JP3504396B2 - Ultrasound endoscope - Google Patents

Description

Description: BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic endoscope capable of inserting an insertion portion into a body cavity, optically observing the inside of the body cavity, and performing ultrasonic diagnosis. 2. Description of the Related Art Ultrasound endoscopes are used to safely insert the insertion portion while optically observing the inside of the body cavity with respect to the digestive tract wall and deep organs such as the pancreas, which are difficult to diagnose by ultrasonic diagnosis from outside the body. While inserting and observing the surface of the lumen wall by optical observation, ultrasonic diagnosis of the tissue inside the body cavity is performed by driving the ultrasonic transducer provided at the distal end of the insertion section. Also, a linear ultrasonic endoscope, a puncture needle is projected from a forceps channel outlet of a distal end hard portion of a convex ultrasonic endoscope or the like,
It has also been practiced to puncture the tissue of the diagnostic part under ultrasound guidance to collect the diseased tissue. For example, JP-A-6-630
Japanese Patent Publication No. 41 discloses a technique of performing a treatment such as puncture under ultrasonic guidance using a convex-type electronic scanning ultrasonic probe. [0003] By the way, puncture compatible ultrasonic endoscopes for inserting an insertion portion while optically observing the inside of a body cavity include a side-view type and a front perspective type depending on the optical observation direction. is there. When these puncture-compatible ultrasonic endoscopes puncture the tissue of the diagnostic part under the guidance of an ultrasonic image depicting the tissue on the side of the distal end and collect diseased tissue, the projection direction of the puncture needle is endoscopic. It almost coincides with the mirror insertion axis direction. Therefore, even if it is attempted to puncture the tissue surface substantially parallel to the direction of the endoscope insertion axis, the puncture needle is punctured, and the puncture needle is slippery, making it difficult to properly puncture. For this reason,
It is conceivable that the puncture needle is raised and the puncture is performed while maintaining the angle to the tissue surface, but it is not easy to raise the hard puncture needle and it is difficult to obtain a sufficient raising angle. . In view of the above problems, a method of raising a puncture needle by providing a forceps raising base and a method of forming the forceps raising base to be large may be adopted. The tip hard portion must be designed large and long. As described above, when the distal end hard portion is large and long, the pain of the patient inserted into the body cavity increases, and the insertion into the body cavity cannot be performed smoothly, which makes it difficult to perform a quick examination. [0005] The present invention is proposed to solve the above problems, without increasing the size of the hard tip portion,
It is an object of the present invention to provide an ultrasonic endoscope provided with a forceps raising base capable of obtaining a sufficient raising angle of a puncture needle. In order to achieve the above object, the present invention provides an ultrasonic vibrator, a forceps channel outlet and a rotation at a distal end of an insertion portion having a rigid distal portion, a curved portion, and a flexible tube. In an ultrasonic endoscope provided with a possible forceps raising table, a force point for raising the forceps on the forceps raising table at the time of inserting forceps into a forceps channel is based on the outer contour of the rigid distal end portion. It is configured such that at the time of inserting the insertion portion into the body cavity, at least the force point is located closer to the hand than the rotation axis of the forceps raising table and the entire forceps raising table is housed in the rigid distal end portion. The ultrasonic endoscope was characterized by the following. As described above, when the forceps are inserted into the forceps channel, the point of force for raising the forceps on the forceps raising base is located outside the outer contour of the hard distal end portion, and the force point relative to the fulcrum applied to the forceps. Since the distance becomes long, the forceps raising base raises the puncture needle largely with a small force, and punctures the tissue of the diagnostic part from an appropriate angle under the ultrasonic guide to collect the diseased tissue. In addition, when the insertion portion is inserted into the body cavity, at least the force point is located closer to the hand than the forceps raising table rotation axis, so that when inserting the insertion portion, the number of dangerous protrusions is reduced, and the insertion portion is smoothly and safely inserted into the body cavity. Can be inserted into [0008] Embodiments of the present invention will be described below with reference to the drawings. 1 to 5 show a first embodiment of the present invention. According to the first embodiment, when the insertion portion is inserted into the body cavity, the forceps raising base is housed in the hard distal end portion, and when the diseased tissue is collected in the body cavity, it is projected from the outer contour of the hard distal end portion to puncture. The present invention relates to a convex ultrasonic endoscope having excellent electrical safety and capable of raising a needle with a small force. FIG. 1A is an overall view of an ultrasonic endoscope.
The operation unit 1 has an angle knob 2 and a forceps channel entrance 3. An insertion section 4 connected to the operation section 1 is provided with a convex ultrasonic transducer having a forward oblique view, a distal end hard section 5 made of hard resin, a bending section 6 which can be bent up, down, left and right by turning an angle knob 2, and a flexible section. It has a tube 7. FIG. 2 is an enlarged perspective view of the distal end hard portion 5. As shown in the figure, the distal end hard portion 5 is provided with a convex ultrasonic transducer 8 for electrically performing beam focusing at the distal end, and is used when the convex ultrasonic transducer 8 is inserted into a body cavity at the proximal side of the convex ultrasonic transducer 8. A light guide having a cover glass 9, an objective lens 10 communicating with a CCD camera (not shown), an air supply / water supply port 11 used for cleaning the objective lens 10, and a forceps channel outlet 12a through which a puncture needle is projected. A non-metallic forceps wire 14 which is moved forward and backward by turning a forceps raising knob 13 (FIG. 1B) of the operation unit 1 and a hard resin made of resin which is connected to the forceps wire 14 and is rotated by the forward and backward movement of the forceps wire 14. A forceps raising base 15 is provided. FIG. 3 is a perspective view for explaining the raising operation of the puncture needle 16 protruding from the forceps channel outlet 12a. The puncture needle 16 includes a superelastic pipe-shaped needle 17,
The needle 17 has a metal stylet (core metal) 18 inserted inside the entire length of the needle 17 and a coil sheath 19 for guiding and protecting the needle 17. And FIG. 3A
FIG. 3B shows a state in which the puncture needle 16 passes through the forceps channel and protrudes from the forceps channel outlet 12a in the same posture, and FIG. 16 shows a state in which it is raised by the θ angle. FIG. 4 is a longitudinal sectional view showing the vicinity of the forceps raising table 15. As shown in FIG. The forceps raising table 15 is configured to be rotatable in the direction of an arrow via a rotation shaft 20, and the forceps wires 14 for operating the forceps raising table 15 are connected via a fixing unit 21. Further, the forceps raising base 15 is formed with a through hole 22 that communicates with the forceps channel 12 when housed in the hard distal end portion. In addition, 23 is a force point on the forceps raising table 15, and 24 is a fulcrum on the forceps channel outlet 12a. With this configuration, when the forceps raising table 15 is rotated and returned to the hand side (this state is shown in FIG. 4), the forceps raising table 15 is rotated by the rotating shaft 20.
It is located in a space 25 formed closer to the user than the front end, and is housed within the outer contour of the distal end hard portion. In this case, the force point 23 of the forceps raising base 15 is located closer to the hand than the rotation shaft 20 and is close to the fulcrum of the forceps channel outlet 12a. On the other hand, when the forceps wire 14 is advanced to rotate the forceps raising table 15 toward the ultrasonic vibrator 8 and is positioned as shown in FIG. 5, the puncture needle 16 indicated by a two-dot chain line It can project from the channel outlet 12a and is supported so as to be in contact with the force point 23 of the forceps raising base 15. At the same time, the puncture needle 16 is
The fulcrum 24 a is in contact with the fulcrum 24. The first embodiment is not limited to the convex type ultrasonic endoscope, but may be other electronic scanning type ultrasonic endoscopes such as a linear type, a sector type, and a mechanical type. It can be applied to a sector type ultrasonic endoscope. Further, as the hard resin selected as the material of the distal end hard portion 5 and the forceps raising stand 15, an appropriate material such as polysulfone or modified PPC may be used. If the forceps raising base 15 is formed so that the vicinity of the force point 23 for raising the forceps when supporting the forceps protrudes into the ultrasonic scanning range and is configured to be drawn on an ultrasonic image, the forceps raising base 15 Of the forceps raising base on the ultrasonic image can be drawn in the vicinity of the ultrasonic transducer surface position on the ultrasonic image. Next, the operation of the first embodiment will be described. In order to collect diseased tissue with the puncture needle 16,
First, the insertion section 4 is inserted into the body cavity in a state where the forceps raising table 15 is stored in the distal end hard section 5 (the state shown in FIG. 4).
In this case, if necessary, the through hole 2 of the forceps raising base 15 may be used.
2 and the forceps channel 12 are used to suck dirt and the like in the body cavity. When the distal end of the insertion section 4 reaches the target diagnostic section, the forceps raising base 15 is operated via the forceps raising knob 13 shown in FIG. 1B. As shown in FIG.
The forceps raising base 15 is rotated so that the power point 23 side moves toward the ultrasonic vibrator 8 side about the rotation axis 20. Then
The forceps raising table 15 is in a state of protruding outward from the outer contour of the hard end portion. In this state, the fulcrum 24 of the puncture needle 16 is
Relative to the force point 23 of the forceps raising table 15
The relative distance between 0 and the fulcrum 24 is nearly double, and the puncture needle 16 can be raised through the forceps raising table 15 with a minimum force. In this state, the puncture needle 16 is inserted from the forceps channel inlet 3 (FIG. 1A) to pass through the forceps channel 12. Then, the puncture needle 16 is projected from the forceps channel outlet 12a as shown in FIG. 3A. Then, the puncture needle 16 is supported by the forceps raising base 15 as shown in FIG. However, since the rising angle of the puncture needle 16 is not sufficient in the state shown in FIGS. 3A and 5, the forceps raising table 15 is operated through the forceps raising knob 13 shown in FIG. It is retracted and the forceps raising table 15 is raised.
Then, the puncture needle 16 is raised as shown in FIG. 3B. As described above, according to the first embodiment, the accommodating space 25 of the forceps raising base 15 in the hard distal end portion 5 is formed on the hand side, so that the puncture needle 16 can be raised. When the forceps raising table 15 is provided, the fulcrum 24 for raising the puncture needle 16 is located on the hand side. On the other hand, since the force point 23 of the forceps raising stand 15 is located on the ultrasonic vibrator 8 side, the relative distance between the fulcrum 24 and the force point 23 becomes longer, and the puncture needle 16 is raised with a small force to a large angle. be able to. Further, since the forceps raising table 15 is operated to raise the puncture needle 16 at a position protruding outward from the outer contour of the distal end hard portion, a large space for operating the forceps raising table 15 is formed in the distal end hard section 5. No need to
The length of the distal end hard portion 5 can be reduced, so that pain of the patient can be reduced and the insertion portion 4 can be inserted smoothly. When inserting and removing the insertion section 4 in a body cavity,
Since the forceps raising table 15 can be accommodated in the hard distal end portion 5, the number of projections can be reduced and damage to the tissue in the body cavity of the patient can be avoided, and the insertion section 4 can be inserted smoothly. Since the metal portion is not exposed on the distal end hard portion 5, the electrical safety is not impaired even when used in combination with the high-frequency treatment instrument. FIGS. 6 to 8 show a second embodiment of the present invention. Parts corresponding to the first embodiment are denoted by the same reference numerals. In the second embodiment, when the insertion portion is inserted into the body cavity, the forceps raising base is housed in the hard distal end portion, and when the operation of collecting the diseased tissue in the body cavity is greatly protruded from the outer contour of the hard distal end portion. The present invention relates to a convex-type ultrasonic endoscope excellent in electrical safety, in which a puncture needle is largely raised with a small force, and furthermore, an end position of a forceps raising stand can be confirmed on an ultrasonic image. FIG. 6 is a partial cross-sectional view of the distal end hard portion corresponding to FIG. 4 in the first embodiment. In the second embodiment, a forceps raising base made of a hard resin is formed of two divided bodies, and operates as shown in FIGS. 6A and 6B by the advance and retreat of the forceps wire 14. As shown, the forceps wire 14 is connected to a first forceps raising table 15a.
The first forceps raising table 15a is adapted to rotate via a second rotation shaft 20b. On the other hand, the second forceps raising base 15b is rotatably fixed to the hard distal end portion via the first rotation shaft 20a. In addition, 23 is a point of force on the first forceps raising base 15a for raising the forceps, and 24 is a fulcrum at the forceps channel outlet 12a. As shown in FIG. 6B, when the forceps wire 14 is retracted, the first forceps raising table 15a rotates via the second rotation shaft 20b and is located in the storage space 25, and the second forceps raising table 15a is moved to the second position. The forceps raising table 15b is connected to the first rotating shaft 20a.
And stops at the standing state. In this case, the second forceps raising table 15b abuts on the forceps channel outlet end face 12b so that further rotation is suppressed. In this case, the force point 23 on the first forceps raising base 15a is located closer to the hand than the first rotation shaft 20a and near the fulcrum 23 at the forceps channel outlet 12a. When the forceps wire 14 is advanced, as shown in FIG. 6A, the first forceps raising table 15a rotates via the second rotation shaft 20b and projects greatly from the storage space 25. The second forceps raising table 15b rotates via the first rotation shaft 20a and abuts against a bottom surface 25a continuous with the storage space 25, so that further rotation is suppressed. In this case, the first forceps raising table 15
The force point 23 at a is located apart from the fulcrum 24 at the forceps channel outlet 12a. Reference numeral 26 indicates an ultrasonic scanning range. Other configurations are the same as those of the first embodiment. The second embodiment is not limited to the convex type ultrasonic endoscope, but may be any other electronic scanning type ultrasonic endoscope such as a linear type, a sector type, and a mechanical type. It can be applied to a sector type ultrasonic endoscope. Further, the material of the forceps raising table 15 is polysulfone, denatured PP.
A hard resin such as C may be appropriately selected and used. Next, the operation of the second embodiment will be described. In order to collect the diseased tissue with the puncture needle, first, the first forceps raising table 15a and the second forceps raising table 15b
Is stored in the distal end hard portion 5 (the state of FIG. 6B),
Insert the insertion part into the body cavity. When the distal end of the insertion section reaches the target diagnostic section, the forceps raising table is operated via the forceps raising knob 13 shown in FIG. 1B. By moving the forceps wire 14, the forceps wire is moved as shown in FIG. 6A. As described above, the first forceps raising table 15a and the second forceps raising table 15b
Rotates, and the force point 23 on the first forceps raising table 15a moves to the ultrasonic vibrator 8 side. Then, the vicinity of the power point 23 of the first forceps raising base 15a largely protrudes outside the outer contour of the hard end portion and enters the ultrasonic operation range 26. In this state, the forceps channel inlet 3 (FIG. 1)
The puncture needle 16 is inserted from A) and inserted through the forceps channel 12. Then, as shown in FIG. 7, the puncture needle 16 is projected from the forceps channel outlet 12a, and is supported on the first forceps raising base 15a. In this state, the rising angle of the puncture needle 16 is not sufficient, so the forceps raising knob 13 shown in FIG. 1B is operated to retract the forceps wire 14 and raise the first forceps raising table 15a. As described above, according to the second embodiment, in addition to the effects of the first embodiment, since the forceps raising base 15 is formed of two divided bodies, the forceps raising base 15a,
When the tip 15b projects out of the outer contour of the distal end hard portion as shown in FIG.
In this embodiment, the puncture needle 16 is further away from the fulcrum 24 required when bending the puncture needle 16. Therefore, the puncture needle 16 can be raised with a smaller force. Further, since the forceps erecting base 15 is formed of two divided bodies, the degree of freedom in its movement increases, and the puncture needle 16 elevates without buckling at one place as in the first embodiment. Easier to do. Further, since the end of the first forceps raising table 15a protrudes largely outside the outer contour of the tip hard portion and enters the ultrasonic operation range 26, the forceps raising on the ultrasonic image 27 as shown in FIG. The upper stand upper end position 28 is the ultrasonic transducer surface position 29
It is drawn in the vicinity. Therefore, the orientation of the puncture needle 16 can be easily performed at the time of ultrasonic diagnosis, and the diagnosis time can be shortened. The contents described in the above embodiments can be considered as the following inventions. 1. In an ultrasonic endoscope provided with an ultrasonic vibrator, a forceps channel outlet, and a rotatable forceps raising table at a distal end of an insertion section having a distal end hard section, a bending section, and a flexible tube, the forceps raising table is The point of force for raising the forceps on the forceps raising table when the forceps is inserted into the channel is located outside the outer contour of the rigid distal end portion, and at least the force points when the insertion section is inserted into the body cavity is rotated by the forceps raising table. An ultrasonic endoscope, wherein the ultrasonic endoscope is configured to be located closer to a hand than a shaft and to be entirely housed in the rigid distal end portion. As described above, since the storage space for the forceps raising table in the distal end hard portion is formed on the near side, when the forceps raising table is in a state where the puncture needle can be raised, the fulcrum for raising the puncture needle is on the near side. Since the force point of the forceps raising table is located on the ultrasonic vibrator side, the relative distance between the fulcrum and the force point is increased, and the puncture needle can be raised at a large angle with a small force. In addition, since the forceps raising table is configured to raise the puncture needle at a position protruding outward from the outer contour of the distal end hard portion, it is not necessary to form a large space for operating the forceps raising table in the distal end hard portion, The length of the rigid portion at the distal end can be shortened, so that the pain of the patient can be reduced and the insertion portion can be inserted smoothly. In addition, when inserting and removing the insertion portion in the body cavity, the forceps raising base can be stored in the hard distal end portion, so that the number of protrusions is reduced and it is possible to avoid damaging the tissue in the patient's body cavity and to prevent the insertion portion from being damaged. Can be smoothly inserted. 2. The forceps raising table is formed by connecting at least two divided bodies, and the first forceps raising table is rotatably fixed to the second forceps raising table via a rotation shaft, and a force point for raising the forceps. 2. The ultrasonic endoscope according to claim 1, wherein the second forceps raising base is rotatably fixed to a hard distal end portion via a rotary shaft. As described above, since the forceps raising base is formed from the two divided bodies, the forceps raising base protrudes largely outside the outer contour of the distal end hard portion, and the position of the force point acting on the puncture needle is required when bending the puncture needle. Move further away from the fulcrum. Therefore, the puncture needle can be raised with a smaller force. Further, since the forceps raising base is formed of the two divided bodies, the degree of freedom of the movement is increased, and the puncture needle can be easily raised without buckling at one place. 3. The first or second aspect, wherein the forceps raising table is formed so that a vicinity of a force point for raising the forceps at the time of supporting the forceps protrudes into an ultrasonic scanning range, and can be drawn on an ultrasonic image. Item 7. The ultrasonic endoscope according to the above item. As described above, the end of the forceps raising stand largely protrudes outside the outer contour of the distal end hard portion and falls within the ultrasonic operation range, so that the position of the forceps raising stand end on the ultrasonic image is near the ultrasonic transducer surface position. Is rendered. Therefore, the orientation of the puncture needle can be easily performed at the time of ultrasonic diagnosis, and the diagnosis time can be shortened.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is an overall view and a partially enlarged view of an ultrasonic endoscope according to a first embodiment of the present invention. FIG. 2 is an enlarged perspective view of the tip end hard portion. FIG. 3 is a perspective view showing a state where the forceps protrudes from a forceps channel, and a perspective view showing a state where the forceps are raised. FIG. 4 is a longitudinal sectional view showing the vicinity of the forceps raising base. FIG. 5 is a longitudinal sectional view showing a relationship between the forceps raising table and a puncture needle. FIG. 6 is a longitudinal sectional view for explaining the operation of a forceps raising stand according to a second embodiment of the present invention. FIG. 7 is a longitudinal sectional view showing a relationship between the forceps raising table and a puncture needle. FIG. 8 is an explanatory diagram showing a drawing state in the ultrasonic image. [Description of Signs] 8 Ultrasonic vibrator 9 Light guide cover glass 10 Objective lens 11 Air supply / water supply port 12a Forceps channel outlet 14 Forceps wire 15 Forceps riser

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Claims (1)

(57) [Claim 1] An ultrasonic vibrator, a forceps channel outlet, and a rotatable forceps elevator are provided at the distal end of an insertion portion having a distal end hard portion, a curved portion, and a soft tube. In the ultrasonic endoscope, the forceps for raising the forceps on the forceps raising table at the time of inserting the forceps into the forceps channel are located outside the external contour of the hard distal end portion, and An ultrasonic endoscope characterized in that at least the force point is located closer to the rotation axis of the forceps raising table when inserted into a body cavity, and the entire forceps raising table is housed in the rigid distal end portion. .