Patent Publication Number: US-2003225332-A1

Title: Ultrasonic therapeutic apparatus

Description:
CROSS-REFERENCE TO RELATED APPLICATION  
       [0001] This application is based upon and claims the benefit of priority from prior Japanese Patent Application No.2002-160557, filed May 31, 2002, the entire contents of which is incorporated herein by reference.  
       BACKGROUND OF THE INVENTION  
       [0002] 1. Field of the Invention  
       [0003] The present invention relates to an ultrasonic therapeutic apparatus and, more particularly, to an ultrasonic therapeutic apparatus used under endoscopic observation.  
       [0004] 2. Description of the Related Art  
       [0005] An ultrasonic therapeutic apparatus which is used under endoscopic observation has heretofore been known.  
       [0006] Each of JP-A-1987-299251 and JP-A-2001-37768 discloses an ultrasonic therapeutic apparatus including an ultrasonic therapeutic probe fitted in a hand piece containing an ultrasonic vibrator. Specifically, in either of the disclosed arts, the hand piece of the ultrasonic therapeutic apparatus is fitted to an operating section of an endoscope, and the ultrasonic therapeutic probe is inserted into a channel of the endoscope to perform ultrasonic treatment under endoscopic observation. JP-A-1987-299251 discloses a combination of an ultrasonic therapeutic apparatus and a flexible endoscope, while JP-A-2001-37768 discloses a combination of an ultrasonic therapeutic apparatus and a rigid endoscope.  
       [0007] In these related arts, the process of inserting an elongated ultrasonic probe into a channel of an endoscope takes place before or during an operation. However, accurate and reliable insertion of the ultrasonic probe into the endoscope is a difficult process. It is preferable to dispose the ultrasonic probe at a position where part of the ultrasonic probe becomes visible in the field of view of the endoscope so that treatments can be performed reliably and safely, but users often feel stress from the process of accurately disposing the ultrasonic probe at such a position.  
       BRIEF SUMMARY OF THE INVENTION  
       [0008] An ultrasonic therapeutic apparatus according to the invention includes an endoscope having an inserting section to be inserted into an object, an ultrasonic vibrator for generating ultrasonic vibration, a vibration transmitting section for transmitting the ultrasonic vibration generated by the ultrasonic vibrator to the object, and a holding member for holding the ultrasonic vibrator and the vibration transmitting section in a distal tip portion of the inserting section of the endoscope.  
       [0009] Accordingly, since the ultrasonic vibrator and the vibration transmitting section are held in the distal tip portion of the inserting section of the endoscope, there is no need for the process of inserting the ultrasonic therapeutic apparatus into the endoscope and positioning the ultrasonic therapeutic apparatus with respect to the endoscope before and during an operation.  
       [0010] An example of the vibration transmitting section is a probe (horn). For good operability, a suction passage may be provided in the probe. Preferably, the probe and the ultrasonic vibrator are removably disposed so that an appropriate probe can be selected according to the contents of an operation to be applied. In this case, the shape of the probe may be a cylinder, a cone, a hook, a spatula or the like.  
       [0011] For good operability, the distal tip portion of the probe may be positioned in the field of view of the endoscope. The probe may be constructed to be movable back and forth, rotatable and tiltable so that the probe can be easily positioned at an appropriate location.  
       [0012] In the case of a tiltable probe, a jaw may be provided in the distal tip portion of the endoscope so that an object can be clamped between the probe and the jaw.  
     
    
    
     BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS  
     [0013] These and other features, aspects, and advantages of the apparatus and methods of the present invention will become better understood with regard to the following description, appended claims, and accompanying drawings where:  
     [0014]FIG. 1 is a view showing an ultrasonic therapeutic apparatus according to a first embodiment of the invention;  
     [0015]FIG. 2A is an enlarged cross-sectional view of a distal tip portion of the ultrasonic therapeutic apparatus shown in FIG. 1;  
     [0016]FIG. 2B is an enlarged front view of the distal tip portion of the ultrasonic therapeutic apparatus shown in FIG. 1;  
     [0017]FIG. 3 is a cross-sectional view showing the distal tip-end side of an ultrasonic therapeutic apparatus body according to a second embodiment of the invention;  
     [0018]FIG. 4 is a perspective view showing the distal tip-end side of an ultrasonic therapeutic apparatus body according to a variation of the second embodiment;  
     [0019]FIG. 5 is a cross-sectional view showing the distal tip-end side of an ultrasonic therapeutic apparatus body according to a third embodiment of the invention;  
     [0020]FIG. 6 is a cross-sectional view showing the distal tip-end side of an ultrasonic therapeutic apparatus body according to a fourth embodiment of the invention;  
     [0021]FIG. 7 is a cross-sectional view showing the distal tip-end side of an ultrasonic therapeutic apparatus body according to a fifth embodiment of the invention;  
     [0022]FIG. 8 is a cross-sectional view showing the distal tip-end side of an ultrasonic therapeutic apparatus body according to a sixth embodiment of the invention;  
     [0023]FIG. 9 is a perspective view showing the distal tip-end side of the ultrasonic therapeutic apparatus body shown in FIG. 8;  
     [0024]FIG. 10 is a view showing a specific example of the observing field of view of the ultrasonic therapeutic apparatus body shown in FIG. 8; and  
     [0025]FIG. 11 is a perspective view showing the distal tip-end side of an ultrasonic therapeutic apparatus body according to a seventh embodiment of the invention. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION  
     [0026] Preferred embodiments of the invention will be described below with reference to the accompanying drawings.  
     [0027]FIGS. 1, 2A and  2 B are views of an ultrasonic therapeutic system and apparatus according to a first embodiment of the invention. FIG. 1 is a view showing the ultrasonic therapeutic system according to the first embodiment. FIG. 2A is an enlarged view of the distal tip portion of the ultrasonic therapeutic apparatus shown in FIG. 1, and FIG. 2B is a front view of the distal tip portion. In the first embodiment, an ultrasonic probe is fixed in a channel in the distal tip portion of an endoscope. Accordingly, a user does not need to perform the process of inserting the ultrasonic probe into the endoscope as a preparatory process before an operation nor as a process during an operation.  
     [0028] The ultrasonic therapeutic system  1  shown in FIG. 1 has the function of performing treatment using ultrasonic waves under endoscopic observation. The ultrasonic therapeutic system  1  includes an endoscope (body)  2  for enabling endoscopic observation, a light source device  3  for supplying illuminating light to the endoscope  2 , an ultrasonic probe unit  5  incorporated in a channel  4  of the endoscope  2 , an ultrasonic driving device  8  for generating an ultrasonic driving signal to be used for generation of ultrasonic waves, and a suction device  11  for sucking and collecting a treated tissue and/or fluids.  
     [0029] Incidentally, as a matter of course, the ultrasonic therapeutic system  1  may also be defined as an ultrasonic therapeutic apparatus which excludes the ultrasonic driving device  8 , the light source device  3 , and the suction device  11 .  
     [0030] The ultrasonic driving device  8  and the ultrasonic probe unit  5  are removably connected to each other by a flexible signal cable  6  which extends from the rear end of the ultrasonic probe unit  5  and has an electrical connector  7  at its extending end for connection to a mating connector (not shown) at the ultrasonic driving device  8 . The suction device  11  and the ultrasonic probe unit  5  are removably connected to each other by a flexible tube  9  which extends from the rear end of the ultrasonic probe unit  5  and has a connecting portion  10  at its extending end for connection to a mating part (not shown) at the suction device  11 .  
     [0031] The endoscope  2  used in the first embodiment is a flexible endoscope, and has an elongated inserting section  13  having flexibility, an enlarged-diameter operating section  14  provided at the rear end of the inserting section  13 , an ocular section  15  provided at the rear end of the operating section  14 , and a light guide cable  16  extended from a side portion of the operating section  14 . A connecting portion  17  provided at the end of the light guide cable  16  is removably connected to the light source device  3 .  
     [0032] The ultrasonic probe unit (ultrasonic vibration unit)  5  which is an ultrasonic therapeutic instrument for giving treatment using ultrasonic waves is incorporated in the channel  4  of the endoscope  2  in a positioned state. The ultrasonic probe unit  5  may also be useful for imaging. In this manner, the endoscope  2  and the ultrasonic probe unit  5  form an ultrasonic therapeutic apparatus body  18 .  
     [0033] The inserting section  13  of the endoscope  2  has a rigid distal tip part  21 , a bending part  22  bendably provided at the rear end of the distal tip part  21 , and an elongated flexible part  23  having flexibility which extends from the rear end of the bending part  22  to the front end of the operating section  14 . The bending part  22  may be articulated by a user with a bending operation knob (not shown) typically located on the operating section  14 , as is known in the endoscope arts.  
     [0034] The light source device  3  contains a lamp (not show), and illuminating light of the lamp is supplied to a light-guide end surface (not shown) in the inside of the connecting portion  17 . The illuminating light supplied to the light-guide end surface is transmitted to the distal tip part  21  of the endoscope  2  through a light guide  24  (for example, an optical fiber) in the interior of the light guide cable  16  and through a light guide (not shown) inserted through the inserting section  13 .  
     [0035] The light guide is divided into two light guides in the interior of the inserting section  13 , and the respective distal tips of the divided light guides are fixed on the insides of observing windows of the distal tip part  21 . Illuminating light transmitted through each of the divided light guides exits from its distal tip end surface, and this exiting light passes through the corresponding one of illuminating optical systems  25  (refer to FIG. 2B) which are disposed at the distal tip end surface in mutually opposed relationship, and exits forwardly from the endoscope  2  in a diffused manner. This exiting light illuminates a subject such as an affected area in a body cavity.  
     [0036] As shown in FIG. 2B, illuminating optical systems  25  are disposed on opposite sides of a front surface  28  of the distal tip part  21  of the endoscope  2 , and an objective optical system (observing optical system)  26  is disposed in the center between the illuminating optical systems  25 . An image of the subject illuminated via the illuminating optical systems  25  is formed by the objective optical system  26 . As shown in FIGS. 2A and 1, an image guide (for example, an optical fiber)  27  is fixed in a hole portion of the distal tip part body  28  via a connecting portion at an image-forming position of the objective optical system  26 .  
     [0037] The image guide  27  transmits an optical image to its rear end surface. The rear end surface of the image guide  27  is fixed in the vicinity of the front end of the ocular section  15 . The user observes the optical image transmitted to the rear end surface of the image guide  27 , at a magnified scale via an ocular optical system (not shown) of the ocular section  15 .  
     [0038] As shown in FIGS. 1 and 2A, the front end of a first ring-shaped bending piece  29  is fixed to the periphery of the rear end of the distal tip part body  28 . A second bending piece  29  is turnably connected to the rear end of the first bending piece  29 , and a third bending piece  29  is turnably connected to the rear end of the second bending piece  29 . In this manner, a plurality of bending pieces  29  are turnably connected in series to form the bending part  22 .  
     [0039] The user can bend the bending part  22  in a desired direction by operating the bending operating knob (not shown) provided in the operating section  14 . Incidentally, the length of the rigid distal tip part  21  is the length from the front end of the distal tip part body  28  to the rear end of the first bending piece  29 . The peripheries of the respective bending pieces  29  are covered with a covering tube  30  (for example, a rubber tube).  
     [0040] The channel  4  is formed by a hollow flexible tube  31  inserted through the inserting section  13 . The front end of the flexible tube  31  is fixedly connected to the rear end of a hole portion  32  formed in the distal tip part body  28 . The hole portion  32  serves as an exit opening of the channel  4 . The rear end of the channel  4  communicates with an inserting channel opening  33  near the rear end of the inserting section  13  (or the front end of the operating section  14 ).  
     [0041] A structure by which the ultrasonic probe unit  5  is incorporated will be described below. In the first embodiment, the ultrasonic probe unit  5  is incorporated in the channel  4  provided in the inserting section  13  of the endoscope  2 , to form part of the ultrasonic therapeutic apparatus body  18 . Accordingly, the ultrasonic therapeutic apparatus  1  has, in addition to a general endoscopic function, the function of giving treatment using ultrasonic waves.  
     [0042] Specifically, an ultrasonic vibrator  35  for generating ultrasonic waves for the ultrasonic probe unit  5  is mounted in the hole portion  32  (which serves as the exit opening of the channel  4 ) of the distal tip part body  28  of the inserting section  13 . The ultrasonic vibrator  35  is mounted on a disk-shaped flange portion  36 . The flange portion  36  is accommodated in the hole portion  32 , and is watertightly fixed (held) in position by being fastened by a nut  37 .  
     [0043] The ultrasonic vibrator  35  has a construction in which, for example, a plurality of disk-shaped Langevin type vibrators are stacked. The ultrasonic vibrator  35  is disposed between the flange portion  36  and a fastening member  38  (such as a screw), and is mounted to the flange portion  36  by being fastened by the fastening member  38 . The flange portion  36  to which the ultrasonic vibrator  35  is mounted is fitted in the hole portion  32  and is fixed in position by being fastened by the nut  37  having a periphery around which a thread portion is formed.  
     [0044] The flange portion  36  having an enlarged diameter is fitted in the inside wall of the hole portion  32  and is in abutment with a stepped surface. A thread is formed around the inside circumferential surface of the hole portion  32  on the front side of the stepped surface. The nut  37  having the periphery around which the thread portion to screw into the thread is formed is fastened to fix the flange portion  36  watertightly in position. In this manner, a structure is realized which prevents water from penetrating the ultrasonic vibrator  35  on the rear side of the flange portion  36 .  
     [0045] A horn (probe)  40  which serves as an ultrasonic wave transmitting portion (vibration transmitting portion) is fixed at its rear end surface to the front surface of the flange portion  36  by bonding or the like. Alternatively, the horn  40  can be integrally formed with the flange portion  36 .  
     [0046] In this manner, the flange portion  36  is at least a part of a holding member which holds the ultrasonic vibrator  35  and the horn (vibration transmitting portion)  40  at the distal tip end of the inserting section  13  of the ultrasonic therapeutic apparatus  1 .  
     [0047] In the first embodiment, the horn (probe)  40  has a conical shape which has a cross-sectional size larger at the rear end part than at its front end part so that the amplitude of vibration is increased and transmitted to the distal tip portion of the horn (probe)  40 .  
     [0048] An ultrasonic vibration is transmitted through the horn  40  to the distal tip portion thereof having a small area size, and the distal tip portion is brought into abutment with a therapeutic target tissue to give treatment such as ablating, cauterizing or emulsifying. In this manner, the distal tip portion of the horn  40  serves as a therapeutic section for giving treatment using ultrasonic waves.  
     [0049] The length from the ultrasonic vibrator  35  to the distal tip of the horn  40  is set (the length of the horn  40  is adjusted) to a quarter wavelength of an ultrasonic vibration to be used, so that the ultrasonic vibration generated by the ultrasonic vibrator  35  can vibrate the distal tip portion of the horn  40  with high efficiency. In this case, a node of vibration appears at the flange portion  36  at the rear end of the horn  40 , and a loop of vibration appears at the distal tip end of the horn  40 .  
     [0050] In the first embodiment, as shown in FIGS. 1 and 2A, the ultrasonic vibrator  35  and the like are disposed in the hole portion  32  which serves as the exit opening of the channel  4  adjacent to the objective optical system  26 , so that the distal tip-end side of the horn  40  enters the observing field of view of the objective optical system  26 .  
     [0051] The fastening member  38 , the ultrasonic vibrator  35 , the flange portion  36  and the horn  40  have a hollow structure, and form a suction passage  41  through which to suck unnecessary tissues and the like resulting from a treatment such as ablating, cauterizing or emulsifying with the distal tip of the horn  40 . The suction passage  41  communicates with the tube  9  fixedly connected to a connecting portion of the fastening member  38 . This tube  9  is inserted through the channel  4  and is extended outwardly from the inserting channel opening  33 .  
     [0052] The signal cable  6  is connected to electrodes on the surface of the ultrasonic vibrator  35 . The signal cable  6  is inserted through the channel  4  and is extended outwardly from the inserting channel opening  33 . The electrical connector  7  provided at the rear end of the signal cable  6  is connected to the ultrasonic driving device  8 . When a foot switch (not shown) or the like is operated, a driving signal is applied to the ultrasonic vibrator  35  from the ultrasonic driving device  8 , whereby ultrasonic waves can be generated by the ultrasonic vibrator  35 .  
     [0053] In this manner, in the first embodiment, an ultrasonic vibration system part in the ultrasonic probe unit  5  is disposed in the interior of the channel  4  in the rigid distal tip part  21  of the inserting section  13 , and is incorporated in the endoscope  2  in such a manner as to be watertightly fixed in position in advance. However, the distal tip portion of the horn  40  protrudes from the distal tip part  21  so that the distal tip-end side of the horn  40  enters the observing field of view of the objective optical system  26 . In this construction, the user does not need an awkward process such as the process of inserting an ultrasonic probe unit into a channel and positioning a therapeutic section so that the therapeutic section can be observed in the field of view.  
     [0054] In addition, according to the first embodiment, merely by slightly modifying the construction of a front end portion of a channel in a general endoscope, it is possible to realize the endoscope  2  (or the ultrasonic therapeutic apparatus body  18 ) in which the ultrasonic probe unit  5  according to the first embodiment is incorporated.  
     [0055] Namely, the ultrasonic therapeutic apparatus body  18  according to the first embodiment can be realized by providing a portion for fixing the ultrasonic vibrator  35  (in the first embodiment, the hole portion  32  having the threaded inside surface) in an exit opening of a channel of a general endoscope, and fixing the ultrasonic vibrator  35  in the portion. Contrarily, as is apparent from FIG. 1, a general endoscope provided with a channel can be obtained if the thread is omitted from the hole portion  32  which serves as the exit opening of the channel  4  in which the ultrasonic vibrator  35  and the like are fixed, and if the ultrasonic vibrator  35  and the like are removed and the tube  9  and the like are removed from the channel  4 . Therefore, according to the first embodiment, the ultrasonic therapeutic apparatus body  18  having an ultrasonic therapeutic function can be easily converted from an ordinary endoscope and vice versa. Accordingly, the manufacturing cost of the ultrasonic therapeutic apparatus can be reduced.  
     [0056] The operation of the first embodiment will be described below. The user inserts the inserting section  13  of the endoscope  2  into a body cavity, and, while observing through the ocular section  15 , disposes the distal tip end of the horn  40  on an therapeutic site to be treated with ultrasonic waves. Then, the user operates operating means (not shown) for generating ultrasonic waves (for example, a foot switch or a hand switch), to apply a driving signal to the ultrasonic vibrator  35  from the ultrasonic driving device  8 . Accordingly, the driving signal is converted to a mechanical vibration by the ultrasonic vibrator  35 , and the thus-obtained ultrasonic vibration is transmitted to the distal tip-end side of the horn  40 . In this manner, the user gives treatment such as ablation, cauterization, emulsification or the like to a living tissue by means of ultrasonic vibration under endoscopic observation.  
     [0057] In addition, the user can suck and collect ablated/cauterized/emulsified unnecessary tissues by activating the suction device  11 .  
     [0058] The first embodiment has many advantages, including the following. According to the first embodiment, since the ultrasonic probe unit  5  is previously incorporated in the endoscope  2 , the user does not need to perform the process of incorporating an ultrasonic probe unit before an operation or the like. Accordingly, the user does not need to perform the processes required in the related art, such as the process of disposing an ultrasonic probe so that the distal tip end thereof faces the inside of the observing field of view of an endoscope, and the complicated process of inserting an ultrasonic probe into a channel.  
     [0059] Accordingly, since it is not necessary to perform the process of inserting an elongated ultrasonic probe or the like into a channel before and/or during an operation, it is possible to ease stress which an operator and/or one responsible for preparation of equipment and materials may experience during the process.  
     [0060] Particularly in the case of a flexible endoscope such as the endoscope  2  according to the first embodiment, it is not necessary to perform the process of inserting a flexible ultrasonic probe, unlike the related art that needs such a difficult process.  
     [0061] In the case of the flexible endoscope according to the first embodiment, since the ultrasonic vibration system is disposed in the interior of the rigid distal tip part  21 , even if an ultrasonic vibration system is made to generate a vibration when a portion following the bending part  22  is bent, stresses can be prevented from being applied to the ultrasonic vibration system, whereby it is possible to improve the durability thereof. Therefore, it is possible to improve the reliability of the ultrasonic vibration system. In addition, the ultrasonic therapeutic apparatus has a structure which makes it possible to easily incorporate the ultrasonic probe unit  5  merely by making a small modification to a flexible endoscope provided with a general channel, whereby it is possible to reduce the manufacturing cost of the ultrasonic therapeutic apparatus.  
     [0062] In addition, repair and maintenance of the ultrasonic probe unit  5  are facilitated. Namely, the ultrasonic probe unit  5  can be comparatively easily removed by removing the nut  37 . Accordingly, repair and maintenance of the ultrasonic probe unit  5  can be easily performed. Therefore, it is possible to reduce the costs of repair and maintenance. In addition, the ultrasonic therapeutic apparatus according to the first embodiment can be used as a general endoscope if the ultrasonic probe unit  5 , the signal cable  6  and the tube  9  are removed.  
     [0063] Incidentally, in the first embodiment, the flange portion  36  of the ultrasonic vibrator  35  is fixedly screwed into the hole portion  32  of the distal tip part body  28 , but this fixing method is not to be construed as limitative. For example, a vibrator mounting frame (not shown) having a threaded inside circumferential surface may be fixed to the inside of the hole portion  32  by bonding or the like. Incidentally, the first embodiment has been described above with reference to the flexible endoscope having a construction in which the inserting section  13  is flexible, but can also be applied to a rigid endoscope having a rigid inserting section.  
     [0064] A second embodiment of the invention will be described below with reference to FIG. 3. According to the second embodiment, in the ultrasonic therapeutic apparatus according to the first embodiment, the ultrasonic vibrator  35  is made solid (no sucking space is provided), and a hook-shaped portion is formed in the distal tip portion of the horn  40 .  
     [0065]FIG. 3 shows the structure of the distal tip-end side of the ultrasonic therapeutic apparatus body  18  according to the second embodiment. In the second embodiment, an ultrasonic probe unit  5 B is used in place of the ultrasonic probe unit  5  of the first embodiment.  
     [0066] As shown in FIG. 3, in the ultrasonic probe unit  5 B, the ultrasonic vibrator  35  and the like are solid (no sucking space is provided), and a hook-shaped portion is formed in the distal tip portion of the horn  40 . In addition, the ultrasonic therapeutic apparatus according to the second embodiment has a structure in which the suction passage  41  is not formed, because the ultrasonic vibrator  35  is solid. The other constituent elements are the same in structure as the corresponding ones of the first embodiment. Therefore, in FIG. 3, the same reference numerals are used to denote the same constituent elements as those described previously in connection with the first embodiment, and the description of the same constituent elements is herein omitted.  
     [0067] The operation of the second embodiment will be described below. According to the second embodiment, the user can perform treatment such as coagulation or incision of a tissue by using ultrasonic waves with a hook-shaped portion  45  hooked on the tissue at a therapeutic site.  
     [0068] Incidentally, the distal tip portion of the horn  40  may be formed in various other shapes. For example, as shown in FIG. 4, a spatula-shaped portion  46  may also be formed. Incidentally, the horns  40  shown in FIGS. 3 and 4 may also be hollow to provide sucking as described above.  
     [0069] The other operation of the second embodiment is the same as that of the first embodiment, except that suction is provided through the horn  40 .  
     [0070] A third embodiment of the invention will be described below with reference to FIG. 5. In the ultrasonic therapeutic apparatus according to the third embodiment, the horn  40  is constructed to allow various kinds of probe members to be interchangeably attached to the distal tip portion of the horn  40  so that a probe member suitable for a particular use can be selected. FIG. 5 shows the structure of the distal tip part  21  of an ultrasonic therapeutic apparatus body according to the third embodiment. According to the third embodiment, in the ultrasonic therapeutic apparatus according to the first embodiment, the construction of part of the horn  40  provided on the front side of the ultrasonic probe unit  5  is modified into an ultrasonic probe unit  5 C capable of forming an ultrasonic therapeutic system suitable for the use of each individual treatment.  
     [0071] The shape of the distal tip part  21  (of the endoscope  2 ) shown in FIG. 5 is such that the distal tip-end side of the horn (or probe)  40  is cut to shorten the horn  40  and an internal thread portion  51  is formed in the distal tip end of the shortened horn  40 . Various kinds of (ultrasonic) therapeutic probe members  52 ,  53  and  54  suitable for individual therapeutic uses can be selectively employed in such a manner that an external thread portion  55  formed at the rear end of a selected one of the therapeutic probe members  52 ,  53  and  54  is fitted in the internal thread portion  51 .  
     [0072] Each of the therapeutic probe members  52 ,  53  and  54  will be described below. The therapeutic probe member  52  has a hollow passage  56 , and the external thread portion  55  at the rear end of the therapeutic probe member  52  can be screwed into the internal thread portion  51  to constitute an ultrasonic probe unit having a function similar to the ultrasonic probe unit  5  of the first embodiment. The therapeutic probe member  53  is solid, and has the hook-shaped portion  45  provided in its therapeutic distal tip portion as described above in connection with the second embodiment. In addition, the therapeutic probe member  54  has the spatula-shaped portion  46  provided in its therapeutic distal tip portion as shown in FIG. 4.  
     [0073] In the case where a selected one of these therapeutic probe members  52 ,  53  and  54  is fitted in the internal thread portion  51 , the length from the ultrasonic vibrator  35  to the distal tip of the selected one of the therapeutic probe members  52 ,  53  and  54  is set to a quarter length of the wavelength of an ultrasonic vibration to be used, as described above in connection with the first embodiment. In this case, the length is set so that a node of vibration appears near the flange portion  36  and a loop of vibration appears near the distal tip end of the selected one of the therapeutic probe members  52 ,  53  and  54 , and it is desirable that the internal thread portion  51  intermediate between the flange portion  36  and the distal tip end of the selected one of the therapeutic probe members  52 ,  53  and  54  be closer to the node than to the loop. In the case where the length of the rigid distal tip part  21  is large, the position of the internal thread portion  51  may be made coincident with the node of vibration by using the setting of a quarter wavelength+a half wavelength, instead of by using the above-described quarter wavelength. The other constituent elements of the second embodiment are similar in construction to the corresponding ones of the first embodiment.  
     [0074] The operation of the third embodiment will be described below. The user connects a desired one of the therapeutic probe members  52 ,  53  and  54  to the distal tip of the horn  40  according to a therapeutic use, and inserts the inserting section  13  of the endoscope  2  into a body cavity. During an operation, if a change occurs in the therapeutic use, the user draws out the endoscope  2  and replaces the selected one with another of the therapeutic probe members  52 ,  53  and  54 . The other operation of the third embodiment is basically the same as that of the first embodiment.  
     [0075] The third embodiment has the following advantages in addition to the advantages of the first embodiment. Namely, it is possible to optimally select and replace the therapeutic probe members  52 ,  53  and  54  according to various therapeutic uses, whereby various treatments can be given by one ultrasonic therapeutic apparatus.  
     [0076] A fourth embodiment of the invention will be described below with reference to FIG. 6. In the fourth embodiment, the horn  40  is capable of being rotated about its central axis, and the entire horn  40  is capable of being accommodated into the endoscope  2  during insertion of the endoscope  2 .  
     [0077]FIG. 6 shows the structure of the distal tip-end side of the ultrasonic therapeutic apparatus body  18  according to the fourth embodiment. In the fourth embodiment, an ultrasonic probe unit  5 D in which the vicinity of a fixing portion of the ultrasonic vibrator  35  is modified is used in place of the ultrasonic probe unit  5 B of the second embodiment.  
     [0078] As shown in FIG. 6, the flange portion  36  at the rear end of the horn  40  of the ultrasonic vibrator  35  is fixed to a rotating and moving member (hereinafter referred to as a rotating member)  61  which has an approximately ring-like shape and is capable of being rotated and moved, by being fastened by the nut  37  which is screwed into the rotating member  61 . An O-ring  62  is fitted in a circumferential groove formed around the periphery of the rotating member  61 , and a hollow portion (enlarged-diameter portion)  63  is provided in the inside circumferential surface of the hole portion  32  of the distal tip part body  28  (of the endoscope  2 ) so that the hollow portion  63  becomes larger in diameter than the inside circumferential surface of the hole portion  32 . The O-ring  62  is engaged with the hollow portion (enlarged-diameter portion)  63  in the state of causing frictional forces to act therebetween and in the state of holding a watertight function.  
     [0079] The hollow portion  63  is formed to extend by a predetermined length in the axial direction. Wires  64  which serve as a transmission member for transmitting rotation and movement are connected to the rotating member  61  at their front ends, and these wires  64  pass through the channel  4  and are connected to a rotation and movement operating member  65  on the operating-section side of the endoscope  2 .  
     [0080] The rotation and movement operating member  65  has a disk  66  to which the wires  64  are fixed at their rear ends and an operating knob  67  secured to the center shaft of the disk  66 . When the operating knob  67  is rotated, the rotating member  61  can be rotated, and when the operating knob  67  is moved back and forth (in FIG. 6, rightwardly and leftwardly), the rotating member  61  can be moved back and forth in the axial direction within the hollow portion  63 . The other constituent elements of the fourth embodiment are basically the same in construction as the corresponding ones of the first embodiment.  
     [0081] The operation of the fourth embodiment will be described below. When the user rotationally operates the rotation and movement operating member  65  provided on the operating-section side of the endoscope  2 , the wires  64  are interclockingly driven and the rotating member  61  is rotationally driven against the sliding friction of the O-ring  62 . As a result, the ultrasonic vibrator  35  fixed to the rotating member  61  is rotationally operated.  
     [0082] In addition, when the user operates the rotation and movement operating member  65  to move it back and forth, the rotating member  61  is moved back and forth in the axial direction within the range of the predetermined length of the hollow portion  63 . In this manner, the ultrasonic vibrator  35  fixed to the rotating member  61  is operated to move back and forth.  
     [0083] The axial length of the hollow portion  63  is selected so that when the rotating member  61  is moved back to the closest position to the operating-section side, the distal tip portion of the horn  40  connected to the ultrasonic vibrator  35  is accommodated into the hole portion  32  which serves as the exit opening of the channel  4 . This state is shown by solid lines in FIG. 6.  
     [0084] When the user is to insert or draw out the distal tip part  21  of the endoscope  2  into or from a body cavity, the distal tip portion of the horn  40  connected to the ultrasonic vibrator  35  is set to the state of being accommodated in the hole portion  32  which serves as the exit opening of the channel  4  as shown by two dot-dash lines in FIG. 6. When the user is to perform treatment using ultrasonic waves, the user protrudes the therapeutic section (in this case, the hook-shaped portion  45 ) provided in the distal tip portion of the horn  40 , from the hole portion  32  as shown by the solid lines in FIG. 6, and places the distal tip portion into the observing field of view and performs treatment using ultrasonic waves, as by rotating the distal tip portion to an angle suitable for incision or the like.  
     [0085] The other operation is the same as those of the second embodiment.  
     [0086] The fourth embodiment has the following advantages in addition to the advantages of the first and second embodiments. Namely, since the distal tip portion of the horn  40  of the ultrasonic vibrator  35  can be rotationally driven, it is possible to realize a far more accurate approach to a therapeutic section. Accordingly, an operator can easily give treatments, and can perform high-quality treatments. In addition, in the case where the ultrasonic therapeutic apparatus is used in combination with a flexible endoscope, the advantage of the fourth embodiment can be doubled when the fourth embodiment is used in combination with the bending operation of the flexible endoscope.  
     [0087] In addition, since the horn  40  can be slid in the axial direction to retract the distal tip portion of the horn  40  into the channel  4  when no treatment is being performed, the inserting section  13  of the endoscope  2  can be made to approach a therapeutic section far more easily during the insertion of the inserting section  13  into a body cavity, whereby during the insertion, the horn  40  of the ultrasonic therapeutic apparatus does not enter the observing field of view so that the user can ensure a clear observing field of view.  
     [0088] Incidentally, in the fourth embodiment, the distal tip portion of the horn (or probe)  40  has the hook-shaped portion  45 , but the shape of the distal tip portion of the horn  40  is not limited to only a hook-like shape. For example, the spatula-shaped portion  46  may be used, and a construction in which various therapeutic probe members having different kinds of distal tip shapes can be removably attached as described above in the third embodiment may also be used.  
     [0089] A fifth embodiment of the invention will be described below with reference to FIG. 7. The fifth embodiment has the feature that the horn  40  can be tilted, in addition to the feature of the fourth embodiment.  
     [0090]FIG. 7 shows the structure of the distal tip-end side of the ultrasonic therapeutic apparatus body  18  according to the fifth embodiment. In the fifth embodiment, an ultrasonic probe unit  5 E which is a modification of the ultrasonic probe unit  5 D of the fourth embodiment is used in place of the ultrasonic probe unit  5 D. The ultrasonic probe unit  5 E basically uses a joint member  71  capable of tilting more than the rotating member  61  shown in FIG. 6, and is constructed to enable tilting operations to be performed on the operating-section side.  
     [0091] As shown in FIG. 7, the flange portion  36  to which the ultrasonic vibrator  35  is fixedly connected is fixed to the joint member  71 . The joint member  71  has an approximately ring-like shape, and its peripheral surface is formed as a spherical portion  72 . This spherical portion  72  is watertightly engaged with the hollow portion  63  provided in the hole portion  32  which forms the exit opening  32  of the channel  4 .  
     [0092] The hollow portion  63  is formed to extend by a predetermined length in the axial direction. Wires  73  (for example, four wires) which also effect joint driving are connected to the joint member  71 , and these wires  73  pass through the channel  4  and are connected to a joint operating section (not shown) on the operating-section side of the endoscope  2 . The joint operating section includes means for tiltably supporting the disk  66  in the rotation and movement operating member  65  shown in FIG. 6, and enables the user to perform the operation of tilting the operating knob  67 . The user can tilt the joint member  71  in various directions, such as upward, downward, rightward and leftward, by performing the operation of tilting the operating knob  67 .  
     [0093] The axial length of the hollow portion  63  is selected so that when the rotating member  71  is moved back to the closest position to the operating-section side, the distal tip portion of the horn  40  connected to the ultrasonic vibrator  35  is accommodated into the channel  4 . The other constituent elements are the same in structure as the corresponding ones of the first embodiment.  
     [0094] The operation of the fifth embodiment will be described below. When the user operates the joint operating section to perform the operation of alternately pulling and pushing the wires  73  which also effect joint driving, the joint member  71  is driven to tilt through the operation of the spherical portion  72  of the joint member  71 . In this manner, the flange portion  36  and the ultrasonic vibrator  35  which are fixed to the joint member  71  are tilted. Accordingly, the distal tip portion of the horn  40  connected at the rear end to the flange portion  36  is tilted as indicated by the crossed arrows in FIG. 7.  
     [0095] The other operation is the same as that of the fourth embodiment. As described above in connection with the fourth embodiment in particular, the hollow portion  63  has the predetermined axial length, and when the user operates joint operating means to move the joint member  71 , the joint member  71  is moved back and forth in the axial direction within the range of the hollow portion  63 , whereby the ultrasonic vibrator  35  and the horn  40  are moved back and forth. Similarly, the user can rotate the ultrasonic vibrator  35  and the horn  40  by rotationally operating the joint operating means.  
     [0096] The fifth embodiment has the following advantage in addition to the advantages of the first and fourth embodiments. Namely, the distal tip portion of the horn  40  of the ultrasonic vibrator  35  can be driven to tilt in a larger number of arbitrary directions than those in the fourth embodiment, whereby the above-described advantage of the fourth embodiment is further improved. In addition, it is possible to realize not only ultrasonic treatment but also blunt peeling or the like using the distal tip portion of the horn  40  connected to the ultrasonic vibrator  35 .  
     [0097] Incidentally, in the fifth embodiment, the distal tip portion of the horn  40  connected to the ultrasonic vibrator  35  has the spatula-shaped portion  46 , but the shape of the distal tip portion of the horn  40  is not limited to only a spatula-like shape. For example, the hook-shaped portion  45  or the hollow shape described above in connection with the first embodiment may be used, and a construction in which various therapeutic probe members having different kinds of distal tip shapes can be removably attached as described above in the third embodiment may also be used.  
     [0098] A sixth embodiment of the invention will be described below with reference to FIGS.  8  to  10 . The sixth embodiment has, in addition to the feature of the fifth embodiment, the feature that the distal tip part body  28  of the endoscope  2  is provided with a jaw so that a living tissue or the like can be grasped between a tiltable horn and the jaw.  
     [0099]FIG. 8 shows the structure of the distal tip-end side of the ultrasonic therapeutic apparatus body  18  according to the sixth embodiment, FIG. 9 shows in perspective view the distal tip-end side shown in FIG. 8, and FIG. 10 shows an example of the observing field of view of the ultrasonic therapeutic apparatus body  18 . In the sixth embodiment, an ultrasonic probe unit  5 F which is a modification of the ultrasonic probe unit  5 E of the fifth embodiment is used in place of the ultrasonic probe unit  5 E.  
     [0100] The sixth embodiment has a basic construction in which, as shown in FIG. 8, a jaw  81  is provided on the distal tip part body  28  so that a living tissue or the like can be treated in the state of being clamped between the distal tip portion of the rod-shaped tiltable horn  40  and the jaw  81 .  
     [0101] As shown in FIGS. 8 and 9, when no tilting operation is being performed, a central axis (Z) which passes through the center of the ultrasonic vibrator  35  and the center of the horn  40  connected thereto is arranged to extend along the optical axis of the objective optical system  26  (i.e., along the axis of the cylindrical distal tip part  21  of the endoscope  2 ).  
     [0102] As shown in FIG. 9, during this state, at the distal tip end surface, the center of the objective optical system  26  is arranged so that the center of the horn  40  is positioned on an axis (Y) crossing the optical axis of the horn  40  at right angles.  
     [0103] Furthermore, the approximately plate-shaped jaw  81  is arranged to protrude from the distal tip end surface along the central axis Z at a position spaced apart from the central axis Z of the horn  40  along an axis (X) crossing the axis Y at right angles.  
     [0104] A hollow portion whose shape corresponds to, for example, the shape of the distal tip-end side of the horn  40  is formed on the surface of the jaw  81  that is opposed to the horn  40 , in such a manner that the hollow portion extends along the center line of the surface. Corrugated portions are respectively formed on the opposite sides of the hollow portion so that a tissue can be clamped firmly between the jaw  81  and the horn  40 . This jaw  81  is formed of a low-friction and heat-resistance material such as a fluororesin (for example, Teflon®). The other constituent elements are the same in construction as the corresponding one of the fifth embodiment.  
     [0105] The operation of the sixth embodiment will be described below. As shown in FIG. 10, the user puts the distal tip portion of the horn  40  and the jaw  81  close to a therapeutic site to be treated, while observing an image  40 ′ of the distal tip portion of the horn  40  and an image  81 ′ of the jaw  81 . Then, the user clamps a tissue of the therapeutic site between the distal tip portion of the horn  40  and the jaw  81 .  
     [0106] In this case, similarly to the case of the fifth embodiment, the joint member  71  is tilted like a joint by the operation of the joint operating means, and the distal tip portion of the horn  40  is tilted toward the jaw  81  to grasp the tissue between the distal tip portion of the horn  40  and the jaw  81 .  
     [0107] Then, the user performs the operation of generating ultrasonic waves, to generate frictional heat due to vibration so that the grasped tissue can be coagulated and/or incised.  
     [0108] In this manner, the sixth embodiment serves, in addition to the advantages of the above-described first to fifth embodiments, the advantage that the user can perform treatments such as coagulation and incision on a therapeutic tissue far more reliably and easily, by clamping the therapeutic tissue.  
     [0109] A seventh embodiment of the invention will be described below with reference to FIG. 11. In the seventh embodiment, small holes are provided in the peripheral wall of the horn  40  of the ultrasonic therapeutic apparatus according to the first embodiment, thereby enabling collection of a mist.  
     [0110]FIG. 11 shows the structure of the distal tip-end side of the ultrasonic therapeutic apparatus body  18  according to the seventh embodiment. The seventh embodiment provides an example in which the ultrasonic vibrator  35  of the first embodiment is improved.  
     [0111] As shown in FIG. 11, the horn  40  connected to the ultrasonic vibrator  35  has at least one small hole  82  on the distal tip side from the flange portion  36 , and the at least one small hole  82  communicates with the hollow suction passage  41 . The at least one small hole  82  is disposed at a position opposed to the objective optical system  26 . The other constituent elements are the same in construction as the corresponding ones of the first embodiment.  
     [0112] The operation of the seventh embodiment will be described below. During ultrasonic treatment, in the case where moisture neighboring a tissue is scattered as mist, the mist is sucked and collected through the small hole  82 .  
     [0113] The seventh embodiment serves the following advantage in addition to the advantage of the first embodiment. Namely, since mist can be collected, a far better field of view can be secured.  
     [0114] In the case where the seventh embodiment is combined with cleaning means for the objective optical system  26  of the endoscope  2 , it is possible to automatically suck and collect a cleaning liquid, whereby it is not only possible to secure a far better field of view, but it is also possible to omit a suction operation and improve the operability of an operator. Furthermore, since it is possible to suck and circulate air surrounding the objective optical system  26 , it is possible to prevent a fog from occurring on the objective optical system  26 . Incidentally, the invention further encompasses other embodiments which are formed by combining part of the above-described embodiments.  
     [0115] As is apparent from the foregoing description, according to each of the first to seventh embodiments, since an ultrasonic vibration is contained in an endoscope, it is possible to omit the process of positioning an ultrasonic therapeutic instrument at the distal tip end of the endoscope and the process of inserting the ultrasonic therapeutic instrument through a channel.  
     [0116] Furthermore, since the process of positioning an observing optical system in an observing field of view is not needed, the difficult and trouble some process of inserting the ultrasonic therapeutic instrument can be eliminated to enable an operator and the like to avoid stress due to such an inserting process. In addition, when the ultrasonic vibrator is combined with a flexible endoscope, no stress is applied to an ultrasonic vibration system, whereby it is possible to realize an ultrasonic therapeutic apparatus which is highly durable and hence highly reliable.  
     [0117] While there has been shown and described what is considered to be preferred embodiments of the invention, it will, of course, be understood that various modifications and changes in form or detail could readily be made without departing from the spirit of the invention. It is therefore intended that the invention be not limited to the exact forms described and illustrated, but should be constructed to cover all modifications that may fall within the scope of the appended claims.