JP4832130B2 - Ultrasound endoscope - Google Patents

Description

  The present invention relates to an ultrasonic endoscope in which an electronic scanning ultrasonic transducer and an endoscope observation means are attached to the distal end of an insertion portion to be inserted into a body cavity.

  The ultrasonic endoscope has an insertion portion that is inserted into a body cavity, and an ultrasonic inspection means and an endoscope observation means are provided at the distal end hard portion of the insertion portion. The endoscope observation means includes an illumination unit and an observation unit, and the observation unit is usually configured to include a solid-state imaging device. Further, the ultrasonic inspection means is constituted by an ultrasonic transducer, and there are a mechanical scanning type and an electronic scanning type as scanning methods using this ultrasonic transducer. An electronic scanning ultrasonic transducer is configured by arranging a predetermined number of ultrasonic transducers in a fixed direction, and by sequentially operating each of these ultrasonic transducers, ultrasonic scanning is performed over a predetermined range. It will be.

  In an ultrasonic endoscope provided with an electronic scanning ultrasonic transducer, as disclosed in Patent Document 1, an ultrasonic transducer is disposed on the distal end side in the hard distal end portion of the insertion portion, and illumination is performed on the rear side. An endoscopic observation means comprising a part and an observation part is attached. In the ultrasonic endoscope according to Patent Document 1, a large number of ultrasonic transducers constituting the ultrasonic transducer are arranged in an arc shape in the axial direction of the distal end hard portion, and the distal end hard The part is provided with an inclined surface at a position on the rear side from the position where the ultrasonic transducer is disposed, and an endoscopic observation means comprising an illumination part and an observation part is attached to the inclined surface, so-called perspective endoscope. It constitutes a mirror.

By operating the ultrasonic transducer, tomographic information of the body tissue can be acquired. Further, when a lesion or the like is detected in the body tissue, treatment such as treatment or cell collection can be performed using a puncture treatment instrument. For this purpose, a treatment instrument insertion passage is formed in the insertion portion, and this treatment instrument insertion passage is provided up to a position before the distal end hard portion in the insertion portion, that is, for directing the distal end hard portion in a desired direction. A flexible tube having flexibility is provided up to the position of the angle portion, and a tunnel-like treatment instrument passage is formed inside the distal end hard portion. A connection pipe is used to connect the flexible tube to the treatment instrument passage. The distal end side of the connection pipe is inserted into the treatment instrument passage, the connection pipe is protruded by a predetermined length toward the angle portion side, and the distal end of the flexible tube is fitted. Accordingly, the treatment instrument insertion path is a straight path that extends in the axial direction of the insertion part up to the angle part positioned in front of the hard end part of the distal end. This passage is opened as a treatment instrument outlet on the inclined surface on which the observation part of the endoscope observation means is mounted. As a result, the treatment instrument derived from the treatment instrument outlet can be captured from the endoscope observation visual field.
JP-A-10-118072

  By the way, since the ultrasonic inspection target is a body tissue, if a region of interest such as a lesion is detected in the body tissue as a result of the ultrasound examination, tissue cells may be collected and examined, or the lesion may be a lesion. If it is clear, it needs to be treated. Therefore, as a treatment instrument used in an ultrasonic endoscope, a puncture treatment instrument inserted into the body is used. Since the puncture treatment instrument is inserted into the body, the tip portion is a needle-like portion made of a sharp metal pipe material. The needle-like part has a predetermined length, and a flexible tube is connected to the needle-like part.

  As described above, the puncture treatment instrument having a needle-like portion at the tip is monitored by the endoscopic observation means before the contact with the inner wall of the body cavity, and is monitored by the ultrasonic examination means after being inserted into the body. However, the puncture treatment instrument derived from the treatment instrument outlet must be constantly monitored by the endoscope observation means in order to ensure higher safety. Therefore, after the treatment tool is led out from the treatment tool outlet, there is no blind part that cannot be monitored by the endoscope observation means, and even if it exists, the distance is as short as possible. Must. However, in Patent Document 1 described above, since the treatment instrument outlet is formed on the same surface as the attachment surface of the endoscope observation means, the treatment instrument outlet cannot be captured in the field of view by the endoscope observation means. . For this reason, when a puncture treatment instrument is used, even if the needle-like portion at the tip of the puncture treatment instrument slightly protrudes from the treatment instrument outlet, it cannot be confirmed by the endoscope observation means. Of course, if the observation field of view is set to an angle of 180 degrees or more, the treatment instrument outlet can be used as the monitoring field of view. However, if a very wide-angle lens is used as the objective optical system, it is possible to accurately observe the site to be observed. There is a problem of disappearing.

  From the above, in the distal hard part, in addition to the inclined flat surface on which the observation part is mounted, another flat surface that is captured by the visual field of the observation part is formed on the hard distal part, and the treatment instrument outlet is provided on this other flat surface. If it is set as the structure opened, a treatment tool derivation | leading-out port can be located in the visual field range by an observation part. However, depending on which position and in what shape the plane forming the treatment instrument outlet is provided, the observation by the endoscope observation means is greatly affected.

  First, it is necessary to ensure the maximum field of view of the observation unit with the field of view obliquely forward. Of course, since the treatment instrument outlet is placed in the observation field, it is inevitable that the observation field with the oblique front is limited, and the observation unit should be provided at a position where a wide field of view is obtained to the maximum. I must. However, that is not enough. The endoscope observation means is provided not only with the observation part but also with the illumination part. If the illumination light emitted from the illumination part is blocked by each part constituting the distal end hard part, the endoscope observation means is also used. Observation is not good. The present invention has been made in view of the above points, and the object of the present invention is to make it possible to capture the treatment instrument outlet in the observation field of view by the observation unit, and to produce uneven illumination and shadows. The purpose is to suppress the formation of a site.

In order to achieve the above-described object, the present invention mounts an electronic scanning ultrasonic transducer in which a plurality of ultrasonic transducers are arranged on the distal end hard portion of the insertion portion, and opens a passage at a position behind the ultrasonic transducer. There is no surface portion, and a treatment instrument outlet for allowing the treatment instrument to be led obliquely forward is formed in the passage opening surface portion, and further inclined obliquely forward from the passage opening surface portion toward the rear side, and the endoscope observation means is provided. An inclined surface portion for mounting the observation means is formed, and the endoscope observation means is an ultrasonic endoscope having an observation portion and at least two illumination portions provided on the left and right sides of the observation portion, treatment instrument outlet is at least partially disposed to lie within the observation field of view of the observation unit, a low-income than mounting portion of the passage opening surface the ultrasonic transducer, the axis of the distal hard portion There is a plane in parallel, and the left and right sides of the passage opening surface are cut off so as to prevent the illumination light from being blocked by the illumination window, thereby forming a light guide retraction wall, and the light guide retraction The wall portion is inclined obliquely forward, and another illumination portion is provided on the light guide retracting wall portion .

Here, the front-rear direction refers to the distal end side in the axial direction of the distal end hard portion and the connection side to the angle portion, and the left-right direction is perpendicular to this, that is, the up-down direction when the angle portion is curved. Left and right direction. Thus, in order to position a part of the treatment instrument outlet in the observation field of view by the observation unit, the endoscope observation means is attached to the passage opening surface portion where the treatment instrument outlet opens in the distal end hard part. The flat surface is different from the inclined surface for mounting the observation means. Here, the different surface is not an extension of the inclined portion for mounting the observation means, but is a plane having a different angle or direction from the inclined surface. Usually, it is a horizontal plane, that is, a plane facing the axial direction of the distal end hard portion, but it can also be an inclined plane. It can be inclined in a direction opposite to the inclined surface portion for observing means mounting, and may be a flat surface inclined in the same direction as that. Furthermore, it may be a curved surface as well as a flat surface. The treatment instrument outlet is disposed in front of the observation part, that is, in the extending direction of the observation visual field of the observation part in the distal end hard part. In order to widen the observation field of view, the observation unit is arranged at a height as high as possible, that is, at a position distant from the transition from the observation unit mounting inclined surface to the passage opening surface. In addition, the illuminating section is provided on the left and right sides of the observing section on the observing means mounting inclined surface section. However, the illuminating section is not limited to two places. An illumination unit is provided.

The passage opening surface portion is a surface on which the treatment instrument outlet port is opened, but the region is limited to a portion where the treatment instrument outlet port is located. The light guide retracting wall portion is formed by cutting off the left and right side portions of the passage opening surface portion. This is to prevent the illumination light from the illumination window from being blocked, and is configured to be cut off obliquely in the left-right direction . The other illumination units described above are formed on the light guide retracting wall.

  At least part of the treatment instrument outlet can be captured in the observation field of view by the observation unit, and safety is ensured even when operating a treatment instrument with a sharp tip, such as a puncture treatment instrument, and the illumination unit It is possible to prevent the illumination unevenness and the shadow part from being generated.

First, the basic configuration of the distal end portion of the insertion portion of the ultrasonic endoscope that is the subject of the present invention will be described. First, FIG. 1 shows a cross-sectional structure of the distal end portion of the insertion portion of the ultrasonic endoscope, FIG. 2 shows the appearance of the distal end portion, FIG. 3 shows its plane, and FIG. It is shown.

  As is apparent from these drawings, the distal end hard portion 1b provided connected to the angle portion 1a of the insertion portion 1 is provided with ultrasonic inspection means and endoscope observation means. The ultrasonic inspection means is composed of an ultrasonic transducer 2 composed of a large number of ultrasonic transducers arranged in the axial direction of the distal end hard portion 1b, and each ultrasonic transducer constituting the ultrasonic transducer 2 is the distal end hard portion 1b. Are arranged from the position in the vicinity of the tip toward the rear end side in the axial direction of the hard tip portion 1b, and the convex shape is formed in this axial direction. These many ultrasonic transducers constituting the ultrasonic transducer 2 are sequentially driven, so that ultrasonic electronic scanning is performed.

  On the other hand, the endoscope observation means is composed of an illumination part 3 and an observation part 4, which are provided with an observation means mounting inclined surface part 5 at a position on the rear end side of the distal end hard part 1 b, and the illumination part 3 and The observation unit 4 is provided on the inclined surface portion 5 for mounting the observation means. The observation unit 4 is disposed at a substantially central position of the inclined surface portion 5 for mounting the observation unit, and includes an objective optical system and a solid-state imaging unit provided at an imaging position of the objective optical system. The illumination unit 3 is formed at two positions on both the left and right sides with the observation unit 4 in between, an optical fiber that transmits illumination light from a light source device to which the endoscope is detachably connected, and a diffusion lens attached to the illumination unit 3 It has composition which has. Further, a cleaning nozzle 6 for ejecting a cleaning fluid toward the observation unit 4 is mounted.

  In the distal end hard portion 1b, a circumferential groove 7 is formed at a position on the rear end side of the mounting portion of the ultrasonic transducer 2. A balloon 8 is detachably attached to the groove 7 as shown in FIG. 1 and is inflated by supplying an ultrasonic transmission medium therein, so that it is transmitted from the ultrasonic transducer 2 toward the body, When receiving the reflected echo from the tomographic part of the body tissue, the attenuation of the ultrasonic signal is suppressed as much as possible.

  The site on the tip side from the position of the observation means mounting inclined surface portion 5 on which the illumination unit 3 and the observation unit 4 are mounted, and the site on the rear side from the position of the ultrasonic transducer 2 is oriented in the axial direction of the tip hard portion 1b. A flat portion is formed, and a treatment instrument outlet 11 for leading a treatment instrument such as the puncture treatment instrument 10 is formed obliquely forward in this flat portion, and this flat portion is the passage opening surface portion 9. It is. The treatment instrument insertion passage 12 that opens to the treatment instrument outlet 11 has a treatment instrument insertion tube 13 at the rear side from the angle portion 1 a, and the treatment instrument insertion tube 13 is substantially parallel to the axis of the insertion section 1. Extended. In the distal end hard portion 1b, a tunnel-like treatment instrument passage 14 is formed. A rigid pipe 15 made of metal or the like is partially inserted into the treatment instrument passage 14, and the distal end of the treatment instrument insertion tube 13 is located at the distal end. The hard pipe 15 is fitted. The hard pipe 15 is composed of a bent pipe with a bent portion formed in the middle portion, and the treatment tool insertion tube 13 extended in the axial direction of the insertion portion 1 is changed in direction so as to be led obliquely forward. Yes.

  Therefore, the distal end hard portion 1b is arranged with the ultrasonic transducer 2, the treatment instrument outlet 11 and the observation portion 4 constituting the endoscope observation means from the distal end side, but as shown in FIG. The ultrasonic tomographic plane by the acoustic transducer 2, the center of the treatment instrument outlet 11, and the observation center by the observation unit 4 are arranged on substantially the same line C. As a result, the puncture treatment instrument 10 derived from the treatment instrument outlet 11 is placed in the observation field of view by the observation unit 4 before being inserted into the body, and after being inserted into the body, It can be reliably captured in the ultrasonic field of view.

  Here, as shown in FIG. 1, the puncture treatment instrument 10 guided into the treatment instrument insertion passage 12 has a flexible tube 10b attached to a needle-like portion 10a made of a metal pipe having a sharp tip. The guide tube 16 is inserted. The puncture treatment instrument 10 is inserted into the guide tube 16 and can be projected and retracted from the tip of the guide tube 16. When the puncture treatment instrument 10 is not used, it is mounted in the treatment instrument insertion path 12 so that the needle-like portion 10 a is positioned inside the guide tube 16. As a result of the examination by the ultrasonic transducer 2, for example, when an affected part is detected, treatment such as extraction from the treatment instrument outlet 11 and insertion into the body to collect tissue cells is performed. As is clear from FIG. 1, the needle-like portion 10 a of the puncture treatment instrument 10 is not protruded from the distal end of the guide tube 16, and the distal end is led out from the treatment instrument outlet 11 to a predetermined position. Preferably, the guide tube 16 is guided to a position slightly touching the inner wall of the body cavity. Thereafter, as indicated by phantom lines in the figure, the puncture treatment instrument 10 located inside the guide tube 16 is operated to be pushed out from the guide tube 16, and the needle-like portion 10 a is led out from the treatment instrument outlet 11. And pierce the inner wall of the body cavity.

  The puncture treatment instrument 10 is led out from the treatment instrument outlet 11, and the distal end portion of the puncture treatment instrument 10 is a sharp needle-like portion 10 a. Therefore, even when this needle-like portion 10a is led out from the treatment instrument outlet 11 while protruding from the guide tube 16 or is housed in the guide tube 16, the tip of the guide tube 16 is pressed against the inner wall of the body cavity. Then, the inner wall of the body cavity may be damaged more than necessary.

  For this purpose, the observation unit 4 needs to put the treatment instrument outlet 11 in the field of view. However, even if the entire treatment instrument outlet 11 is not in the field of view, if the distal end side, that is, a part on the side where the ultrasonic transducer 2 is mounted is in the field of view by the observation unit 4, The purpose is achieved. The passage opening surface portion 9 where the treatment instrument outlet 11 opens is a flat portion facing the axial direction of the distal end hard portion 1b, and the observation device mounting inclined surface portion 5 is provided on the rear end side of the passage opening surface portion 9. Thus, the angle of the observation means mounting inclined surface portion 5 and the attachment position of the observation portion 4 are adjusted, and the distal end portion of the treatment instrument outlet 11 is placed in the observation visual field of the observation portion 4.

  Here, when the observation means mounting inclined surface portion 5 is viewed from the front, that is, when viewed from the distal end side, it has an arcuate surface shape. Will be placed on the lower side. Therefore, it becomes a position closer to the passage opening surface portion 9 than the observation portion 4, and when the left and right side portions of the passage opening surface portion are extended to the outer peripheral surface portion of the distal end hard portion 1b, the following inconveniences are caused. Occurs.

  That is, since the observation unit 4 has an oblique front, the illumination light emitted from the illumination unit 3 must be illuminated with a substantially uniform amount of light in this direction. However, as shown by the oblique lines in FIG. 5A, when the left and right sides of the passage opening surface portion 9P are extended to the outer peripheral surface portion of the distal end hard portion 1b, the passage opening surface portion 9P partially blocks the optical path of the illumination light. It will be. Therefore, in the observation visual field VP, the hatched portion in FIG. 5B becomes a shadow, and illumination light does not reach or unevenness in the amount of light occurs, and the endoscope observation image becomes unclear. There is a point.

  From the above, the passage opening surface portion 9 is limited to the position of the treatment instrument outlet 11, and the left and right portions thereof are cut off obliquely downward, whereby the light guide retracting wall portion 17, 17 is formed. Here, as is clear from FIG. 1, the distal end hard portion 1 b is provided with a hard pipe 14 as a treatment instrument lead-out path, but a special member is inserted into the left and right side portions of the hard pipe 14. Therefore, even if this part is cut off and used as the light guide retreating wall part 17, it does not cause any trouble. Further, if necessary, cut portions 18 and 18 are formed on both the left and right sides of the mounting portion of the ultrasonic transducer 2 so as to be continuous with the light guide retracting wall portion 17. As a result, as shown in FIG. 6A, the shaded portion indicated by the oblique lines can be suppressed to be smaller than when the passage opening surface portion extends to the outer peripheral surface portion of the distal end hard portion. . For this reason, in the observation visual field VI of FIG. 6B, illumination with no unevenness can be performed almost entirely. As a result, a clear endoscopic observation image is obtained, and the observation accuracy by the endoscopic observation means is improved.

  By the way, in operating the puncture treatment instrument 10, the puncture treatment instrument 10 is pushed by the treatment instrument insertion passage 12 that is inclined with respect to the axis of the distal end hard portion 1b by being pushed by the proximal end portion of the flexible tube 10b. The tip portion of is guided obliquely upward toward the front. Since the passage opening surface portion 9 is formed at a predetermined angle with respect to the observation means mounting inclined surface portion 5 provided with the observation portion 4 and the like in the distal end hard portion 1b, the plane of the passage opening surface portion 9 is inclined to the observation means mounting portion. It is closer to the inner wall of the body cavity than when it is provided on the inclined extended portion of the surface portion 5. As a result, the distance from the treatment instrument outlet 11 to the insertion into the body cavity inner wall is shortened, and the length for guiding the distal end portion of the puncture treatment instrument 10 is increased accordingly. Thereby, the stability of the puncture treatment instrument 10 is improved, the sniping property is improved when inserting into the body, and the thrust force when inserting into the body can be increased. For this reason, the operativity of the puncture treatment tool 10 becomes high.

Based on the above, in the present invention, as shown in FIGS. 7 to 9, the passage opening surface portion 20 inclined toward the left and right sides of the distal end hard portion 1b is inclined obliquely forward. The light guide retreat wall 21 is used as a light guide. The distal end portion of the treatment instrument outlet 11 is opened at a position that enters the observation field of view of the observation unit 4. Moreover, each of these light-guiding saving wall portion 21 other illumination portion 22 is provided.

As described above, the light guide retracting wall portion 21 is cut in front of the observation means mounting inclined surface portion 5 and the passage opening surface portion 20 is cut obliquely forward to form the light guide retracting wall portion 21. It is possible to prevent the illumination light from being blocked. Moreover, in addition to the illumination part 3 provided on the observation means mounting inclined surface part 5, in addition to the light guide escape wall part 21, another illumination part 22 is provided, so that the illumination light can be made more uniform. especially Ru, it is possible to prevent the hard portion seen as a shadow of illumination occurs.

FIG. 2 is a cross-sectional view of the distal end portion of the insertion portion in the basic configuration of the ultrasonic endoscope as the object of the present invention. It is an external view of the front-end | tip part of the insertion part of FIG. It is a top view of the front-end | tip part of the insertion part of FIG. It is a side view of the front-end | tip part of the insertion part of FIG. It is explanatory drawing which shows the part of the shadow by which illumination light is interrupted | blocked when not providing the retracting wall part for light guide in a channel | path opening surface part. It is explanatory drawing which shows the part of the shadow by which illumination light is interrupted when the escape wall part for light guides is provided in the channel | path opening surface part. It is an external view of a distal portion of the insertion portion showing the form of implementation of the present invention. It is a plan view of a distal portion of the insertion portion showing the form of implementation of the present invention. It is a side view of a distal portion of the insertion portion showing the form of implementation of the present invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Insertion part 1a Angle part 1b Hard tip part 2 Ultrasonic transducer 3 Illumination part 4 Observation part 5 Inclined surface part 9 and 20 for observation means Aperture opening surface part 10 Puncture treatment tool 11 Treatment tool outlet 17 and 21 Retraction wall for light guide Part

Claims (2)

An electronic scanning ultrasonic transducer in which a plurality of ultrasonic transducers are arranged is attached to the distal end hard portion of the insertion portion, and a passage opening surface portion is formed at a position behind the ultrasonic transducer, and a treatment instrument is obliquely attached to the passage opening surface portion. Forming a treatment instrument outlet that is led out toward the front, and further inclined toward the front side from the passage opening surface portion obliquely forward, and forming an observation means attachment inclined surface portion to which an endoscope observation means is attached, Endoscope observation means is an ultrasonic endoscope as an observation unit and at least two illumination units provided on the left and right sides of the observation unit.
The treatment instrument outlet is arranged so that at least a part thereof is located in the observation visual field of the observation unit,
There is a light guide retreat wall by cutting off the left and right sides of the passage opening surface so as to suppress the illumination light from the illumination window being blocked.
An ultrasonic endoscope characterized in that the light guide retracting wall portion is inclined obliquely forward, and another illumination portion is provided on the light guide retracting wall portion. mirror. Said passage opening surface, the a low-income than mounting portion of the ultrasonic transducer, ultrasonic endoscope according to claim 1, characterized in that a configuration in which the direction parallel to the axis of the plane of the distal end rigid portion mirror.

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