JPH0216729Y2 - - Google Patents

Description

[Detailed Description of the Invention] [Technical Field of the Invention] The present invention relates to an endoscope provided with an insertion channel for guiding a puncture needle through the endoscope.

[Technical background of the invention and its problems]

A patent application filed in 1983 was proposed as an ultrasonic diagnostic device that performs both in-vivo ultrasonic diagnosis and puncture.
-61345 has an ultrasonic probe at the tip of the insertion section of the endoscope, a channel through which the puncture needle is inserted, and a puncture needle lifting device at the tip of the insertion section. is provided. Then, the puncture needle introduced through the insertion channel is guided to protrude from the tip of the endoscope.

By the way, the puncture target site is normally located at a distance of about 20 to 30 mm from the position of the ultrasound probe, and if the diagnostic width is 30 mm, the length of the puncture needle is at least 20 mm, even just the part protruding from the endoscope. 35
mm is required. This length is considerable, and if the puncture needle is placed in the flexible tube of the endoscope's insertion channel and the insertion portion is bent, it may break through the inner wall of the channel and cause water leakage. Furthermore, during operation of the puncture needle, the needle may be drawn into the channel, causing the above-mentioned phenomenon.

[Purpose of invention]

This invention was made with attention to the above circumstances,
The purpose of this is to securely store the puncture needle so that even if it is curved during insertion, it will not pierce the inside of the insertion channel, so that it can be guided safely to the target site in the body cavity, and it will not put a burden on the patient. To provide an endoscope that allows a procedure to be performed immediately without applying any pressure, and that is also easy to operate for a surgeon.

[Summary of the idea]

The present invention is an endoscope that is provided with an insertion channel for guiding a puncture needle having a hard needle body at the tip. The endoscope is provided with a storage opening for storing the puncture needle and a positioning means for fixing the puncture needle when the needle reaches the storage opening.

[Example of idea]

Hereinafter, each embodiment of the present invention will be described based on the drawings.

A first embodiment is shown in FIGS. 1-7.

In Figure 1, 1 is the first endoscope, 2 is the second endoscope, and 3 is the puncture needle. , for example, shows the puncture needle 3 puncturing the pancreatic body. Note that the target organ for ultrasonic puncture using this ultrasonic diagnostic apparatus is the stomach or its surrounding organs.

FIG. 2 shows the first endoscope 1 and its peripheral equipment. That is, in addition to the first endoscope 1, it includes a light source device 4, a water tank 5, an ultrasonic observation device 6, and a water pump 7. The first endoscope 1 includes a long insertion section 8 to be inserted into a living body cavity, an operation section 9 connected to the proximal end of the insertion section 8, and an eyepiece section 10 provided on the operation section 9. Consisting of a universal cord 11 and a connector 12 provided at the extending end of the universal cord 11, the connector 1
2 is connected to a light source device 4.
The insertion section 8 is formed by connecting a distal end portion 15 to the distal end of a flexible tube 13 via a curved tube 14. The outer skin of the flexible tube 13 is made of, for example, urethane resin, and its outer surface is coated with a slippery urethane coating material to make it slippery. curved pipe 1
Reference numeral 4 has a core material formed by connecting a plurality of curved pieces 16, and a waterproof rubber tube 17 as an outer skin is fitted around the outer periphery of the core material. The main body of the tip portion 15 is made of a hard material, and an ultrasonic probe 18 is provided on the lower side surface thereof. This ultrasonic probe 18 is attached with a damper material 19 interposed therebetween, and a signal cable 20 is connected thereto. This signal cable 20 passes through the insertion section 8 and the operation section 9, is led out of the endoscope 1, and is electrically connected to the ultrasonic observation device 6. This ultrasonic observation device 6 includes an ultrasonic probe 18
The ultrasound images received are displayed on the screen. By the way, as shown in FIG. 2, the diagnostic width 1 of the ultrasonic probe 18 is 30 mm. The longer this diagnostic width 1 is, the more desirable it is because a wider range can be observed and diagnosed, but on the other hand, the length of the hard tip 15 has to be that long, making it difficult to pass it through the examinee's throat. Therefore, as mentioned above, around 30mm is usually appropriate.
Further, the higher the frequency of the ultrasonic probe 18, the better the resolution, but the distance that the ultrasonic waves can reach becomes shorter, and the depth that can be diagnosed becomes shallower. Therefore, in this embodiment, the depth is 5 MHz to 7.5 MHz, and the best imaged depth is around 4=20 to 5=30 mm.

In addition, the ultrasonic probe 18 and the damper material 19
It is surrounded by signal cables 20 in three directions around it, as shown in FIG. As shown in FIG. 3, the cross-sectional shape of the tip portion 15 is a rectangle with rounded corners. Compared to a circular shape, this shape has a smaller cross-sectional area when the same internal organs are placed, and can reduce pain for the subject. Further, the tip portion of the tip portion 15 is approximately
It is cut out at a 45 degree angle. This inclined surface 21 is provided with an observation window 22, an air/water supply nozzle 23 directed toward the observation window 22, and an illumination window 24.

On the other hand, an illumination lamp 25 is installed in the light source device 4, and the light emitted from this illumination lamp 25 is
The light is emitted from the illumination window 24 through the light guide fiber 26 of the endoscope. In addition, the observation window 22
The optical image that enters the objective optical system 27 from above is observed at the eyepiece 10 through an image guide fiber 28 provided within the insertion section 8, as shown in FIG. The observation optical system consisting of the observation window 22 and the objective optical system 27 has a viewing direction of 45 degrees with respect to the longitudinal direction of the insertion section 8, and a viewing angle of 150 degrees.
It is now possible to observe a range from 30 degrees above the front to 30 degrees below and backwards. by the way,
The tip 15 of the first endoscope is an ultrasonic probe 18
, so it is quite long. Therefore,
During insertion, especially when inserting into the descending limb of the duodenum, it is extremely difficult to do so unless you can see the front. Also,
Since the direction of ultrasonic examination is lateral (downward in this example), it is important to be able to see the lateral and posterior sides in order to orient and know which side you are looking at. This is necessary when performing ultrasonic diagnosis of the stomach wall, for example, when examining the degree of cancer progression, or when accurately facing the ultrasound probe 18 to a lesion. Furthermore, the viewing angle is
It is desirable that the temperature is 120 degrees or higher.

The light source device 4 is further provided with an air pump 30. This air supply pump 30 pressurizes the inside of the water supply tank 5 described above, and also pressurizes the inside of the first endoscope 1.
It is connected to an air supply pipe line 31 that is piped inside. Further, a water supply pipe 32 is installed inside the first endoscope 1 , and one end of this water supply pipe 32 is immersed in the water of the water supply tank 5 . The other end of the water supply pipe 32 merges with the other end of the air supply pipe 31 and communicates with the air and water supply nozzle 23 . The air supply pipe line 31 and the water supply pipe line 32 are controlled to open and close by an air/water supply switching valve 33 provided in the operating section 9, so that it is possible to select between air supply and water supply to the air and water supply nozzle 23. A suction changeover valve 34 is provided in the operating section 9 in parallel with the air/water supply changeover valve 33, and is adapted to control the suction operation through a suction channel (not shown).

As shown in FIG. 2, another water passage 35 is piped to the first endoscope. One end of this water passage 35 is connected to a connection mouthpiece 36 provided on the operating section 9, and the other end is connected to a plurality of, for example, three, water supply ports 37 provided on the distal end portion 15 of the insertion section 8.
These water supply ports 37 are arranged in a straight line along the longitudinal axis direction of the insertion section 8, and the ultrasonic probe 18
It is installed on the upper side opposite to the installation side. Further, the installation range of the water supply ports 37 overlaps with the diagnostic width 1 of the ultrasonic probe 18. Each water supply port 37 is formed into a wide-mouthed tapered shape. Therefore, the deaerated water does not gush out forcefully.

As shown in FIG.
When you step on the button, the pump 38 operates and the deaerated water tank 41
Degassed water is supplied from the supply tube 41a to the water passage 35.

By the way, ultrasonic waves for ultrasonic diagnosis are extremely attenuated and cannot be transmitted in the air, so the ultrasonic probe 18 must be placed in water to transmit them, but ordinary water does not penetrate air. Contains a lot and is not suitable. Therefore, deaerated water produced by sufficiently boiling is used. However, it is not necessary to fill the entire stomach with deaerated water, and it is sufficient to submerge the ultrasound probe 18 in water as shown in Fig. 1. It is desirable that the particles travel along the side circumference of the tip 15 and accumulate quickly without scattering. Otherwise, air will easily get mixed in with the degassed water. In addition, if the degassed water flows over the entire length of the ultrasound probe 18 when the ultrasound probe 18 is placed on the stomach wall, it is possible to easily obtain good images over the entire diagnostic range. . In this example,
Since the water inlets 37 are provided at positions overlapping (parallel to) the diagnostic width 1 of the ultrasonic probe 18, the degassed water exiting the water inlets 37 quickly reaches the surface of the ultrasonic probe 18. Further, since a plurality of water supply ports 37 are provided, degassed water can easily reach the entire length of the ultrasonic probe 18. Furthermore, since the outlet of the water supply port 37 is tapered and wide, the degassed water does not gather force and blow out, and the water is gently transmitted along the side circumference of the tip 15 to the ultrasonic probe 18. The surface can be immersed. Note that when the water pump 7 is in use, the water pump 7 is directly electrically connected to the living body through deaerated water. Therefore, the water pump 7 is designed to be electrically safe so that the subject will not receive an electric shock.

On the other hand, an ultrasonic puncture needle guide port 42 consisting of a hole penetrating diagonally as shown in FIG. 43 is provided. This ultrasonic puncture needle guide port 42 faces into the inspection plane by the ultrasonic probe 18, and is inclined at about 50 degrees with respect to the longitudinal axis direction of the insertion section 8. For this reason,
The needle body 54 (described later) of the puncture needle 3 that has passed through the ultrasound puncture needle guide port 42 is used for diagnosis in the target area where the ultrasound image is most clear, that is, at a distant front point approximately 25 mm from the surface of the ultrasound probe 18. It is designed to reach near the center of width 1. The inner diameter of the ultrasonic puncture needle guide port 42 differs depending on the outer diameter of the puncture needle 3. Since the tapered portion 43 is provided at the entrance of the ultrasound puncture needle guide port 42, the puncture needle 3 can be easily introduced into the ultrasound puncture needle guide port 42. Further, the ultrasonic puncture needle guide port 42 is provided closer to the tip than the ultrasonic probe 18. Therefore, puncture needle 3
There is no possibility of making a hole in the rubber tube 17 when attempting to insert the needle into the ultrasonic puncture needle guide port 42. Furthermore, compared to providing the ultrasonic puncture needle guide port 42 closer to the user's hand than the ultrasonic probe 18, the length of the tip portion 15 can be made shorter, thereby reducing the pain of the subject. Further, the observation window 22 and the illumination window 24 were provided not on the distal end surface and the upper surface of the distal end portion 15 as shown in FIGS. 4 and 5, but on the inclined surface 21 inclined downward at 45 degrees. Therefore, when inserting the puncture needle 3 into the ultrasonic puncture needle guide port 42,
The puncture needle 3 does not damage the observation window 22 or the illumination window 24.

On the other hand, as shown in FIG. 6, the second endoscope is a direct-viewing endoscope, and like the first endoscope 1, it has an operating section 9, an eyepiece section 10, and a universal cord 1.
1, a connector 12, a flexible tube 13, a curved tube 14, a tip 15, etc. However, the material of the outer skin of the flexible tube 13 is a Teflon tube different from that of the flexible tube 13 of the first endoscope 1. Furthermore, although not shown, similar to the first endoscope 1, an air supply pipe 3
1. A water supply pipe 32 is provided, and an air and water supply nozzle 23 is provided facing the observation window 22. Furthermore, a puncture needle insertion channel 44 is provided inside the insertion section 8 over the entire length from the operation section 9 . This puncture needle insertion channel 44 is designed to become straight when the insertion section 8 is straightened. The insertion opening 45 has a cylindrical shape, into which the proximal hard part 46 of the puncture needle 3 is inserted. The length of the insertion port 45 is, for example, approximately 130 mm. Further, the distal end portion 15 has a storage opening 47 that passes through the distal end portion 15 in the longitudinal direction. The length of the storage port 47 is approximately 60 mm.
The insertion port 45 and the storage port 47 are connected by a flexible tube 48 such as a Teflon tube.
When the insertion portion 8 is straightened, the insertion port 45, the storage port 47, and the flexible tube 48 are almost in a straight line.
Therefore, the puncture needle 3 can be inserted from the operating section side. Storage port 47 and flexible tube 48
The inner diameter of the tube is approximately 2 mm. A screw 49 is formed near the entrance side end of the insertion port 45.
A screw 50 is screwed into 9. Further, on the opposite side of the screw 50, a click member 51 serving as a positioning means is provided so as to be movable forward and backward along the diameter line of the insertion port 45.
is biased inwardly by the The opposite side of this spring 52 is locked with a lid 53.

By the way, the puncture needle 3 has a needle body 54, a soft sheath 55 with the needle body 54 attached to the tip, and a proximal hard part 4 attached to the proximal end of the soft sheath 55.
6. It is composed of a flexible tube 56 attached to the tip of the hard part 46 on the proximal side and a cap 57 as a connection port for an instrument attached to the other end of the flexible tube 56. The needle body 54 has an outer diameter of 0.4 to 0.6 mm, a length of about 50 mm, and is made of stainless steel. The soft sheath 55 is made of a Teflon tube, and the end of the needle body 54 is inserted into the inside of the distal end of the soft sheath 55 to be bonded and bonded.
Fixed. Further, the end surface of the soft sheath 55 constitutes an abutment protrusion 58 . The outer diameter of this bulging protrusion is 1.8 mm or less. The length of the hard part 46 on the hand side is approximately 170 mm.
There is an annular V around the entire circumference near the tip side end of 6.
A groove 59 is provided. A plurality of lines 60 are further provided on the side peripheral surface of the hard portion 46 on the proximal side.
The line 60 is made by pouring paint into a shallow V-groove, and the line 60 is the one on the most distal side when the V-groove 59 matches the click member 51 of the second endoscope 2.
5, and this is located at a point approximately 10 mm from the distal end surface of the proximal hard portion 46, which does not include the mouthpiece for connecting the soft sheath 55. In other words, in the clicked state, the mating length between the insertion port 45 and the hard part 46 on the proximal side is 10 mm.
It is becoming. The second line 60 is from the first line
At the 50mm position, after that there are 7 wires at 10mm intervals, a total of 9
A book line 60 is provided. That is, the second line 60 is 50 mm from the click position of the needle body 54.
The protrusion indicates that almost the entire length of the needle body 54 has come out from the storage opening 47, and the ninth line 60 indicates that the puncture needle 3 has protruded approximately 120 mm from the second endoscope 2. The flexible tube 56 is made of a thick silicone tube, and the mouthpiece 57 is provided with a taper for a syringe as defined by JIS. A syringe 61 as a suction device is connected to the cap 57. In addition, a suction passage 62 is provided along the entire length of the puncture needle 3, and the negative pressure generated by the syringe 61 is applied to the needle body 5.
It is designed to reach the tip of 4. A protective sleeve 63 shown in FIG. 7 can be fitted onto the needle body 54. The outer diameter of the protective sac 63 is approximately 1.5 mm.
The protective sac 63 is fitted when the puncture needle 3 is inserted, and is removed before inserting the second endoscope 2 into the body cavity.

Next, the operation of the first embodiment will be explained.

First, the subject is given the minimum amount of anesthesia necessary and drugs are administered to stop peristalsis. Then, the passageway 35 of the first endoscope 1 whose insertion section 8 has been sufficiently sterilized is filled with deaerated water in advance, and the endoscope 1 is inserted radially. After carefully looking at the inside of the stomach that can be seen through the observation window 22 and deciding where to place the ultrasound probe 18, and applying the ultrasound probe 18 to that area,
Ultrasonic diagnosis is performed while the foot switch 40 is turned on and degassed water is flown to guide it to the puncture point of the lesion. At this time, it is preferable to display the puncture position or puncture direction on the display of the ultrasonic observation device 6 in advance.

Next, the insertion section 8 of the second endoscope 2, the inside of the puncture needle insertion channel 44, and the puncture needle 3 are sufficiently sterilized, the insertion section 8 is straightened, and the needle body 54 is covered with the protective sac 63. The puncture needle 3 is inserted into the puncture needle insertion channel 44. After the click is activated, the puncture needle 3 is further pushed out from the second endoscope 2, the protective sac 63 is removed, and the puncture needle 3 is returned to the click position. In this way, the needle body 54
This prevents damage to the flexible tube 48. At this time, the needle body 54 is located in the storage opening 47. The proximal hard part 46 is locked to the insertion port 45 using the screw 50. This prevents the needle body 54 from inadvertently protruding from the storage opening 47 during insertion and injuring the subject. Since the flexible tube 13 and the curved tube 14 are covered with a soft sheath 55, the flexible tube 1
Even if the puncture needle 3 or the curved tube 14 is bent, the puncture needle 3 will not break. Note that at this time, the position of the needle body 54 is slightly moved back and forth within the storage opening 47, but the needle body 54 is located within the storage opening 47.
It will never come out. Connect the syringe 61 to the mouthpiece 57 with the syringe 61 inserted, and give the subject a second injection.
Insert the endoscope 2. At that time, the first endoscope 1
If the flexible tubes 13 of the second endoscope 2 and the second endoscope 2 are both coated with the same coating, the flexible tubes 13 may touch each other and the position of the ultrasound probe 18 may be greatly shifted. In the embodiment, the material of the outer cover is changed, and the flexible tube 1 of the second endoscope 2 is
This doesn't happen because 3 is made of Teflon, which has good slipperiness. In other words, if the materials are different, it will be difficult to stick to them. The material of the outer skin may be selected by changing the above example. After the second endoscope 2 has been inserted to a certain extent, unnecessary lights of the first endoscope 1 are turned off. This will eliminate the glare.

Next, insert the storage port 47 into the ultrasonic puncture needle guide port 4.
It is also an extension of 2. At this time, the distance between the first endoscope 1 and the second endoscope 2 is preferably about 60 mm. Therefore, loosen the screw 50 and insert the puncture needle 3 into the second position.
Push it out little by little from the endoscope 2. When the needle body 54 is pushed out about 55 mm, it completely comes out of the storage opening 47. Further, the puncture needle 3 is pushed out, and the needle body 54 is inserted into the tapered part 4.
3, and further insert it into the ultrasonic puncture needle guide port 42. If the tip end of the needle body 54 enters the ultrasonic puncture needle guide port 42 while the rear side of the needle body 54 is in the storage port 47, the needle body 54 will move when the first endoscope 1 and the second endoscope 2 move.
Please be careful as it may break. During the puncture, administer general anesthesia as necessary to prevent the target from moving and minimize the effects of breathing. The puncture needle 3 is further pushed out, and the tip of the needle body 54 finally penetrates the stomach wall and reaches the pancreas, capturing the lesion. At that time, even if the puncture needle 3 is pushed out too far, the abutment protrusion 58 hits the entrance of the ultrasonic puncture needle guide port 42, so the tip of the needle body 54 passes through the examination area and advances into the blind area. It is safe without any problems. Here, after locking the screw 50 to prevent the puncture needle 3 from moving forward or backward, the syringe 61 is operated to suction and biopsy the lesion. Soft tube 56
Due to the presence of the syringe 61, even when the syringe 61 is operated, the movement is not transmitted to the proximal hard part 46 or the needle body 54. Then, the screw 50 is released, the puncture needle 3 is quickly pulled out to the click position, and the needle body 54 is stored in the storage opening 47. A click feeling indicates that the needle body 54 has been stored in the storage opening 47. The second endoscope 2 and the first endoscope 1 are removed. Note that since the needle body 54 is extremely thin, it does not eject a large amount by puncturing. In addition, bacteria in the stomach attaches to the pancreas, which can be dealt with by administering antibiotics.

A second embodiment is shown in FIGS. 8 and 9. This is because the structure of the second endoscope 2 is different.
That is, the flexible tube 48 is connected to the constituent members of the distal end portion 15 via the channel pipe 66. The inner diameter of the channel pipe 66 is the storage opening 47.
An abutment protrusion 67 is formed on the tip side end surface of the channel pipe 66, which is smaller than the inner diameter of the channel pipe 66. Insertion port 4
5 is provided with a ring-shaped resistance member 68 made of rubber. The inner diameter of resistance member 68 is smaller than the outer diameter of soft sheath 55. The outer diameter of the distal end of the soft sheath 55 is increased by being fitted onto the needle body 54, thereby forming an abutment protrusion 69 serving as a positioning means. The outer diameter of the soft sheath 55 is smaller than the inner diameter of the channel pipe 66. Therefore, when the puncture needle 3 is pulled in the withdrawal direction, the abutting protrusion 67 and the abutting protrusion 69 come into contact with each other, and the needle body 54 is properly stored at a predetermined position in the storage opening 47 at this time. A cap 57 is attached to the proximal end of the flexible sheath 55 with a tightening ring 70. Puncture needle 3
To set it on the endoscope 2, first, the base 57,
The puncture needle 3 is inserted into the second endoscope 2 in the opposite direction without the tightening ring 70, that is, the soft sheath 55
Connect the base 57 by passing it through the storage opening 47 from the proximal end of the housing. When inserting the second endoscope 2 into the subject, the puncture needle 3 is held tight until the abutting protrusion 69 abuts the abutting protrusion 67. Even if you release your hand in this state, the puncture needle 3 will not come off from the second endoscope 2 due to the frictional force between the resistance member 68 and the soft sheath 55. Furthermore, the resistance member 68 has the effect of allowing the puncture needle 3 to protrude little by little during puncturing. 71 is a tube spring, and this tube spring 71 has a function of urging the puncture needle 3 in the pulling direction. The tube spring 71 has the shape of a thick rubber tube divided in half as shown in FIG. 9, and its length is longer than the distance between the tapered portion 43 and the tightening ring 70. By providing the tube spring 71, the puncture needle 3 is completely prevented from accidentally sticking out from the second endoscope 2. Note that the tube spring 71 can be attached to and detached from the soft sheath 55.

A third embodiment is shown in FIG. This is because the soft sheath 55 is connected to the needle body 54 via the attachment member 72. Further, the mounting member 72 is provided with a flange portion, thereby forming the abutting protrusions 58 and 69.

Note that the ultrasonic probe 18 may be of an electronic sector scan type, and in this case, a wider range of inspection is possible.

[Effect of idea]

As explained above, in the endoscope of the present invention, the distal end of the insertion section communicates with the insertion channel, and
A storage opening is formed in which a puncture needle having a hard needle body at its tip is stored. Therefore, the puncture needle can be stored safely, easily and reliably within the endoscope, and even if it is curved during insertion, it can be guided to the target site within the body cavity without penetrating the inner wall of the channel. In addition, treatment can be performed immediately,
Improved operability can reduce the burden on patients and operators.

[Brief explanation of the drawing]

Fig. 1 is a usage state diagram showing an embodiment of the present invention, Fig. 2 is a diagram schematically illustrating the configuration around the first endoscope, and Fig. 3 is along the line - in Fig. 2. 4 is a sectional view of the observation optical system at the distal end of the first endoscope, FIG. 5 is a sectional view of the illumination optical system at the distal end, and FIG. 6 is a sectional view of the illumination optical system at the distal end of the first endoscope. 7 is a cross-sectional view of the needle body portion of the puncture needle, and FIG. 8 is a schematic diagram illustrating the configuration of the second endoscope of the second embodiment. Figure 9 is also D- in Figure 8.
A sectional view taken along line D, and FIG. 10 is a sectional view of the vicinity of the needle body of the third embodiment. 1...First endoscope, 2...Second endoscope, 3
... Puncture needle, 8 ... Insertion part, 15 ... Tip part, 4
2...Ultrasonic puncture needle guide port, 44...Puncture needle insertion channel, 54...Needle body, 67...Abutment projection, 68...Resistance member.

Claims (1)

[Claims for Utility Model Registration] (1) In an endoscope provided with an insertion channel for guiding the insertion of a puncture needle having a hard needle at the tip, the endoscope is formed within the distal end of the insertion section and communicates with the insertion channel. An endoscope further comprising: a storage opening for storing the needle; and positioning means for fixing the puncture needle when the needle reaches the storage opening. (2) The positioning means is provided with an abutment projection on the end of the storage opening on the endoscope proximal side that hits the puncture needle and prevents the needle body of the puncture needle from entering the endoscope proximal side. The endoscope according to claim 1 of the utility model registration claim, characterized in that: (3) The endoscope according to claim 1 or 2, which is characterized by being provided with a resistance means that prevents the forward and backward movement of the puncture needle.