JP3799612B2 - Ultrasound endoscope device - Google Patents

Description

  The present invention relates to an ultrasonic endoscope apparatus, and more particularly to an ultrasonic endoscope apparatus that guides an endoscope insertion portion into a body cavity using an insertion assisting tool.

  Conventionally, in order to observe the gallbladder, bile duct, and pancreas from the stomach, duodenum, or small intestine, etc., an insertion part provided with an ultrasonic transducer at the tip is orally inserted into the body cavity, and the ultrasonic transducer is used for observation. 2. Description of the Related Art Ultrasound endoscopes that obtain ultrasonic images of gallbladder polyps, bile duct polyps, bile duct tumors, pancreatic cysts, and the like by transmitting and receiving ultrasonic waves are known. Further, the ultrasonic wave generated from the ultrasonic transducer is necessary for observation if the air is present between the ultrasonic transducer and the observation site, and the ultrasonic wave is attenuated and cannot reach the observation site. An ultrasound image cannot be obtained. For this reason, a balloon is provided at the distal end of the insertion portion so as to cover the ultrasonic transducer, and an ultrasonic transmission medium such as water substantially equivalent to the acoustic impedance of the living body is injected into the balloon, and the balloon is observed during observation. By adhering to the part, attenuation of ultrasonic waves is prevented and a good ultrasonic image is obtained (for example, Patent Document 1).

  On the other hand, when inserting the insertion portion of the endoscope into the deep digestive tract such as the small intestine, simply pushing the insertion portion makes it difficult for the force to be transmitted to the distal end of the insertion portion due to the complicated bending of the intestinal tract. Insertion is difficult. Therefore, an insertion aid called an overtube or a sliding tube is attached to the insertion portion of the endoscope and inserted into the body cavity, and the insertion portion is guided by this insertion aid, so that the extra portion of the insertion portion is inserted. An endoscope apparatus that prevents bending and bending has been proposed (for example, Patent Document 2). The overtube refers to an insertion aid that is inserted orally and used for the small intestine, and the sliding tube refers to an insertion aid that is inserted transanally and used for the large intestine.

As a conventional endoscope apparatus, there is known a double balloon type endoscope apparatus in which a first balloon is provided at a distal end portion of an endoscope insertion portion and a second balloon is provided at a distal end portion of an overtube. (For example, Patent Document 3). In a double-balloon type endoscope apparatus, the insertion part and the overtube are inserted into the intestinal tract for a predetermined length, both balloons are inflated to bring both balloons into close contact with the intestinal wall, and then the insertion part and the overtube are simultaneously handled. The operation of contracting the bent intestinal tract straight by pulling it back is performed. Thereafter, by repeatedly performing the insertion operation of the insertion portion and the overtube and the hand pulling operation, the insertion portion is inserted into the target site while pulling the intestinal tract.
JP 2001-112761 A JP-A-10-248794 JP 2001-340462 A

  However, the conventional ultrasonic endoscope disclosed in Patent Document 1 cannot be inserted into the deep digestive tract of the small intestine or the large intestine, and there is a problem that ultrasonic diagnosis of the deep part cannot be performed.

  The present invention has been made in view of such circumstances, and an object thereof is to provide an ultrasonic endoscope apparatus capable of performing ultrasonic diagnosis of a deep digestive tract.

According to the first aspect of the present invention, in order to achieve the object, a first balloon is attached to a distal end portion of an insertion portion, and an ultrasonic transducer is provided on a proximal end portion side of the insertion portion with respect to the first balloon. And an insertion assisting tool for assisting insertion of the insertion portion into the body cavity when the second balloon is attached to the distal end portion and the insertion portion of the endoscope is inserted. A medium supply for supplying an ultrasonic transmission medium to a body cavity space where the ultrasonic transducer is located, which is formed by inflating the first balloon and the second balloon. Means and a sealing balloon provided on an inner peripheral surface of the insertion assisting tool and sealing a gap between the outer peripheral surface of the insertion portion and the inner peripheral surface of the insertion assisting tool, and the first balloon and the Formed by the second balloon Between cavity space, it is characterized in that sealing by the sealing balloon.

  According to the first aspect of the present invention, the insertion portion and the insertion assisting tool are inserted into the intestinal tract for a predetermined length, the first balloon and the second balloon are inflated to bring both balloons into close contact with the intestinal wall, and the insertion portion. At the same time, the insertion assisting tool is pulled together, and the bent intestinal tract is contracted straightly. Thereafter, the first balloon is deflated and the distal end portion of the insertion portion is inserted into the deep part of the intestinal tract. When the distal end portion of the insertion portion reaches the target site in the deep portion, the first balloon is inflated to fix the distal end portion of the insertion portion to the intestinal tract, and the second balloon is inflated to place the distal end portion of the insertion aid in the intestinal tract. Secure to. By this operation, a body cavity space for sealing the ultrasonic transducer is formed by the inflated first balloon and second balloon. Thereafter, an ultrasonic transmission medium is supplied from the medium supply unit to the body cavity space, and the body cavity space is filled with the ultrasonic transmission medium, and then an ultrasonic diagnosis is performed. According to the above operation, the ultrasonic endoscope apparatus of the present invention makes it possible to make an ultrasonic diagnosis of the deep digestive tract.

  According to the ultrasonic endoscope apparatus according to the present invention, the first balloon and the second balloon are inflated to form a body cavity space that seals the ultrasonic transducer by the first balloon and the second balloon. Since the ultrasonic diagnosis is performed after the body cavity space is filled with the ultrasonic transmission medium, the deep digestive tract can be ultrasonically diagnosed.

  Hereinafter, preferred embodiments of an ultrasonic endoscope apparatus according to the present invention will be described with reference to the accompanying drawings.

  FIG. 1 shows a configuration diagram of an ultrasonic endoscope apparatus according to an embodiment of the present invention. The ultrasonic endoscope apparatus shown in FIG. 1 includes an ultrasonic endoscope 10, an overtube (insertion assisting tool) 70, and a balloon control apparatus 100.

  The ultrasonic endoscope 10 includes a hand operation unit 12 and an insertion unit 14 connected to the hand operation unit 12. A universal cable 16 is connected to the hand operation unit 12, and a connector (not shown) connected to a processor or a light source device (not shown) is provided at the tip of the universal cable 16.

  The hand operation unit 12 is provided with an air / water supply button 18, a suction button 20, and a shutter button 22 that are operated by an operator, and a pair of angle knobs 24 and 24 and a forceps insertion unit 26 are respectively provided. It is provided in the position. In addition, the hand operating unit 12 is provided with a balloon air supply port 30 for supplying air to the first balloon 28 and sucking air from the first balloon 28 at a position that does not interfere with the operation. Yes.

  Further, a sub operation unit 34 is connected to the hand operation unit 12. An ultrasonic cord 32 having an ultrasonic connector 36 is connected to the sub operation unit 34, and the ultrasonic connector 36 is detachably connected to a signal processing unit of an ultrasonic observation apparatus (not shown).

  On the other hand, the insertion portion 14 includes a flexible portion 38, a bending portion 40, and a distal end hard portion 42. The bending portion 40 is configured by connecting a plurality of node rings so as to be able to bend, and is remotely operated by a turning operation of a pair of angle knobs 24, 24 provided in the hand operation portion 12. Thereby, the observation surface 44 of the distal end hard portion 42 can be directed in a desired direction.

  Further, a protruding portion 56 provided with an ultrasonic transducer 54 is integrally formed at the distal end portion of the distal end hard portion 42 as shown in FIG. A first balloon 28 that covers the distal end portion is attached to the distal end portion of the protruding portion 56 excluding the ultrasonic transducer 54. The ultrasonic transducer 54 is driven so as to oscillate ultrasonic waves by an ultrasonic observation device, and the received ultrasonic waves are signal-processed by a signal processing unit of the ultrasonic observation device, and are sent to a monitor (not shown). Displayed as an ultrasound image.

  As shown in FIG. 2, an objective optical system 46, an illumination lens 48, a forceps port 50, and an air / water supply port 51 are provided at predetermined positions on the observation surface 44 formed in the tapered shape of the distal end hard portion 42. . By operating the air / water supply button 18 shown in FIG. 1, water or air that is an ultrasonic transmission medium is selectively ejected from the air / water supply port 51.

  As shown in FIG. 2, an air supply / suction port 60 is opened on the outer peripheral surface of the protrusion 56 to which the first balloon 28 is attached. The air supply / suction port 60 has an inner diameter of 0 inserted through the insertion unit 14. 1 communicates with the balloon air inlet 30 of FIG. 1 through an air supply tube (not shown) of about 8 mm. Accordingly, when air is supplied to the balloon air supply port 30, air is blown out from the air supply / suction port 60, so that the first balloon 28 is inflated and when air is sucked from the balloon air supply port 30, the air supply / suction port 60 Since air is aspirated, the first balloon 28 is deflated.

  The overtube 70 shown in FIG. 1 is formed of a tube main body 72 and a gripping portion 74. As shown in FIG. 4, the tube body 72 is formed in a cylindrical shape and has an inner diameter slightly larger than the outer diameter of the insertion portion 14. The tube main body 72 is a molded product of a flexible urethane-based resin, and the outer peripheral surface thereof is coated with a lubricant coat, and the inner peripheral surface is also coated with a lubricant coat. A rigid grip 74 is connected to the tube body 72 in a watertight state. The insertion portion 14 shown in FIG. 1 is inserted toward the tube main body 72 from the proximal end opening 74 </ b> A of the grip portion 74.

  In addition, an inlet 66 for injecting a lubricating liquid such as water into the tube main body 72 is communicated with the base end side of the tube main body 72 via a tube 68.

  Further, a balloon air supply port 76 is provided on the proximal end side of the tube main body 72. An air supply tube 78 having an inner diameter of about 1 mm is connected to the balloon air supply port 76, and this tube 78 is bonded to the outer peripheral surface of the tube main body 72 and extends to the distal end portion of the tube main body 72.

  The distal end portion 80 of the tube main body 72 is formed in a tapered shape as shown in FIG. 3 in order to prevent the intestinal wall from being caught. A second balloon 82 made of an elastic material such as rubber is attached to the proximal end side of the distal end portion 80 of the tube main body 72. The second balloon 82 is mounted in a state where the tube main body 72 penetrates, and includes a central bulging portion 82c and attachment portions 82a and 82b at both ends thereof. The distal end side attachment portion 82a is folded inside the bulging portion 82c, and the folded attachment portion 82a is fixed to the tube main body 72 by winding an X-ray contrast yarn 84. The proximal-side attachment portion 82 b is disposed outside the second balloon 82, and is fixed to the tube main body 72 by winding a thread 86.

  The bulging portion 82c is formed in a substantially spherical shape in a natural state (a state in which neither is inflated nor contracted), and the size thereof is larger than a size in a natural state (a state in which neither is inflated nor contracted) of the first balloon 28. Largely formed. Accordingly, when air is supplied to the first balloon 28 and the second balloon 82 at the same pressure, the outer diameter of the bulging portion 82c of the second balloon 82 is larger than the outer diameter of the bulging portion 28c of the first balloon 28. Become. For example, when the outer diameter of the first balloon 28 is φ25 mm, the outer diameter of the second balloon 82 is configured to be φ50 mm.

  The above-described tube 78 is opened inside the bulging portion 82c, and an air supply / suction port 88 is formed. Accordingly, when air is supplied from the balloon air supply port 76, air is blown out from the air supply / suction port 88, and the bulging portion 82c is expanded. Further, when air is sucked from the balloon air supply port 76, air is sucked from the air supply suction port 88 and the second balloon 82 is deflated.

  Furthermore, balloons 91 and 92 are respectively attached to the proximal end portion and the distal end portion of the overtube 70. The balloons 91 and 92 are formed in a donut shape, and are adhered to the inner peripheral surface of the overtube 70 over the entire periphery with an adhesive or the like. Further, a tube 94 attached to the inner peripheral surface of the overtube 70 is communicated with the balloons 91 and 92. A connector 96 is provided at the proximal end of the tube 94, and a tube 98 is connected to the connector 96. The tube 98 is connected to the balloon control device 100 shown in FIG. The balloon control device 100 has a built-in pump (not shown) for supplying air to the tube 98 or sucking air from the tube 94, and a controller for controlling the air pressure at that time. It is operated by operating an operation button (not shown). Therefore, by operating the balloon control device 100, air can be supplied to the balloons 91 and 92 of FIG. 4 via the tube 98, or air can be sucked from the balloons 91 and 92 via the tube 98. . The balloons 91 and 92 expand in a donut shape by supplying air, and contact the outer peripheral surface of the insertion portion 14 inserted through the overtube 70 over the entire circumference. Thereby, the gap between the outer peripheral surface of the insertion portion 14 and the inner peripheral surface of the overtube 70 is sealed by the balloons 91 and 92. At that time, the air pressure in the balloons 91 and 92 is controlled so that the balloons 91 and 92 are slidable with respect to the insertion portion 14. In addition, the balloons 91 and 92 are contracted by sucking air and stick to the inner peripheral surface of the overtube 70. Thereby, the insertion part 14 becomes non-contact with the balloons 91 and 92, and the insertion part 14 can be easily inserted into and removed from the overtube 70.

  On the other hand, the balloon control device 100 shown in FIG. 1 supplies and sucks air to the first balloon 28 shown in FIG. 1 and supplies air to the second balloon 82 in addition to the balloons 91 and 92 shown in FIG.・ Air supply / suction pump (not shown) for suction. The balloon control device 100 includes a device main body 102 having a pump, a sequencer, and the like (not shown) and a hand switch 104 for remote control.

  On the front panel of the apparatus main body 102, a power switch SW1, a stop switch SW2, a pressure gauge 106 for the first balloon 28, and a pressure gauge 108 for the second balloon 82 are provided. Further, a tube 110 for supplying and sucking air to the first balloon 28 and a tube 120 for supplying and sucking air to the second balloon 82 are attached to the front panel of the apparatus main body 102. Reservoir tanks 130 and 140 for accumulating bodily fluids flowing back from the first balloon 28 and the second balloon 82 when the first balloon 28 and the second balloon 82 are broken in the middle of the tubes 110 and 120, respectively. Provided.

  Further, the hand switch 104 holds the same stop switch SW3 as the stop switch SW2 on the apparatus main body 102 side, the ON / OFF switch SW4 that supports pressurization / decompression of the first balloon 28, and the pressure of the first balloon 28. There is provided a pause switch SW5 for holding, an ON / OFF switch SW6 for instructing pressurization / depressurization of the second balloon 82, and a pause switch SW7 for holding the pressure of the second balloon 82. The hand switch 104 is electrically connected to the apparatus main body 102 via a cable 150.

  The balloon control device 100 configured as described above supplies air to the first balloon 28, the second balloon 82, and the balloons 91 and 92 (see FIG. 4) to inflate them, and controls the air pressure to a constant value. Thus, the first balloon 28, the second balloon 82, and the balloons 91 and 92 are held in an inflated state. In addition, air is sucked from the first balloon 28, the second balloon 82, and the balloons 91, 92 to be contracted, and the air pressure is controlled to a constant value to control the first balloon 28, the second balloon 82, and the balloons 91, 92. Is held in a contracted state.

  Next, an example of an operation method of the ultrasonic endoscope apparatus will be described with reference to FIGS.

  First, as shown in FIG. 5A, the insertion portion 14 is inserted into the intestinal tract (for example, the descending leg of the duodenum) 90 with the overtube 70 placed on the insertion portion 14. At this time, the first balloon 28, the second balloon 82, and the balloons 91 and 92 are deflated.

  Next, as shown in FIG. 5 (b), the second balloon 82 is inflated by supplying air to the second balloon 82 in a state where the tip 80 of the overtube 70 is inserted to the bent portion of the intestinal tract 90. As a result, the second balloon 82 is locked to the intestinal tract 90, and the tip 80 of the overtube 70 is fixed to the intestinal tract 90.

  Next, as shown in FIG. 5 (c), only the insertion portion 14 of the endoscope 10 is inserted into the deep portion of the intestinal tract 90. Then, as shown in FIG. 5 (d), air is supplied to the first balloon 28 and inflated. Thereby, the first balloon 28 is fixed to the intestinal tract 90. At that time, since the first balloon 28 is smaller in size when inflated than the second balloon 82, the burden on the intestinal tract 90 is small, and damage to the intestinal tract 90 can be prevented.

  Next, after the air is sucked from the second balloon 82 and the second balloon 82 is contracted, the overtube 70 is pushed in and inserted along the insertion portion 14 as shown in FIG. And after pushing the front-end | tip 80 of the overtube 70 to the vicinity of the 1st balloon 28, as shown in FIG.5 (f), air is supplied to the 2nd balloon 82, and it is made to expand. Thereby, the second balloon 82 is fixed to the intestinal tract 90. That is, the intestinal tract 90 is grasped by the second balloon 82.

  Next, as shown in FIG. As a result, the intestinal tract 90 contracts substantially straight, and the excess bending or bending of the overtube 70 is eliminated.

Next, as shown in FIG. 5 (h), air is sucked from the first balloon 28 to contract the first balloon 28. Then, the distal end hard portion 42 of the insertion portion 14 is inserted as deep as possible in the intestinal tract 90. That is, the insertion operation shown in FIG. Thereby, the distal end hard portion 42 of the insertion portion 14 can be inserted into the deep portion of the intestinal tract 90.

  When the distal hard portion 42 reaches the target site, the first balloon 28 is inflated to fix the distal hard portion 42 of the insertion portion 14 to the intestinal tract 90 and the second balloon 82 is inflated, as shown in FIG. Thus, the distal end portion 80 of the overtube 70 is fixed to the intestinal tract 90. Then, the balloons 91 and 92 are inflated to bring the balloons 91 and 92 into close contact with the outer peripheral surface of the insertion portion 14. As a result, a body cavity space 160 that seals the ultrasonic transducer 54 with the first balloon 28, the second balloon 82, and the balloon 92 is formed. Thereafter, the air supply / water supply button 18 of the hand operating unit 12 shown in FIG. 1 is operated to supply water 162 to the body cavity space 160 from the control device 100 via the air supply / water supply port 51 (see FIG. 2). The body cavity space 160 is filled with water 162. Thereafter, an ultrasonic diagnosis by the ultrasonic transducer 54 is performed.

  By the above operation, the ultrasonic endoscopic apparatus according to the embodiment makes it possible to make an ultrasonic diagnosis of the deep digestive tract.

  In addition, according to the ultrasonic endoscope apparatus of the embodiment, when an ultrasonic image is obtained, an ultrasonic image centered on the intestinal tract 90 is obtained by rotating the insertion portion 14 about its axis. be able to. Further, a continuous tomographic image can be obtained by pulling the insertion portion 14 at a predetermined speed.

  In the embodiment, water is supplied to the body cavity space 160 from the insertion portion 14 side of the endoscope. However, the present invention is not limited to this, and water is supplied from the inlet 66 of the overtube 70. You may do it. In this case, the balloon 92 shown in FIG. 4 is deflated, or the balloon 92 is unnecessary. In this case, the balloon 91 functions as a check valve by inflating the balloon 91. Furthermore, the check valve is not limited to the balloon 91, and may be a cylindrical tube that seals the gripping portion 74 and the insertion portion 14 of the overtube 70 in a watertight state.

1 is a system configuration diagram of an ultrasonic endoscope apparatus according to an embodiment of the present invention. The perspective view which shows the front-end | tip part of an endoscope insertion part Side sectional view of the overtube with the insertion section inserted Side sectional view including a partially broken part of the overtube Explanatory drawing which shows the operating method of the ultrasonic endoscope apparatus shown in FIG. Explanatory drawing which shows the ultrasonic diagnosis condition by the ultrasonic endoscope apparatus shown in FIG.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 10 ... Ultrasound endoscope, 12 ... Hand operation part, 14 ... Insertion part, 28 ... 1st balloon, 30 ... Balloon air supply port, 52 ... Air supply suction port, 54 ... Ultrasonic transducer, 70 ... Overtube , 72 ... tube main body, 74 ... gripping part, 82 ... second balloon, 90 ... intestinal tract, 91, 92 ... balloon, 100 ... balloon control device, 102 ... device main body, 104 ... hand switch

Claims (4)

An ultrasonic endoscope in which a first balloon is attached to a distal end portion of an insertion portion, and an ultrasonic transducer is attached to a proximal end portion side of the insertion portion with respect to the first balloon ;
An ultrasonic endoscope apparatus comprising: a second balloon attached to a distal end portion; and an insertion assisting tool in which the insertion portion of the endoscope is inserted to assist insertion of the insertion portion into a body cavity .
Medium supply means for supplying an ultrasonic transmission medium to a body cavity space where the ultrasonic transducer is located, formed by inflating the first balloon and the second balloon;
Provided on the inner peripheral surface of the insertion assisting tool, provided with a sealing balloon for sealing a gap between the outer peripheral surface of the insertion portion and the inner peripheral surface of the insertion assisting tool,
An ultrasonic endoscope apparatus , wherein the body cavity space formed by the first balloon and the second balloon is sealed by the sealing balloon . The insertion assisting tool is provided with an injection port, and the sealing balloon for sealing a gap between the outer peripheral surface of the insertion part and the inner peripheral surface of the insertion assisting tool is provided on the proximal end side from the injection port. The ultrasonic endoscope apparatus according to claim 1, wherein: An ultrasonic endoscope in which a first balloon is attached to a distal end portion of an insertion portion, and an ultrasonic transducer is provided on a proximal end portion side of the insertion portion with respect to the first balloon;
An insertion assisting tool that is attached to the distal end of the second balloon and into which the insertion portion of the endoscope is inserted to assist insertion of the insertion portion into the body cavity;
(1) First, in a state where the first balloon and the second balloon are deflated and the insertion assisting tool is put on the insertion part, the insertion part is inserted into the intestinal tract,
(2) Next, with the distal end of the insertion aid inserted into the intestine, the second balloon is fixed to the intestine by supplying air to the second balloon and inflating it,
(3) Then, after inserting only the insertion part into the deep part of the intestine, the first balloon is fixed to the intestine by supplying air to the first balloon and inflating it,
(4) Next, after air is sucked from the second balloon to contract the second balloon, the insertion aid is inserted along the insertion portion, and the tip of the insertion aid is pushed to the vicinity of the first balloon. After that, the second balloon is fixed to the intestinal tract by supplying air to the second balloon and inflating it,
(5) Next, the intestinal tract is contracted substantially straight by pulling the insertion aid and the insertion portion,
After performing the operations (3) to (5) at least once,
(6) After sucking air from the first balloon and deflating the first balloon, only the insertion part is inserted into the deep part of the intestinal tract, the ultrasonic transducer reaches the target site, and then the air enters the first balloon. In an ultrasonic endoscope apparatus for fixing the first balloon to the intestinal tract by supplying and inflating
Ultrasonic waves characterized by comprising medium supply means for supplying an ultrasonic transmission medium to a body cavity space formed by inflating the first balloon and the second balloon and in which the ultrasonic transducer is located Endoscopic device. A balloon provided on the inner periphery of the insertion assisting tool and sealing a gap between the outer peripheral surface of the insertion portion and the inner peripheral surface of the insertion assisting tool is provided, and the first balloon and the second balloon are provided by the balloon. The ultrasonic endoscope apparatus according to claim 3, wherein a body cavity space formed by the sealing is sealed.

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