JP3146908B2 - Body cavity inspection device - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an in-vivo inspection apparatus which is inserted into a body cavity and performs a required inspection, such as an endoscope, an ultrasonic inspection apparatus to be inserted into a body cavity, and an ultrasonic endoscope. It is about.

[0002]

2. Description of the Related Art As an example of a body cavity inspection apparatus, for example, there is an ultrasonic endoscope in which an endoscope and an ultrasonic inspection apparatus are combined. In this ultrasonic endoscope, an insertion section to be inserted into the body of a patient or the like is connected to a main body operation section which is held and operated by an operator, and an endoscope observation mechanism and an ultrasonic An observation mechanism is provided. This ultrasonic endoscope has been widely used in recent years because it can perform endoscopy of the condition in the body cavity and also obtain ultrasonic tomographic information in the body and can comprehensively inspect and diagnose the patient's body. It is becoming.

[0003]

When an affected part is found by an endoscope observation mechanism or an ultrasonic observation mechanism, a desired treatment or treatment is performed using forceps, a high-frequency treatment tool, and a puncture treatment tool. In order to perform the treatment, a treatment instrument insertion passage is provided in the insertion portion, and the treatment instrument insertion passage is opened at the distal end thereof. Here, from the viewpoint of safety and operability, the operation of the treatment tool must be performed at least under monitoring by the endoscope observation mechanism. Must be in the observation field of view. In the case of a direct-view type in which the endoscope observation mechanism is provided at the distal end of the insertion section, an opening of the treatment instrument insertion passage is also provided at this distal end face, and a side view provided at the side face of the distal end portion of the insertion section In the case of the mold, the treatment instrument insertion passage is also opened on this side.

On the other hand, the ultrasonic observation mechanism transmits an ultrasonic signal from an ultrasonic transducer toward the body and receives a reflected echo from a tomographic portion of a body tissue. It is necessary to reduce the attenuation of this ultrasonic signal because it is greatly attenuated in the interior, and when observing the area just below the mucous membrane with ultrasonic waves, the ultrasonic transducer is separated from the inner wall of the body cavity to some extent, and the stand-off is performed. You also need to have it.
For this purpose, the ultrasonic transducer is arranged in a balloon formed of a flexible film body having excellent acoustic characteristics, and an ultrasonic transmission medium is sealed in the balloon to reduce the ultrasonic signal attenuation. Demonstrate the stand-off function.

It is advantageous to make the observation field of view by the endoscope observation mechanism and the observation field of view by the ultrasonic observation mechanism as coincident as possible in order to perform inspection and diagnosis. For example, when the endoscope observation mechanism is arranged on the distal end face of the insertion section and the endoscope observation field of view is directed forward, it is preferable that the ultrasonic observation field of view of the ultrasonic observation mechanism is also directed forward. However, with such a configuration, the endoscope observation mechanism is also covered by the balloon, and the treatment tool operated in the endoscope observation field cannot be led out. In short, when configured as an ultrasonic endoscope, the treatment instrument can be led out and a balloon can be mounted unless the ultrasonic observation mechanism is arranged at a position distant from the endoscope observation mechanism. There is a problem that can not be.

[0006] Further, even in the case of an ultrasonic inspection apparatus of the type inserted into a body cavity, since it is necessary to use a puncture treatment tool, it is necessary to adopt a configuration in which a balloon is attached and a lead-out path for the puncture treatment tool is provided. Can not. Further, in some endoscopes, a flexible film is applied to prevent contamination of a portion to be inserted into a body cavity. However, in this case, a treatment tool cannot be used.

The present invention has been made in view of the above points, and an object of the present invention is to allow a treatment tool to be led out to the outside while a flexible membrane such as a balloon is mounted on an insertion portion. It is to make.

[0008]

In order to achieve the above-mentioned object, the present invention provides a guide pipe through which a treatment tool is passed.
This guide is provided so that it can appear and disappear in the treatment tool insertion passage.
A bag-shaped flexible membrane is connected to the outer peripheral surface of the tip of the pipe.
The flexible membrane is fixed to the outer peripheral surface of the distal end of the insertion section.
The insertion part has an opening inside the flexible membrane at the tip.
And a flexible membrane is provided from the fluid supply path.
By supplying fluid to the body, the flexible membrane is expanded.
The guide pipe from the treatment instrument insertion passage.
Length, and by applying a negative pressure inside the flexible membrane.
To reduce the flexible membrane and treat the guide pipe.
It is characterized in that it is configured to be drawn into the tool insertion passage .

[0009]

By providing the flexible membrane integrally with the guide pipe as described above, the treatment tool can be led out through the guide pipe while being attached to the insertion portion. In the case where the flexible membrane is used as a balloon, the balloon must be kept in a reduced state when the insertion portion is inserted into the body cavity. On the other hand, when the distal end of the insertion portion reaches a site to be inspected, it is necessary to supply an ultrasonic transmission medium to the balloon to expand the balloon.

When the balloon is in a contracted state, a guide pipe provided integrally with the balloon is buried in the treatment instrument insertion passage. As a result, when it is inserted into the body cavity of the patient, it can be inserted safely and smoothly.
When it is necessary to inflate the balloon in the inspection target portion in the body cavity, a fluid is supplied into the balloon. This will cause the balloon to bulge,
The guide pipe provided integrally with the balloon projects reliably forward as the balloon expands. As a result, the balloon is slightly deformed, but the portion where the ultrasonic vibrator is provided is completely buried in the medium for transmitting ultrasonic waves. Therefore, the function of preventing the attenuation of the ultrasonic transmission / reception signal can be reliably exerted, and a guide path of the treatment tool by the guide pipe is secured.

[0011]

Embodiments of the present invention will be described below with reference to the drawings. In the following description, a flexible membrane that is configured as an ultrasonic endoscope and that is mounted on the ultrasonic endoscope is a balloon that is filled with an ultrasonic transmission medium and expands. Although the present invention is shown, the present invention is not limited to this ultrasonic endoscope, but can be applied to other in-vivo examination devices having an insertion portion to be inserted into a body cavity. In addition to the protective cover for preventing the insertion portion from being stained, the protective cover can be configured as well as the one that exhibits the function of

FIG. 1 shows an overall system of an ultrasonic endoscope. In the figure, 1 is an ultrasonic endoscope, 2 is an endoscope observation device unit, 3 is an ultrasonic observation device unit, and the ultrasonic endoscope 1 is used for an operator to hold and operate. It is composed of a main body operation section 10, an insertion section 11 to be inserted into a body cavity, and a universal cord 12. The insertion portion 11 is a flexible portion 11a that is bent in an arbitrary direction along an insertion path in a body cavity from a portion continuously provided to the main body operation portion 10, and an angle portion 11b is provided at a tip of the flexible portion 11a, Further, a tip end main body 11c is connected to the angle portion 11b. On the other hand, the universal cord 12 is detachably connected to the light source connector 12a and the electric connector 12b detachably connected to the light source / processor unit 2a of the endoscope observation device unit 2 and the signal processing unit 3a of the ultrasonic observation device unit 3. And an ultrasonic connector 12c connected to the other.

FIGS. 2 to 5 show the main body 1 of the distal end portion of the insertion portion 11.
1c shows a configuration. As is clear from these figures, an endoscope observation mechanism 20 and an ultrasonic observation mechanism 30 are provided as inspection mechanisms on the distal end surface of the distal end portion main body 11c.

The endoscope observation mechanism 20 includes an illumination window 21 for illuminating the interior of the body cavity with illumination light, and an observation window 22 for observing the interior of the body cavity. The emission end of the light guide faces the illumination window 21, and the light guide is connected to the light source connector 12 of the universal cord 12 from the insertion section 11 through the main body operation section 10.
a, the illumination light is transmitted by connecting the light source connector 12a to the light source / processor unit 2a. Further, an objective lens faces the observation window 22, and a solid-state imaging device such as a CCD faces the image forming position of the objective lens. After being transmitted to the light source / processor unit 2a and subjected to predetermined signal processing, an image in the body cavity is displayed on the monitor 2b.

On the other hand, the ultrasonic observation mechanism 30 has a cap 31 made of a resin material having excellent acoustic characteristics protruding forward at a position below the position of the endoscope observation mechanism 20 on the distal end surface of the distal end main body 11c. The ultrasonic vibrator 33 is mounted on a rotating base 32 disposed in the cap 31. The rotating shaft 32 is provided at both ends of the rotating base 32.
4a and 34b are provided continuously, and the rotating shafts 34a and 3b
4b is rotatably supported by bearings 35 on the side walls 31a and 31b of the cap 31, respectively. Rotating shaft 34
a extends through the side wall 31a, and the tip of the rotation transmitting means 36 is connected to the tip. The rotation transmitting means 36 is obtained by inserting a flexible shaft 36b composed of a close contact coil into an outer sleeve 36a. When the base end of the flexible shaft 36b is rotated around an axis, the rotational force is rotated. It is transmitted to the shaft 34a. Thereby, the rotation of the rotation base 32 provided with the ultrasonic vibrator 33 becomes possible, and during this rotation,
By driving the ultrasonic transducer 33, transmitting an ultrasonic pulse at each predetermined angle, and receiving a reflected echo,
Information on tissue tomography in the body is obtained. The reflected echo signal received by the ultrasonic transducer 33 is transmitted to the signal processing unit 3a of the ultrasonic observation device unit 3, and after performing predetermined signal processing, an ultrasonic image is displayed on the monitor 3b.

An endoscope observation mechanism 20 and an ultrasonic observation mechanism 30
Is provided on the distal end surface of the distal end portion main body 11c at different positions in the up and down direction. The distal end main body 11c also includes a treatment instrument insertion passage 4 for inserting a treatment instrument therethrough.
Fluid supply path 41 for supplying fluid such as zero and degassed water
Is open.

The ultrasonic endoscope 1 having the above configuration includes:
The balloon assembly 50 is detachably mounted to exhibit a function of suppressing attenuation and a stand-off function when transmitting and receiving an ultrasonic signal. The balloon assembly 50 has a bag-shaped flexible film main body 51, and a fastening ring 52 is connected to an end of the flexible film main body 51. Here, the flexible film main body 51 has excellent acoustic characteristics and is a transparent flexible thin film member.
For example, it is formed of latex or the like.

The distal end of a guide pipe 53 is integrally connected to the flexible membrane main body 51 constituting the balloon assembly 50. The guide pipe 53 is mounted so as to be able to protrude and retract into the treatment instrument insertion passage 40. The guide pipe 53 has a locking groove 53a formed on the outer peripheral surface on the distal end side, and has an inner surface on the proximal end side. In addition, an attraction taper portion 53b for facilitating the passage of the treatment tool is formed. The fastening ring 52 connected to the flexible film main body 51 is fixed by being fitted into an annular concave groove 54 provided on the outer peripheral surface of the distal end main body 11c.

A check valve 55 made of an elastic material such as rubber is attached to the tip of the guide pipe 53.
This check valve 55 has a slit 55a formed therein.
The slit 55a is covered by a tongue piece 55b. The tongue piece 55b is directed outward so that the guide pipe 5
By attaching the treatment tool to the treatment instrument 3, the treatment tool can be led out from the guide pipe 53, but it is possible to prevent fluid or the like from entering from outside.

Next, a method of manufacturing the balloon assembly 50 will be described with reference to FIGS.

First, a jig 60 shown in FIG. 6 is used to form the balloon assembly 50. This jig 60
Is formed of a substantially columnar member, and its outer diameter dimension is the insertion portion 11.
Is smaller than the outer diameter of the distal end body 11c.
Further, a cylindrical groove 61 is provided at the tip of the jig 60, and the guide pipe 53 is inserted into the groove 61 in a substantially close fitting shape. Here, on the distal end surface of the insertion portion 11, the position where the treatment tool insertion passage 40 is provided is located eccentric from the center thereof, and thus the groove 61 of the jig 60 is also eccentric so as to correspond thereto. It is provided in. The depth of the groove 61 is slightly shallower than the length of the guide pipe 53 in the axial direction, and when the guide pipe 53 is mounted in the groove 61, the distal end thereof has a slight length from the distal end surface of the jig 60. Protrude. An annular locking groove 53 a is formed on the outer peripheral surface of the projecting portion of the guide pipe 53, and the locking groove 53 a serves as a resin reservoir for fixing the flexible film main body 51. Further, a portion inside the groove 61 is a protruding portion 6 protruding from the front end surface.
2, and the projecting portion 62 is
When it is inserted into the groove 61, it is flush with the distal end surface of the guide pipe 53.

In order to form the balloon assembly 50 using the jig 60 having the above configuration, first, the guide pipe 53 is formed.
Is inserted into the groove 61 of the jig 60, and as shown in FIG. 7, a resin liquid tank 63 in which a resin such as latex is dissolved in a solvent.
To a predetermined depth. When the jig 60 is pulled up after a predetermined time has passed, the resin adheres to the portion of the jig 60 projecting from the groove 61 including the locking groove 53a of the guide pipe 53, and the resin is laminated on the surface. I do. Then, when the resin has dried to some extent, as shown in FIG. 8, the resin adhering to the outer peripheral surface of the jig 60 is wrapped in the direction of the arrow from the front end side and is biased toward the front end side. As a result, a fastening ring 52 whose end bulges in a circular cross section is formed. Further, since the inside of the guide pipe 53 is excess resin, the resin at this portion is cut off. Thereafter, the guide pipe 53 is removed together with the resin from the jig 60, and a check valve 55 is attached to the end of the guide pipe 53.
Is inserted and fixed by an adhesive or the like to form a guide pipe 53, a balloon assembly 50 including a flexible film body 51 and a fastening ring.

When examining the inside of a patient using the ultrasonic endoscope 1, the balloon assembly 50 is attached to the insertion section 11. To mount the balloon assembly 50, first, the guide pipe 53 is inserted into the treatment instrument insertion passage 40 until it is substantially non-projected, and the flexible membrane 51 is fitted into the distal end main body 11c, and the concave groove is formed. The fastening ring 52 is fitted into the fitting 54. In order to position the guide pipe 53 at the position where the guide pipe 53 has entered the treatment instrument insertion passage 40 most, the treatment instrument insertion passage 40 is positioned at a position recessed from the distal end opening by the length of the guide pipe 53 in the axial direction. Should be formed. Here, the fastening ring 52 is in the natural state,
Since the diameter of the fixing ring 52 is smaller than the outer diameter of the fixing ring 52, the fixing ring 52 is stably held in the groove 54, and is stably held. It will be in close contact.

Since the illumination window 21 and the observation window 22 are located inside the flexible membrane 51 in the balloon assembly 50, the illumination window 21 and the observation window 22 are used to efficiently irradiate the illumination light and secure the observation field of view. The flexible membrane 51 is preferably brought into close contact with the distal end body 11c, and a water film is preferably interposed therebetween. For this purpose, the fluid supply path 41 is first connected to a negative pressure source, and suction is performed to remove air between the flexible film body 51 and the distal end body 11c. The illumination window 21 and the observation window 22 are brought into close contact with the flexible film body 51 by supplying only the amount.

In this state, the insertion portion 11 is inserted into the body of the patient. Although the flexible film 51 is attached to the surfaces of the illumination window 21 and the observation window 22, the illumination window 21 and the observation window 22 are transparent. There is no hindrance to observing the inside of the body cavity under light irradiation, so that the insertion operation can be performed smoothly. In addition, since the guide pipe 53 is kept in a substantially non-projecting state from the distal end main body 11c, the guide pipe 53 can be inserted smoothly without damaging the body wall of the patient when inserted into the body cavity. Then, the distal end portion of the insertion section 11 is guided to a site to be inspected, so that an endoscopic inspection in the body cavity can be performed. When an affected part or the like is found during the examination, forceps or other treatment tools can be inserted through the treatment instrument insertion passage 40 to perform a treatment such as excision of the affected part. Here, since the guide pipe 53 of the balloon assembly 50 is fitted in the treatment instrument insertion passage 40, the treatment instrument is connected to the check valve 5 provided at the distal end thereof through the guide pipe 53.
5 will be opened and led out.

Further, an ultrasonic inspection can be performed if necessary. In performing the ultrasonic inspection, first, for example, degassed water is supplied from the fluid supply path 41 as an ultrasonic transmission medium into the flexible membrane 51 of the balloon assembly 50, and the flexible membrane 51 Is bulged to the state shown in FIG. Here, since the guide pipe 53 is inserted into the treatment instrument insertion passage 40 so as to be able to protrude and retract, the flexible pipe 51 is pulled by the flexible pipe 51 in accordance with the expansion of the flexible pipe 51 so that the guide pipe 53 projects. That is, the flexible film body 51 smoothly assumes a predetermined swelling shape. In this expanded state, the ultrasonic vibrator 3
The entire cap 31 on which the 3 is attached is buried in the degassed water. In order to prevent the guide pipe 53 from deviating from the treatment instrument insertion passage 40 when the flexible film body 51 is swelled by the degassed water, the treatment instrument insertion passage is formed even when the guide pipe 53 is in the most protruding state. It is also possible to lengthen the extra length portion located inside 40 or to provide a stopper for regulating the most protruding position at the opening of treatment instrument insertion passage 40 or the like.

In the above state, the flexible membrane 51 is brought into contact with the inner wall of the body cavity, and the ultrasonic vibrator 33 is rotated. The ultrasonic scanning can be performed by receiving the reflected echo from the radiator. Then, the reflected echo signal sent from the ultrasonic transducer 33 is taken into the signal processing unit 3a of the ultrasonic observation apparatus unit 3 and subjected to predetermined signal processing, whereby an ultrasonic image can be displayed on the monitor 3b. Here, since deaerated water is interposed between the ultrasonic transducer 33 and the inner wall of the body cavity as an ultrasonic transmission medium, attenuation of transmitted and received ultrasonic signals is suppressed, and a clear ultrasonic image is monitored. 3b.

Here, since the ultrasonic observation field of view 30 is located within the range of the endoscope observation field of view 20, the observation by the ultrasonic is performed while the observation by the endoscope observation mechanism 20 is performed. Ultrasonic observation is possible, and transmission and reception of ultrasonic signals can be performed via degassed water. Further, as a result of the examination using ultrasonic waves, if there is an affected part in the body, the treatment is performed using a puncture treatment tool. For this purpose, as shown by a virtual line in FIG.
Insert at 0. The treatment instrument F can be opened to the outside by opening the check valve 55 from the guide pipe 53, and since the treatment instrument F thus derived can be operated under observation by the endoscope observation mechanism 20, safety is ensured. Operation is possible.

When the ultrasonic inspection is completed, the deaerated water is discharged from the flexible membrane 51 of the balloon assembly 50 to reduce the size of the flexible membrane 51. At the same time, the guide pipe 53
Must also be drawn into the treatment tool insertion passage 40. Therefore, by connecting the fluid supply path 41 to a suction source and sucking deaerated water, the flexible film body 51 is reduced and brought into a state of attaching to the inner surface of the distal end portion main body 11c. However, since there is a frictional resistance between the guide pipe 53 and the treatment tool insertion passage 40, it is not possible to exert a force enough to draw the guide pipe 53 into the treatment tool insertion passage 40 only by suction of the deaerated water. Can not. Therefore, the treatment tool insertion passage 40 is connected to the suction source together with the fluid supply passage 41 to perform suction. Guide pipe 53
Is provided with a check valve 55, which does not open even if suction force acts on the check valve 55.
3 is drawn into the treatment instrument insertion passage 40, and can be reliably returned to the state shown in FIG. Therefore, when the insertion portion 11 is pulled out from the body cavity or when the site to be inspected is changed, the internal wall is not damaged, and the smoothness of the operation can be ensured. .

In the above-described embodiment, the ultrasonic endoscope 1 is provided with an ultrasonic vibrator 33 in a cap 31 protruding from the distal end surface of the insertion portion 11, and the ultrasonic vibrator 33 is attached to the ultrasonic vibrator 33. Although the scanning is performed in the rotation direction, the arrangement position of the ultrasonic transducer and the scanning method are not limited to this. For example, the ultrasonic transducers are arranged side by side over a predetermined length in the axial direction from the distal end of the insertion portion, and the ultrasonic transducers thus arranged are sequentially operated to perform electronic linear scanning. be able to. Alternatively, only the ultrasonic observation mechanism may be provided at the distal end of the insertion portion, and the insertion into the body cavity may be guided by means of X-ray fluoroscopy without mounting the endoscope observation mechanism.

[0031]

Since the present invention has the above-described structure,
With the entire distal end of the entrance covered with a flexible membrane,
Even if the flexible membrane is expanded, the insertion section is inserted through the guide pipe.
The treatment instrument can be drawn out from the treatment instrument insertion passage provided in
When inserting the insertion part into a body cavity, etc.,
The guide pipe to the tip of the insertion section.
Thus, it is possible to maintain the non-projecting state .

[Brief description of the drawings]

FIG. 1 is an overall configuration diagram of an ultrasonic endoscope as one embodiment of a body cavity inspection apparatus according to the present invention.

FIG. 2 is an external view of a distal end portion of the insertion section in FIG.

FIG. 3 is a cross-sectional view taken along the line XX of FIG. 2 in a state where the flexible membrane of the balloon assembly is inflated.

FIG. 4 is a perspective view of the balloon assembly shown in FIG.
It is -Y sectional drawing.

FIG. 5 is a cross-sectional view similar to FIG. 3 in a state where the flexible membrane of the balloon assembly is reduced.

FIG. 6 is a sectional view of a jig used for manufacturing a balloon assembly.

FIG. 7 is an operation explanatory view showing a step of laminating a flexible film of the balloon assembly.

FIG. 8 is an operation explanatory view showing a step of forming a fastening ring of the balloon assembly.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Ultrasonic endoscope 11 Insertion part 11c Tip main body 20 Endoscope observation mechanism 21 Illumination window 22 Observation window 30 Ultrasonic observation mechanism 32 Rotating base 33 Ultrasonic transducer 36 Rotation transmitting member 40 Treatment tool insertion passage 41 Fluid Supply path 50 Balloon assembly 51 Flexible membrane 52 Fastening ring 53 Guide pipe 60 Jig

──────────────────────────────────────────────────続 き Continued on the front page (58) Fields surveyed (Int.Cl. ⁷ , DB name) A61B 8/12 A61B 1/00-1/32 A61M 25/00

Claims (4)

(57) [Claims] 1. A device in which a predetermined inspection mechanism and a treatment tool insertion passage for inserting a treatment tool are provided at a distal end portion of an insertion portion to be inserted into a body cavity, wherein a guide pipe through which the treatment tool passes is provided. In the treatment tool insertion passage
The guide pipe is provided so as to be able to protrude and retract.
The flexible membrane is connected to the distal end of the insertion section.
It is fixed to the outer peripheral surface, and the distal end of the insertion portion has an opening inside the flexible membrane.
A fluid supply passage for supplying fluid into the flexible membrane from the fluid supply passage.
This causes the flexible membrane to swell and the gas
The id pipe is projected from the treatment tool insertion passage by a predetermined length,
By making the inside of the flexible film negative pressure,
The body is reduced, and the guide pipe is connected to the treatment tool.
An intracorporeal inspection device, wherein the device is configured to be drawn into an insertion passage . 2. An endoscope observation mechanism and an ultrasonic observation mechanism together with a treatment instrument insertion passage are provided on the distal end surface of the insertion portion, and the flexible film body is formed from a transparent member. The insertion mechanism is configured to cover the mechanism and the ultrasonic observation mechanism, and an annular groove is formed on the outer peripheral surface of the insertion portion, and a fixing fitting is fitted to the end of the flexible film body in the groove. 2. The body cavity inspection apparatus according to claim 1, wherein a ring is provided continuously. 3. The fluid supplied from the fluid supply path is
3. The method according to claim 2, wherein the medium is an ultrasonic transmission medium.
Body cavity inspection device. 4. A body cavity according to claim 1 or 2, characterized in that a configuration wherein the guide pipe for mounting a check valve capable of deriving a treatment tool to the outside from the treatment instrument insertion path side inspection apparatus.