JP3255652B2 - Laser device - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a laser device, and more particularly to a laser device having an ultrasonic probe.

[0002]

2. Description of the Related Art Conventionally, as a therapeutic treatment in a body cavity using an endoscope and a laser device, for example, in the case of performing hemostasis or cauterizing a malignant tissue such as cancer, the contents of the treatment are carried out in advance by animal experiments or desk experiments. In addition, the output of the laser, the laser irradiation time, and the like are grasped according to the distance to the subject and the like, and the clinic is approached based on the experimental results.

In the case of treatment in a body cavity, the laser irradiation time is relatively short, and the distance from the laser irradiation end to the subject is difficult to understand under an endoscope. It was difficult to grasp whether the light had been irradiated to the depth. For this reason, the actual situation is that the treatment by laser irradiation is performed based almost on the intuition and experience of the surgeon.

[0004] For this reason, there is a risk that bleeding or perforation may occur due to excessive cauterization, or that unnecessary parts may be burned, which is very dangerous. Conversely, there is a possibility that a part that must be cauterized may be left behind, which may result in incomplete treatment.

[0005] In order to solve these problems, the present applicant has disclosed, as shown in Japanese Patent Publication No.
An endoscope laser device that controls the output of laser light by combining an ultrasonic diagnostic unit with an ultrasonic element has been proposed.

Furthermore, as disclosed in Japanese Patent Application Laid-Open No. 2-5936, a laser apparatus using an ultrasonic diagnostic means in combination with the ultrasonic element is applied to remove atheroma formed in a blood vessel. Proposed.

In such a laser device, for example, an ultrasonic probe provided with an ultrasonic probe at the tip and a laser probe for emitting a laser beam are formed separately so that a portion to be inspected can be observed. Cautery treatment is to be performed. However, in the case of this laser device, since the ultrasonic probe and the laser probe are used facing each other, the ultrasonic probe is irradiated with laser light, and the ultrasonic probe is damaged. Therefore, there are disadvantages such as the output of the ultrasonic probe is attenuated, the treatment effect is not improved, and the life of the probe is shortened.

[0008] To solve this problem, attempts have been made to bundle the side-view ultrasonic probe and the side laser probe and to integrally form them so that the laser can be irradiated within the ultrasonic observation range. However, when the side-view ultrasonic probe and the side laser probe are bundled, there is a risk of damaging the ultrasonic probe in manufacturing, and there is also a problem in durability.

[0009]

As described above, in the conventional laser apparatus, since the ultrasonic probe is irradiated with the laser beam and the ultrasonic probe is damaged, the output of the ultrasonic probe is damaged. Decay, the therapeutic effect does not increase,
There is a problem that the life of the probe is shortened. In addition, a side laser probe for avoiding this is very difficult in manufacturing and has a problem in durability. Furthermore, it is difficult to grasp the relationship between the ultrasonic image obtained by the ultrasonic probe and the laser irradiation position.For example, when performing treatment such as atheroma that grows from the inner wall of the blood vessel toward the center and is formed in the blood vessel, It is difficult to compare the ultrasonic image with the ablation position of the laser beam.

The present invention has been made in view of the above circumstances, has excellent durability, does not adversely affect an ultrasonic probe even when irradiated with a laser beam, and is capable of comparing an obtained ultrasonic image with a laser irradiation position. It is an object of the present invention to provide a laser device whose relationship can be easily grasped.

[0011]

According to a first aspect of the present invention, there is provided a laser device having an elongated insertion portion and a side facing the insertion portion.
An ultrasonic probe that transmits and receives ultrasonic waves,
Through the insertion part, and the irradiation end is
From the irradiation end in the axial direction of the insertion portion.
Laser irradiation means for irradiating a laser beam, and the ultrasonic probe
Between the probe and the irradiation end, and a laser from the irradiation end.
Laser light by the laser irradiation means by deflecting the laser light.
Intersecting the launch area with the ultrasound observation area of the ultrasound probe
Characterized by comprising a reflecting means, further claims
In the laser device according to the second aspect, the angle of the reflection means is changed.
And changing means .

[0012]

[Function] In the laser device according to the first aspect of the present invention, the insertion portion has
Ultrasonic observation area transmitted and received from the ultrasonic probe at the tip
And the laser beam from the irradiation end proximal to the ultrasonic probe.
Irradiate by the reflection means between the ultrasonic probe and the irradiation end
The laser irradiation area to be deflected intersects. Claims
In the laser device of the second aspect, the angle of the reflection means is changed.
Become

[0013]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is a schematic configuration diagram showing a distal end portion of a laser device according to a first embodiment of the present invention.

The laser apparatus 1 emits an ultrasonic wave to a subject and obtains an ultrasonic image such as an ultrasonic tomographic image from a reflected echo wave, and emits a laser beam to a portion to be inspected to obtain a lesion. This is a device that performs cautery treatment such as hemostasis or resection. On the distal end side of the laser device 1, there is provided an elongated and flexible diagnostic and treatment probe 2 connected to various devices on the rear end side (not shown). This diagnostic treatment probe 2
Is an elongated and flexible ultrasonic probe 3 that emits an ultrasonic wave to a portion to be examined and receives a reflected echo wave thereof, and an optical fiber or the like that emits a laser beam in the axial direction of the diagnostic treatment probe 2. And a laser probe 4 having a characteristic.

The laser device 1 is provided with the ultrasonic probe 3
Is driven in a predetermined mode, and the ultrasonic probe 3 receives the echo wave emitted from the ultrasonic probe 3 and returned from the portion to be inspected, and processes a signal output from the ultrasonic probe 3. A display device such as an ultrasonic processing device and a monitor (not shown) for obtaining an ultrasonic tomographic image is provided. In addition, the laser device 1
Includes a laser oscillator (not shown) that emits laser light, a laser control device (not shown) that controls the laser oscillator to emit predetermined laser light, and the like.

The diagnostic probe 2 transmits laser light emitted from the laser oscillator through the laser probe 4 and emits the laser light from the laser emission end 4a of the laser probe 4 to a portion to be inspected.

The diagnostic and treatment probe 2 has a flexible shaft 5 which is flexible and is provided in parallel with the laser probe 4 and is rotatable. The flexible shaft 5 is inserted into the distal end side. The protruding ultrasonic tip 2a is provided. The ultrasonic tip 2a is bent obliquely to the outer peripheral side of the diagnostic treatment probe 2 with respect to the axial direction at the position of the laser emission end 4a of the laser probe 4, and protrudes from the emission end 4a of the laser probe 4. ing. An ultrasonic probe 3 fixed to the tip of the flexible shaft 5 is provided inside. Therefore, the ultrasonic probe 3 rotates in the circumferential direction of the ultrasonic distal end portion 2a, and performs so-called radial scanning.

The laser probe 4 emits laser light in the axial direction from its emission end 4a, while the ultrasonic probe 3 emits ultrasonic waves on the side having the laser probe 4. The direction is orthogonal to the side surface of the ultrasonic tip 2a. Therefore, the ultrasonic probe 3
The ultrasonic observation area C of FIG. 1 intersects with the laser irradiation area D of the laser light emitted from the laser probe 4.

In the ultrasonic diagnosis, there are A mode, B mode, M mode, etc. as a display method on a monitor or the like, and the ultrasonic processing apparatus has an ultrasonic emission and echo wave processing technique. Although pulse compression or the like is used, it is a well-known technique and will not be described in detail.

The laser device 1 can be applied to an endoscope as one of the most suitable use cases. That is, the diagnosis and treatment probe 2 is used as an insertion portion of an endoscope, and reaches the vicinity of a test site in a body cavity to achieve ultrasonic diagnosis and laser treatment.

In the present embodiment, the target portion to be inspected is located at a position where the ultrasonic observation area C of the ultrasonic probe 3 and the laser irradiation area D of the laser beam emitted from the laser probe 4 intersect. For example, while observing the obtained ultrasonic tomographic image of the target test site through endoscopic endoscopic observation, cautery treatment with laser light can be performed as necessary. Further, the ultrasonic probe 3 is bent at a position of the laser emitting end 4a in an oblique direction on the outer peripheral side of the diagnostic and treatment probe 2 with respect to the axial direction, and protrudes from the laser emitting end 4a. 2
a and located outside the laser irradiation area D of the laser probe 4. For this reason, the ultrasonic probe 3 does not receive the laser beam emitted from the laser probe 4 and is not damaged by the laser beam. Therefore, the output of the ultrasonic probe 3 can be prevented from being attenuated due to the laser irradiation, and the treatment can be performed based on, for example, an ultrasonic tomographic image obtained by a stable output. Further, since the laser probe 4 is of a direct-radiation type and only the flexible shaft 5 is bent in order to obtain a side-view type ultrasonic probe, it is easy to manufacture and has excellent durability. Further, the ultrasonic probe 3 and the laser probe 4
Since the positional relationship with the laser emitting end 4a is always fixed, the correspondence between the ultrasonic diagnostic image of the test site and the laser irradiation position can be easily grasped, and laser irradiation is performed only on the necessary test site. Can be done and safe.

FIG. 2 is a schematic configuration diagram showing a tip portion of a laser device according to a second embodiment of the present invention.

FIG. 2 shows the configuration of the ultrasonic probe 11 and the laser probe 12 of the laser device 10. The laser device 10 includes, for example, a distal end portion 13a of an elongated insertion portion 13a of a catheter 13 which can be inserted into a body cavity of a subject.
In addition, an ultrasonic probe 11 and a laser probe 12 are provided,
It is for observing and diagnosing the inside of a body cavity with ultrasonic waves, and performing laser treatment.

The ultrasonic probe 11 is provided with a plurality of ultrasonic probes (not shown), for example, for obtaining an ultrasonic diagnostic image by a known electronic scanning method which is sequentially switched by an electronic switch or the like. It is. The ultrasonic probe 11 is disposed in a first groove 13 c provided in a distal end portion 13 b of the catheter 13, and has a direction in which ultrasonic waves are emitted with respect to an axial direction of an insertion portion 13 a of the catheter 13. It is provided so as to be diagonally backward. In addition, the electronic scanning method includes linear electronic scanning,
Although there is a sector electronic scanning, it is a well-known technique and will not be described in detail.

The distal end portion 13b of the catheter 13 is
It is provided so as to cut out from the outer peripheral side to the middle of the width direction,
A second groove 13d is formed at the rear end of the first groove 13c.
Is provided. The second groove 13 d of the catheter 13 has, at its rear end, an emission end 12 of the laser probe 12 inserted in the axial direction of the insertion portion 13 a of the catheter 13.
The laser beam emitted from a laser oscillator (not shown) is radiated in the axial direction from the emission end of the laser probe 12. Furthermore, the second of the catheter 13
The groove portion 13d has an axial direction, for example, 4
A reflection mirror 14 having an inclination of 5 degrees is provided, and this reflection mirror 14 directs the laser light emitted from the emission end of the laser probe 12 in a direction toward the outer periphery of the distal end portion 13b of the catheter 13 and at right angles to the axial direction. It is designed to reflect. Therefore, the ultrasonic observation region E of the ultrasonic probe 11 intersects with the laser irradiation region F where the laser light emitted from the laser probe 12 is reflected by the reflection mirror 14. Then, the laser device 10 is connected to the crossed ultrasonic probe 11.
For example, while observing a test site in the ultrasonic observation area E by using an ultrasonic tomographic image, laser treatment can be performed while observing the ultrasonic tomographic image.
In addition, it is effective also as an endoscope instead of the catheter 13.

In this embodiment, the insertion portion 1 of the catheter 13
3a is inserted into the body cavity of the subject, and the ultrasonic observation area E of the ultrasonic probe 11 and the laser irradiation area F of the laser probe 12
The target test site is located in a region where the target crosses. In this state, the laser device 10 can perform ablation treatment or the like with laser light as necessary while observing an ultrasonic tomographic image of the target test site. Also, the ultrasonic probe 11
Is provided at a position other than the laser irradiation region F of the laser probe 12, so that the ultrasonic probe 11 is not irradiated with the laser beam and the ultrasonic probe 11 is not damaged. Therefore, output attenuation of the ultrasonic probe 11 due to laser irradiation can also be prevented, a stable ultrasonic diagnostic image can be obtained with a stable output, and stable laser treatment can be performed. Further, since the side-view laser probe 12 is realized by the reflection mirror 14, the fabrication is easy and the durability is excellent. Emission end 1 of ultrasonic probe 11 and laser probe 12
Since the positional relationship with 2a is always fixed, it is easy to associate the ultrasonic diagnostic image of the test site with the laser irradiation position, so that it is easy to perform laser irradiation only on the necessary test site. And safe laser treatment can be performed.

FIG. 3 is a schematic structural view showing a tip portion of a laser device showing a modification of the second embodiment of the present invention. The laser device 10A shown in FIG. 3 includes a reflection mirror 14A that can change the reflection angle of the laser light, instead of the fixed reflection mirror 14 of the second embodiment. In addition, the same configurations and operations as in the second embodiment are denoted by the same reference numerals, and description thereof is omitted.

The distal end portion 13B of the catheter 13A has a groove portion 13C provided so as to be cut out from the outer peripheral side to the middle in the width direction. This catheter 13
In the groove 13C, the ultrasonic probe 11 is provided at the tip end in the axial direction, and the laser emitted from the emission end 12a of the laser probe 12 is pulled and relaxed by a wire (not shown) in the middle of the rear end. The reflection mirror 14A for changing the light reflection angle is provided. Therefore, the ultrasonic observation region E of the ultrasonic probe 11 intersects with the laser irradiation region F where the laser light emitted from the laser probe 12 is reflected by the reflection mirror 14A.

In this embodiment, the intersection area between the ultrasonic observation area E of the ultrasonic probe 11 and the laser irradiation area of the laser probe 12 can be moved by changing the reflection angle of the reflection mirror 14A. Therefore, this intersection area is wider than that of the second embodiment, and laser treatment can be performed on a wider range of positions. Further, the laser beam can be moved without moving the insertion portion 13b of the catheter 13, and the range of the laser treatment is expanded. Further, when it is not necessary to emit a laser beam, the reflection mirror 14A can be set to a state in which the reflection mirror 14A is protruded in parallel with the axial direction, so that there is no obstruction at the time of insertion. The other configuration and operation and effect are the same as in the second embodiment, and the description is omitted.

FIG. 4 is a schematic structural view of a tip portion of a laser device according to a third embodiment of the present invention. FIG. 4 shows a part of a laser device 20. The laser device 20 includes a slender diagnostic treatment probe 23 having a laser probe 25 and an ultrasonic probe 22 and insertable into the body, and a diagnostic treatment probe. 23 is provided with the above-mentioned ultrasonic processing device, a display device, a laser oscillator, a laser control device, and the like, which are connected to the rear end side of 23, and obtains an ultrasonic diagnostic image. It is a device for performing treatment.

The diagnostic probe 23 has a hollow flexible shaft 24 having flexibility inserted in the axial direction. The flexible shaft 24 is inserted from the rear end side of the diagnostic treatment probe 23 to the middle of the distal end side, and rotates about the axis of the diagnostic treatment probe 23. A laser probe 25 for transmitting a laser beam emitted from the laser oscillator is inserted into the inside of the diagnostic / treatment probe 23, and the laser probe 25 positioned at the front end side of the diagnostic / treatment probe 23 is emitted therefrom. Laser light is emitted from the end 25a. In addition, the probe for diagnosis and treatment 23
Is a cone-shaped reflector 26 that reflects laser light
The cone-shaped reflector 26 has a reflection surface 26a for laser light formed in a conical shape with the center of the axis of the diagnostic treatment probe 23 as a center, and the reflection surface 26a and the emission of the laser probe 25 are provided. The end 25a is disposed so as to face the end.
The reflection surface 26a of the cone-shaped reflector 26 reflects the laser light emitted from the emission end 25a of the laser probe 25 obliquely to the rear end side in the axial direction with respect to the axis center of the diagnostic probe 23. It has become.

On the other hand, the ultrasonic probe 22 is provided on the outer peripheral side of the distal end of the flexible shaft 24, and according to a pulse signal from the ultrasonic processing device, applies ultrasonic waves substantially perpendicular to the axial direction and for diagnostic treatment. The laser beam is emitted toward the outer periphery of the probe 23, and receives a reflected echo wave from the test site and outputs it to the ultrasonic processing apparatus.
Further, the ultrasonic probe 22 performs so-called radial scanning that emits an ultrasonic wave while rotating together with the rotation of the flexible shaft 24. Therefore, the ultrasonic observation area G of the ultrasonic probe 22 intersects with the laser irradiation area H where the laser light emitted from the laser probe 25 is reflected by the cone-shaped reflector 26. Then, the laser device 20 scans the test site in the ultrasonic observation region G of the crossed ultrasonic probe 22 by, for example,
While observing with an ultrasonic tomographic image, laser treatment can be performed while observing the ultrasonic tomographic image. In addition, without using the flexible shaft 24,
A plurality of ultrasonic probes may be arranged on the outer periphery of the diagnostic probe 23 to perform electronic scanning as in the second embodiment. Further, the reflection surface 26a of the cone-shaped reflector 26 may be formed not only in a conical shape but also in each surface of a polygonal pyramid (for example, a triangular pyramid) having a plurality of planes.

In this embodiment, the target object is located in a region where the ultrasonic observation region G of the ultrasonic probe 22 and the laser irradiation region H of the laser probe 25 intersect. While observing the ultrasonic tomographic image of the site, cautery treatment or the like using a laser beam can be performed as necessary. In addition, since the ultrasonic probe 22 is provided at a position other than the laser irradiation area H of the laser probe 25, the ultrasonic probe 22 is irradiated with the laser light to damage the ultrasonic probe 22. I do not receive it. Therefore, output attenuation of the ultrasonic probe 22 due to laser irradiation can also be prevented, a stable ultrasonic diagnostic image can be obtained with a stable output, and stable and safe laser treatment can be performed. Further, since a cone-shaped reflector 26 realizes a side-view type laser probe, manufacture is easy. In addition, since the positional relationship between the ultrasonic probe 22 and the emission end 25a of the laser probe 25 is always fixed, it is easy to associate the ultrasonic diagnostic image of the test site with the laser irradiation position. In addition, it is possible to easily perform laser irradiation only on necessary test sites, and to perform safe laser treatment. Further, since the laser beam reflected by the cone-shaped reflector 26 is radiated in a conical shape in the outer circumferential direction of the diagnostic treatment probe 23, the affected part formed around the tube wall of the subject, for example, the atheroma in the blood vessel is cauterized. It is effective to treat.

[0034]

According to the present invention, both the ultrasonic probe and the laser irradiating means are provided in the insertion portion, and the ultrasonic probe is inserted.
The ultrasonic probe is not irradiated with the laser beam even if the laser irradiating means irradiates the laser beam because the laser beam is radiated to the side of the entrance portion. In addition, there is an effect that excellent durability can be achieved, and the obtained ultrasonic diagnostic image can be easily associated with the laser irradiation position.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram showing a distal end portion of a laser device according to a first embodiment of the present invention .

FIG. 2 is a schematic configuration diagram showing a distal end portion of a laser device according to a second embodiment of the present invention .

FIG. 3 is a schematic configuration diagram showing a tip portion of a laser device according to a modification of the second embodiment of the present invention .

FIG. 4 is a schematic configuration diagram showing a tip portion of a laser device according to a third embodiment of the present invention .

──────────────────────────────────────────────────の Continuing on the front page (72) Inventor Mamoru Kaneko 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Tatsuya Saito 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside the Olympus Optical Co., Ltd. (72) Eiichi Fuse, inventor 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside the Olympus Optical Co., Ltd. Katsuya Suzuki 2-43-2, Hatagaya, Shibuya-ku, Tokyo O-Limpus Optical Industry Co., Ltd. (72) Inventor Yoshiyasu Aoki 2-43-2 Hatagaya, Shibuya-ku, Tokyo Examiner at O-Limpus Optical Industry Co., Ltd. Seijiro Nakata (56) References JP-A-57-66748 (JP) , A) JP-A-59-46952 (JP, A) JP-A-59-189837 (JP, A) JP-A-2-192888 (JP, A) (58) Field (Int.Cl. ^7, DB name) A61B 18/20 A61N 5/06

Claims (2)

(57) [Claims] 1. An elongated insertion portion and a side portion of the insertion portion.
An ultrasonic probe provided for transmitting and receiving ultrasonic waves,
The ultrasonic probe is inserted into the insertion portion so that its irradiation end is
Is located closer to the base end, and is located in the axial direction of the insertion portion from the irradiation end
Laser irradiating means for irradiating a laser beam to the
Probe and disposed between the irradiation end and the laser beam is deflected from the irradiation end, crossing the ultrasonic observation region of the laser beam irradiated region and said ultrasonic probe of said laser irradiation means A laser device comprising: a reflection unit. 2. A changing means for changing an angle of the reflecting means.
The laser device according to claim 1, further comprising: