JP3742771B2 - Ultrasound diagnostic treatment device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an apparatus for diagnosis and treatment using ultrasound.
[0002]
[Prior art]
Conventionally, image diagnosis using an ultrasonic endoscope has been used as a method for diagnosing an initial cancer occurring in the digestive tract or the like. Ultrasound endoscopes include a wide-range ultrasound endoscope in which a catheter-like ultrasound probe is provided on an optical endoscope, and a small diameter designed to be inserted into a body cavity from the forceps opening of the optical endoscope. There is a catheter-like ultrasonic probe. In any of these types, the ultrasonic probe portion is generally configured as a torque wire having an ultrasonic transducer attached to the side surface of the distal end portion and rotatably inserted into a catheter-like sheath tube. Then, the ultrasonic transducer is rotated by rotationally driving the torque wire. That is, an ultrasonic beam is radiated in the lateral direction of the sheath tube (that is, in the radial (radial) direction) to perform radial scanning.
[0003]
On the other hand, in recent years, studies have been conducted on the treatment of cancer tissues using photoactive anticancer agents such as porphyrin. As an example, there is already a technique and apparatus for guiding a laser beam from a forceps port of an endoscope to irradiate the affected part in the body to which an anticancer agent has been administered.
[0004]
In addition, methods for activating a photosensitive drug with ultrasonic waves are disclosed in Japanese Patent Application Laid-Open No. 08-245420 and Japanese Patent Publication No. 11-504534. This method is for thrombolysis treatment, in which a photosensitive drug is injected into the blood vessel and the drug is activated only in the vicinity of the affected part by irradiating the affected part with ultrasound instead of light. It suppresses the occurrence of side effects. In this prior art, a catheter-like ultrasonic probe with an ultrasonic transducer attached to the tip is inserted into a blood vessel and guided to the affected area, and ultrasonic waves are emitted from the transducer toward the affected area. Since the thrombus is located in front of the insertion direction when viewed from the catheter-like ultrasonic probe inserted into the blood vessel, the vibrator is disposed so as to irradiate ultrasonic waves in the forward direction of the catheter-like ultrasonic probe.
[0005]
[Problems to be solved by the invention]
The conventional technique for activating an anticancer agent by irradiating a laser beam with an optical laser fiber has the following problems. First, since the laser beam has a small irradiation spot and power control is not easy, it is difficult to activate the anticancer agent by uniformly irradiating an anticancer agent administration site having a certain size. In addition, there is a problem that an anticancer agent activation effect cannot be expected for a cancer tissue existing under the surface mucosa where the laser beam does not reach. In addition, the condition of the affected area and the treatment effect can only be confirmed visually with an optical endoscope. In order to know the condition of the affected area inside the surface layer, an ultrasonic probe or the like is inserted from the forceps port instead of the optical fiber for laser light irradiation. Work such as to do was necessary.
[0006]
In addition, Japanese Patent Application Laid-Open No. 08-245420 and Japanese Patent Application Laid-Open No. 11-504534 do not disclose a mechanism or method for confirming an affected area state or a therapeutic effect. Since the devices described in these publications are for intravascular treatment, visual confirmation with an endoscope is impossible. In this prior art, the ultrasonic generator does not include a mechanism for generating a tomographic image, and ultrasonic radiation is used exclusively for treatment.
[0007]
The present invention has been made in view of such problems, and an object of the present invention is to provide an apparatus that can smoothly execute image diagnosis of an affected area and treatment by drug activation.
[0008]
[Means for Solving the Problems]
To achieve the above object, an ultrasonic diagnostic treatment apparatus according to the present invention includes an ultrasonic probe inserted into a body cavity and capable of transmitting and receiving an ultrasonic beam, and an ultrasonic beam having a predetermined diagnostic power to the ultrasonic probe. , And diagnostic control means for generating a diagnostic image by an echo reception signal by the scanning, and therapeutic control for causing the ultrasonic probe to output an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power And switching control means for switching between the diagnostic control means and the treatment control means.
[0009]
In this configuration, by switching between the diagnostic control means and the treatment control means, it is possible to perform both image diagnosis and treatment by drug activation with a single ultrasonic probe.
[0010]
An ultrasonic diagnostic treatment apparatus according to the present invention includes an endoscope apparatus, an ultrasonic probe that protrudes from a distal end portion of the endoscope apparatus, and that can transmit and receive an ultrasonic beam, and a predetermined diagnosis for the ultrasonic probe. A diagnostic control unit that scans an ultrasonic beam having a power for use and generates a diagnostic image by an echo reception signal obtained by the scanning; and an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power on the ultrasonic probe. And control means for switching between the diagnostic control means and the treatment control means.
[0011]
In this configuration, treatment with diagnostic imaging and drug activation can be performed with a single ultrasound probe, and when combined with an endoscope, the effect can be confirmed with an endoscope as soon as treatment with ultrasound irradiation is completed. It can be visually confirmed, and it is also possible to monitor with an endoscope whether or not the ultrasonic probe is displaced from the affected area during ultrasonic irradiation.
[0012]
In a preferred aspect of the present invention, the ultrasonic probe includes a probe shaft having an ultrasonic transducer attached to a distal end portion thereof, and a sheath that accommodates the probe shaft, and the ultrasonic wave is rotated by rotating the probe shaft. Radial scanning of the beam is possible, an opening is provided on the side surface of the distal end of the sheath, and the ultrasonic beam is output without passing through the sheath when the output direction of the ultrasonic beam is within the range of the opening. It was to so.
[0013]
According to this aspect, by providing an opening in the sheath, at the time of ultrasonic irradiation for drug activation, the ultrasonic wave can reach the affected area without passing through the sheath, and waste of ultrasonic energy can be reduced.
[0014]
In a further preferred aspect, the position of the opening is obtained based on an echo reception signal obtained when the ultrasonic beam is scanned radially, and a guide display for adjusting the opening position is displayed together with the diagnostic image based on the information on the opening position. Display means are provided.
[0015]
In this mode, a guide display related to the opening position (for example, a display indicating the range of the opening and a therapeutic range by the ultrasonic wave passing through the opening) is displayed together with the diagnostic image, thereby operating the ultrasonic probe and the sheath. Helping to direct the opening to the affected area.
[0016]
In another preferred embodiment, the treatment control means is obtained by obtaining the position of the opening from an echo reception signal when the ultrasonic beam is scanned radially and controlling the rotation of the probe shaft. Directional alignment means for aligning the ultrasonic beam output direction with the position of the opening, and before starting the output period of the ultrasonic beam with the drug activation power, the ultrasonic beam output by the direction alignment means Align the direction.
[0017]
According to this configuration, if the opening is directed to the affected area, the output direction of the ultrasonic beam can be automatically adjusted according to the opening, and the affected area is effectively irradiated with the ultrasonic wave of the drug activation power. be able to.
[0018]
In a preferred aspect of the present invention, the treatment control means interrupts the output of the ultrasonic beam at the drug activation power at a predetermined timing even during the output period, and the direction adjustment means causes the superposition to the opening. Align the sound beam output direction. The deviation from the opening of the vibrator during the output period can be automatically calibrated.
[0019]
In a further preferred aspect, a marker having an ultrasonic reflectance higher than that of the sheath is provided on at least a part of the periphery of the opening.
[0020]
In this aspect, since the opening can be detected more clearly by providing the marker, the above-described guide display and beam direction alignment can be performed with higher accuracy.
[0021]
In another preferred aspect, an injection means for injecting liquid into the sheath is provided, and the injected liquid is discharged from the opening.
[0022]
In this aspect, the liquid injected into the sheath and discharged from the opening is filled between the vibrator and the sheath and acts as an acoustic medium, and also acts as a coolant for cooling the heat-generated vibrator.
[0023]
According to still another preferred aspect, a sheath rotating mechanism for rotating the sheath is provided. In this aspect, the sheath can be rotated and the direction of the opening can be adjusted.
[0024]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, embodiments of the present invention (hereinafter referred to as embodiments) will be described with reference to the drawings.
[0025]
[Overview]
The ultrasonic diagnostic treatment apparatus of the present embodiment realizes image diagnosis using ultrasonic waves and drug activation using ultrasonic waves with a single ultrasonic probe.
[0026]
The ultrasonic diagnostic treatment apparatus of the present embodiment includes a mechanism for controlling the ultrasonic probe in two modes, a diagnostic mode and a treatment mode. In the diagnostic mode, the transducer is driven with relatively low power for diagnosis (several to several tens of mW) to transmit / receive ultrasonic waves to form a diagnostic image. In the treatment mode, the vibrator is driven with a strong power suitable for drug activation (for example, about 1 W, which is higher than the power at the time of diagnosis) to emit a strong ultrasonic wave to activate the drug accumulated in the affected area of the subject. . Thus, both diagnostic image generation and drug activation are realized with one ultrasonic probe. The detailed configuration of the apparatus according to the embodiment will be described below.
[0027]
[Device configuration]
First, the structure of the ultrasonic probe of the ultrasonic diagnostic treatment apparatus of this embodiment will be described with reference to FIG. FIG. 1 shows a state in which the distal end portion of the ultrasonic probe 10 protrudes from the forceps port 28 of the endoscope distal end portion 22.
[0028]
The ultrasonic probe 10 is configured in such a manner that a probe shaft 14 with an ultrasonic transducer 16 attached to the tip is inserted into a flexible sheath 12 formed of resin or the like. The probe shaft 14 is constituted by, for example, a torque wire and has flexibility, but twist caused by rotation is minimized. A signal cable connected to the ultrasonic transducer 16 passes through the probe shaft 14.
[0029]
In this example, the ultrasonic transducer 16 has the ultrasonic transmission / reception surface directed to the side surface so as to transmit / receive an ultrasonic beam toward the side surface direction of the ultrasonic probe 10 (that is, the direction perpendicular to the longitudinal direction of the probe 10). It is attached to the tip of the probe shaft 14 in a posture. The sheath 12 has an outer diameter of about 2 to 3 mm, for example, and the ultrasonic transducer 16 has an ultrasonic transmission / reception surface with a size of about 1 mm square, for example.
[0030]
An opening 12 a is provided at the distal end portion of the sheath 12. The opening 12 a is provided at a position corresponding to the ultrasonic transducer 16 in a state where the probe shaft 14 is inserted to the distal end of the sheath 12. FIG. 2 is a diagram illustrating a state in which the opening 12a of the sheath 12 is viewed from the front. As shown in FIG. 2, the opening 12 a has a sufficient size so that the entire ultrasonic transmission / reception surface of the ultrasonic transducer 16 is exposed to the outside (that is, not covered by the sheath 12). Thereby, in a state where the ultrasonic transducer 16 is aligned with the opening 12 a, the ultrasonic wave radiated from the ultrasonic transducer 16 can be radiated to the outside without being attenuated by the sheath 12. In the treatment mode, an ultrasonic wave is emitted in a state where the opening 12a is directed to the affected tissue 102 (see FIG. 1) of the body cavity wall 100, so that the ultrasonic energy can effectively reach the affected tissue 102. ing. The shape of the opening 12a shown in FIG. 2 is an example, and basically the opening 12a may have any shape.
[0031]
FIG. 3 is a diagram showing the appearance of the entire probe portion of the apparatus according to the present embodiment. The endoscope distal end portion 22 shown in FIG. 1 is a distal end portion of the insertion portion 21 extending from the endoscope operation portion 20. The illumination port 24 and the observation port 26 (see FIG. 1) of the endoscope distal end 22 are used as a light guide (optical fiber) for illumination passing through the insertion unit 21 and the endoscope operation unit 20 and for observation and photographing. The light guides are connected to each other, and further extend to the light source unit and the processor (not shown) through the connection cord 20a. In addition to the light guide, the insertion portion 21 is provided with a forceps channel extending from the treatment instrument introduction portion 20b to the forceps port 28. The ultrasonic probe 10 of the present embodiment also passes through the forceps channel from the treatment instrument introducing portion 20b and protrudes from the forceps port 28.
[0032]
The probe driving unit 10a incorporates a motor and other rotation mechanisms for driving the probe shaft 14 to rotate. By rotating the probe shaft 14 by this rotation mechanism, the ultrasonic transducer 16 provided at the tip rotates, and radial scanning is realized. The probe drive unit 10a is connected to an ultrasonic diagnostic treatment apparatus main body (not shown) via a connection cord 10b, and rotationally drives the probe shaft 14 according to a drive control signal from the main body. The signal cable connected to the ultrasonic transducer 16 is also connected to the main body through the connection cord 10b.
[0033]
A sheath rotating operation section 17 is provided in the vicinity of the probe driving section 10a. The sheath rotation operation unit 17 is connected to the sheath 12, and the sheath 12 rotates when the operator turns the sheath rotation operation unit 17. The sheath rotation operation unit 17 is for positioning the opening 12a at a desired rotation position.
[0034]
In addition, a water injection tube 18 connected to a water injection mechanism (not shown) is connected to the probe driving unit 10a. A liquid such as water or physiological saline is injected into the sheath 12 from the water injection mechanism through the water injection tube 18. This liquid injection is performed to remove air from the sheath 12 (particularly, the front surface of the vibrator) so that the ultrasonic waves are transmitted to the subject and to cool the ultrasonic vibrator 16. The injected liquid is discharged from the opening 12a.
[0035]
Next, the control mechanism of the apparatus of this embodiment will be described with reference to FIG. In the configuration shown in the figure, other units excluding the ultrasonic probe 10 and the probe shaft rotation drive unit 42 are provided in the main body of the ultrasonic treatment diagnostic apparatus.
[0036]
In this configuration, the ultrasonic probe 10 is connected to the switch 30. The switch 30 is connected to the diagnostic transmission / reception unit 32 and the treatment transmission unit 40, and under the control of the control unit 46, both of them are selectively switched and connected to the ultrasound probe 10.
[0037]
The diagnostic transmission / reception unit 32 supplies a drive signal with a diagnostic power of about several mW to several tens of mW to the ultrasonic probe 10 to excite the ultrasonic transducer 16 and echo signals received by the ultrasonic transducer 16. The signal is subjected to signal processing such as amplification and input to the image forming unit 34. The image forming unit 34 performs a process for generating a diagnostic image such as a B-mode tomographic image based on the echo signal. The diagnostic image is generated on the image memory unit 36 and displayed on the display unit 38. The diagnostic transmission / reception unit 32, the image forming unit 34, the image memory unit 36, and the display unit 38 may have the same configuration as that of a general ultrasonic diagnostic apparatus.
[0038]
The therapeutic transmitter 40 supplies a drive signal of a drug activation power (for example, about 1 W) stronger than the diagnostic power to the ultrasonic probe 10 and excites the ultrasonic transducer 16. On the other hand, the treatment transmitter 40 generates a drive signal for continuous wave transmission. By using a continuous wave, the energy density of the emitted ultrasonic wave can be increased. The frequency of ultrasonic waves for drug activation is about 1 to several MHz. Of course, since the frequency of the ultrasonic wave that is easily activated may be different depending on the medicine to be used, it is also preferable that the excitation frequency be switched according to the medicine.
[0039]
The probe shaft rotation drive unit 42 is a mechanism for driving the probe shaft 14 to rotate, and is built in the probe drive unit 10 a of the ultrasonic probe 10. The probe shaft rotation drive unit 42 is controlled by the control unit 46. In the diagnosis mode, radial scanning is realized by continuously rotating the probe shaft 14 at a predetermined rotational speed corresponding to the image frame rate. In the treatment mode, the rotation of the probe shaft 14 is servo-controlled in order to align the ultrasonic transmission / reception surface of the ultrasonic transducer 16 in the direction of the opening 12a. The alignment process for the opening 12a will be described in detail later.
[0040]
The opening position detection unit 44 detects the position of the opening 12a based on the echo reception signal acquired by the diagnostic transmission / reception unit 32 during radial scanning. The detection of the opening position is performed based on the presence or absence of an echo by the sheath 12. That is, during radial scanning, while there is no echo from the distance of the sheath 12 while the direction of the ultrasonic beam is in the range of the opening 12a, for example, the distance portion of the sheath 12 in the echo reception signal is extracted by the gate, By determining whether or not the level is higher than a predetermined threshold value, it is possible to determine whether or not there is an opening 12a in the beam direction at that time. Information on the detected opening position is used for control when the orientation of the ultrasonic transducer 16 is aligned with the opening 12a. Further, by superimposing and displaying information on the opening position on a diagnostic image such as a B-mode tomographic image, it helps the operator when aligning the opening 12a toward the affected tissue.
[0041]
The control unit 46 controls each unit of the apparatus described so far according to an operation instruction input from the operation unit 48 by the operator, and performs an operation according to the instruction. A diagnosis mode and a treatment mode are also realized by the control of the control unit 46.
[0042]
The water injection mechanism 50 is a mechanism for supplying a liquid such as water or physiological saline into the sheath 12. The supplied liquid is discharged from the opening 12 a of the sheath 12. By continuously supplying the liquid into the sheath 12 over the diagnosis mode and the treatment mode, an action as an acoustic medium and a cooling action of the ultrasonic transducer 16 can be obtained, and a substance outside the sheath 12 can be supplied from the opening 12a. Backflow into the sheath 12 can be prevented, and contamination of the internal ultrasonic transducer 16 and the like can be prevented.
[0043]
[Example of work procedure]
The configuration of the apparatus according to the present embodiment has been described above. Next, an example of work procedures for diagnosis and treatment using this apparatus will be described. In the following, a case of diagnosing and treating cancers of the digestive tract such as the stomach and duodenum will be described as an example.
[0044]
(1) Preparation
For example, hematoporphyrin and its derivatives (so-called polyphyllins) are known to accumulate in malignant tumors. For example, conventionally, when a predetermined time such as 48 hours has elapsed after administration of hematoporphyrin, an optical fiber is inserted into the stomach and the like, and laser light is applied to the affected area to activate hematoporphyrin and perform treatment. Similarly, in the present embodiment, a medicine is administered to a patient in advance, and the diagnosis / treatment by this apparatus is executed in accordance with the timing at which the medicine accumulates in the affected area.
[0045]
(2) Identification of affected area
In diagnosis and treatment using this apparatus, first, the target digestive tract is filled with water, physiological saline, or the like, and then the insertion portion 21 of the endoscope is inserted from the mouth. Then, the affected part is identified visually through the optical system of the endoscope, the tip of the ultrasonic probe 10 is brought close to the affected part, and the ultrasonic probe 10 is operated in the diagnostic mode to form a diagnostic image, indicate. With this diagnostic image, the surgeon can grasp not only the surface of the affected area but also the situation inside the affected area, and can more accurately identify the affected area.
[0046]
(3) Positioning of the sheath opening
Thus, when the affected part is specified by both the endoscope and the ultrasonic image, the operator operates the sheath rotation operation part 17 to rotate the sheath 12 so that the opening 12a faces the affected part. The positioning of the opening 12a can be performed while visually confirming the position of the opening 12a using an endoscope, and further, while confirming the positional relationship between the opening 12a and the affected part on an ultrasonic diagnostic image. be able to. That is, in the B-mode diagnostic image by radial scanning, the portion where the sheath 12 is present is displayed with high luminance, whereas the portion of the opening 12a has low luminance because there is no ultrasonic reflection, and the “C” shape as a whole. The sheath image 206 is displayed. Therefore, the opening 12a can be aligned by operating the sheath rotation operation portion 17 and rotating the sheath 12 so that the open portion of the “C” -shaped cross section faces the affected area. As described above, in the case of an ultrasonic image, the relative positional relationship between the affected part and the opening 12a is easier to identify than the endoscope, and thus the opening 12a can be accurately positioned.
[0047]
In order to further facilitate the positioning of the opening 12a, as shown in FIG. 5, an opening position guide display 208 indicating the opening 12a is displayed on the ultrasonic image, or a rough treatment range (drug activity in the treatment mode). It is also possible to display the treatment range guide display 210 indicating the effective range of the control.
[0048]
Here, the illustrated opening position guide display 208 is a display showing both ends of the opening 12a. That is, in radial scanning, the beam direction at the time when the echo reception signal intensity at the distance of the sheath 12 passes a predetermined threshold value (threshold value that distinguishes the echo level of the sheath 12 from the echo level at the opening 12a). It is determined that both ends of the opening 12a are superimposed on the diagnostic image and displayed. Of course, the marker form of the illustrated opening position guide display 208 is an example, and various display forms such as displaying the range of the opening 12a in color are also conceivable. The opening position guide display 208 allows the operator to better understand the position and range of the opening 12a.
[0049]
Further, the exemplary treatment range guide display 210 is in the form of a broken line marker surrounding the treatment range assumed by ultrasonic irradiation in the treatment mode. This display is generated based on the detection result of the opening position. Of course, the display form of the treatment range guide display 210 is not limited to this.
[0050]
According to such a display, for example, the affected part tissue image 202 that is surrounded by the normal tissue image 204 in the ultrasonic image is displayed in front of the opening indicated by the opening position guide display 208 or the treatment range guide display 210. By adjusting the position of the opening 12a by turning the sheath 12 so as to be included in the treatment range, the opening 12a can be accurately aligned.
[0051]
In this alignment, if it is found from the treatment range guide display 210 or the like that the ultrasonic transducer 16 is too far from the affected area, the ultrasonic transducer 16 is operated by operating an endoscope or an ultrasonic probe. Can be brought closer to the affected area.
[0052]
(4) Treatment by drug activation
When the affected part is specified and the opening 12a is positioned with respect to the affected part, the operator switches the mode of the apparatus to the treatment mode with the operation unit 48. When the mode is switched to the treatment mode, the control unit 46 controls the probe shaft rotation driving unit 42 so that the ultrasonic beam from the ultrasonic transducer 16 faces the affected part, and the probe shaft 14 is fixed in this state. In the positioning of the ultrasonic transducer 16, for example, an ultrasonic beam having diagnostic power is transmitted and received while the probe shaft 14 is rotated. The position of the opening 12a is determined by the opening position detection unit 44 from the echo reception signal at this time, and the ultrasonic transducer 16 is stopped at a position substantially corresponding to the center of the opening 12a. This control can be realized using a servo mechanism. If the rotation speed of the probe shaft 14 is made slower than that at the time of diagnostic image generation at the time of alignment, alignment can be performed more easily and with high accuracy.
[0053]
When the ultrasonic transducer 16 is aligned with the opening 12a, the control unit 46 switches the switch 30 to the therapeutic transmission unit 40 and drives the ultrasonic transducer 16 with a driving signal of the drug activation power. As a result, when the affected tissue is irradiated with ultrasonic waves of about 1 W and several MHz emitted from the ultrasonic transducer 16, the same drug activation effect as that obtained when laser light is irradiated is obtained. One treatment period by this drug activation is performed over a predetermined time such as several tens of minutes.
[0054]
(5) Confirmation of therapeutic effect
When one treatment period is completed, the apparatus can be switched to a diagnostic mode by an operator's operation to form a diagnostic image of the affected area. By confirming the state of tumor atrophy or tissue degeneration due to the action of the drug from this diagnostic image, the therapeutic effect can be determined. When the therapeutic effect is not sufficient, the treatment period by ultrasonic irradiation of the drug activation power is performed again, and the therapeutic effect is confirmed in the diagnosis mode. In this way, the treatment period and treatment effect confirmation can be repeated until it is determined that a sufficient treatment effect has been obtained. The therapeutic effect on the tissue surface can also be confirmed by visual confirmation using an endoscope.
[0055]
Although a series of work procedures has been described above, the ultrasonic transducer 16 may be displaced from the opening direction in a long-time treatment. Therefore, for example, one treatment period is divided into a plurality of sections, and the position of the ultrasonic transducer 16 is adjusted by the control of the control unit 46 every time one section of ultrasonic irradiation is completed. By doing so, it is possible to suppress a decrease in treatment efficiency due to the displacement of the ultrasonic transducer 16.
[0056]
In addition, the opening 12a and the ultrasonic probe 10 itself may be displaced from the affected area during the treatment mode due to the movement of the patient or the digestive tract. For example, when the surgeon monitors an endoscopic image during the treatment mode and finds a displacement of the opening 12a or the like, for example, the operator adjusts the position of the opening 12a while observing the endoscope, or enters the diagnosis mode. This can be solved by adjusting the position of the opening 12a while switching and viewing the ultrasonic image.
[0057]
In addition, when the treatment mode (4) is repeated a plurality of times while the endoscope is inserted into the patient's body, diagnostic images generated for effect confirmation are stored before treatment and between treatment modes. In addition, by providing this apparatus with a function for displaying the data in time series, it is possible to display in an easy-to-understand manner how the affected tissue changes as the treatment progresses.
[0058]
The preferred embodiments of the present invention have been described above. As can be seen from this description, the apparatus of the present embodiment includes a therapeutic transmitter 40 for emitting ultrasonic waves of high energy density for drug activation in addition to the diagnostic transmitter / receiver 32 for diagnostic image formation. Therefore, both diagnosis and drug activation treatment can be performed with one ultrasonic probe 10. Diagnosis and treatment can be performed without inserting / removing the ultrasonic probe 10 into / from the body, so that the transition from the identification of the affected area to the treatment and the transition from the treatment to the confirmation of the treatment effect can be performed smoothly. Moreover, since the ultrasonic wave has a greater reachable depth than the laser beam, it can be treated deeper than the conventional drug activation treatment method using the laser beam.
[0059]
Further, in this embodiment, by using a combination of an optical endoscope and an ultrasonic diagnostic treatment apparatus, positional deviations of the ultrasonic probe 10 and the sheath opening 12a during ultrasonic irradiation treatment are monitored with the endoscope. Can be dealt with quickly.
[0060]
In the present embodiment, by providing the opening 12a in the sheath 12, the following various effects can be obtained.
[0061]
First, since the ultrasonic wave is not blocked by the sheath 12 at the opening 12a, the ultrasonic energy in the treatment mode can be efficiently transmitted to the affected part by directing the opening 12a toward the affected part.
[0062]
Moreover, the cooling effect of the ultrasonic transducer | vibrator 16 can be heightened by discharging | emitting the liquid inject | poured in the ultrasonic probe 10 from the water injection mechanism 50 from the opening 12a. In particular, when a high power for activating the drug is used as in the present embodiment, the heat generation of the ultrasonic transducer 16 can be a big problem, but the configuration of the present embodiment is always new to the ultrasonic transducer 16. A cooling liquid (which is of course an acoustic medium) can be supplied, and a high cooling effect can be obtained.
[0063]
Further, the opening 12a can be used as a reference for positioning the ultrasonic transducer 16 in the treatment mode, and as a result, the ultrasonic transducer 16 can be automatically positioned as described above. Of course, for this purpose, it is necessary to position the opening 12a toward the affected part, but this can be done relatively easily by manual operation while viewing the diagnostic image as described above.
[0064]
In addition, by providing a marker made of a material such as metal that reflects ultrasonic waves better than the sheath 12, the opening position detection unit 44 can more reliably determine the opening position. The marker may be provided in the form of a border that surrounds the periphery of the opening 12a, for example.
[0065]
The embodiment described above is only one aspect of the present invention, and various modifications are possible within the scope of the technical idea of the present invention.
[0066]
【The invention's effect】
As described above, according to the present invention, it is possible to execute both image diagnosis and drug activation treatment with one ultrasonic probe. Further, in the present invention, by providing an opening at the distal end of the sheath of the probe, it is possible to obtain effects such as improvement in ultrasonic wave irradiation efficiency and automation of positioning of the transducer during treatment.
[Brief description of the drawings]
FIG. 1 is a diagram illustrating a configuration of a distal end portion of an ultrasonic probe of an ultrasonic diagnostic treatment apparatus according to an embodiment.
FIG. 2 is a diagram showing a state in which an opening of a sheath is viewed from the front.
FIG. 3 is a diagram showing an appearance of the entire probe portion of the apparatus according to the embodiment.
FIG. 4 is a functional block diagram illustrating a control mechanism of the apparatus according to the embodiment.
FIG. 5 is a diagram schematically showing an ultrasonic image obtained by radial scanning.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 10 Ultrasonic probe, 12 sheath, 12a opening, 14 probe axis | shaft, 16 ultrasonic transducer | vibrator, 22 End-of-endoscope part, 28 Forceps opening, 30 Switch, 32 Diagnosis transmission / reception part, 34 Image formation part, 36 Image memory Unit, 38 display unit, 40 treatment transmission unit, 42 probe shaft rotation drive unit, 44 opening position detection unit, 46 control unit, 48 operation unit, 50 water injection mechanism.

Claims (8)

An ultrasonic probe inserted into a body cavity and capable of transmitting and receiving an ultrasonic beam;
Diagnostic control means for causing the ultrasonic probe to scan an ultrasonic beam having a predetermined diagnostic power and generating a diagnostic image by an echo reception signal by the scanning;
A therapeutic control means for causing the ultrasonic probe to output an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power;
Switching control means for switching between the diagnostic control means and the treatment control means;
The ultrasonic probe includes a probe shaft having an ultrasonic transducer attached to a distal end portion thereof, and a sheath that accommodates the probe shaft, and the ultrasonic beam can be radially scanned by rotating the probe shaft. And
An ultrasonic diagnosis is configured such that an opening is provided on a side surface of the distal end portion of the sheath, and the ultrasonic beam is output without passing through the sheath when the output direction of the ultrasonic beam is within the range of the opening. A therapeutic device,
An aperture display means for obtaining a position of the opening from an echo reception signal when the ultrasonic beam is scanned radially and displaying a guide display for adjusting the opening position together with the diagnostic image based on the information of the opening position;
Ultrasonic diagnosis and treatment system you wherein a. An endoscopic device;
An ultrasonic probe that protrudes from the distal end of the endoscope device and can transmit and receive an ultrasonic beam;
Diagnostic control means for causing the ultrasonic probe to scan an ultrasonic beam having a predetermined diagnostic power and generating a diagnostic image by an echo reception signal by the scanning;
A therapeutic control means for causing the ultrasonic probe to output an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power;
Switching control means for switching between the diagnostic control means and the treatment control means;
The ultrasonic probe includes a probe shaft having an ultrasonic transducer attached to a distal end portion thereof, and a sheath that accommodates the probe shaft, and the ultrasonic beam can be radially scanned by rotating the probe shaft. And
An ultrasonic diagnosis is configured such that an opening is provided on a side surface of the distal end portion of the sheath, and the ultrasonic beam is output without passing through the sheath when the output direction of the ultrasonic beam is within the range of the opening. A therapeutic device,
An aperture display means for obtaining a position of the opening from an echo reception signal when the ultrasonic beam is scanned radially and displaying a guide display for adjusting the opening position together with the diagnostic image based on the information of the opening position;
Ultrasonic diagnosis and treatment system you wherein a. An ultrasonic probe inserted into a body cavity and capable of transmitting and receiving an ultrasonic beam;
Diagnostic control means for causing the ultrasonic probe to scan an ultrasonic beam having a predetermined diagnostic power and generating a diagnostic image by an echo reception signal by the scanning;
A therapeutic control means for causing the ultrasonic probe to output an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power;
Switching control means for switching between the diagnostic control means and the treatment control means;
The ultrasonic probe includes a probe shaft having an ultrasonic transducer attached to a distal end portion thereof, and a sheath that accommodates the probe shaft, and the ultrasonic beam can be radially scanned by rotating the probe shaft. And
An ultrasonic diagnosis is configured such that an opening is provided on a side surface of the distal end portion of the sheath, and the ultrasonic beam is output without passing through the sheath when the output direction of the ultrasonic beam is within the range of the opening. A therapeutic device,
The therapeutic control means obtains the position of the opening from an echo reception signal when the ultrasonic beam is scanned radially, and controls the rotation of the probe shaft to output the ultrasonic beam to the obtained position of the opening. Aligning means for aligning the direction, before starting the output period of the ultrasonic beam with the drug activation power, align the ultrasonic beam output direction by the direction alignment means ,
An ultrasonic diagnostic treatment apparatus. An endoscopic device;
An ultrasonic probe that protrudes from the distal end of the endoscope device and can transmit and receive an ultrasonic beam;
Diagnostic control means for causing the ultrasonic probe to scan an ultrasonic beam having a predetermined diagnostic power and generating a diagnostic image by an echo reception signal by the scanning;
A therapeutic control means for causing the ultrasonic probe to output an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power;
Switching control means for switching between the diagnostic control means and the treatment control means;
The ultrasonic probe includes a probe shaft having an ultrasonic transducer attached to a distal end portion thereof, and a sheath that accommodates the probe shaft, and the ultrasonic beam can be radially scanned by rotating the probe shaft. And
An ultrasonic diagnosis is configured such that an opening is provided on a side surface of the distal end portion of the sheath, and the ultrasonic beam is output without passing through the sheath when the output direction of the ultrasonic beam is within the range of the opening. A therapeutic device,
The therapeutic control means obtains the position of the opening from an echo reception signal when the ultrasonic beam is scanned radially, and controls the rotation of the probe shaft to output the ultrasonic beam to the obtained position of the opening. Aligning means for aligning the direction, before starting the output period of the ultrasonic beam with the drug activation power, align the ultrasonic beam output direction by the direction alignment means,
An ultrasonic diagnostic treatment apparatus. The therapeutic control unit interrupts the output of the ultrasonic beam with the drug activation power at a predetermined timing during the output period, and the ultrasonic beam output direction alignment with respect to the opening is performed by the direction adjusting unit. The ultrasonic diagnostic treatment apparatus according to claim 3 or 4, wherein: The ultrasonic diagnostic treatment apparatus according to any one of claims 1 to 5 , further comprising a marker having an ultrasonic reflectance higher than that of the sheath at least at a part of the periphery of the opening. An ultrasonic probe inserted into a body cavity and capable of transmitting and receiving an ultrasonic beam;
Diagnostic control means for causing the ultrasonic probe to scan an ultrasonic beam having a predetermined diagnostic power and generating a diagnostic image by an echo reception signal by the scanning;
A therapeutic control means for causing the ultrasonic probe to output an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power;
Switching control means for switching between the diagnostic control means and the treatment control means;
The ultrasonic probe includes a probe shaft having an ultrasonic transducer attached to a distal end portion thereof, and a sheath that accommodates the probe shaft, and the ultrasonic beam can be radially scanned by rotating the probe shaft. And
An ultrasonic diagnosis is configured such that an opening is provided on a side surface of the distal end portion of the sheath, and the ultrasonic beam is output without passing through the sheath when the output direction of the ultrasonic beam is within the range of the opening. A therapeutic device,
A marker having a higher ultrasonic reflectivity than the sheath is provided on at least a part of the periphery of the opening.
An ultrasonic diagnostic treatment apparatus. An endoscopic device;
An ultrasonic probe that protrudes from the distal end of the endoscope device and can transmit and receive an ultrasonic beam;
Diagnostic control means for causing the ultrasonic probe to scan an ultrasonic beam having a predetermined diagnostic power and generating a diagnostic image by an echo reception signal by the scanning;
A therapeutic control means for causing the ultrasonic probe to output an ultrasonic beam having a predetermined drug activation power higher than the diagnostic power;
Switching control means for switching between the diagnostic control means and the treatment control means;
Wherein the ultrasound probe includes a probe shaft ultrasonic transducers are attached to the distal end, front SL and a sheath for containing the probe axis, radial scanning ultrasonic beams by rotating the probe shaft Is possible,
An ultrasonic diagnosis is configured such that an opening is provided on a side surface of the distal end portion of the sheath, and the ultrasonic beam is output without passing through the sheath when the output direction of the ultrasonic beam is within the range of the opening. A therapeutic device,
A marker having a higher ultrasonic reflectivity than the sheath is provided on at least a part of the periphery of the opening.
An ultrasonic diagnostic treatment apparatus.

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