Patent Description:
In the related art, an inspection method which is referred to as a biopsy and includes collecting a small amount of body tissue and observing the body tissue using a microscope is known. In case of collecting tissue of the deep portion of an organ or the like, since an observation by using an optical endoscope is difficult, ultrasonic tomographic images of an organ are acquired by using an ultrasonic endoscope or the like, and tissue is collected by piercing a puncture needle having a tubular needle tube into the organ under ultrasonic observation in some cases.

For example, a puncture needle device in which an outer needle and an inner needle are arranged in a sheath that can be inserted into a treatment tool channel of an ultrasonic endoscope or the like is disclosed in Patent Document <NUM>. Since the puncture needle device disclosed in Patent Document <NUM> is provided with the sheath, an inner surface of the treatment tool channel is not easily damaged by sharp distal ends of the outer needle and the inner needle.

A puncture needle that is used while being inserted into an endoscope is required to be able to be bent and deformed by the endoscope and to hardly buckle inside the endoscope. For example, a puncture needle device in which an outer cylindrical tube having excellent flexibility and an inner cylindrical tube that is harder than the outer cylindrical tube are installed substantially coaxially with each other and a puncture needle is inserted into the inner cylindrical tube is disclosed in Patent Document <NUM>.

In the puncture needle device disclosed in Patent Document <NUM>, it is disclosed that a main component of the outer cylindrical tube is polytetrafluoroethylene (PTFE), and a main component of the inner cylindrical tube is polyether ether ketone (PEEK).

As a further example, Patent Document <NUM> discloses an ultrasonic endoscope including a treatment instrument insertion channel through which a treatment instrument such as a puncture treatment tool is inserted. More specifically, the puncture treatment tool includes a puncture needle having a sharp distal end, which is inserted through a flexible guide tube. Moreover, a hard tubular lead-out portion is provided at the distal end of the guide tube for directing the puncture needle in a predetermined direction.

In the ultrasonic endoscope disclosed in Patent Document <NUM>, an outer needle, an inner needle, and a sheath are deformed in a bent shape by using a raising base which changes a direction of the outer needle, the inner needle, and the sheath. Also, the puncture needle device disclosed in Patent Document <NUM> is constituted such that the needles are moved with respect to the sheath while the needles and the sheath are deformed in the bent shape by the raising base so that one of the needles is pierced into an organ. Since the puncture needle device disclosed in Patent Document <NUM> is similarly used for treatment by combining the puncture needle device with an endoscope, a case in which the outer cylindrical tube, the inner cylindrical tube, and the puncture needle are deformed in the bent shape and the puncture needle is advanced and retracted in the inner cylindrical tube in the bent state is considered.

In techniques disclosed in Patent Documents <NUM> and <NUM>, when the sheath or the inner cylindrical tube (hereinafter referred to as the "sheath or the like") is deformed in the bent shape with a small curvature radius (a large curvature), the outer needle or the inner needle disclosed in Patent Document <NUM> or the puncture needle disclosed in Patent Document <NUM> is likely to be punctured to an inner surface of the sheath or the like.

The present invention was made in view of the above-described circumstances, and an object of the present invention is to provide an endoscope puncture needle and a biopsy system in which, even if a sheath or the like is deformed in a bent shape with a small curvature radius, a needle is hardly punctured to an inner surface of the sheath or the like and the needle is easily inserted into a channel of an endoscope.

An endoscope puncture needle according to a first aspect of the present invention includes the features of claim <NUM>.

An endoscope puncture needle according a further aspect includes the features of claim <NUM>.

In the endoscope puncture needle according to the first aspect, the operation section may include an attachment adapter which slidably supports the operation main body and is attachable to the endoscope, a distal end of the outer sheath may be arranged at more distal position than a proximal end of an active bending section when the attachment adapter is attached to the endoscope, the active bending section deforming the channel to a bent shape, and the distal-end-side inner tube may be arranged inside the outer sheath along a central line of the outer sheath in a range from the proximal end of the active bending section to the distal end of the outer sheath.

In the endoscope puncture needle according to the first aspect, the operation section may include an attachment adapter slidably supporting the operation main body and being attachable to the endoscope, a distal end of the outer sheath may be arranged at more distal position than a proximal end of a raising base of the endoscope when the attachment adapter is attached to the endoscope, and the distal-end-side inner tube may be arranged inside the outer sheath along a central line of the outer sheath in a range from the proximal end of the raising base to the distal end of the outer sheath.

In the endoscope puncture needle according to the first aspect, the operation section may include an attachment adapter slidably supporting the operation main body and being attachable to the endoscope, a distal end of the outer sheath may be arranged at more distal position than a proximal end of a pipeline-shaped slope section being inclined with respect to a central axis of the channel of the endoscope when the attachment adapter is attached to the endoscope, and the distal-end-side inner tube may be arranged inside the outer sheath along a central line of the outer sheath in a range from the proximal end of the slope section to the distal end of the outer sheath.

In the endoscope puncture needle according to the first aspect, the operation section may include an attachment adapter slidably supporting the operation main body and being attachable to the endoscope, when the attachment adapter is attached to the endoscope, a distal end of the outer sheath may be located at more distal position than a proximal end of a raising base of the endoscope, and a proximal end of the distal-end-side inner tube may be located at more proximal position of the outer sheath than the proximal end of the raising base, and a distal end of the proximal-end-side inner tube may be located inside the outer sheath which is bent by an active bending section of the endoscope.

In the endoscope puncture needle according to the first aspect, Shore hardness of an inner surface of the distal-end-side inner tube may be higher than Shore hardness of an inner surface of the proximal-end-side inner tube.

A biopsy system includes the features of claim <NUM>. Specifically, the biopsy system includes: an endoscope provided with a channel through which a treatment tool is capable of being inserted and a bending application section by which the treatment tool in the channel is bent; and an endoscope puncture needle being attachable to the endoscope. The endoscope puncture needle may include: an outer sheath being insertable into a channel of an endoscope and has a coil shape; a needle tube having a needle tip arranged inside the outer sheath; an operation section being connected to a proximal end of the outer sheath and advances and retracts the needle tube with respect to the outer sheath; a proximal-end-side inner tube arranged at an inside of a proximal end section of the outer sheath and made of plastics; and a istal-end-side inner tube arranged at an inside of a distal end section of the outer sheath, through which the needle tube is insertable, and made of plastics, the distal-end-side inner tube having an inner circumferential surface that is relatively harder than the proximal-end-side inner tube. The operation section may include: an operation main body connected to the proximal end of the outer sheath; a needle slider connected to a proximal end of the needle tube and is provided to be movable along a longitudinal axis of the operation main body with respect to the operation main body; and an engaging mechanism in which the needle slider is engaged to the operation main body in a longitudinal axial direction of the operation main body when the needle slider is moved closest to a proximal end side along the longitudinal axis with respect to the operation main body. A distal end of the needle tube is arranged inside the distal-end-side inner tube when the needle slider is engaged to the operation main body.

According to the endoscope puncture needle system according to the present invention, a needle tip is hardly punctured to an inner surface of a distal-end-side inner tube in a moving region of a distal end of a needle tube, and the needle tube and a sheath can be easily inserted into the channel even if a channel of an endoscope is bent.

An example of the present invention will be described, exemplifying a biopsy system provided with an endoscope puncture needle according to this embodiment. <FIG> is an overall diagram of a biopsy system provided with an endoscope puncture needle according to this embodiment. <FIG> is a cross-sectional view of a distal end portion of an ultrasonic endoscope in the biopsy system according to this embodiment. <FIG> is a perspective view of an endoscope puncture needle. <FIG> is a cross-sectional view of a distal end portion of the endoscope puncture needle. <FIG> is a schematic cross-sectional view of an operation section of the endoscope puncture needle.

A biopsy system <NUM> according to this embodiment shown in <FIG> is a medical instrument (a biopsy needle) capable of being used for a biopsy in which tissue in a body is collected. The biopsy system <NUM> is provided with an ultrasonic endoscope <NUM> and an endoscope puncture needle <NUM> (hereinafter simply referred to as a "puncture needle <NUM>").

As shown in <FIG>, the ultrasonic endoscope <NUM> is provided with an insertion section <NUM>, an operation section <NUM>, a universal cord <NUM>, an optical source apparatus <NUM>, an optical observation unit <NUM>, and an ultrasonic observation unit <NUM>. The insertion section <NUM> is inserted into a body from a distal end. The operation section <NUM> is attached to a proximal end of the insertion section <NUM>. A first end of the universal cord <NUM> is connected to a lateral section of the operation section <NUM>. A second end of the universal cord <NUM> is connected to the optical source apparatus <NUM> via a branching cable 112a, is connected to the optical observation unit <NUM> via a branching cable 112b, and is connected to the ultrasonic observation unit <NUM> via a branching cable 112c.

A distal end rigid section <NUM>, an active bending section <NUM>, and a flexible tube section <NUM> are provided at the insertion section <NUM> and are arranged in this order from a distal end side.

As shown in <FIG>, the distal end rigid section <NUM> is provided with an optical imaging mechanism <NUM>, an ultrasonic scanning mechanism <NUM>, and a raising base <NUM>. The optical imaging mechanism <NUM> is provided to perform optical observation. The ultrasonic scanning mechanism <NUM> is provided to perform ultrasonic observation. The raising base <NUM> is provided to adjust a direction of the puncture needle <NUM> inserted into a channel <NUM> which will be described below.

The optical imaging mechanism <NUM> is provided with an imaging optical system, an image sensor, and various constitutions (not shown) such as a central processing unit (CPU) which controls an operation of the image sensor. In the imaging optical system, a field of vision is directed diagonally in front of the distal end rigid section <NUM>. The image sensor is constituted by a charge coupled device (CCD), a complementary metal oxide semiconductor (CMOS), or the like which detects an image of a subject which is incident through the imaging optical system.

The ultrasonic scanning mechanism (a probe) <NUM> is provided with an ultrasonic wave vibrator (not shown) which emits and receives ultrasonic waves. The ultrasonic scanning mechanism <NUM> receives reflected waves in which the ultrasonic waves emitted by the ultrasonic wave oscillator strikes an observed object and reflects by the ultrasonic wave oscillator, and outputs signals based on the ultrasonic waves received by the ultrasonic wave oscillator to the ultrasonic observation unit <NUM>. The ultrasonic scanning mechanism <NUM> of this embodiment is used to acquire an ultrasonic image of tissue serving as a biopsy target and to acquire an ultrasonic image of a needle tube <NUM> in a process of a procedure of a biopsy.

As shown in <FIG>, the raising base <NUM> is a member which changes a direction of a distal portion of a sheath section <NUM> (refer to <FIG>) of the puncture needle <NUM> in a direction which intersects a central line of the insertion section <NUM>. The raising base <NUM> presses an outer surface of the sheath section <NUM> by pulling a raising wire (not shown) extending to the operation section <NUM> at the operation section <NUM>, and the sheath section <NUM> can thus be deformed in a bent state (refer to <FIG>).

The active bending section <NUM> is a cylindrical member constituted of a plurality of joints 105c which are formed in a cylindrical shape and are arranged and coupled in a central line direction of the insertion section <NUM>. The active bending section <NUM> is bent in a predetermined direction by pulling an angle wire (not shown), which is fixed to distal end 105a (refer to <FIG>) of the active bending section <NUM> and extends to the operation section <NUM>, at the operation section <NUM>. The active bending section <NUM> of this embodiment can be bent in two directions in a scanning direction of ultrasonic waves of the ultrasonic scanning mechanism <NUM>.

Both of the raising base <NUM> and the active bending section <NUM> are bending application sections which deform the puncture needle <NUM> serving as a treatment tool in this embodiment in accordance with an active bending operation using the operation section <NUM>.

The flexible tube section <NUM> is a cylindrical member which is formed flexible so as to be able to guide the distal end rigid section <NUM> to a desired position in luminal tissue or coelom.

Conduits (not shown) for the purpose of air transfer, water transfer, suction, or the like with the channel <NUM> are provided inside the active bending section <NUM> and the flexible tube section <NUM>.

As shown in <FIG> and <FIG>, the channel <NUM> is a cylindrical section through which the puncture needle <NUM> can be inserted.

As shown in <FIG>, a distal end (a distal end opening 107a) of the channel <NUM> is opened at a portion near a distal end section of the distal end rigid section <NUM>. As shown in <FIG>, a proximal end of the channel <NUM> is opened at a lateral surface of a distal end side of the operation section <NUM>. The raising base <NUM> can come into contact with the outer surface of the sheath section <NUM> of the puncture needle <NUM> in a process in which the sheath section <NUM> of the puncture needle <NUM> protrudes from the distal end of the channel <NUM>. A proximal end port 107b which is formed in a flange shape is fixed to the proximal end of the channel <NUM>. The puncture needle <NUM> which is used together with the ultrasonic endoscope <NUM> can be fixed to the proximal end port 107b.

As shown in <FIG>, the operation section <NUM> has an outer surface formed such that an operator who uses the ultrasonic endoscope <NUM> can hold the operation section <NUM> in his/her hand. The operation section <NUM> is provided with a bending operation mechanism <NUM> and a plurality of switches <NUM>. The bending operation mechanism <NUM> is provided to pull the angle wire to bend the active bending section <NUM> or pull the raising wire to operate the raising base <NUM>. The plurality of switches <NUM> are provided to perform air transfer, water transfer, or suction via the pipelines.

The optical source apparatus <NUM> is a device which emits illumination light which is used by an optical imaging mechanism <NUM> to perform imaging.

The optical observation unit <NUM> is configured to display an image captured by an image sensor of the optical imaging mechanism <NUM> on a monitor <NUM>.

The ultrasonic observation unit <NUM> receives a signal output from the ultrasonic scanning mechanism <NUM>, generates an image on the basis of this signal, and displays the generated image on the monitor <NUM>.

Next, a constitution of the puncture needle <NUM> according to this embodiment will be described.

As shown in <FIG>, the puncture needle <NUM> is provided with an insertion body <NUM>, an operation section <NUM>, and a stylet <NUM>.

The insertion body <NUM> is an elongated member capable of being inserted into the channel <NUM> of the ultrasonic endoscope <NUM> shown in <FIG>. As shown in <FIG>, the insertion body <NUM> is provided with the needle tube <NUM> and the sheath section <NUM>.

The needle tube <NUM> is a cylindrical member which has distal and proximal ends and is advanced or retracted by the operation section <NUM> of the puncture needle <NUM>.

A material which has flexibility and has elasticity which is easily restored to a rectilinear state even if the needle tube <NUM> is bent by an external force is preferably used as a material of the needle tube <NUM>. For example, an alloy material such as a stainless steel alloy, a nickel titanium alloy, and a cobalt chromium alloy can be adopted as a material of the needle tube <NUM>.

The distal end of the needle tube <NUM> is sharp enough for tissue to be punctured with the needle tube <NUM>. The distal end of the needle tube <NUM> is provided with an opening <NUM> through which the tissue is suctioned inside the needle tube <NUM>. A distal end of the opening <NUM> of the needle tube <NUM> is constituted as a needle tip <NUM> that is punctured to the tissue. A shape of the needle tip <NUM> is not particularly limited, but puncture performance with respect to the tissue is considered in the shape of the needle tip <NUM>. The needle tip <NUM> of the needle tube <NUM> is disposed inside an outer sheath <NUM> which will be described below and can protrude from or withdraw into a distal end of the outer sheath <NUM>.

The opening <NUM> provided at the distal end of the needle tube <NUM> is formed by cutting a distal end of a tubular member which forms the needle tube <NUM> at an oblique angle with respect to the tubular member itself and is formed to be sharp so as to be able to puncture to biological tissue. A specific shape of the opening <NUM> may be appropriately selected from various well-known shapes in consideration of tissue or the like serving as a target.

As shown in <FIG>, the sheath section <NUM> is provided with the outer sheath <NUM> and an inner sheath <NUM>.

The outer sheath <NUM> has a coil shape as a whole and can be inserted into the channel <NUM> of the ultrasonic endoscope <NUM>.

The outer sheath <NUM> is provided with a coiled body <NUM> and a cylindrical distal end tip <NUM>. The coiled body <NUM> is constituted by winding a metallic wire in a coil shape. The distal end tip <NUM> is fixed to a distal end of the coiled body <NUM>.

A material and a shape of the wire which constitutes the coiled body <NUM> are appropriately selected focusing on easiness of bending and a recovering force of the coiled body <NUM>. For example, the material of the wire is selected from stainless steel, a shape memory alloy, a super-elastic alloy, or the like, and the shape of the wire is selected from a circular cross-sectional shape, a rectangular cross-sectional shape, or the like.

The distal end tip <NUM> is a cylindrical member which is fixed to a distal end surface of the coiled body <NUM> and is formed with a through hole through which the needle tube <NUM> can be inserted.

The inner sheath <NUM> is provided with a distal-end-side inner tube 74A and a proximal-end-side inner tube 74B.

The distal-end-side inner tube 74A is a cylindrical member which has a distal end 74aA and a proximal end 74bA. The needle tube <NUM> slides inside the distal-end-side inner tube 74A. The distal-end-side inner tube 74A is made of a plastic for the purpose of reducing sliding resistance between the outer sheath <NUM> and the needle tube <NUM>. The distal-end-side inner tube 74A is located between a distal end section of the outer sheath <NUM> and a distal end (a needle tip) of the needle tube <NUM> in a radial direction of the outer sheath <NUM> in a state in which a needle slider <NUM> is moved closest to a proximal end side along a longitudinal axis with respect to an operation main body <NUM>, and the needle slider <NUM> is engaged to the operation main body <NUM> in a longitudinal axial direction of the operation main body <NUM>. The distal-end-side inner tube 74A is configured such that a clearance between the outer sheath <NUM> and the needle tube <NUM> is reduced for preventing meandering of the needle tube <NUM>. An inner surface of the distal-end-side inner tube 74A of this embodiment is harder than the proximal-end-side inner tube 74B to prevent the inner surface of the distal-end-side inner tube 74A from being damaged by the sharp distal end of the needle tube <NUM>. The distal-end-side inner tube 74A may be a cylindrical member made of, for example, polyether ether ketone (PEEK). The proximal end 74bA of the distal-end-side inner tube 74A is located at more proximal position than a proximal end of a moving region of the distal end (the needle tip <NUM> in this embodiment) of the needle tube <NUM>.

The distal end 74aA of the distal-end-side inner tube 74A is fixed to the distal end tip <NUM>. In an entire length of the distal-end-side inner tube 74A, a proximal part located at more proximal position than a place at which the distal-end-side inner tube 74A is fixed to the distal end tip <NUM> is not fixed to the outer sheath <NUM>. For this reason, the distal-end-side inner tube 74A can be relatively moved with respect to the outer sheath <NUM> when the outer sheath <NUM> and the distal-end-side inner tube 74A are bent.

The distal end 74aA of the distal-end-side inner tube 74A may be directly fixed to the coiled body <NUM> without being fixed to the distal end tip <NUM>. The proximal end 74bA of the distal-end-side inner tube 74A may be connected to a distal end 74aB of the proximal-end-side inner tube 74B such that the distal end 74aA of the distal-end-side inner tube 74A is not fixed to the coiled body <NUM>. In this case, the proximal-end-side inner tube 74B which will be described below is fixed to the coiled body <NUM> or the operation section <NUM> which will be described below (preferably the operation main body <NUM>).

An inner diameter of the distal end tip <NUM> may be greater than an inner diameter of the inner sheath <NUM>. When the inner diameter of the distal end tip <NUM> is greater than the inner diameter of the inner sheath <NUM>, the needle tube <NUM> arranged in the inner sheath <NUM> is spaced apart from an inner surface of the distal end tip <NUM> at a position of the distal end tip <NUM>, thereby frictional resistance is reduced compared to when the needle tube <NUM> slides with respect to the inner surface of the distal end tip <NUM>.

Here, at the point of use, the moving region of the needle tip <NUM> may vary by receiving effects by expansion and contraction, a meandering state, or the like when the outer sheath <NUM>, the inner sheath <NUM>, and the needle tube <NUM> are used. The moving region of the distal end (the needle tip <NUM>) of the needle tube <NUM> is limited by the operation section <NUM> in this embodiment. To be specific, the needle slider <NUM> shown in <FIG> is provided to be movable along the longitudinal axis of the operation main body <NUM> with respect to the operation main body <NUM>. As shown in <FIG>, the operation main body <NUM> slidably supports the needle slider <NUM> in a state in which a convex section 23a of the needle slider <NUM> is fitted into a concave section 9a of the operation main body <NUM> such that the needle slider <NUM> can be moved in an axial direction of the operation main body <NUM>.

The needle slider <NUM> can be moved to a position which comes into contact with a stopper <NUM> (refer to <FIG>) when the needle slider <NUM> is moved toward a distal end of the operation main body <NUM>. The stopper <NUM> can be moved with respect to the operation main body <NUM> until the stopper <NUM> comes into contact with a portion (no reference numeral) of a distal end of the operation main body <NUM> whose diameter is enlarged. For this reason, the needle slider <NUM> is configured to be able to advance to a position at which the distal end of the needle tube <NUM> sufficiently protrudes from a distal end of the sheath section <NUM> when the stopper <NUM> comes into contact with the portion of the operation main body <NUM> whose diameter is enlarged.

As shown in <FIG>, the operation section <NUM> is provided with an engaging mechanism <NUM> which restricts movement of the needle slider <NUM> toward a proximal side of the operation main body <NUM>. The engaging mechanism <NUM> is constituted by an engaging surface 9b formed on the operation main body <NUM> and a contact surface 23b formed on the convex section 23a of the needle slider <NUM>. The engaging surface 9b and the contact surface 23b come into contact with each other when the needle slider <NUM> is moved closest to the proximal end side along the longitudinal axis of the operation main body <NUM> with respect to the operation main body <NUM>.

The needle slider <NUM> is engaged to the operation main body <NUM> in the longitudinal axial direction of the operation main body <NUM> in a state in which the engaging surface 9b and the contact surface 23b come into contact with each other. The needle slider <NUM> can be moved to a position which is engaged by the engaging mechanism <NUM> shown in <FIG> (a position at which the contact surface 23b of the convex section 23a comes into contact with the engaging surface 9b of the operation main body <NUM>) when the needle slider <NUM> is moved toward the proximal end of the operation main body <NUM>. When the needle slider <NUM> is engaged to the operation main body <NUM> by the engaging mechanism <NUM>, the distal end of the needle tube <NUM> enters the distal-end-side inner tube 74A from the proximal end 74bA of the distal-end-side inner tube 74A and is disposed inside the distal-end-side inner tube 74A.

In other words, the needle slider <NUM> can be moved from a position at which the needle slider <NUM> is engaged to the operation main body <NUM> to a position at which the needle slider <NUM> comes into contact with the stopper <NUM> which is in contact with the portion of the operation main body <NUM> whose diameter is enlarged, and the distal end of the needle tube <NUM> can thus protrude from or withdraw into the distal end of the sheath section <NUM> in a process in which the needle slider <NUM> is moved between the two positions.

The proximal-end-side inner tube 74B is a cylindrical member which has the distal end 74aB and a proximal end (not shown). The proximal-end-side inner tube 74B is arranged inside the outer sheath <NUM>. Part of the needle tube <NUM> other than the needle tip <NUM> (that is, a part of a distal portion of the needle tube <NUM> which is located at more proximal position than the needle tip <NUM>) is inserted into the proximal-end-side inner tube 74B. In other words, the proximal-end-side inner tube 74B is arranged between a proximal end of the outer sheath <NUM> and a proximal end of the needle tube <NUM> in the radial direction of the outer sheath <NUM>. The distal end 74aB of the proximal-end-side inner tube 74B is located at more proximal position than the moving region of the distal end (the needle tip <NUM>) of the needle tube <NUM>. The distal end 74aB of the proximal-end-side inner tube 74B is arranged substantially coaxially with the proximal end 74bA of the distal-end-side inner tube 74A.

In this embodiment, the proximal-end-side inner tube 74B is arranged at an inside of the outer sheath <NUM> where is more proximal side than the proximal end 74bA of the distal-end-side inner tube 74A such that the needle tip <NUM> does not come into contact with an inner surface of the proximal-end-side inner tube 74B. A proximal end (not shown) of the proximal-end-side inner tube 74B is fixed to the operation section <NUM>.

The proximal end of the proximal-end-side inner tube 74B may not be directly fixed to the operation section <NUM>. For example, the proximal-end-side inner tube 74B may be fixed to the outer sheath <NUM>, and the operation section <NUM> may be fixed to the proximal end of the outer sheath <NUM>.

The proximal-end-side inner tube 74B may be fixed to the needle tube <NUM>. In this case, a gap corresponding to an amount of protrusion of the needle tube <NUM> from the outer sheath <NUM> is preferably provided between the distal end 74aB of the proximal-end-side inner tube 74B and the proximal end 74bA of the distal-end-side inner tube 74A. With such a constitution, since the needle tube <NUM> can protrude from the outer sheath <NUM> without a distal end side of the proximal-end-side inner tube 74B entering the distal-end-side inner tube 74A, the sheath section <NUM> is not necessary to increase an outer diameter.

In the proximal-end-side inner tube 74B, the meandering of the needle tube <NUM> is prevented by reducing the clearance between the outer sheath <NUM> and the needle tube <NUM>. Since the proximal-end-side inner tube 74B is arranged in a region with which the sharp needle tip <NUM> of the needle tube <NUM> does not come in contact, it is not necessary to always select a material for the purpose of protection from the needle tip <NUM> of the needle tube <NUM>. The proximal-end-side inner tube 74B may be made of a plastic. The proximal-end-side inner tube 74B may be a cylindrical member made of, for example, high density polyethylene (HDPE) to decrease sliding resistance with respect to the outer sheath <NUM> and the needle tube <NUM>.

In a relationship between a constitution of the distal-end-side inner tube 74A and a constitution of the proximal-end-side inner tube 74B, constitutions of inner surfaces thereof satisfy at least one of the following (Condition <NUM>) to (Condition <NUM>).

The distal-end-side inner tube 74A and the proximal-end-side inner tube 74B are made of different materials, and the inner surface (an inner circumferential surface) of the distal-end-side inner tube 74A is harder than the inner surface (an inner circumferential surface) of the proximal-end-side inner tube 74B.

Materials of the distal-end-side inner tube 74A and the proximal-end-side inner tube 74B are not particularly limited, but a coating harder than the inner surface (the inner circumferential surface) of the proximal-end-side inner tube 74B is formed on the inner surface (the inner circumferential surface) of the distal-end-side inner tube 74A.

The distal-end-side inner tube 74A is a multilayer tube which has an outer circumferential section and an inner circumferential section, and a layer which is at an innermost circumference has the harder inner surface (inner circumferential surface) than the inner surface (the inner circumferential surface) of the proximal-end-side inner tube 74B.

In addition, a relationship between hardness of the inner surface of the distal-end-side inner tube 74A and hardness of the inner surface of the proximal-end-side inner tube 74B may be defined by Shore hardness (HS) of inner surfaces of each of the distal-end-side inner tube 74A and the proximal-end-side inner tube 74B. To be specific, Shore hardness of the inner surface of the distal-end-side inner tube 74A is higher than Shore hardness of the inner surface of the proximal-end-side inner tube 74B.

For example, the distal-end-side inner tube 74A may be made of a plastic whose Shore hardness is within a range of <NUM> or more and <NUM> or less such that the needle tip <NUM> is hardly punctured. In this case, the proximal-end-side inner tube 74B may have a softer constitution than the distal-end-side inner tube 74A and may be made of a plastic whose Shore hardness is within a range of <NUM> or more and <NUM> or less. To be specific, the distal-end-side inner tube 74A may be made of polyether ether ketone (PEEK). In this case, the proximal-end-side inner tube 74B may be made of polyethylene (PE).

As shown in <FIG> and <FIG>, the operation section <NUM> is connected to the proximal end of the outer sheath <NUM>.

The operation section <NUM> is provided with the operation main body <NUM>, an attachment adapter <NUM>, and the needle slider <NUM>. The attachment adapter <NUM> is provided at the distal end side of the operation main body <NUM>. The needle slider <NUM> is provided at the proximal end side of the operation main body <NUM>.

The operation main body <NUM> is formed of, for example, acrylonitrile butadiene styrene (ABS) or the like. The operation main body <NUM> has a lumen through which the needle tube <NUM> and the sheath section <NUM> are inserted. The distal end side of the operation main body <NUM> is inserted into the attachment adapter <NUM> which is formed in a tubular shape. The proximal end side of the operation main body <NUM> is inserted into the needle slider <NUM> which is formed in a tubular shape. The operation main body <NUM> and the attachment adapter <NUM>, and the operation main body <NUM> and the needle slider <NUM> can slide in an axial direction while relative rotation thereof around an axis is suppressed by engaging grooves and convex sections or the like (not shown) which are formed in the outer circumferential surface thereof with each other. The outer sheath <NUM> of the sheath section <NUM> is connected to the operation main body <NUM>. The sheath section <NUM> arranged inside the operation main body <NUM> is fixed to the operation main body <NUM>.

The attachment adapter <NUM> is a cylindrical member which fixes the operation section <NUM> to the proximal end port 107b of the ultrasonic endoscope <NUM>. The sheath section <NUM>, the needle tube <NUM>, and the stylet <NUM> are inserted into the attachment adapter <NUM>.

The attachment adapter <NUM> is coupled to the operation main body <NUM> to be substantially coaxial with the operation main body <NUM>.

The attachment adapter <NUM> and the operation main body <NUM> can be fixed by a fixing screw <NUM>. When the fixing screw <NUM> is tightened to the operation main body <NUM>, the attachment adapter <NUM> is pressed to the operation main body <NUM> so that the attachment adapter <NUM> and the operation main body <NUM> can be fixed without sliding to each other. The operation main body <NUM> can be moved with respect to the attachment adapter <NUM> along a central line of the attachment adapter <NUM> while the fixing screw <NUM> is loose. The operation section <NUM> is constituted such that the sheath section <NUM> is advanced together with the needle tube <NUM> when the operation main body <NUM> is moved toward a distal end side of the attachment adapter <NUM> with respect to the attachment adapter <NUM>. Thus, a protruding length of the sheath section <NUM> from the channel <NUM> in a state that the operation section <NUM> is fixed to the ultrasonic endoscope <NUM> can be adjusted by changing a positional relationship between the attachment adapter <NUM> and the operation main body <NUM>, and the protruding length can be fixed by the fixing screw <NUM>.

Unevenness may be formed at an outer circumferential surface of a distal end section of the attachment adapter <NUM> such that the operator is capable of easily gripping the attachment adapter <NUM>.

As shown in <FIG>, the needle slider <NUM> is a cylindrical member which holds a proximal end portion of the needle tube <NUM>. The proximal end side of the needle tube <NUM> protrudes from a proximal end of the sheath section <NUM>, extends to an inside of the needle slider <NUM>, and is connected to the needle slider <NUM> at a proximal end of the needle slider <NUM>. In this embodiment, for example, the proximal end side of the needle tube <NUM> is fixed to the needle slider <NUM>. The needle slider <NUM> is coupled to the operation main body <NUM> so as to be capable of moving with respect to the operation main body <NUM>. The operation section <NUM> can advance the needle tube <NUM> with respect to the outer sheath <NUM> by moving the needle slider <NUM> toward the distal end side of the operation main body <NUM> with respect to the operation main body <NUM>. As described above, the operation section <NUM> can advance or retract the needle tube <NUM> with respect to the outer sheath <NUM>.

Unevenness may be formed at an outer circumferential surface of a distal end section of the needle slider <NUM> such that the operator is capable of easily gripping the attachment adapter <NUM>.

As shown in <FIG>, the stopper <NUM> is attached to the distal end side of the needle slider <NUM> so as to be capable of moving with respect to the operation main body <NUM>. The stopper <NUM> has a fixing screw <NUM> and can be fixed to the operation main body <NUM> by tightening the fixing screw <NUM>. Since the needle slider <NUM> can advance with respect to the operation main body <NUM> until the needle slider <NUM> comes into contact with the stopper <NUM>, a maximum protruding length of the needle tube <NUM> from the sheath section <NUM> can be adjusted by adjusting a fixed position of the stopper <NUM> with respect to the operation main body <NUM>.

A state that the needle slider <NUM> is at a position at which the needle slider <NUM> is moved to a limit at the proximal end side of the operation main body <NUM> is an initial state before the puncture needle <NUM> is used. In the initial state, the distal end (the needle tip <NUM>) of the needle tube <NUM> is located inside the distal-end-side inner tube 74A.

As described above, in this embodiment, the operation section <NUM> defines the moving region of the distal end of the needle tube <NUM>.

The stylet <NUM> is attached to a proximal end portion of the needle slider <NUM>. The stylet <NUM> is a needle-shaped member which is inserted into the needle tube <NUM>. A distal end of the stylet <NUM> is not limited to the needle shape, but may have an end surface along a surface which intersects a longitudinal axis of the stylet <NUM>, and may have a curved surface such as a hemispherical surface.

Next, an action of the biopsy system <NUM> according to this embodiment will be described. <FIG> is a view for describing an action of the puncture needle <NUM>.

In the biopsy system <NUM> (refer to <FIG>) according to this embodiment, as shown in <FIG> and <FIG>, the puncture needle <NUM> is moved inside the outer sheath <NUM> such that the needle tube <NUM> comes into contact with an inner surface of the inner sheath <NUM> rather than an inner surface of the coiled body <NUM> of the outer sheath <NUM>. In particular, the needle tip <NUM> of the needle tube <NUM> advances or retracts in the distal-end-side inner tube 74A and can protrude from an opening of a distal end of the distal-end-side inner tube 74A.

Since the inner sheath <NUM> is made of a plastic, frictional resistance between the needle tube <NUM> and the inner sheath <NUM> is smaller than frictional resistance between metals. For this reason, in this embodiment, a smaller amount of force than a conventional puncture needle is required for moving the needle tube <NUM> with respect to the sheath section <NUM>.

When the sheath section <NUM> is located at the active bending section <NUM> or the raising base <NUM> of the ultrasonic endoscope <NUM>, the sheath section <NUM> is deformed in a bent shape by the active bending section <NUM> and the raising base <NUM> (refer to <FIG>). When the sheath section <NUM> is in the bent shape, an inclined angle of the needle tip <NUM> with respect to an inner surface of the sheath section <NUM> is greater than that when the sheath section <NUM> is in a rectilinear state. For this reason, when the sheath section <NUM> is in the bent state, the sheath section <NUM> and the needle tip <NUM> have a positional relationship in which the needle tip <NUM> easily punctures the inner surface of the sheath section <NUM> in comparison with the sheath section <NUM> which is in the rectilinear state. However, since the inner surface of the distal-end-side inner tube 74A of this embodiment is a hard surface so as to hardly puncture the needle tip <NUM>, the needle tip <NUM> hardly punctures the distal-end-side inner tube 74A even if the needle tip <NUM> is moved in the distal-end-side inner tube 74A.

When the sheath section <NUM> is located at the active bending section <NUM> or the raising base <NUM> of the ultrasonic endoscope <NUM>, the needle tube <NUM> passing through the sheath section <NUM> which is in the bent state is difficult to move at a part of the sheath section <NUM> which is bent and deformed due to a magnitude of frictional resistance with respect to the sheath section <NUM> in comparison with the sheath section <NUM> which is in the rectilinear state. In the sheath section <NUM> of the puncture needle <NUM> provided in the biopsy system <NUM> according to this embodiment, the plastic inner sheath <NUM> is arranged inside the metallic coiled body <NUM>. For this reason, an amount of force required for moving the needle tube <NUM> at a portion at which frictional resistance is great due to bent and deformation of the sheath section <NUM> is smaller than that when there is no inner sheath <NUM>. In other words, according to the puncture needle <NUM> according to this embodiment, the needle tube <NUM> can be moved as intended by the operator with a light force even if the sheath section <NUM> is bent and deformed.

Unlike the distal-end-side inner tube 74A, since the proximal-end-side inner tube 74B is not always necessary to consider the inner surface which is difficult to puncture the needle tip <NUM>, a more flexible tube than the distal-end-side inner tube 74A may be adopted. For this reason, the insertion body <NUM> can be smoothly inserted in a process in which the insertion body <NUM> is inserted into the channel <NUM> having a complicated bent shape when the flexible tube section <NUM> of the ultrasonic endoscope <NUM> is in the body and meanders or the like.

In this embodiment, since the frictional resistance between the plastic inner sheath <NUM> and the metallic needle tube <NUM> is small, an amount of force for moving the needle tube <NUM> with respect to the sheath section <NUM> is small enough even if a difference (a clearance) between the inner diameter of the inner sheath <NUM> and the outer diameter of the needle tube <NUM> is small. For this reason, a gap in which the needle tube <NUM> is likely to meander in the sheath section <NUM> can be reduced, and following performance of the distal end portion of the needle tube <NUM> with respect to the advancing and retracting operation of the needle tube <NUM> in the operation section <NUM> is good.

In a conventional puncture needle, a distal end of a needle tube is not moved even if a proximal end portion of the needle tube is press toward the distal end thereof by a slider, and the slider is pushed back toward the proximal end with a recovering force by which the meandering needle tube is returned in a rectilinear shape. However, in this embodiment, since the needle tube <NUM> does not easily meander in the sheath section <NUM>, when the needle tube <NUM> is moved toward the distal end by using the needle slider <NUM> of the operation section <NUM>, the meandering of the needle tube <NUM> does not easily accumulate in the sheath section <NUM> and thus the distal end of the needle tube <NUM> is efficiently performed. As a result, in the biopsy system <NUM> according to this embodiment, as described above, the slider is not easily pushed back toward the proximal end with the recovering force by which the needle tube is returned in the rectilinear shape.

In this embodiment, the distal end 74aA of the distal-end-side inner tube 74A is fixed to the distal end tip <NUM>, and the distal end tip <NUM> is further fixed to a distal end section of the coiled body <NUM>. For this reason, the distal end tip <NUM> of the distal end portion of the outer sheath <NUM> holds the distal-end-side inner tube 74A such that a distal end portion of the inner sheath <NUM> is not moved inside the coiled body <NUM> even if the sheath section <NUM> is deformed in the bent shape, or an amount of operation force is transferred from the proximal end side of the sheath section <NUM> to the distal end side of the sheath section <NUM>. Thus, since the distal end of the inner sheath <NUM> is not moved more proximal side than the distal end of the outer sheath <NUM>, the coiled body <NUM> of the outer sheath <NUM> does not come into direct contact with the needle tube <NUM>.

The distal end 74aA of the distal-end-side inner tube 74A is fixed to the distal end section of the coiled body <NUM> via the distal end tip <NUM>, and a portion of the distal-end-side inner tube 74A which is more proximal side than the distal end 74aA of the distal-end-side inner tube 74A is slidable with respect to the coiled body <NUM>. For this reason, extending of the coiled body <NUM> is not regulated even if the distal-end-side inner tube 74A is arranged in the coiled body <NUM>. Thus, flexibility of the outer sheath <NUM> constituting the coiled body <NUM> is not easily reduced.

In this embodiment, the distal end tip <NUM> is not necessary to always arrange at the distal end portion of the outer sheath <NUM>, and a distal end 74a of the inner sheath <NUM> may be directly fixed to the distal end portion of the coiled body <NUM> of the outer sheath <NUM>.

In this embodiment, in the coiled body <NUM> of the outer sheath <NUM>, a gap is generated in the wire constituting the coiled body <NUM> while the outer sheath <NUM> is bent by the raising base <NUM> and the active bending section <NUM>. When the distal end of the needle tube <NUM> enters and is caught by the gap of the wire, the moving of the needle tube <NUM> is likely to be obstructed, or the distal end of the needle tube <NUM> is likely to be deformed. In this embodiment, since the inner sheath <NUM> is arranged inside of the coiled body <NUM> of the outer sheath <NUM>, the gap of the wire of the coiled body <NUM> is covered with the inner sheath <NUM>. As a result, the needle tube <NUM> advancing or retracting inside the inner sheath <NUM> is not easily caught by the gap of the wire of the coiled body <NUM> even if the insertion body <NUM> is bent at a position of the raising base <NUM> or the active bending section <NUM>. When a plastic structure which covers the wire having a gap at an inner wall of a portion of the outer sheath <NUM> bent in a bent shape whose curvature radius is great is provided, the catching of the distal end of the needle tube <NUM> can be prevented even if an entire area of the coiled body <NUM> is not covered.

An example of a procedure using the puncture needle <NUM> according to this embodiment will be illustrated. <FIG> is a schematic diagram illustrating a process of the example of the procedure of a biopsy using the puncture needle according to this embodiment. <FIG> is a schematic diagram illustrating a process of puncturing tissue using a needle tube in the example of the procedure using the puncture needle according to this embodiment.

Hereinafter, a usage aspect of the puncture needle <NUM> will be described, exemplifying treatment of the biopsy in which the needle tube <NUM> of the puncture needle <NUM> punctures lesions in the body serving as target tissue and cells or the like of the lesions are collected through the inside of the needle tube <NUM>. The procedure of the biopsy which will be exemplified below is an example of the biopsy with respect to a pancreatic head in pancreas <NUM> shown in <FIG> and <FIG>. An adaptable target of the puncture needle <NUM> according to this embodiment is not limited to the puncturing in the biopsy of the pancreatic head.

First, the operator inserts the insertion section <NUM> of the ultrasonic endoscope <NUM> shown in <FIG> into the body, introduces a distal end section of the insertion section <NUM> into a portion near the target tissue (the pancreatic head in this embodiment) while appropriately bending the active bending section <NUM> under observation by using the optical imaging mechanism <NUM>. After the introducing, the operator determines a site on which the biopsy is performed on the basis of observed results by the optical imaging mechanism <NUM> and the ultrasonic scanning mechanism <NUM>. For example, when the biopsy is performed on the pancreatic head, the insertion section <NUM> is moved while the active bending section <NUM> is bent such that the optical imaging mechanism <NUM> and the ultrasonic scanning mechanism <NUM> which are provided at the insertion section <NUM> of the ultrasonic endoscope <NUM> reach the duodenum <NUM>.

When the biopsy on the pancreatic head is performed by using the ultrasonic endoscope <NUM>, there is a need to bend the active bending section <NUM> to capture a puncturing site of the puncture needle <NUM> in a field of vision of the ultrasonic endoscope <NUM>. In particular, when the biopsy on the pancreatic head is performed as in this embodiment, the active bending section <NUM> is bent to an extent close to a performance limit of the active bending section <NUM> of the ultrasonic endoscope <NUM>.

Next, the operator inserts the distal end side of the insertion body <NUM> of the puncture needle <NUM> into the channel <NUM> from the proximal end port 107b provided at the operation section <NUM> of the ultrasonic endoscope <NUM> shown in <FIG>. The operator couples the attachment adapter <NUM> of the operation section <NUM> to the proximal end port 107b. Thus, the operation section <NUM> of the puncture needle <NUM> is fixed to the ultrasonic endoscope <NUM> so as not to rotate with respect to the operation section <NUM>.

For example, when back cutting is performed on the needle tube <NUM>, the needle tip <NUM> is difficult to come into contact with the inner surface of the sheath section <NUM>. In addition, similarly, when the needle tube <NUM> is, for example, a Menghini needle, the needle tip <NUM> is difficult to come into contact with the inner surface of the sheath section <NUM>.

Next, the operator loosens the fixing screw <NUM> (refer to <FIG>), and adjusts an amount of protrusion of the sheath section <NUM> from a distal end of the insertion section <NUM> of the ultrasonic endoscope <NUM> to an appropriate amount by relatively sliding the attachment adapter <NUM> and the operation main body <NUM> while observing the sheath section <NUM> and the inside of the body by the optical imaging mechanism <NUM> and the ultrasonic scanning mechanism <NUM>. After the adjusting, the operator tightens the fixing screw <NUM> to fix the amount of protrusion.

Next, the stopper <NUM> is moved in consideration of a distance from target tissue T on which the biopsy is performed on the basis of the observed results using the ultrasonic scanning mechanism <NUM> and is fixed to the operation main body <NUM> at a desired position, and a maximum protruding length of the needle tube <NUM> is adjusted.

As shown in <FIG>, a protruding direction of the insertion body <NUM> from the distal end opening 107a of the channel <NUM> is set by using the raising base <NUM> such that the needle tube <NUM> is pushed toward a position of the target tissue T.

The raising base <NUM> presses the outer surface of the sheath section <NUM>, thus the sheath section <NUM>, the needle tube <NUM>, and the stylet <NUM> are deformed in a bent state. In this embodiment, a state in which the stylet <NUM> is inserted into the needle tube <NUM> is not essential. In the procedure of the biopsy on the pancreatic head as in this embodiment, the insertion body <NUM> is bent to an extent close to a performance limit of the active bending section <NUM> or the raising base <NUM> of the ultrasonic endoscope <NUM>.

Next, the operator advances the needle slider <NUM> shown in <FIG> toward a distal end of the operation section <NUM>. The sheath section <NUM> is set in the bent shape by the raising base <NUM>, but the needle tip <NUM> is difficult to puncture the inner surface of the distal-end-side inner tube 74A. Thus, the needle tube <NUM> is pushed by the needle slider <NUM> toward the distal end of the sheath section <NUM>.

When the distal end of the needle tube <NUM> slightly protrudes from the sheath section <NUM>, the stylet <NUM> is returned into the needle tube <NUM>. Thus, the needle tube <NUM> can puncture the tissue using the sharp needle tip <NUM> of the needle tube <NUM>. After that, once the needle tube is drawn such that the distal end of the needle tube <NUM> is accommodated in the sheath section <NUM>.

Next, as shown in <FIG>, the operator further advances the needle slider <NUM> toward the distal end of the operation section <NUM> while the distal end of the sheath section <NUM> comes into contact with an intestinal wall. Thereby, the needle tip <NUM> of the needle tube <NUM> protrudes from the distal end of the sheath section <NUM>, punctures the tissue, and is pushed toward the target tissue T on which the biopsy is performed. At this time, the stylet <NUM> is disposed near the distal end inside the needle tube <NUM> such that no tissue other than the biopsy target enters the needle tube <NUM>. When tissue other than the biopsy target enters the needle tube <NUM>, the stylet <NUM> protrudes from the distal end of the needle tube so that the tissue other than the biopsy target can be discharged from the needle tube.

The operator can acquire positional information of the distal-end-side portion of the needle tube <NUM> inserted into the tissue by the ultrasonic scanning mechanism <NUM>. For this reason, the operator can observe an ultrasonic image indicating an image of the distal-end-side portion of the needle tube <NUM> acquired in the ultrasonic scanning mechanism <NUM> using the ultrasonic observation unit <NUM> shown in <FIG>. The operator moves the distal end (the needle tip <NUM>) of the needle tube <NUM> to the target tissue T on which the biopsy is performed while referencing to the image of the distal end portion of the needle tube <NUM> which is clearly displayed on the ultrasonic observation unit <NUM>.

The operator pulls out the stylet <NUM> from the insertion body <NUM> and the operation section <NUM> to suction the tissue to the needle tube <NUM>. Thus, a through hole which extends from the distal end of the needle tube <NUM> to the proximal end of the needle slider <NUM> is generated. The operator connects a syringe or the like to a port (not shown) arranged in the proximal end of the needle slider <NUM>, suctions the needle tube <NUM>, and collects cells or the like of the target tissue T on which the biopsy is performed by suctioning the needle tube <NUM> from the distal end of the needle tube <NUM>. The needle tube may be finely moved in the target tissue T by advancing and retracting the needle slider <NUM> to acquire a greater amount of biopsy tissue.

When a necessary amount of cells or the like has been collected, the needle tube <NUM> is pulled out of the tissue by retracting the needle slider <NUM> toward a proximal end of the operation section <NUM>, and the distal end of the needle tube <NUM> is accommodated in the sheath section <NUM>. When the needle tube <NUM> has been pulled out of the tissue, the attachment adapter <NUM> is detached from the proximal end port 107b of the operation section <NUM> of the ultrasonic endoscope <NUM>, and the puncture needle <NUM> is removed from the channel <NUM>. Finally, the ultrasonic endoscope <NUM> is removed from the patient, and the series of treatments end.

Embodiments and examples of the present invention have been described in detail above with reference to the drawings, but a specific constitution is not limited to the embodiments, and various changes in design or the like are also included without departing from the gist of the present invention.

For example, in the above-described embodiments, in an entire length of the outer sheath, the distal-end-side inner tube may be arranged at only a region at which the outer sheath is assumed to be deformed in the bent shape by the raising base. In other words, the distal-end-side inner tube is arranged inside the outer sheath along the central line of the outer sheath in a range from the proximal end of the raising base to the distal end of the outer sheath. In this case, the distal end of the outer sheath is arranged at more distal position than the proximal end of the raising base when the attachment adapter <NUM> is attached to the endoscope <NUM>. The distal end of the outer sheath may protrude from the channel <NUM>.

In the above-described embodiments, in the entire length of the outer sheath, the distal-end-side inner tube may be arranged at only a region at which the outer sheath is assumed to be deformed in the bent shape by the raising base and the active bending section. In other words, the distal-end-side inner tube is arranged inside the outer sheath along the central line of the outer sheath in a range from the proximal end of the active bending section to the distal end of the outer sheath. In this case, the distal end of the outer sheath is arranged at more distal position than the proximal end of the active bending section when the attachment adapter <NUM> is attached to the endoscope <NUM>.

In the above-described embodiments, when the ultrasonic endoscope does not have the raising base, in the entire length of the outer sheath, the distal-end-side inner tube may be arranged at only a region at which the outer sheath is assumed to be deformed in the bent shape by the active bending section. In other words, in this state, the distal-end-side inner tube is arranged inside the outer sheath along the central line of the outer sheath in a range from the proximal end of the active bending section to the distal end of the outer sheath.

The ultrasonic endoscope may have a pipeline-shaped slope section which is inclined with respect to the central axis of the channel <NUM> in place of the raising base. In this case, the distal end of the outer sheath is arranged at more distal position than a proximal end of the slope section when the attachment adapter <NUM> is attached to the endoscope <NUM>. In this state, in the entire length of the outer sheath, the distal-end-side inner tube may be arranged at only a region at which the outer sheath is assumed to be deviated by the slope section or a range including this region. In other words, in this state, the distal-end-side inner tube is arranged inside the outer sheath along the central line of the outer sheath in a range from the proximal end of the slope section to the distal end of the outer sheath.

Claim 1:
An endoscope puncture needle (<NUM>) comprising:
an outer sheath (<NUM>) which is insertable into a channel (<NUM>) of an endoscope (<NUM>) and has a coil shape;
a needle tube (<NUM>) having a needle tip (<NUM>) and arranged inside the outer sheath (<NUM>); and
an operation section (<NUM>) connected to a proximal end of the outer sheath (<NUM>) and configured to advance and retract the needle tube (<NUM>) with respect to the outer sheath (<NUM>),
wherein the operation section (<NUM>) includes:
an operation main body (<NUM>) connected to the proximal end of the outer sheath (<NUM>);
a needle slider (<NUM>) connected to a proximal end of the needle tube (<NUM>) and provided to be movable along a longitudinal axis of the operation main body (<NUM>) with respect to the operation main body (<NUM>); and
an engaging mechanism (<NUM>) in which the needle slider (<NUM>) is engaged to the operation main body (<NUM>) in a longitudinal axial direction of the operation main body (<NUM>),
characterized in that the endoscope puncture needle (<NUM>) further comprises:
a proximal-end-side inner tube (74B) arranged at an inside of a proximal end of the outer sheath (<NUM>) and made of plastics; and
a distal-end-side inner tube (74A) arranged at an inside of a distal end section of the outer sheath (<NUM>), through which the needle tube (<NUM>) is insertable, and made of plastics, the distal-end-side inner tube (74A) having an inner circumferential surface that is relatively harder than the proximal-end-side inner tube (74B), and
a distal end of the needle tube (<NUM>) is arranged inside the distal-end-side inner tube (74A) when the needle slider (<NUM>) is engaged to the operation main body (<NUM>).