JP5006591B2 - 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 inserted into the lumen is brought into contact with the mucosal surface near the affected area, and an ultrasonic tomographic image including an image of the affected area is obtained. Then, while observing this ultrasonic tomographic image, the treatment tool is protruded from the distal end of the treatment instrument insertion channel, and the distal end of the treatment instrument is operated up and down by the treatment instrument raising means, so that the target affected area is obtained. Take action.

  As described above, since an ultrasonic endoscope observes a tomographic image of a region to be examined, it is difficult to observe with an optical endoscope. It is expected as a means to perform removal of the shadowed lymph nodes.

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

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

  Here, in this ultrasonic endoscope, the treatment instrument insertion channels are arranged in parallel to each other.

  However, when the treatment instrument insertion channels are arranged in parallel to each other as described above, the distal end portions of the treatment instruments inserted into the treatment instrument insertion channels are in close proximity to each other. For this reason, for example, when the treatment instrument raising means is operated so that one treatment instrument is brought close to the other treatment instrument, the distal end of the treatment instrument interferes with the other treatment instrument with a slight operation amount. There is a problem that the movable range of the treatment instrument is narrow.

  In addition, since the movable range of the treatment tool is narrow, for example, when the affected part has an elongated shape along the insertion portion flexible tube, the treatment tool can be operated even if the raising operation of the treatment tool is performed to the maximum. An area of the affected area that does not reach is generated. In such a case, the ultrasonic probe must be reapplied to the other part so that the treatment tool can reach this region, which increases the burden on the practitioner and increases the burden on the patient. Will be given.

  In addition, when the ultrasonic probe is reapplied, the position of the observed ultrasonic tomographic image shifts, so the image of the affected area must be searched again, and the ultrasonic tomographic image must be adjusted so that this image appears in a position where it can be easily treated. I must. Adjustment of this ultrasonic tomographic image takes time and further increases patient pain.

JP 2004-154300 A

An object of the present invention is to provide an ultrasonic endoscope capable of allowing a plurality of treatment instruments to reach a wider range and performing a wider range of treatment without changing the position of the ultrasonic probe. There is to do.

Such an object is achieved by the present inventions (1) to (5) below.
(1) an insertion portion flexible tube to be inserted into the lumen;
An ultrasonic probe of an electronic convex system that is provided at the distal end of the insertion tube and that transmits and receives ultrasonic waves;
An ultrasonic endoscope having a plurality of treatment instrument insertion channels provided inside the flexible tube along the insertion portion and capable of inserting a treatment instrument for treating a tissue in the lumen.
The axis near the distal end opening in one of the plurality of treatment instrument insertion channels and the axis near the distal end opening in one of the remaining treatment instrument insertion channels are the distal opening. The axes of a plurality of treatment instruments that are intersected at the proximal end side of the two and inserted into the two treatment instrument insertion channels are configured to expand toward the distal end side in the plane of scanning the ultrasonic waves of the ultrasonic probe. And having a treatment instrument raising means for changing at least one of the plurality of treatment instruments projected from the two treatment instrument insertion channels,
The two treatment instrument insertion channels are configured such that the axes of the plurality of treatment instruments expand toward the distal end when the treatment instrument raising means is not acting,
The treatment instrument raising means is configured to change the protruding direction of the treatment instrument in a direction in which the axes of the plurality of treatment instruments are narrowed toward the distal end side by operating the treatment instrument raising means. Ultrasound endoscope.

This allows multiple treatment tools to reach a wider range or easily maintain a closer distance to each other, and perform a wider range of treatments without changing the position of the ultrasound probe. Or an ultrasonic endoscope capable of performing a finer treatment within a narrower range.
In particular, even when a treatment is performed on an affected part having an elongated shape along the insertion portion flexible tube, a treatment is performed on a wider range of the affected part with the ultrasonic probe in contact with one place. Can do.
Thereby, a plurality of treatment tools can be surely displayed on the ultrasonic tomographic images. 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.

(2) In the two treatment instrument insertion channels in which the axis in the vicinity of the distal end side opening portion intersects on the proximal side from the distal end side opening portion, the relative angle θ formed by these axes is 0.01 to 30 °. The ultrasonic endoscope according to (1) .

  Accordingly, the distal end portions of both of the two treatment tools protruding from the two treatment tool insertion channels are surely positioned within the ultrasonic scanning surface and can be observed on the ultrasonic tomographic image. The separation distance between the distal end portions of each treatment instrument can be sufficiently ensured.

(3) The spacing distance between the channels in the vicinity of the distal end side opening in two adjacent ones of the plurality of treatment instrument insertion channels is 0.01 to 10 mm, as described in (1) or (2) above Ultrasound endoscope.

  Accordingly, the distal end portions of the plurality of treatment instruments projected from the plurality of treatment instrument insertion channels are separated from each other while reducing the burden on the patient by preventing a significant increase in the distal end portion of the insertion section flexible tube. A sufficient distance can be secured.

(4) The ultrasonic endoscope according to any one of (1) to (3) , including an optical component that optically observes the inside of the lumen.
Thereby, the ultrasonic diagnostic image and the optical endoscopic image can be switched and displayed, and the practitioner can easily recognize the position of the affected part in the lumen.

(5) In any one of the above (1) to (4) , each of the plurality of treatment instrument insertion channels is configured such that the distal end side opening is located on the proximal end side of the ultrasonic probe. The described ultrasonic endoscope.

According to the present invention, since a plurality of treatment instruments can reach a wider range, an ultrasonic endoscope capable of performing a wider range of treatment without changing the position of the ultrasonic probe is provided. can get. Thereby, the procedure can be simplified to reduce the burden on the practitioner and the burden on the patient.

  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 diagram (longitudinal sectional view) showing a state in which the treatment instrument protrudes from the distal end portion of the bending portion shown in FIG. 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 and 4 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 ultrasonic waves toward the test portion and receives ultrasonic waves reflected from the test portion is attached to the distal end surface of the bending portion 21. ing.

  The ultrasonic probe 22 is a so-called electronic convex ultrasonic transducer, and has a substantially arc shape in a side view. The ultrasonic scanning range U of the ultrasonic probe 22 extends outside the substantially arcuate portion and is in a plane along the axis of the bending portion 21. 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 test portion is received by the ultrasonic probe 22 and converted into an electric signal, and is transmitted via the ultrasonic signal cable and the ultrasonic connector 10. 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 portion to be examined 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 that supplies and sucks deaerated water through a water supply pipe (not shown) and a drain pipe (not shown).

  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 pipe and the water supply channel and passes through the water supply port to the balloon 16. Supplied in. 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 channel and the drain pipe, and the balloon 16 is contracted.

  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 optical observation window (optical component) 23 for optical observation of the direction of the ultrasonic scanning range U and an illumination window (optical component) for illuminating the observation range are provided on the inclined surface 211. ) 24 are juxtaposed.

  An imaging element (CCD) (not shown) that captures a subject image at the observation site is provided inside the distal end portion of the curved portion 21 of the optical observation window 23.

  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 onto the observation site from the distal end portion of the bending portion 21 (insertion portion flexible tube 2) to illuminate.

  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 output 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 optical components such as an image pickup device, the ultrasonic tomogram and the electron are inserted with the insertion portion flexible tube 2 inserted into the lumen. Images 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. In other words, the first treatment instrument protrusion 25 and the second treatment instrument protrusion 26 become the distal end side openings of the first treatment instrument insertion channel 27 and the second treatment instrument insertion channel 28, respectively. ing. The positional relationship and configuration of the first treatment instrument insertion channel 27 and the second treatment instrument insertion channel 28 will be described in detail later.

  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 first treatment instrument 11 and the second treatment instrument 12 inserted through the treatment instrument insertion channel 27 have their distal ends from the first treatment instrument protrusion 25 and the second treatment instrument protrusion 26. It protrudes into the ultrasonic scanning range U along the plane A.

  As the first treatment instrument 11 and the second treatment instrument 12 inserted through the first treatment instrument insertion channel 27 and the second treatment instrument insertion channel 28, forceps, acupuncture forceps, injection / puncture needle, catheter Etc. 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 used simultaneously. Therefore, a plurality of treatments can be performed on a target affected part using these plurality of treatment tools 11 and 12, or a plurality of organs can be treated simultaneously. It can be carried out.

  Further, both the first treatment instrument protrusion 25 and the second treatment instrument protrusion 26 shown in FIG. 2 are arranged such that their axes are located in the plane A of FIG. Thereby, the first treatment instrument 11 protruding from the first treatment instrument protrusion 25 and the second treatment instrument 12 protruding from the second treatment instrument protrusion 26 are included in the ultrasonic scanning range U. The treatment tools 11 and 12 can be displayed on the ultrasonic tomographic image with certainty. 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, reliable treatment can be performed on the portion to be examined.

  A treatment instrument raising piece (treatment instrument raising means) 13 is provided in the vicinity of the first treatment instrument protrusion 25 in the recess 212. The treatment instrument raising piece 13 is rotatably supported by the bending portion 21 by a support shaft 14 attached in the recess 212. That is, the treatment instrument raising piece 13 rotates along the plane A in FIG. An operation wire 15 that advances and retreats to the axis of the bending portion 21 is connected to the treatment instrument raising piece 13 at the distal end side of the support shaft 14. By operating the operation wire 15, the operation wire 15 rotates around the support shaft 14. The operation wire 15 can be operated remotely by operating an operation lever (not shown) provided on the peripheral surface of the operation unit 6 and pulling the operation wire 15.

  As shown in FIG. 4, when the first treatment instrument 11 protrudes from the first treatment instrument protrusion 25, the end surface of the treatment instrument raising piece 13 is the same as that of the first treatment instrument 11. It is provided to abut. By rotating the treatment tool raising piece 13 in a state where the end surface of the treatment tool raising piece 13 is in contact with the first treatment tool 11, the protruding direction of the first treatment tool 11 is changed, and accordingly. Thus, the position of the distal end portion of the first treatment instrument 11 can be changed.

FIG. 4 shows a state in which the first treatment tool 11 is raised by the rotation of the treatment tool raising piece 13. In FIG. 4, the first treatment tool 11 indicated by a dotted line is in a state before being raised by the treatment tool raising piece 13, and the first treatment tool 11 indicated by a solid line is the rise of the treatment tool. This is a state after the raising operation by the piece 13. Here, the distance between the distal end portion of the first treatment instrument 11 before the raising operation and the distal end portion of the first treatment instrument 11 after the raising operation is referred to as “movable range L ₁ ”. To tell.

  As shown in FIG. 4, the first treatment instrument 11 and the second treatment instrument 12 are protruded from the first treatment instrument projection 25 and the second treatment instrument projection 26, respectively (first When the treatment tool 11 is in the dotted line state) and the operation wire 15 shown in FIG. 2 is manipulated in the retracting direction (direction to be pulled to the proximal end side), the treatment instrument raising piece 13 rotates clockwise in FIG. Thereby, the front-end | tip part of the 1st treatment tool 11 rises along the plane A, and moves to the direction approaching the 2nd treatment tool 12 (a 1st treatment tool is a state of a continuous line).

  On the other hand, when the operation wire 15 is operated in the advancing direction (direction to be sent to the distal end side), the treatment instrument raising piece 13 rotates counterclockwise in FIG. As a result, the distal end portion of the first treatment instrument 11 descends along the plane A and moves in a direction away from the second treatment instrument 12. By rotating the treatment instrument raising piece 13 in this way, the angle of the projection direction of the first treatment instrument 11 with respect to the projection direction of the second treatment instrument 12 can be arbitrarily changed along the plane A. it can.

  The treatment instrument raising piece 13 may be provided to raise the second treatment instrument 12, and the first treatment instrument raising piece for raising the first treatment instrument 11, Both the first treatment tool 11 and the second treatment tool 12 may be operated to rise by providing both of the second treatment tool raising pieces for raising the second treatment tool 12. .

  In addition, the treatment instrument raising piece 13 may be in constant contact with the protruded first treatment instrument 11, and abuts against or separates from the first treatment instrument 11 by an operation with an operation wire 15 described later. It may be a thing to do.

  Next, the positional relationship and configuration of the first treatment instrument insertion channel 27 and the second treatment instrument insertion channel 28 will be described.

  Here, conventionally, these treatment instrument insertion channels have been arranged in parallel. For this reason, the front-end | tip part of the treatment tool inserted in each treatment tool penetration channel is in the state comparatively close mutually, and the reach | attainment range of each treatment tool was restricted to the narrow range. Therefore, for example, when the treatment tool raising piece is used to operate one treatment tool to be close to the other treatment tool, there is a problem that the movable range is narrow.

  Further, in order to widen the movable range of the treatment tool, it is necessary to change the position of the ultrasonic probe. In this case, the procedure becomes complicated and the burden on the practitioner increases, and the patient suffers a great deal of pain. Was giving.

  On the other hand, when maintaining the distance between the distal ends of each treatment instrument closer, conventionally, the operation wire is operated to raise the treatment instrument raising piece, and one treatment instrument is used as the other treatment instrument. The operation wire was supported in the state of approaching. However, in such a state, there is a possibility that the treatment instrument raising piece rotates in response to a slight movement of the operation lever that pulls the operation wire, and the distal end portion of the treatment instrument moves unintentionally accordingly. It was. For this reason, it is required to securely fix the operating lever for pulling the operating wire at an arbitrary position and maintain this state. However, such an operation imposes a great burden on the practitioner. This is a problem in the operability of the sonic endoscope.

  On the other hand, in the ultrasonic endoscope of the present invention, the axes in the vicinity of the distal end side opening portions of the plurality of treatment instrument insertion channels are non-parallel to each other, and the plurality of the treatment instrument insertion channels inserted into these treatment instrument insertion channels. The treatment instrument shafts are configured to be non-parallel to each other. Thereby, a some treatment tool can be easily reached | maintained in the state which made the mutual distance reach | attained more widely, or the mutual distance was brought closer. Accordingly, it is possible to perform a wider range of treatment or perform a narrower range of detailed treatment without operating the insertion section and changing the position of the ultrasonic probe.

Specifically, in the ultrasonic endoscope 1 of the present embodiment, the first treatment instrument insertion channel 27 in the vicinity of the first treatment instrument projection port 25 and the second treatment instrument insertion channel 28 are provided. The shafts in the vicinity of the second treatment instrument projection 26 are non-parallel to each other and intersect with each other on the proximal side with respect to the projections 25 and 26. Note that “the axes intersect” means that the respective virtual lines drawn by extending the axes in the axial direction intersect each other. Thereby, the axis | shaft near the 1st treatment tool protrusion 25 and the axis | shaft near the 2nd treatment tool protrusion 26 come to diverge on the front end side. For this reason, the respective treatment tools 11 and 12 are inserted into the first treatment tool insertion channel 27 and the second treatment tool insertion channel 28, respectively, and the first treatment tool protrusion 25 and the second treatment tool protrusion are inserted. When protruding from the mouth 26, the treatment instruments 11 and 12 are radially expanded toward the distal end side, and the distance between the distal ends of the treatment instruments 11 and 12 is set such that these channels are arranged in parallel. It is wider than if it is. Therefore, for example, when the first treatment tool 11 is raised by rotating the treatment tool raising piece 13, the first treatment tool 11 and the second treatment tool 12 are less likely to interfere with each other and can be moved widely. it can be obtained ranges _{L 1.} As a result, for example, even when a treatment is performed on an affected part having an elongated shape along the insertion portion flexible tube 2, the ultrasound probe 22 is brought into contact with one place and a wider range of the affected part can be obtained. Treatment can be performed.

In this case, an axis in the vicinity of the first treatment instrument protrusion 25 of the first treatment instrument insertion channel 27 and an axis in the vicinity of the second treatment instrument protrusion 26 of the second treatment instrument insertion channel 28 are formed. The relative angle θ is preferably 0.01 to 30 °, more preferably 1 to 20 °, and still more preferably 3 to 20 °. By setting the relative angle θ in such a range, the distal end portions of both the treatment instruments 11 and 12 are surely positioned in the ultrasonic scanning range U so that they can be observed on an ultrasonic tomographic image. The separation distance between the distal end portions of the treatment instruments 11 and 12 can be sufficiently ensured. Further, for example, when the first treatment instrument 11 is raised by rotating the treatment tool raising piece 13, it can be operated in a wider movable range L ₁ .

Further, the first treatment instrument projection port 25 distance _{L 2} between the channels of the second treatment instrument projection port 26 is preferably about 0.01 to 10 mm, is about 0.1~5mm And is more preferably about 1 to 5 mm. By setting the distance L ₂ to such a range, to prevent significant enlargement of the distal end portion of the bending portion 21 while reducing the burden on the patient, the distal ends of the respective treatment instrument 11 A sufficient separation distance can be secured. Further, for example, when the first treatment instrument 11 is raised by rotating the treatment tool raising piece 13, it can be operated in a wider movable range L ₁ .

  The cross-sectional shape of each treatment instrument insertion channel 27, 28 may be any shape such as a rectangle, a square, a square such as a diamond, a triangle, a hexagon, an octagon, a circle, an ellipse, etc. It is preferable that the cross-sectional area is similar to the cross-sectional shape of the instruments 11 and 12 and slightly wider than the cross-sectional area of each treatment instrument 11 and 12. Thereby, each treatment tool 11 and 12 can be easily inserted into each treatment tool insertion channel 27 and 28, and each treatment tool 11 and 12 can be easily operated toward a target position.

  The cross-sectional areas of the treatment instrument insertion channels 27 and 28 may be substantially constant or may vary along the axis (longitudinal direction).

  Next, a usage method (action) of the ultrasonic endoscope 1 will be described with reference to FIG. Here, a case will be described as an example where treatment is performed on the affected part 101 that is present in the mucous membrane 100 and has an elongated shape along the insertion portion flexible tube 2 by the ultrasonic endoscope 1. .

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

  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, an operation of supplying deaerated water into the balloon 16 is performed as necessary. 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 first treatment tool 11 and the second treatment tool 12 are inserted into the first treatment tool insertion channel 27 and the second treatment tool insertion channel 28, respectively, and the ultrasonic tomography of the ultrasonic diagnostic apparatus is performed. While confirming the image, the first treatment instrument protrusion 25 and the second treatment instrument protrusion 26 are projected.

Then, by operating an operation lever (not shown) for pulling the operation wire 15, the treatment instrument raising piece 13 is rotated, and the first treatment instrument 11 thus projected is raised (the protruding direction is adjusted). ), The affected area 101 is treated using the first treatment tool 11 and the second treatment tool 12. At this time, as described above, the axis near the first treatment instrument protrusion 25 of the first treatment instrument insertion channel 27 and the vicinity of the second treatment instrument protrusion 26 of the second treatment instrument insertion channel 28 Is formed so that the first treatment instrument 11 and the second treatment instrument 12 expand toward the distal end side. and, the first treatment tool 11 can be elevation operator in a wider range of movement L _1. Therefore, even when a treatment is performed on a relatively elongated affected part 101 as shown in FIG. 4, the treatment can be performed on a wider range of the affected part with the ultrasonic probe in contact with one place. . Thereby, the procedure can be simplified to reduce the burden on the practitioner and the burden on the patient.

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

  FIG. 5 is a diagram (longitudinal sectional view) schematically showing a distal end portion of a bending portion provided in the ultrasonic endoscope of the second embodiment, and FIG. 6 is a treatment from the distal end portion of the bending portion shown in FIG. It is a schematic diagram (longitudinal sectional view) showing a state in which the tool is protruded. Hereinafter, in FIGS. 5 and 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.

  As shown in FIG. 5, in the ultrasonic endoscope 1 according to the second embodiment, the first treatment instrument insertion channel 27 has a shaft in the vicinity of the first treatment instrument protrusion 25 and the second treatment instrument insertion. Except that the axis of the common channel 28 in the vicinity of the second treatment instrument protrusion 26 is not parallel to each other and is configured to intersect on the tip side of each of the protrusions 25 and 26. This is the same as the ultrasonic endoscope of the first embodiment.

  That is, the axis near the first treatment instrument protrusion 25 and the axis near the second treatment instrument protrusion 26 converge on the distal end side. For this reason, the respective treatment tools 11 and 12 are inserted into the first treatment tool insertion channel 27 and the second treatment tool insertion channel 28, respectively, and the first treatment tool protrusion 25 and the second treatment tool protrusion are inserted. When projecting from the mouth 26, the treatment instruments 11, 12 come to converge toward the distal end side, and the distance between the distal ends of the treatment instruments 11, 12 is parallel to the channels 27, 28. It becomes narrower than the case where it is arrange | positioned. Therefore, for example, without using the treatment instrument raising piece 13, it is possible to easily maintain the protruding distal end portions of the treatment instruments 11 and 12 closer to each other. Thereby, it is possible to perform a fine treatment in a narrower range on the affected area 101 without forcing the practitioner to perform complicated operations.

  In the present embodiment, the treatment instrument raising piece 13 may be configured to push up the first treatment instrument 11 upward, but is configured to pull down the first treatment instrument 11 downward. It may be. Thereby, the movable range of the first treatment instrument 11 is widened, and the treatment can be performed on a wider range of the affected part in a state where the ultrasonic probe 22 is in contact with one place.

  In this case, an axis in the vicinity of the first treatment instrument protrusion 25 of the first treatment instrument insertion channel 27 and an axis in the vicinity of the second treatment instrument protrusion 26 of the second treatment instrument insertion channel 28 are formed. The relative angle θ is preferably 0.01 to 20 °, more preferably 1 to 10 °, and still more preferably 2 to 10 °. By setting the relative angle θ in such a range, each treatment according to the reach distance of the ultrasonic wave while preventing the first treatment tool 11 and the second treatment tool 12 from interfering with each other. In the appropriate protruding range of the tools 11 and 12, the separation distance of the distal end portions of the treatment tools 11 and 12 can be made sufficiently close.

  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. it can.

  For example, in the present embodiment, two treatment instrument insertion channels are disposed, but three or more treatment instrument insertion channels may be disposed.

  Further, the ultrasonic endoscope of the present invention may be configured such that any two or more configurations of the respective embodiments can be appropriately selected. In the ultrasonic endoscope having such a configuration, for example, the members constituting the first treatment instrument insertion channel 27 and the second treatment instrument insertion channel 28 are detachable. According to the size, part, etc. of the affected part to be diagnosed, the member having the configuration of the first embodiment and the member having the configuration of the second embodiment can be appropriately selected and used. Accordingly, by selecting and using a member in one ultrasonic endoscope, a plurality of treatment tools can be made to reach a wider range, or the distance between the treatment tools can be easily maintained in a closer state. Can be. As a result, a wider range of treatments or a narrower range of fine treatments can be performed without changing the position of the ultrasonic probe 22.

  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 in which a treatment tool is protruded from a distal end portion of a bending portion illustrated in FIG. 2. It is a figure (longitudinal section) showing typically a tip part of a curving part with which an ultrasonic endoscope of a 2nd embodiment is provided. FIG. 6 is a schematic diagram (longitudinal sectional view) showing a state in which a treatment instrument is protruded from the distal end portion of the bending portion shown in FIG. 5.

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 22 Ultrasonic probe 23 Optical observation window 24 Illumination window 25 1st treatment tool protrusion 26 Second treatment tool Protrusion port 27 First treatment instrument insertion channel 28 Second treatment instrument insertion channel 29 First treatment instrument insertion hole 30 Second treatment instrument insertion hole 6 Operation section 61, 62 Operation knob 7 First Connection portion flexible tube 8 Light source insertion portion 81 Light source connector 82 Image signal connector 83 Water supply / drain port 9 Second connection portion flexible tube 10 Ultrasonic connector 11 First treatment tool 12 Second treatment tool 13 Treatment tool Raising piece (treatment tool raising means)
14 support shaft 15 operation wire 16 balloon 17 tank 100 mucous membrane 101 affected part

Claims (5)

An insertion portion flexible tube to be inserted into the lumen;
An ultrasonic probe of an electronic convex system that is provided at the distal end of the insertion tube and that transmits and receives ultrasonic waves;
An ultrasonic endoscope having a plurality of treatment instrument insertion channels provided inside the flexible tube along the insertion portion and capable of inserting a treatment instrument for treating a tissue in the lumen.
The axis near the distal end opening in one of the plurality of treatment instrument insertion channels and the axis near the distal end opening in one of the remaining treatment instrument insertion channels are the distal opening. The axes of a plurality of treatment instruments that are intersected at the proximal end side of the two and inserted into the two treatment instrument insertion channels are configured to expand toward the distal end side in the plane of scanning the ultrasonic waves of the ultrasonic probe. And having a treatment instrument raising means for changing at least one of the plurality of treatment instruments projected from the two treatment instrument insertion channels,
The two treatment instrument insertion channels are configured such that the axes of the plurality of treatment instruments expand toward the distal end when the treatment instrument raising means is not acting,
The treatment instrument raising means is configured to change the protruding direction of the treatment instrument in a direction in which the axes of the plurality of treatment instruments are narrowed toward the distal end side by operating the treatment instrument raising means. Ultrasound endoscope. The two treatment instrument insertion channel axis in the vicinity of the tip end opening intersect at the proximal side of the distal end opening to claim 1 relative angle θ of these axes forms is 0.01 to 30 ° The described ultrasonic endoscope. The ultrasonic endoscope according to claim 1 or 2 , wherein a separation distance between the channels in the vicinity of the distal end side opening in two adjacent ones of the plurality of treatment instrument insertion channels is 0.01 to 10 mm. The ultrasonic endoscope according to any one of claims 1 to 3 having an optical component for observing the lumen optically. Wherein the plurality of treatment instrument insertion channel are both ultrasonic endoscope according to any one of claims 1 to 4 the tip side opening is configured to be positioned on the proximal side of the ultrasonic probe mirror.

Images