an electronic endoscopic image.

  Thereby, the ultrasonic diagnostic image and the electronic endoscopic image can be switched and displayed, and the practitioner can easily recognize the position of the affected part in the lumen.

  According to the present invention, since a plurality of treatment tools can be mounted, it is possible to perform complicated treatments on the target affected part (test part) in a proper manner using the plurality of treatment tools.

  In addition, since the protruding directions of the plurality of treatment tools projected from the treatment tool projection port can be changed at exactly the same angle and simultaneously, it is possible to reduce the burden on the practitioner and perform the treatment efficiently and safely. it can.

  Hereinafter, an ultrasonic endoscope of the present invention will be described in detail based on a preferred embodiment shown in the accompanying drawings.

<First Embodiment>
First, a first embodiment of the ultrasonic endoscope of the present invention will be described.

  FIG. 1 is an overall view showing a first embodiment of an ultrasonic endoscope of the present invention, FIG. 2 is a plan view showing a distal end portion of a bending portion provided in the ultrasonic endoscope shown in FIG. 1, and FIG. FIG. 4 is a cross-sectional view taken along the line VV of the distal end portion shown in FIG. 2, and FIG. 4 is a schematic view (longitudinal sectional view) showing how the treatment tool protruding from the distal end portion of the bending portion shown in FIG. FIG. 5 is a longitudinal sectional view showing an example of a treatment instrument raising piece. In the following description, the upper side in FIG. 1 is referred to as “base end”, the lower side is referred to as “tip”, the upper side in FIGS. 3 to 5 is referred to as “upper”, and the lower side is referred to as “lower”.

  The ultrasonic endoscope 1 shown in FIG. 1 is connected to a long insertion portion flexible tube 2 having flexibility (flexibility), and a proximal end portion of the insertion portion flexible tube 2. An operation unit 6 that grips and operates the entire ultrasonic endoscope 1, a first connection unit flexible tube 7 connected to the operation unit 6, and an operation unit via the first connection unit flexible tube 7 The light source insertion part (connection part) 8 connected to 6, the second connection part flexible tube 9 connected to the operation part 6, and the operation part 6 via the second connection part flexible tube 9. The ultrasonic connector 10 is connected.

  The insertion portion flexible tube 2 is used by being inserted into a lumen. As shown in FIG. 1, the insertion portion flexible tube 2 has a flexible tube portion 20 from the hand (base end) side, and a bending portion 21 that is provided at the distal end portion of the flexible tube portion 20 and can be bent. is doing.

  The bending portion 21 can be bent in four directions by operating the operation knobs 61 and 62 installed on the side surface of the operation portion 6, and the directions thereof can be changed.

  As shown in FIGS. 3 and 4, an ultrasonic probe 22 that transmits an ultrasonic wave toward the affected part (examined part) and receives an ultrasonic wave reflected from the affected part is attached to the distal end surface of the bending part 21. It has been.

  The ultrasonic probe 22 is a so-called electronic convex ultrasonic transducer, and has a substantially arc shape in a side view. A surface (hereinafter referred to as an ultrasonic scanning range) U on which the ultrasonic probe 22 scans ultrasonic waves extends outside the substantially arcuate portion, and is within a plane along the axis of the bending portion 21. is there. A one-dot chain line A in FIG. 2 indicates the position of the plane. Hereinafter, this plane indicated by a one-dot chain line A in FIG. 2 is referred to as “plane A”.

  The ultrasonic probe 22 is ultrasonically transmitted by an ultrasonic signal cable (not shown) continuously disposed in the insertion portion flexible tube 2, the operation portion 6, and the second connection portion flexible tube 9. Connected to the connector 10.

  The ultrasonic connector 10 is inserted into a connection portion of an ultrasonic diagnostic apparatus (peripheral device) (not shown).

  The ultrasonic wave (reflected wave) transmitted from the ultrasonic probe 22 and reflected from the affected part is received by the ultrasonic probe 22 and converted into an electrical signal, and the ultrasonic wave is transmitted through the ultrasonic signal cable and the ultrasonic connector 10. It is transmitted to the ultrasonic diagnostic apparatus. Then, a predetermined analysis is performed in the ultrasonic diagnostic apparatus, and an ultrasonic tomographic image of the affected part is displayed on a monitor device (not shown).

  It is to be noted that a balloon 16 as shown in FIG. 3 may be attached to the periphery of the ultrasonic probe 22 as appropriate according to the site of the affected part before the insertion part flexible tube 2 is inserted into the lumen. Good. In this state, the insertion portion flexible tube 2 is inserted into the lumen, and deaerated water is supplied into the balloon 16 as will be described later, and the balloon 16 is observed in an inflated state. When observing a site that is difficult to store deaerated water such as the esophagus, a clearer ultrasonic tomographic image can be obtained.

  A water supply port (not shown) and a drain port (not shown) are provided at the distal end portion of the bending portion 21.

  A water supply channel formed continuously in the insertion portion flexible tube 2, the operation portion 6, the first connection portion flexible tube 7, and the light source insertion portion 8, respectively, at the water supply port and the drain port. (Not shown) and the end part of each front end side of the drainage channel (not shown) are open. In addition, the proximal ends of the water supply channel and the drainage channel are opened at a water supply / drainage port 83 provided in the light source insertion portion 8. The water supply / drain port 83 is connected to a tank 17 for supplying / suctioning deaerated water via a water supply / drain pipe 84.

  When deaerated water is supplied from the tank 17 in a state where the balloon 16 is attached to the ultrasonic probe 22, the deaerated water supplied from the tank 17 passes through the water supply / drain pipe 84 and the water supply channel and passes through the water supply port. It is supplied into the balloon 16. Thereby, deaerated water is stored in the gap between the inner surface of the balloon 16 and the ultrasonic probe 22, and the balloon 16 is inflated. On the other hand, when the deaerated water is discharged from the balloon 16, the deaerated water in the balloon 16 is sucked to the tank 17 side through the drain port, the drain channel, and the water supply / drain pipe 84, whereby the balloon 16 contracts. .

  Further, the distal end portion of the bending portion 21 has an inclined surface 211 that is inclined toward the distal end side.

  As shown in FIG. 2, an observation window 23 for observing the direction of the ultrasonic scanning range U as an electronic endoscopic image and an illumination window 24 for illuminating the observation range are arranged on the inclined surface 211. It is installed.

  An objective optical system (not shown) is disposed on the back surface (the surface facing the inside of the curved portion) of the observation window 23, and a subject image is displayed corresponding to the projection position of the subject by the objective optical system. An image pickup device (image pickup component) (not shown) for shooting is provided.

  The image pickup device includes a light source insertion portion by an image signal cable (not shown) continuously disposed in the insertion portion flexible tube 2, the operation portion 6, and the first connection portion flexible tube 7. 8 is connected to an image signal connector 82 provided in the apparatus 8.

  Further, inside the distal end portion of the curved portion 21 of the illumination window 24, the insertion portion flexible tube 2, the operation portion 6, the first connection portion flexible tube 7, and the light source insertion portion 8 are continuously provided. The tip of the arranged light guide is arranged. The light guide is configured by bundling a plurality of optical fibers made of, for example, quartz glass, multicomponent glass, resin material, or the like.

  A light source connector 81 connected to a light guide is provided along with an image signal connector 82 at the distal end of the light source insertion portion 8, and the light source connector 81 and the image signal connector 82 are connected to a light source processor device (peripheral not shown). The light source insertion portion 8 is connected to the light source processor device by being inserted into the connection portion of the device. A monitor device (not shown) is connected to the light source processor device via a cable.

  Light emitted from the light source processor device passes through the light source connector 81 and the light guide, and is irradiated from the distal end portion of the bending portion 21 (insertion portion flexible tube 2) to illuminate the inside of the lumen.

  The reflected light (subject image) from the observation site illuminated by the illumination light is imaged by the image sensor. The image sensor outputs an image signal corresponding to the captured subject image. This image signal is transmitted to the light source insertion unit 8 via the image signal cable.

  Then, predetermined processing (for example, signal processing, image processing, etc.) is performed in the light source insertion unit 8 and the light source processor device, and then input to the monitor device. In the monitor device, an optical endoscopic image (electronic image) captured by the image sensor, that is, an endoscope monitor image of a moving image is displayed.

  Various operations of peripheral devices such as the light source processor device, the monitor device, and the above-described ultrasonic diagnostic device (for example, switching between a moving image and a still image of an electronic image, operation of a filing system of an electronic image and / or an imaging device) Stop, operation of the electronic image recording device and / or stop, etc.) can be remotely operated by pressing each control button provided on the peripheral surface of the operation unit 6.

  In addition, since the ultrasonic endoscope 1 includes the ultrasonic probe 22 and an imaging component such as an imaging element, an ultrasonic tomographic image can be obtained with the insertion portion flexible tube 2 inserted into the lumen. An electronic image can be switched and displayed. As a result, the state of the surface in the lumen can be visually recognized by an electronic image, and the cross section of the lumen can be observed by an ultrasonic tomographic image. That is, by switching and displaying these images, the practitioner can easily recognize the position of the affected part in the lumen.

  In addition, the inclined surface 211 is formed with a recess 212, and the first treatment instrument protrusion 25 and the second treatment instrument protrusion 26 are provided in the recess 212.

  The first treatment instrument projection port 25 and the second treatment instrument projection port 26 are respectively provided with a first treatment instrument insertion channel 27 and a second treatment instrument which are continuously formed in the insertion portion flexible tube 2. The tip of the insertion channel 28 is open.

  Further, the first treatment instrument insertion channel 27 and the second treatment instrument insertion channel 28 have respective proximal end side opening portions provided in the proximal end portion of the insertion portion flexible tube 2. It communicates with the instrument insertion hole 29 and the second treatment instrument insertion hole 30. That is, in the ultrasonic endoscope 1, the first treatment instrument 11 and the second treatment instrument 12 are inserted from the first treatment instrument insertion hole 29 and the second treatment instrument insertion hole 30, respectively. The first treatment instrument insertion channel 27 and the second treatment instrument insertion channel 28 are inserted. The distal ends of the first treatment instrument 11 and the second treatment instrument 12 inserted through the treatment instrument insertion channels 27 and 28 are the first treatment instrument projection port 25 and the second treatment instrument projection. It protrudes from the mouth 26 along the plane A into the ultrasonic operation range U.

  As the first treatment tool 11 and the second treatment tool 12 inserted through the first treatment tool insertion channel 27 and the second treatment tool insertion channel 28, forceps, acupuncture forceps, an electric knife, injection / puncture A needle, a catheter, etc. are mentioned. The first treatment tool 11 and the second treatment tool 12 may be the same or different.

  Thus, since this ultrasonic endoscope 1 has the plurality of treatment instrument insertion channels 27 and 28, the plurality of treatment instruments 11 and 12 can be simultaneously mounted. Therefore, it is possible to perform a complicated procedure such as performing a plurality of treatments on the target affected area using the plurality of treatment tools 11 and 12 in a proper manner.

Further, the treatment instrument raising means 4 is provided in the recess 212.
The treatment instrument raising means 4 includes a treatment instrument raising piece 41, a support shaft 42, and an operation wire 43.

  When the first treatment instrument 11 is projected straight from the first treatment instrument projecting port 25 on the side surface 213 in the recess 212 so that the axial direction thereof is substantially orthogonal to the plane A. In addition, it is attached to be lower than the protruding first treatment instrument 11. As the support shaft 42, a metal pin or the like is used.

  The treatment instrument raising piece 41 is formed in a small piece of a size that can be accommodated in the recess 212 with a sufficient gap. In the present embodiment, the treatment instrument raising piece 41 is a small piece having a triangular longitudinal section, but the shape of the treatment instrument raising piece 41 is not limited to this.

  The treatment instrument raising piece 41 is disposed such that one side surface thereof faces the lower surface 214 in the recess 212. Hereinafter, in the treatment instrument raising piece 41, a side surface facing the lower surface 214 side is referred to as a reference surface 410.

  In the treatment instrument raising piece 41, a support shaft hole 44 through which the support shaft 42 is inserted is substantially perpendicular to the plane A and below a first protrusion insertion hole 411 described later. So as to penetrate. The treatment instrument raising piece 41 is rotatable with respect to the bending portion 21 by inserting the support shaft 42 into the support shaft hole 44 and attaching the support shaft 42 to the side surface 213 in the recess 212 as described above. It is supported by.

  In such a treatment instrument raising piece 41, as shown in FIG. 3, the reference surface 410 and the lower surface 214 in the recess 212 form a predetermined angle θ (θ> 0 °) (hereinafter, “ In the initial state, the first protrusion insertion hole 411 formed so that the axial direction of the first treatment instrument insertion channel 27 coincides with the extending direction thereof, and the second treatment instrument A second protrusion insertion hole 412 formed so that the axial direction of the insertion channel 28 coincides with the extending direction thereof is provided so as to penetrate the treatment instrument raising piece 41.

  When the first treatment instrument 11 is protruded from the first treatment instrument protrusion 25 with the treatment instrument raising piece 41 in the initial state, the tip of the protruding first treatment instrument 11 is inserted into the first protrusion. It is inserted into the proximal end side opening of the common hole 411 and protrudes from the distal end side opening. Further, when the second treatment instrument 12 is projected from the second treatment instrument projection 26, the projected distal end portion of the second treatment instrument 12 is the proximal end opening of the second projection insertion hole 412. And protrudes from the front end side opening.

  The treatment instrument raising piece 41 is rotated with the first treatment instrument 11 and the second treatment instrument 12 projecting from the first projection insertion hole 411 and the second projection insertion hole 412 respectively. Thus, the protruding direction of the first treatment instrument 11 and the protruding direction of the second treatment instrument 12 can be easily changed at the same angle at the same time. Moreover, since the protrusion direction of the 1st treatment tool 11 and the protrusion direction of the 2nd treatment tool 12 can be changed according to the rotation angle of the treatment tool raising piece 41, each treatment tool 11 and 12 can be changed. There is also an advantage that the projecting direction can be adjusted to a desired angle.

  The first treatment instrument 11 projected from the first projection insertion hole 411 and the second treatment instrument 12 projected from the second projection insertion hole 412 both have their axes. Are disposed in the plane A of FIG. Thereby, the 1st treatment tool 11 and the 2nd treatment tool 12 can be included in the ultrasonic scanning range U, and each of these treatment tools 11 and 12 is displayed on an ultrasonic tomogram, respectively. Can do. Thereby, the practitioner can surely visually recognize the behavior of the first treatment instrument 11 and the second treatment instrument 12 on the ultrasonic tomographic image. As a result, a reliable treatment can be performed on the affected area.

  Further, the treatment instrument raising piece 41 is configured to change the protruding direction of the first treatment instrument 11 and the protruding direction of the second treatment instrument 12 along the plane A in FIG. Thereby, the process of changing the protruding direction of each treatment instrument 11, 12 can be surely visually confirmed on the ultrasonic tomographic image.

  In addition, these 1st protrusion part insertion holes 411 and 2nd protrusion part insertion hole 412 are the distance from the spindle 42 used as the rotation center of the treatment tool raising piece 41, as shown in FIG. Are different. Thereby, each treatment tool 11 and 12 can be protruded along the rotation direction of the treatment tool raising piece 41, and the treatment performed using the two treatment tools 11 and 12 can be performed more efficiently.

  In addition, when the ultrasonic endoscope 1 changes the protruding direction of the first treatment instrument 11 and the protruding direction of the second treatment instrument 12 with the treatment instrument raising piece 41, the ultrasonic endoscope 1 A treatment instrument advancing / retreating mechanism for pulling or feeding at least one of the treatment instruments 11 and 12 may be provided so that the position of the distal end portion does not shift. Thereby, since the position of the front-end | tip part of both the treatment tools 11 and 12 will be in the state always aligned, the complicated treatment using the some treatment tools 11 and 12 can be performed more efficiently.

  The cross-sectional shapes of the first protrusion insertion hole 411 and the second protrusion insertion hole 412 are, for example, rectangular, square, rhombus, etc., triangle, hexagon, octagon, circle, ellipse. However, it is preferable that the cross-sectional area is similar to the cross-sectional shape of each treatment instrument 11, 12 and slightly wider than the cross-sectional area of each treatment instrument 11, 12. Thereby, the treatment tools 11 and 12 can be easily and stably inserted into the protrusion insertion holes 411 and 412.

  In addition, an operation wire 43 that advances and retreats in the axial direction of the bending portion 21 is connected to the treatment instrument raising piece 41 at a portion on the distal end side with respect to the support shaft 42. The treatment instrument raising piece 41 rotates about the support shaft 42 when the operation wire 43 is operated. The operation wire 43 is operated by rotating an operation lever (not shown) that is provided on the peripheral surface of the operation unit 6 and that pulls the operation wire 43. That is, by transmitting the movement of the operation lever to the treatment instrument raising piece 41 via the operation wire 43, the treatment instrument raising piece 41 can be remotely operated. As a result, the practitioner can easily and reliably rotate the treatment instrument raising piece 41.

  A state in which the first treatment tool 11 and the second treatment tool 12 are raised by the treatment tool raising means 4 as described above will be described with reference to FIGS. 3 and 4. In FIG. 4, the first treatment instrument 11 and the second treatment instrument 12 indicated by dotted lines are in a state before being raised by the treatment instrument raising means 4, and the first treatment instrument indicated by a solid line. 11 and the second treatment tool 12 are in a state after being raised by the treatment tool raising means 4.

  First, by operating the operation lever, as shown in FIG. 3, the treatment instrument raising piece 41 is brought into an initial state.

  Then, the first treatment instrument 11 is inserted from the first treatment instrument insertion hole 29, the first treatment instrument insertion channel 27 is inserted, and the first treatment instrument insertion port 25 is protruded. The first treatment instrument 11 projected from the first treatment instrument protrusion 25 enters the first projection insertion hole 411 of the treatment instrument raising piece 41. As shown by the dotted line in FIG. 4, the distal end portion of the first treatment instrument 11 projects from the distal end side of the first projecting portion insertion hole 411.

  Further, the second treatment instrument 12 is inserted from the second treatment instrument insertion hole 30, the second treatment instrument insertion channel 28 is inserted, and the second treatment instrument insertion port 26 is protruded. The second treatment tool 12 projected from the second treatment tool protrusion 26 enters the second protruding portion insertion hole 412 of the treatment tool raising piece 41. As shown by a dotted line in FIG. 4, the distal end portion of the second treatment instrument 12 projects from the distal end side of the second projecting portion insertion hole 412.

  With the first treatment instrument 11 and the second treatment instrument 12 thus inserted through the protruding portion insertion holes 411 and 412 of the treatment instrument raising piece 41, the operation wire 43 is retracted. To operate. As a result, the treatment instrument raising piece 41 rotates clockwise. As a result, the first treatment instrument 11 is pressed by the inner wall surface of the first protrusion insertion hole 411 and bent upward, and the second treatment instrument 12 is provided with the second protrusion insertion hole 412. The treatment tools 11 and 12 are each pressed along the plane A and moved from the position indicated by the dotted line in FIG. 4 to the position indicated by the solid line.

  Next, when the operation wire 43 is operated in the traveling direction, the treatment instrument raising piece 41 rotates counterclockwise. Thereby, the 1st treatment tool 11 and the 2nd treatment tool descend | fall along the plane A, and respectively move to the position shown with a dotted line from the position shown as the continuous line in FIG.

  By rotating the treatment instrument raising piece 41 in this manner, the protruding directions of the first treatment instrument 11 and the second treatment instrument 12 can be arbitrarily changed along the plane A.

  Here, in the present embodiment, the first treatment tool raising piece 41 protrudes from the first treatment tool 11 and the second treatment tool protrusion 26 protruding from the first treatment tool protrusion 25. Since the two treatment tools 12 are raised at the same time, the protruding directions of the first treatment tool 11 and the second treatment tool 12 can be changed at the same angle at the same time. Therefore, the distance between the distal end portions of the first treatment tool 11 and the second treatment tool 12 can be kept accurately and constant during the operation.

  For this reason, for example, forceps (first treatment tool 11) and electric scalpel (second treatment tool 12) are used to perform complicated treatments such as lifting an organ with forceps and incising a shadowed portion of the organ. When performing the raising operation with the treatment tool raising piece 41, in the process of the raising operation, the site to be incised is hidden or hidden by the organ, or the position to be incised by the electric knife is shifted. Can be prevented, and a predetermined position can be reliably incised.

  In addition, for example, when the affected part is incised while raising the electric scalpel constituted by the working electrode and the counter electrode mounted as the first treatment tool 11 and the second treatment tool 12, Since the heat generated between the electrodes can be kept constant in the process of the upper operation, the affected part can be incised at a constant depth, and the treatment tools 11 and 12 come into contact with each other to cause a short circuit. Can be prevented.

  Further, the treatment instrument raising piece 41 can be simultaneously rotated by operating one operation lever, whereby the plurality of treatment instruments 11 and 12 are raised, so that simple lever operation is possible. Thus, the protruding direction of the plurality of treatment tools 11 and 12 can be changed, and the procedure of the practitioner can be simplified and the treatment can be performed efficiently and safely.

  Next, a usage method (action) of the ultrasonic endoscope 1 will be described with reference to FIG. Here, a case where a portion from position a to position b shown in FIG. 4 is incised by an electric knife configured by a working electrode and a counter electrode mounted as the first treatment tool 11 and the second treatment tool 12 is shown. Explained as an example.

  First, the rubber balloon 16 is put on the ultrasonic probe 22 as necessary. Then, the mouth of the balloon 16 is fixed to the proximal end portion of the ultrasonic probe 22 with an O-ring.

  Further, by operating the operation lever, the treatment instrument raising piece 41 is set to the initial state shown in FIG.

  Next, while confirming the image of the monitor device connected to the light source processor device, the insertion portion flexible tube 2 is inserted into the lumen, and the ultrasonic probe 22 is brought close to the surface of the mucous membrane 100.

  Next, when the balloon 16 is attached, an operation of supplying deaerated water into the balloon 16 is performed. Thereby, deaerated water is supplied from the water supply port of the curved portion 21 to the gap between the inner surface of the balloon 16 and the ultrasonic probe 22, and the balloon 16 is inflated. In this state, the outer surface of the balloon 16 (or the outer surface of the ultrasonic probe 22) is brought into contact with the surface of the mucous membrane 100, ultrasonic waves are transmitted and received from the ultrasonic probe 22, and an ultrasonic tomographic image is displayed on the screen of the ultrasonic diagnostic apparatus. Is displayed.

  Next, the working electrode (first treatment tool) 11 and the counter electrode (second treatment tool) 12 are inserted through the first treatment tool insertion channel 27 and the second treatment tool insertion channel 28, respectively. While confirming the ultrasonic tomogram of the ultrasonic diagnostic apparatus, the working electrode 11 and the counter electrode 12 are protruded from the first treatment instrument protrusion 25 and the second treatment instrument protrusion 26. Then, the working electrode 11 and the counter electrode 12 protruding from the first treatment instrument protrusion 25 and the second treatment instrument protrusion 26 are respectively connected to the first protrusion insertion hole 411 of the treatment instrument raising piece 41. In addition, the tip is inserted into the second protrusion insertion hole 412 and the tip thereof is guided to the position a of the affected part 101.

  Then, heat is generated by applying a predetermined voltage between the working electrode 11 and the counter electrode 12, and incision of the affected part 101 is started. At the same time, by operating the operation lever, the treatment instrument raising piece 41 is rotated clockwise, and the working electrode 11 and the counter electrode 12 are raised along the plane A until reaching the position b of the affected area 101. Let me rise.

  Subsequently, when a voltage is applied between the working electrode 11 and the counter electrode 12 and the electrodes 11 and 12 are raised from the treatment instrument raising piece 41, a portion operated by heat generated between the electrodes. Is burned out, and the part from the position a to the position b of the affected part 101 is incised.

  Here, in this embodiment, since the working electrode 11 and the counter electrode 12 are simultaneously raised by the same treatment tool raising piece 41, the separation distance between the electrodes 11 and 12 is set in the course of this operation. Kept constant. Therefore, a uniform amount of heat can be applied to a portion from the region a to the region b, and an incision can be performed with a uniform depth.

  Further, the treatment instrument raising piece 41 can be rotated by operating one operation lever. As a result, the plurality of treatment instruments 11 and 12 are raised and operated by a simple lever operation. The projecting direction of the plurality of treatment instruments 11 and 12 can be changed, and the procedure of the practitioner can be simplified and the treatment can be performed efficiently and safely.

  Further, the treatment instrument raising piece 41 shown in FIG. 5 is formed by forming a first protrusion insertion hole 411 and a second protrusion insertion hole 412 in a block-shaped member. When the treatment instruments 11 and 12 are inserted into the projection insertion holes 411 and 412, the projection directions of the treatment instruments 11 and 12 can be reliably regulated in all directions, up and down, left and right. The tools 11 and 12 can surely reach the target position and can be reliably held at that position.

  Furthermore, the treatment instrument raising piece 41 shown in FIG. 5 has an advantage that it is easy to manufacture because it has a relatively simple shape in which two holes are provided in a block-shaped member. .

<Second Embodiment>
Next, a second embodiment of the ultrasonic endoscope of the present invention will be described.

  FIG. 6 is a longitudinal sectional view showing a treatment instrument raising piece provided in the ultrasonic endoscope of the second embodiment. Hereinafter, in FIG. 6, the upper side is described as “upper” and the lower side is described as “lower”.

  Hereinafter, the ultrasonic endoscope 1 according to the second embodiment will be described. However, the description will focus on differences from the ultrasonic endoscope 1 according to the first embodiment, and description of similar matters will be omitted. To do.

  The ultrasonic endoscope 1 of the second embodiment is the same as the ultrasonic endoscope of the first embodiment except that the configuration of the treatment instrument raising piece 41 is different.

  The treatment instrument raising piece 41 shown in FIG. 6 has a small piece shape that can be accommodated in the recess 212 with a sufficient gap.

  The treatment instrument raising piece 41 is formed integrally with the first groove forming portion 413, the second groove forming portion 414, and one side portion of the groove forming portions 413, 414, and each of these groove forming portions. 413 and 414 are connected to each other.

  Each of the first groove forming portion 413 and the second groove forming portion 414 shown in FIG. 6 has a first protrusion insertion groove 416 and a second protrusion insertion groove 417 on the upper surface thereof. Yes. Each of the first protrusion insertion groove 416 and the second protrusion insertion groove 417 is a groove having a substantially V-shaped cross section in a direction orthogonal to the axis of the insertion portion flexible tube 2. is there.

  In addition, the surface of the first groove forming portion 413 opposite to the first protruding portion insertion groove 416 is disposed so as to face the lower surface 214 in the concave portion 212. Hereinafter, the surface of the treatment instrument raising piece 41 that faces the lower surface 214 is referred to as a reference surface 410.

  A support hole 44 (see FIG. 3) through which the support shaft 42 is inserted is provided in the first groove forming portion 413 of the treatment instrument raising piece 41 so as to be substantially orthogonal to the plane A. The support shaft 42 is inserted into the support shaft hole 44, and the support shaft 42 is attached to the side surface 213 in the recess 212 as described above, so that the treatment instrument raising piece 41 can rotate with respect to the bending portion 21. Supported.

  The first protrusion insertion groove 416 formed in the first groove forming portion 413 is in a state where the reference surface 410 and the lower surface 214 in the recess 212 form a predetermined angle θ (θ> 0 °). (Hereinafter referred to as “initial state”), the axial direction of the first treatment instrument insertion channel 27 and the extending direction thereof coincide with each other.

  The second protrusion insertion groove 417 formed in the second groove forming portion 414 is in a state in which the reference surface 410 and the lower surface 214 in the recess 212 form a predetermined angle θ (θ> 0 °). In the (initial state), the axial direction of the second treatment instrument insertion channel 28 coincides with the extending direction thereof.

  When the first treatment instrument 11 is protruded from the first treatment instrument protrusion 25 with the treatment instrument raising piece 41 in the initial state, the tip of the protruding first treatment instrument 11 is inserted into the first protrusion. The insertion groove 416 is inserted from the proximal end side end portion, inserted into the insertion groove 416 and protrudes from the distal end side end portion. Further, when the second treatment instrument 12 is projected from the second treatment instrument projecting opening 26, the projected distal end portion of the second treatment instrument 12 is the proximal end portion of the second projection insertion groove 417. Is inserted through the insertion groove 417 and protrudes from the tip end portion.

  The cross-sectional shapes of the first protrusion insertion groove 416 and the second protrusion insertion groove 417 are, for example, rectangular, square, rhombus, etc., triangle, hexagon, octagon, semicircular, semielliptical However, the cross-sectional shape of the portion in contact with each treatment instrument 11, 12 is similar to the cross-sectional shape of each treatment tool 11, 12 accommodated in this portion, and the cross-sectional area thereof A slightly larger cross-sectional area is preferred. Thereby, each treatment tool 11 and 12 can be easily and stably inserted into the protrusion insertion grooves 416 and 417.

  In addition, an operation wire 43 that advances and retreats in the axial direction of the bending portion 21 is connected to the treatment instrument raising piece 41 at a portion on the distal end side with respect to the support shaft 42. The treatment instrument raising piece 41 rotates about the support shaft 42 by operating the operation wire 43. The operation wire 43 can be operated remotely by rotating a control lever provided on the peripheral surface of the operation unit 6 and pulling the operation wire 43.

  The raising operation of the first treatment tool 11 and the second treatment tool 12 by the treatment tool raising means 4 is performed in place of the first protrusion insertion hole 411 and the second protrusion insertion hole 412. Except that the first treatment instrument 11 and the second treatment instrument 12 are inserted into the first protrusion insertion groove 416 and the second protrusion insertion groove 417, the same as in the first embodiment. Done.

  In the second embodiment, the same operation and effect as in the first embodiment can be obtained.

  Further, the treatment instrument raising piece 41 shown in FIG. 6 is formed with a first protrusion insertion groove 416 and a second protrusion insertion groove 417. Each of the protrusion insertion grooves 416 and 417 is open at the periphery of the protrusion insertion holes 411 and 412 of the first embodiment. For this reason, when the ultrasonic endoscope 1 is cleaned, the cleaning liquid can be efficiently distributed to the protrusion insertion grooves 416 and 417, and the cleaning can be performed reliably.

  In addition, since each of the projection insertion grooves 416 and 417 can insert the treatment instruments 11 and 12 having various shapes and thicknesses, the width of selection of the types and dimensions of the treatment instruments 11 and 12 can be increased. Can be enlarged.

<Third Embodiment>
Next, a third embodiment of the ultrasonic endoscope of the present invention will be described.

  FIG. 7 is a longitudinal sectional view showing a treatment instrument raising piece provided in the ultrasonic endoscope of the third embodiment. Hereinafter, in FIG. 7, the upper side is described as “upper” and the lower side is described as “lower”.

  Hereinafter, the ultrasonic endoscope 1 according to the third embodiment will be described, but the description will focus on differences from the ultrasonic endoscope 1 according to the first embodiment, and description of similar matters will be omitted. To do.

  The ultrasonic endoscope 1 of the third embodiment is the same as the ultrasonic endoscope 1 of the first embodiment except that the configuration of the treatment instrument raising piece 41 is different.

  The treatment instrument raising piece 41 shown in FIG. 7 has a small piece shape that can be accommodated in the recess 212 with a sufficient gap.

  The treatment instrument raising piece 41 is disposed such that one side surface 213 faces the lower surface 214 in the recess 212. Hereinafter, the surface of the treatment instrument raising piece 41 that faces the lower surface 214 in the recess 212 is referred to as a reference surface 410.

  In the treatment instrument raising piece 41, a support shaft hole 44 (see FIG. 3) through which the support shaft 42 is inserted is substantially orthogonal to the plane A, and a first protrusion insertion hole 418 described later. It is provided so that it may become below. The treatment instrument raising piece 41 is rotatably supported by the bending portion 21 by inserting the support shaft 42 into the support shaft hole 44 and attaching the support shaft 42 to the side surface 213 in the recess 212 as described above. Is done.

  Further, the treatment instrument raising piece 41 is in a state where the reference surface 410 and the lower surface 214 in the recess 212 form a predetermined angle θ (θ> 0 °) (hereinafter referred to as “initial state”). The first protrusion insertion hole 418 is formed so that the axial direction of the first treatment instrument insertion channel 27 coincides with the extending direction thereof.

  Further, a second protrusion is provided on the surface (upper surface) opposite to the reference surface 410 of the treatment instrument raising piece 41 so that the axial direction of the second treatment instrument insertion channel 28 coincides with the extending direction thereof. A part insertion groove 419 is formed.

  When the first treatment instrument 11 is protruded from the first treatment instrument protrusion 25 with the treatment instrument raising piece 41 in the initial state, the tip of the protruding first treatment instrument 11 is inserted into the first protrusion. It is inserted into the proximal end side opening of the through hole 418 and protrudes from the distal end side opening. Further, when the second treatment instrument 12 is projected from the second treatment instrument projecting opening 26, the projected distal end portion of the second treatment instrument 12 is the base end side end portion of the second projection insertion groove 419. And is inserted into the insertion groove 419 and protrudes from the end on the front end side.

  The cross-sectional shape of the first protrusion insertion hole 418 may be any shape such as a rectangle, a square, a square such as a rhombus, a triangle, a hexagon, an octagon, a circle, an ellipse, etc. The cross-sectional area of the first treatment instrument 11 is preferably similar to that of the first treatment instrument 11 and slightly larger than the cross-sectional area of the first treatment instrument 11. Thereby, the first treatment instrument 11 can be easily and stably inserted into the protruding portion insertion hole 418.

  Further, the cross-sectional shape of the second protrusion insertion groove 419 may be any shape such as a rectangle, a square, a rectangle such as a rhombus, a triangle, a hexagon, an octagon, a circle, an ellipse, It is preferable that the cross-sectional shape of the portion in contact with the treatment tools 11 and 12 is similar to the cross-sectional shape of the treatment device accommodated in this portion, and is a slightly larger cross-sectional area than the cross-sectional area. Thereby, the second treatment instrument 12 can be easily and stably inserted through the second protrusion insertion groove 419.

  In addition, an operation wire 43 that advances and retreats in the axial direction of the bending portion 21 is connected to the treatment instrument raising piece 41 at a portion on the distal end side with respect to the support shaft 42. The treatment instrument raising piece 41 rotates about the support shaft 42 by operating the operation wire 43. The operation wire 43 can be operated remotely by rotating a control lever provided on the peripheral surface of the operation unit 6 and pulling the operation wire 43.

  The raising operation of the first treatment tool 11 and the second treatment tool 12 by the treatment tool raising means 4 is performed in place of the first protrusion insertion hole 411 and the second protrusion insertion hole 412. Except that the first treatment tool 11 and the second treatment tool 12 are inserted into the first protrusion insertion hole 418 and the second protrusion insertion groove 419, the same as in the first embodiment. Done.

  Also in the third embodiment, the same actions and effects as in the first embodiment can be obtained.

  Moreover, since the ultrasonic endoscope 1 according to the third embodiment is configured by combining the first embodiment and the second embodiment, the effects of both the embodiments are exhibited.

  The ultrasonic endoscope according to the present invention has been described with respect to the illustrated embodiments. However, the present invention is not limited to these embodiments, and may be replaced with any configuration that exhibits the same function. Alternatively, an arbitrary configuration can be added.

  For example, in the above-described embodiment, two treatment instrument insertion channels are provided, but three or more treatment instrument insertion channels may be provided.

  Moreover, although two insertion parts (insertion hole or insertion groove) are provided in the treatment instrument raising piece, three or more insertion parts may be provided.

  Further, the ultrasonic endoscope of the present embodiment is configured to observe the inside of the lumen as an electronic image, but may be configured to observe as an optical image.

1 is an overall view showing a first embodiment of an ultrasonic endoscope of the present invention. It is a top view which shows the front-end | tip part of the bending part with which the ultrasonic endoscope shown in FIG. 1 is provided. It is the VV sectional view taken on the tip part shown in FIG. FIG. 3 is a schematic diagram (longitudinal sectional view) illustrating a state where a treatment tool protruding from a distal end portion of a bending portion illustrated in FIG. 2 is operated to be raised. It is a longitudinal cross-sectional view which shows an example of the treatment tool raising piece with which the ultrasonic endoscope shown in FIG. 1 is provided. It is a longitudinal cross-sectional view which shows the treatment tool raising piece with which the ultrasonic endoscope of 2nd Embodiment is provided. It is a longitudinal cross-sectional view which shows the treatment tool raising piece with which the ultrasonic endoscope of 3rd Embodiment is provided.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Ultrasonic endoscope 2 Insertion part flexible tube 20 Flexible tube part 21 Curved part 211 Inclined surface 212 Recessed part 213 Side surface 214 Lower surface 22 Ultrasonic probe 23 Observation window 24 Illumination window 25 1st treatment tool protrusion port 26 2nd Treatment tool projection 27 first treatment tool insertion channel 28 second treatment tool insertion channel 29 first treatment tool insertion hole 30 second treatment tool insertion hole 4 treatment tool raising means 41 treatment tool Raising piece 410 Reference surface 411 First protrusion insertion hole 412 Second protrusion insertion hole 413 First groove forming part 414 Second groove forming part 415 Connection part 416 First protrusion insertion groove 417 Second protrusion insertion groove 418 First protrusion insertion hole 419 Second protrusion insertion groove 42 Support shaft 43 Operation wire 44 Support shaft hole 6 Operation section 61, 62 Operation knob 7 First connection Flexible tube 8 Source insertion portion 81 Light source connector 82 Image signal connector 83 Water supply / drainage port 84 Water supply / drainage tube 9 Second connection portion flexible tube 10 Ultrasonic connector 11 First treatment tool 12 Second treatment tool 16 Balloon 17 Tank 100 Mucosa 101 affected area

Claims (8)

An insertion portion flexible tube to be inserted into the lumen;
An ultrasonic probe that is provided at the distal end of the insertion tube and that transmits and receives ultrasonic waves;
Ultrasound endoscopy having a plurality of treatment instrument insertion channels provided inside the insertion section flexible tube and capable of inserting a plurality of treatment instruments for performing treatment on the test portion in the lumen. A mirror,
A treatment instrument raising piece provided with a plurality of insertion portions through which the plurality of treatment instruments protruding from the distal end side opening can be inserted, and rotating the treatment instrument raising piece , the protrusion direction of the plurality of treatment instrument projecting from the distal end opening of the treatment instrument insertion channel, have a treatment instrument raising means for varying simultaneously and at the same angle,
The ultrasonic endoscope , wherein each of the insertion portions has a different distance from a rotation center of the treatment instrument raising piece . Wherein at least one of the plurality of insertion portions, ultrasonic endoscope according to the treatment instrument to claim 1, which is a collar can be inserted. At least one ultrasonic endoscope according to the treatment instrument to claim 1 or 2 which is insertable groove of the plurality of insertion portions.   An insertion portion flexible tube to be inserted into the lumen;
  An ultrasonic probe that is provided at the distal end of the insertion tube and that transmits and receives ultrasonic waves;
  Ultrasound endoscopy having a plurality of treatment instrument insertion channels provided inside the insertion section flexible tube and capable of inserting a plurality of treatment instruments for performing treatment on the test portion in the lumen. A mirror,
  A treatment instrument raising means for changing the protruding direction of the plurality of treatment instruments protruding from the distal end side opening of the plurality of treatment instrument insertion channels simultaneously and at the same angle;
  The plurality of treatment tools protruding from the plurality of treatment tool insertion channels are all disposed such that their axes are positioned in a plane for scanning the ultrasonic waves of the ultrasonic probe. Endoscope.   An insertion portion flexible tube to be inserted into the lumen;
  An ultrasonic probe that is provided at the distal end of the insertion tube and that transmits and receives ultrasonic waves;
  Ultrasound endoscopy having a plurality of treatment instrument insertion channels provided inside the insertion section flexible tube and capable of inserting a plurality of treatment instruments for performing treatment on the test portion in the lumen. A mirror,
  A treatment in which the protruding directions of the plurality of treatment tools protruding from the distal-side openings of the plurality of treatment instrument insertion channels are changed simultaneously and at the same angle along the ultrasonic scanning surface of the ultrasonic probe. An ultrasonic endoscope comprising a raising unit. The ultrasonic endoscope according to any one of claims 1 to 5, further comprising: an operation lever for remotely operating the treatment instrument raising piece; and a wire for transmitting movement of the operation lever to the treatment tool raising piece. At least two of the plurality of treatment tools constitute a pair of electrodes,
The ultrasonic endoscope according to any one of claims 1 to 6 , wherein the two treatment tools function as an electric knife by applying a voltage between the pair of electrodes. The ultrasonic endoscope according to any one of claims 1 to 7 having an image pickup part for observing the lumen as the electronic endoscopic image.

Images