JP3806713B2 - Endoscope hood and endoscope - Google Patents

Description

The present invention relates to an endoscope hood and an endoscope that are detachably attached to an endoscope .

  Conventionally, when observing and treating inside a narrow lumen in a human body or between living tissues without a cavity such as subcutaneous tissue with an endoscope, by attaching a hood to the insertion portion of the endoscope, Techniques have been developed for preventing contamination of the observation window due to adherence of biological tissue to the observation window of the endoscope, and ensuring a space for endoscope observation.

  Moreover, as shown in Japanese Patent Application No. 7-172466, the applicant of the present invention as a hood to be attached to an insertion portion of an endoscope, as shown in Japanese Patent Application No. 7-172466, or as shown in Japanese Patent Application No. 7-172139. Have been filed with a shape that completely covers the endoscope and is suitable for tissue detachment.

  Japanese Patent Publication No. 4-10328 discloses a configuration in which an opening is provided on the side surface of the hood, and a treatment instrument such as a knife can be used through the opening. Further, WO94 / 11052 discloses a configuration in which the field of view of an endoscope is obtained during an observation procedure by opening the distal end of a tube body through which the endoscope is inserted, and Japanese Patent Publication No. 4-17648 discloses an open / close type. The thing of the structure which has the window for these treatment tools is disclosed.

  In recent years, endoscopic treatments have been performed in areas without cavities such as treatment of blood vessels in the human body, treatment of the spine, treatment of the esophagus, and treatment of the kidney. In this case, a procedure is performed in which the various hoods are attached to the insertion portion of the endoscope, and the endoscope is inserted while the living tissue without a cavity is separated by the hood.

  By the way, when the hood hits the fascia between the muscles during the insertion of the endoscope, for example, it is very difficult to perform an operation of incising it and moving it forward only by blunt operation with the hood. Since it becomes difficult, there is a problem that tissue peeling cannot be performed smoothly. In addition, there is also a problem that hemostasis has to be stopped if bleeding occurs inadvertently during tissue peeling.

  However, in the prior art, it is difficult to cope smoothly when the above problem occurs. That is, in the technique of Japanese Patent Application No. 7-172139, when performing an operation of incising a fascia between muscles, only a blunt operation to press the distal end portion of the hood into the living tissue can be performed. In addition, there is a problem that it is difficult to improve, and it is necessary to perform another troublesome work of inserting another hemostatic means between tissues in parallel when bleeding is stopped.

  In the technique of Japanese Patent Laid-Open No. 4-10328, since the opening of the hood is arranged on the side surface, even when a treatment tool such as a scalpel is used through this opening, the living tissue in front of the endoscope is There is a problem that it is not effective for incision and peeling, and since it does not have a hemostatic means, the bleeding site cannot be effectively stopped.

  Further, in the techniques of Japanese Patent Application Nos. 7-172466, 4-17648, and WO94 / 11052, a treatment tool for incision and hemostasis is inserted into the body through the treatment tool channel of the endoscope, Although it is possible to cope with this, in this case, there is a problem that the insertion / removal operation of the treatment instrument into / from the treatment instrument channel of the endoscope and the operation thereof become complicated.

  In the case of WO94 / 11052, since the tube through which the endoscope is inserted is not transparent, it is necessary to perform a peeling operation blindly, which makes the operation difficult and also increases safety. There's a problem.

The present invention has been made paying attention to the above circumstances, and its purpose is to perform a biological tissue peeling operation and a hemostasis operation easily and safely while visually confirming a treatment target portion of the biological tissue visually. To provide an endoscope hood and an endoscope .

The invention according to claim 1 is provided so as to cover at least a distal end of an insertion portion of an endoscope to be inserted into a body, and at least a portion covering an observation optical system of the endoscope is made of a translucent material, A hood main body that can transmit through the wall surface of the translucent material and can be observed by the observation optical system, a pressing portion that is provided at a distal end portion of the hood main body and that presses against the living body to peel the biological tissue, and the pressing A first electrode provided in the vicinity of the edge portion at the tip of the portion, and a surface area larger than the first electrode on the rear end side with respect to the first electrode of the pressing portion; And a second electrode for supplying an electric current for coagulating / incising the living tissue between them.
According to a second aspect of the present invention, there is provided an insertion portion that is inserted into a body and includes an observation optical system at a distal end, and is provided so as to cover at least the distal end of the insertion portion, and at least a portion that covers the observation optical system is made of a translucent material. A hood main body configured to transmit through the wall surface of the translucent material and capable of being observed by the observation optical system, and a pressing portion provided at a distal end portion of the hood main body for pressing the living body and peeling the biological tissue And a first electrode provided in the vicinity of the edge portion at the front end of the pressing portion, and a rear surface side with respect to the first electrode of the pressing portion, provided with a larger surface area than the first electrode, An endoscope comprising: a second electrode for supplying a current for coagulating / dissecting a living tissue between the first electrode and the first electrode .

According to the present invention, since the hood main body is made of a translucent material, a state in which the biological tissue is peeled off at the edge portion provided at the tip of the hood main body, or between the first electrode and the second electrode. The treatment can be performed while observing the state of the coagulation / incision treatment by applying a high-frequency cauterization current. Further, the first electrode is provided in the vicinity of the edge portion at the front end of the pressing portion, and has a smaller surface area than the second electrode disposed on the rear end side with respect to the first electrode of the pressing portion. Therefore, the incision pseudo-solid treatment (cauterization) can be performed intensively on the first electrode side, and the cauterized biological tissue portion can be easily peeled off at the edge portion. Thereby, incision and coagulation treatment can be performed safely and easily even with fascia or hard biological tissue .

  A first embodiment of the present invention will be described below with reference to FIGS. 1 to 2E. FIG. 1 shows a schematic configuration of a sheath 1 with a transparent hood and a rigid endoscope 2 inserted into the sheath 1 of the present embodiment.

  The sheath 1 with a transparent hood is provided with a double cylinder comprising an inner cylinder 3 and an outer cylinder 4 disposed on the outer peripheral surface of the inner cylinder 3. Here, the inner cylinder 3 is set longer than the length of the outer cylinder 4. The both ends of the inner cylinder 3 are extended to the outside of the both ends of the outer cylinder 4.

  Further, a transparent hood (hood main body) 5 is provided at the front end portion of the inner cylinder 3, and an endoscope fixing portion 6 is provided at the rear end portion of the inner cylinder 3. The inner diameter of the inner cylinder 3 is set to a size that allows the endoscope 2 to be inserted over the entire length.

  Further, the transparent hood 5 is provided with a substantially cylindrical fixed hood 7 fixed to the distal end portion of the inner cylinder 3 and a movable hood 8. The fixed hood 7 and the movable hood 8 are made of a transparent material (translucent material), for example, a resin material such as acrylic, polycarbonate, or polysulfone, or glass. The endoscope 2 can be observed through the wall surface of the transparent hood 5 while the endoscope 2 is inserted into the inner cylinder 3.

  Further, the fixed hood 7 is formed with a notch 9 in the lower part on the tip side of the cylindrical body. The movable hood 8 is formed with an engaging portion 10 having a shape corresponding to the cylindrical notch 9 of the fixed hood 7. Further, the base end portion of the movable hood 8 is rotatably connected to the fixed hood 7 by a hinge 11 formed of a rotation pin.

  In addition, a rod connecting portion 12 is projected from the outer peripheral surface of the movable hood 8. A distal end portion of an operating rod 13 for opening and closing the movable hood 8 is attached to the rod connecting portion 12 by a fixing pin 14. Further, the proximal end portion of the operation rod 13 is fixed to the outer peripheral surface of the distal end portion of the outer cylinder 4.

  Further, a substantially wedge-shaped pressing portion 15 is formed at the distal end portion of the movable hood 8 as shown in FIG. A first electrode 17 is attached to the edge portion 16 at the tip edge of the pressing portion 15. Further, a second electrode 18 is attached in the vicinity of the first electrode 17. Here, the width of the first electrode 17 is set to be smaller than the diameter of the transparent hood 5, and the surface area of the first electrode 17 is set to be smaller than that of the second electrode 18. A bipolar type incision and coagulation means is formed between the first electrode 17 and the second electrode 18 to cause incision and coagulation of the living tissue by supplying a high-frequency cauterization current.

  The cord 19 connected to the electrodes 17 and 18 passes between the inner cylinder 3 and the outer cylinder 4 and is guided to the outside from a cord insertion hole 20 formed in the outer peripheral surface of the rear end portion of the outer cylinder 4. , Connected to a power supply device for energizing a high-frequency cauterization current (not shown).

  Further, a flange portion 21 is formed at the inner end portion of the engaging portion 10 of the movable hood 8 detachably engaged with the notch portion 9 of the fixed hood 7 as shown in FIG. The flange portion 21 is provided with a sealing means 22 to which a rubber member such as silicon rubber is attached or to which grease or the like is applied. When the movable hood 8 is engaged with the notch 9 of the fixed hood 7 being closed, the sealing means 22 keeps the airtight between the fixed hood 7 and the movable hood 8.

  In addition, the endoscope fixing portion 6 is provided with an inner tube connecting portion 23 that is externally fitted to the rear end portion of the inner tube 3. A tube-shaped seal member 24 made of a rubber material or the like is provided on the inner peripheral surface of the rear end portion of the inner cylinder connecting portion 23. Further, a projecting portion 25 is projected on the outer peripheral surface of the rear end portion of the inner tube connecting portion 23 in a direction orthogonal to the axial direction of the inner tube 3. A screw member 26 for tightening the seal member 24 is attached to the projecting portion 25. Then, after the endoscope 2 is inserted into the inner cylinder 3, the screw member 26 is tightened, so that the seal member 24 is tightened and fixed to the outer peripheral surface of the endoscope 2, and the endoscope 2 is airtight. It is supposed to be fixed. Note that an air supply port body 27 communicating with the internal space of the inner cylinder 3 is provided on the outer peripheral surface of the front end portion of the inner cylinder connecting portion 23 so as to project.

  An inner cylinder fixing portion 28 is provided at the rear end portion of the outer cylinder 4. The inner cylinder fixing portion 28 is provided with an outer cylinder connecting portion 29 that is fitted onto the rear end portion of the outer cylinder 4. A tube-shaped sealing member 30 made of a rubber material or the like is provided on the inner peripheral surface of the rear end portion of the outer cylinder connecting portion 29. Further, a projecting portion 31 projects from the outer peripheral surface of the rear end portion of the outer tube coupling portion 28 in a direction orthogonal to the axial direction of the outer tube 4. A screw member 32 for tightening the seal member 30 is attached to the projecting portion 31.

  Then, after the inner cylinder 3 is inserted into the outer cylinder 4, the screw member 32 is tightened, whereby the seal member 30 is tightened and fixed to the outer peripheral surface of the inner cylinder 3, and the inner cylinder 3 is airtightly fixed. It is like that. The seal member 30 of the outer cylinder 4 is moved along the inner cylinder 3 in a state where the screw member 32 is rotated in the direction opposite to the tightening direction to loosen the tightening of the seal member 30 to the outer peripheral surface of the inner cylinder 3. Can be slid. Thereby, the fixed position of the outer cylinder 4 with respect to the inner cylinder 3 can be adjusted to an arbitrary position in the axial direction of the inner cylinder 3.

  A substantially conical airtight member 33 is provided on the outer peripheral surface of the outer cylinder 4. A ring-shaped seal member 34 capable of air-sliding on the outer peripheral surface of the outer cylinder 4 is attached to the rear end portion of the hermetic member 33. The seal member 34 is fixed to the rear end portion of the airtight member 33 in a state of being sandwiched between the fixing member 35 screwed to the rear end portion of the airtight member 33 and the airtight member 33. Further, a pair of yarn hooking portions 36 are provided on the outer peripheral surface of the rear end portion of the airtight member 33.

  Next, the operation of the present embodiment having the above configuration will be described. Here, the procedure for observing the spine Y by inserting the endoscope 2 from the patient's skin through the muscle layer and into the body tissue X as shown in FIGS. 2 (B) and 2 (C). Based on

  First, after inserting the endoscope 2 into the sheath 1 with the transparent hood, the screw member 26 is tightened and fixed. Subsequently, a small incision, i.e., an incision, is formed so that the transparent hooded sheath 1 can be inserted into the patient's skin to expose the muscle layer in the body. In this state, when the edge portion 16 of the transparent hood 5 of the sheath 1 with the transparent hood is aligned and pushed in the direction of the muscle fiber from the cut of the patient's skin, the muscle tissue is peeled off, as shown in FIG. 2 (B). The distal end of the transparent hooded sheath 1 is inserted into the body tissue X in the body.

  At this time, since the state of the living tissue X can be observed through the transparent wall surface of the transparent hood 5 by the endoscope 2 in the sheath 1, the peeling can be safely advanced while confirming the traveling of the blood vessel and the like. FIG. 2D shows an observation image of the living tissue X observed through the transparent wall surface of the transparent hood 5 by the endoscope 2 during the insertion operation of the sheath 1 with the transparent hood.

  Further, when the distal end portion of the transparent hood 5 hits the fascia or hard tissue during the insertion operation of the distal end portion of the sheath 1 with the transparent hood, a high-frequency ablation current is applied to the first electrode 17 and the second electrode 18. Is done. This is a bipolar system in which a current flows between the first electrode 17 and the second electrode 18 and is safe because a current flows between the electrodes 17 and 18. Here, since the surface area of the first electrode 17 is set smaller than that of the second electrode 18, the current density per unit area is increased. Therefore, the living tissue X can be cauterized intensively on the first electrode 17 side. Thereby, the incision and coagulation of the living tissue X are performed, and the fascia and the hard living tissue can be separated.

  Further, since the first electrode 17 is in the vicinity of the edge portion 16 at the distal end edge of the movable hood 8, the cauterized biological tissue X can be easily peeled off by the edge portion 16. Therefore, the peeling operation can be advanced more easily. Since the width of the first electrode 17 is set to be smaller than the diameter of the transparent hood 5, for example, in the case of fascia, if the patient's skin has an incision of about 3 mm, the transparent hood having a diameter of about several tens of millimeters It has been experimentally confirmed that the substantially wedge-shaped pressing portion 15 of the attached sheath 1 can be inserted into the body. Therefore, the transparent hooded sheath 1 can be inserted into the body with a smaller incision and coagulation with respect to the living tissue X of the patient. Furthermore, during the operation of inserting the sheath 1 with the transparent hood into the body, the state of incision and coagulation of the living tissue X can be confirmed through the transparent wall surface of the transparent hood 5 by the endoscope 2 in the sheath 1, which is safe.

  Further, even when bleeding, it is possible to stop bleeding by applying the first electrode 17 and the second electrode 18 at the tip of the transparent hood 5 to the bleeding part, so that it is not necessary to use a new hemostatic treatment tool, and smooth. The biological tissue X can be peeled off.

  Further, when the engaging portion 10 of the movable hood 8 is engaged with the notch portion 9 of the fixed hood 7, the sealing means 22 provided on the flange portion 21 of the inner end portion of the engaging portion 10 of the movable hood 8 Since blood can be prevented from entering the inside of the transparent hood 5 from the joint between the fixed hood 7 and the movable hood 8, the endoscope 2 in the sheath 1 with the transparent hood can be prevented from being contaminated.

  Further, when the sheath 1 with the transparent cap reaches the spine Y, the airtight member 33 is slid along the outer peripheral surface of the outer cylinder 4 toward the distal end portion and pressed against the peripheral portion of the small incision portion of the skin. In this state, a suture thread is used to sew between the thread hook 36 and the skin, and the airtight member 33 is fixed to the skin.

  Next, the outer cylinder 4 is moved backward relative to the inner cylinder 3. At this time, the operation rod 13 is pulled backward as the outer cylinder 4 moves. Therefore, the movable hood 8 is rotated downward about the hinge 11, and the movable hood 8 is opened downward with respect to the fixed hood 7.

In this state, CO ₂ gas or the like is fed into the body from the air supply port 27 on the proximal side of the sheath 1 with the transparent hood through the inner cylinder 3. Thereby, the part peeled off by the opening operation of the movable hood 8 is further expanded by the supply of this gas, and as shown in FIG. 2C, a body space S necessary for observation and treatment of the spine Y is secured. . At this time, since the movable hood 8 is opened downward with respect to the fixed hood 7, the spine Y is directly observed without passing through the transparent wall surface of the transparent hood 5 by the endoscope 2 in the sheath 1. And a clear visual field of the endoscope 2 can be obtained. FIG. 2E shows an observation image of the spine Y that is directly observed by the endoscope 2 in the sheath 1 without passing through the transparent wall surface of the transparent hood 5.

  Further, when the living tissue X in the body is observed through the transparent wall surface of the transparent hood 5 by the endoscope 2 in the sheath 1, the living tissue X in close contact with the transparent hood 5 can be clearly observed. However, the visual field of the living tissue X that is away from the transparent hood 5 is markedly deteriorated, making it difficult to observe the living tissue X. Therefore, it is sufficient for the living tissue X to directly observe the living tissue X to be observed with the endoscope 2 by opening the movable hood 8 downward with respect to the fixed hood 7 as in the present embodiment. This is important for proper observation and treatment.

In addition, when the glass surface of the observation optical system of the endoscope 2 becomes cloudy and the field of view of the endoscope 2 becomes difficult to see, CO ₂ gas or the like is released with the movable hood 8 of the transparent hood 5 slightly opened. By sending, fogging can be effectively removed from the glass surface of the observation optical system.

  Although it is known that fogging is prevented by blowing dry gas on the glass surface or the like of the observation optical system at the tip of the endoscope 2, the endoscope is viewed with the transparent hood 5 as in the present embodiment. By encircling the periphery of the tip of the mirror 2, the glass surface of the observation optical system at the tip of the endoscope 2 can be efficiently supplied by supplying a small amount of dry gas into a small space formed in the transparent hood 5. It can be exposed to dry gas, and the effect of removing and preventing fogging can be further improved.

  Therefore, the above configuration has the following effects. That is, since the bipolar first electrode 17 and the second electrode 18 that form the incision and coagulation means are provided on the edge portion 16 of the movable hood 8 of the transparent hood 5, during the operation of inserting the endoscope 2 into the body, The incision and coagulation of the living tissue X can be performed by flowing a high-frequency cauterization current between the first electrode 17 and the second electrode 18, and the living tissue X can be efficiently peeled off.

  Further, since the surface area of the first electrode 17 is set smaller than that of the second electrode 18 and the current density per unit area is increased, the living tissue X can be intensively ablated on the first electrode 17 side, and the current density is small. The biological tissue X can be efficiently peeled in the incision and coagulation range.

  Further, when the biological tissue X is peeled off, the endoscope 2 in the sheath 1 can pass through the transparent wall surface of the transparent hood 5 and directly check the biological tissue X visually. Peeling operation and hemostasis work can be performed.

  Furthermore, after the biological tissue X is peeled, the movable hood 8 is opened downward with respect to the fixed hood 7 so that the biological tissue X to be observed can be directly observed with the endoscope 2. The spine Y can be directly observed by the endoscope 2 without passing through the transparent wall surface of the transparent hood 5, and a clear visual field of the endoscope 2 can be obtained.

In addition, since the movable hood 8 is opened with respect to the fixed hood 7, CO ₂ gas or the like is fed into the body through the inner cylinder 3. A sufficient body space S required for observation and treatment can be secured. Furthermore, by sending CO ₂ gas or the like through the inner cylinder 3 into the body, it is possible to remove or prevent fogging of the glass surface of the observation optical system of the endoscope 2.

  In the present embodiment, a configuration in which the bipolar first electrode 17 and the second electrode 18 that form the incision coagulation means are provided on the edge portion 16 of the movable hood 8 of the transparent hood 5 is shown. The incision and coagulation means may be formed by a monopolar type with one electrode.

  Further, in the present embodiment, the configuration in which the bipolar first electrode 17 and the second electrode 18 are directly fixed to the surface of the movable hood 8 of the transparent hood 5 is shown. However, a heat insulating material such as fluororesin or ceramic is movable. It may be inserted between the hood 8 and the electrodes 17 and 18. At this time, if a transparent heat insulating member such as a fluororesin is used, the field of view by the endoscope 2 is not blocked. A similar effect can be obtained by attaching an antenna for generating a microwave instead of the electrodes 17 and 18.

  FIG. 3A shows a second embodiment of the present invention. This is provided with a transparent sheath 41 made of a transparent material (translucent material) as an endoscope hood into which the insertion portion of the rigid endoscope 2 is inserted.

  In this transparent sheath 41, a sheath main body (hood main body) 42 is formed by an integrally formed cylindrical body whose tip is closed. The closing surface 43 at the distal end of the sheath body 42 is formed by an inclined surface that is cut obliquely with respect to the axial direction of the sheath body 42.

  Further, a projecting portion 44 extending in the axial direction is provided on the outer peripheral surface of the sheath body 42. The protruding portion 44 is disposed at a portion corresponding to the distal end edge portion of the inclined surface of the distal end blocking surface 43 of the sheath body 42.

  The protruding portion 44 is provided with a laser fiber insertion hole 45. A laser fiber (incision coagulation means) 46 for guiding laser light can be inserted into the laser fiber insertion hole 45.

  Therefore, in the case of the above configuration, the living body tissue is peeled by pushing the sheath body 42 in a state where the distal end edge of the slope of the distal end blocking surface 43 of the sheath body 42 of the transparent sheath 41 is applied to the living tissue. Is possible. Furthermore, when the living tissue is peeled off at the distal end of the sheath body 42, when the living tissue hits or bleeds, the living tissue is peeled off by irradiating laser light from the laser fiber 46. Work can be continued and hemostasis can be performed.

  FIG. 3B shows a third embodiment of the present invention. This is because the laser fiber 46 is embedded in the peripheral wall portion of the sheath body 42 in advance by integrally inserting the laser fiber 46 into the peripheral wall portion of the sheath body 42 in the transparent sheath 41 of the second embodiment. It is a thing.

  Therefore, in addition to the effects similar to those of the second embodiment, the configuration of the entire sheath body 42 of the transparent sheath 41 can be further simplified in this embodiment, even with the above configuration. It is suitable for making the entire transparent sheath 41 disposable.

  FIG. 3C shows a fourth embodiment of the present invention. This is an endoscope hood provided with a transparent sheath 51 having a configuration different from that of the second embodiment.

  That is, in the transparent sheath 51 of the present embodiment, the sheath body 52 is formed by a cylindrical body formed of a transparent material whose tip is closed in a substantially conical shape. A heating member (incision coagulation means) 53 is attached to the distal end of the sheath body 52. As the heat generating member 53, for example, a material which is coated with a fluororesin to prevent scorching around a heater which generates heat when an electric current is passed is used.

  Further, the heat generating member 53 is connected to a connector 55 connected to the power supply side via a lead wire 54 disposed on the outer peripheral surface of the sheath body 52. The lead wire 54 may be embedded in the peripheral wall surface of the sheath body 52 or may be disposed inside the sheath body 52.

  Therefore, in the above configuration, the living tissue can be peeled by pushing the sheath body 42 in a state where the distal end of the sheath body 52 of the transparent sheath 51 is in contact with the living tissue. Furthermore, by applying a current to the heat generating member 53 at the tip of the sheath body 42, operations such as cauterization of the living tissue and hemostasis can be performed.

  In this embodiment, the heat generating member 53 is directly fixed to the surface of the sheath main body 52 of the transparent sheath 51. However, a heat insulating material such as fluororesin or ceramic is provided between the sheath main body 52 and the heat generating member 53. You may put in. At this time, if a transparent heat insulating member such as a fluororesin is used, the field of view by the endoscope 2 is not blocked.

  FIG. 3D shows a fifth embodiment of the present invention. In the present embodiment, an ultrasonic sheath 61 configured to cut and coagulate a living tissue using ultrasonic vibration is provided.

  The ultrasonic sheath (incision coagulation means) 61 is provided with an elongated pipe-like probe 63 into which an endoscope 62 can be inserted. An ultrasonic transducer 64 is connected to the proximal end portion of the probe 63. The ultrasonic transducer 64 has an endoscope insertion hole 65 into which the endoscope 62 can be inserted. A transparent hood (hood main body) 66 is attached to the tip of the probe 63.

  Therefore, in the above configuration, the ultrasonic vibration generated by the ultrasonic vibrator 64 is transmitted to the transparent hood 66 via the probe 63, and the living tissue in contact with the transparent hood 66 is incised and coagulated. be able to.

  FIG. 3E shows a sixth embodiment of the present invention. This is a modification of the fifth embodiment. In other words, in the present embodiment, a notch 71 is formed at the tip of the probe 63 of the fifth embodiment at an angle with respect to the axial direction of the probe 63, and the notch 71 at the tip of the probe 63 is formed. Is provided with a transparent member (hood main body) 72 as an endoscope hood.

  Therefore, in the above configuration, the living tissue can be incised and coagulated directly by the probe 63, so that ultrasonic vibration can be efficiently transmitted to the living tissue. Note that the transmission efficiency of ultrasonic vibration is greatly influenced by the material of the probe 63. Therefore, when the probe 63 is brought into direct contact with a living tissue as in the present embodiment, ultrasonic vibration from the probe 63 is transmitted through the transparent hood 66 as in the ultrasonic sheath 61 of the fifth embodiment. Compared with the case of transmitting to a living tissue, it is possible to perform operations such as peeling of the living tissue and hemostasis effectively.

  FIG. 4 shows a seventh embodiment of the present invention. In the present embodiment, an endoscope insertion hole 83 with a closed tip and a treatment instrument hole 84 with both ends open are provided in the sheath body 82 of the transparent sheath 81, and the endoscope insertion hole 83 has an endoscope. 85, and an ultrasonic probe (incision coagulation means) 86 is inserted into the treatment instrument hole 84.

  Therefore, in the above configuration, the living tissue can be incised and coagulated directly by the ultrasonic probe 86, so that ultrasonic vibration can be efficiently transmitted to the living tissue.

  FIGS. 5A to 5D show an eighth embodiment of the present invention. In the present embodiment, a transparent sheath 93 composed of a double cylinder comprising an outer sheath 91 made of a transparent material as an endoscope hood and a transparent inner sheath 92 inserted into the outer sheath 91 is provided. It is provided.

  Here, a closed wedge-shaped pressing portion 94 is formed at the distal end portion of the outer sheath 91. Further, a streak portion 95 extending in the axial direction of the outer sheath 91 is provided on the outer peripheral surface on the distal end side of the outer sheath 91 as shown in FIG.

  Further, the distal end portion of the inner sheath 92 is held in a state of being inserted to a position near the pressing portion 94 of the outer sheath 91. An endoscope 96 can be inserted into the inner sheath 92.

  Therefore, in the above configuration, the inner sheath 92 is held in a state where the distal end portion of the inner sheath 92 is inserted to a position near the pressing portion 94 of the outer sheath 91 as shown in FIG. By inserting the endoscope 96 into the sheath 92, the state of the living tissue can be observed through the transparent wall surface of the pressing portion 94 of the outer sheath 91 by the endoscope 96 in the transparent sheath 93. At this time, since the sculptured portion 95 at the tip of the outer sheath 91 is not broken, the inside of the outer sheath 91 can be held in a watertight state. Therefore, it is possible to prevent liquid from entering the outer sheath 91.

  Further, when the inner sheath 92 is slid forward with respect to the outer sheath 91, the portion of the braided portion 95 of the outer sheath 91 is destroyed, and the inner sheath 92 protrudes as shown in FIG. Therefore, in this case, the living tissue can be directly observed by the endoscope 96 in the transparent sheath 93 without passing through the transparent wall surface of the pressing portion 94 of the outer sheath 91. A field of view can be obtained.

  At this time, by slightly pulling the distal end of the endoscope 96 inwardly of the inner sheath 92 from the distal end of the inner sheath 92, the endoscope 96 contacts the living tissue even when the outer sheath 91 is opened. Can be prevented.

  The same effect can be obtained even if a slit is formed in the peripheral wall portion of the outer sheath 91 instead of providing the streaked portion 95 of the outer sheath 91 and the slit portion is sealed with a sealing agent such as rubber or an adhesive. It is done.

  FIGS. 6A, 6B, and 7 show a ninth embodiment of the present invention. In the present embodiment, a transparent sheath 101 suitable for inserting a perspective-type or side-view type endoscope is provided.

  A lower surface opening 103 is formed at the distal end of the sheath body 102 of the transparent sheath 101. Further, a transparent shutter member 104 is attached to the lower surface opening 103 so as to be opened and closed.

  Here, a shutter guide groove 105 is provided on the inner peripheral surface of the peripheral portion of the lower surface opening 103 at the distal end of the sheath body 102 as shown in FIG. A shutter member 104 is fitted in the shutter guide groove 105. A watertight state is secured between the shutter guide groove 105 and the shutter member 104 by a watertight member such as rubber or grease.

  Further, the distal end portion of the operation rod 106 is fixed to the shutter member 104. The base end portion of the operation rod 106 is connected to an operation ring 107 slidably provided on the outer peripheral surface of the sheath body 102 of the transparent sheath 101. Then, by sliding the operation ring 107 backward, the shutter member 104 is slid rearward as shown in FIG. 6B, and the lower surface opening 103 of the sheath body 102 is opened.

  Therefore, in the present embodiment, as shown in FIG. 6 (A), in the state where the lower surface opening 103 of the sheath body 102 of the transparent sheath 101 is closed by the shutter member 104, the inside of the sheath body 102 is a perspective type or By inserting the side-view type endoscope, the state of the living tissue can be observed through the transparent wall surface of the shutter member 104 by the perspective type in the transparent sheath 101 or the side-view type endoscope. At this time, since the watertight state is secured between the shutter guide groove 105 and the shutter member 104 by a watertight member such as rubber or grease, the inside of the sheath body 102 can be held in a watertight state. Therefore, liquid can be prevented from entering the sheath body 102.

  Further, the lower surface opening 103 of the sheath body 102 is opened by sliding the operation ring 107 rearward and sliding the shutter member 104 rearward as shown in FIG. 6B. Therefore, in this case, since the living tissue can be directly observed through the lower surface opening 103 of the sheath main body 102 by the perspective-type or side-view type endoscope in the transparent sheath 101, the shutter member 104 is transparent. A clear visual field of a perspective or side view endoscope can be obtained without passing through a wall surface.

  At this time, the distal end portion of the perspective-type or side-view type endoscope is accommodated in the sheath main body 102, and the distal end portion of the perspective-type or side-view type endoscope is located outside the sheath main body 102. Since it does not protrude, even when the shutter member 104 is being opened, it is possible to prevent the perspective-type or side-view type endoscope from coming into contact with the living tissue and becoming dirty.

  FIGS. 8A and 8B show a tenth embodiment of the present invention. The sheath 110 is made of a transparent material, has a wedge-shaped tip, and is provided with an opening 111. The endoscope 112 is a perspective type endoscope. It can be observed through the opening 111 as shown in FIG. 8 (A), and the endoscope 112 is rotated by 180 ° and slightly retracted, so that the transparent material of the sheath 110 is interposed as shown in FIG. 8 (B). Observation is possible.

  In addition, this invention is not limited to the said embodiment, Of course, various deformation | transformation can be implemented in the range which does not deviate from the summary of this invention.

  Next, other characteristic technical matters of the present application are appended as follows.

(Additional Item 1) In the endoscope hood that covers at least the distal end portion of the endoscope to be inserted into the body, the endoscope hood includes at least a part of the transparent portion and the vicinity of the distal end of the transparent portion, An endoscopic hood comprising an incision coagulation means for incising and coagulating tissue.

  (Additional Item 2) In an endoscope hood that covers at least the distal end portion of an endoscope having an observation window in the vicinity of the distal end portion, the hood has a transparent portion, and energy output means for incising and coagulating tissue. An endoscope hood comprising energy supply means for supplying energy to the hood.

  (Additional Item 3) In Additional Item 2, the endoscope hood has an opening.

  (Additional Item 4) In Additional Item 2, the endoscope hood has an opening that can be opened and closed.

  (Effects of Supplementary Items 3 and 4) A clear visual field can be obtained without passing through a transparent portion.

  (Additional Item 5) The endoscope according to Additional Item 4, wherein when the opening is open, the endoscope has a portion that can be directly observed within the visual field range of the endoscope without passing through the transparent portion. For food.

  (Additional Item 6) In the additional item 5, the endoscope hood according to claim 5, further comprising a watertight means for preventing liquid from entering the opening.

  (Additional Item 7) In Additional Items 2 to 6, the energy supply means includes an electrode for supplying a high-frequency cauterization current.

  (Additional Item 8) In Additional Item 7, the means for supplying a high-frequency cauterization current has a bipolar electrode.

  (Additional Item 9) In Additional Item 7, the means for supplying a high-frequency cauterization current has a monopolar electrode.

  (Additional Item 10) In Additional Items 2 to 6, the energy supply means is laser transmission means.

  (Additional Item 11) In Additional Items 2 to 6, the energy supply means includes a member that generates heat electrically.

  (Additional Item 12) In Additional Items 2 to 6, the energy supply means includes ultrasonic vibration generation means.

  (Additional Item 12-2) In Additional Items 2 to 6, the energy supply means includes means for transmitting microwaves.

  (Additional Item 13) In any one of Additional Items 7, 8, and 9, the endoscope hood has an edge portion, and an electrode is provided in the vicinity of the edge portion.

  (Additional Item 14) In any one of Additional Items 7, 8, 9, and 13, the width of the electrode is smaller than the diameter of the endoscope hood.

  (Additional Item 15) In any one of Additional Items 8, 13, and 14, the surface area of one of the two electrodes is smaller than the other.

  (Additional Item 16) In Additional Item 15, the endoscope hood has an edge portion, and an electrode having a smaller surface area is provided in the vicinity of the edge portion.

  (Additional Item 17) In any one of the additional items, the endoscope hood includes an air supply / water supply means.

  (Additional Item 18) In an endoscope hood that covers at least the distal end portion of an endoscope having an observation window in the vicinity of the distal end portion, the hood has a transparent portion and an openable / closable opening portion. An endoscope hood characterized by having a portion that can be directly observed without passing through the transparent portion within the field of view of the endoscope when the is open.

  (Additional Item 19) An endoscope hood according to Additional Item 18, wherein the opening has a watertight means for preventing liquid from entering inside.

  (Additional Item 20) In Additional Item 19, the watertight means is a rubber member.

  (Additional Item 21) In Additional Item 19, the watertight means is grease.

  (Additional Item 22) In Additional Item 19, the watertight means is an integrally formed member, and the opening is opened when a part is broken.

  (Additional Item 23) In an endoscope hood that covers at least the distal end portion of an endoscope having an observation window in the vicinity of the distal end, the hood has a transparent member and an opening, and the observation through the transparent member and the opening Endoscope hood characterized by being able to selectively observe from the section.

  (Problems to be solved by the techniques of the supplementary items 18 to 23) In recent years, treatments in areas without a cavity, such as blood vessel treatment, spine treatment, esophageal treatment, and kidney treatment, have been performed. A technique for securing a cavity is performed by inserting an endoscope while peeling between tissues using the hood or an openable sheath. In WO83 / 03189 and WO94 / 11052, when the scope is inserted into tissue, the distal end of the scope is covered, resulting in blindness. In Japanese Examined Patent Publication No. 4-17648, although there is an opening for inserting a treatment instrument, observation cannot be performed through this opening, and observation is always performed through a transparent hood. It is good when the tissue is in close contact with the hood, but when there is a space between the hood and the tissue, the appearance becomes worse as much as the hood passes. In addition, when a scope is inserted into a tissue using the above three conventional techniques, if bleeding occurs, blood may infiltrate into the gap or opening of the hood, contaminating the scope, and the visual field may deteriorate. In Japanese Patent Application No. 7-172466, the hood portion is open, and it cannot be said that the shape is optimal for peeling, and there is a problem at the time of bleeding similar to the above. In Japanese Patent Application No. 7-172139, the hood always covers the scope, and there is a problem similar to that of Japanese Patent Publication No. 4-17648. Obtaining a clear visual field at all times is essential for endoscopic observation and treatment.

  (Purpose of Supplementary Items 18 to 23) The endoscope can be easily inserted while separating the tissues, and during that time, the endoscope can be prevented from being soiled, and the work can be performed under the microscope. An object of the present invention is to provide an endoscopic hood capable of obtaining a clearer visual field when it is possible.

  (Operation of Additional Items 18 to 23) When inserting into a tissue while performing a peeling operation, the endoscope is prevented from becoming dirty by completely covering the endoscope, and observation can be performed from the transparent portion. Further, by opening the opening after the peeling operation, observation can be performed without using a hood, and a clear visual field can be obtained. In addition, blood entry is prevented by providing a watertight means in the opening.

  (Effects of Supplementary Items 18 to 23) An endoscope can be easily inserted while peeling between tissues, during which the endoscope can be prevented from being soiled and can be operated under the microscope. A clearer field of view can be obtained when there is space in the screen.

The schematic block diagram of the sheath with a transparent hood and endoscope in the 1st Embodiment of this invention. (A) is a perspective view which shows the front-end | tip part of the sheath with a transparent hood of 1st Embodiment, (B) is a longitudinal cross-sectional view of the principal part which shows the tissue peeling state by use of the sheath with a transparent hood of the embodiment. , (C) is a longitudinal sectional view of the main part showing a state in which the hood is opened after tissue separation by using the transparent hooded sheath of the embodiment, (D) is a plan view showing an endoscopic image of (B), (E) is a top view which shows the endoscopic image of (C). (A) is a perspective view showing a transparent sheath of a second embodiment of the present invention, (B) is a perspective view showing a tip part of a transparent sheath of a third embodiment of the present invention in a partial cross section, (C) is a perspective view showing the transparent sheath of the fourth embodiment of the present invention, (D) is a longitudinal sectional view showing the ultrasonic sheath of the fifth embodiment of the present invention, and (E) is the present invention. The longitudinal cross-sectional view of the principal part which shows the ultrasonic sheath of 6th Embodiment of this. The longitudinal cross-sectional view which shows the transparent sheath of the 7th Embodiment of this invention. (A) is a perspective view showing a transparent sheath of an eighth embodiment of the present invention, (B) is a longitudinal sectional view showing a closed state of a distal end opening of the transparent sheath of the embodiment, and (C) is the same. The cross-sectional view which shows the braided part of the transparent sheath of embodiment, (D) is a longitudinal cross-sectional view which shows the open state of the front-end | tip opening part of the transparent sheath of the embodiment. (A) The longitudinal cross-sectional view which shows the closed state of the shutter member of the transparent sheath of the 9th Embodiment of this invention, (B) The longitudinal cross-sectional view which shows the open state of the shutter member of the transparent sheath of the embodiment . FIG. 7 is a cross-sectional view taken along line 7-7 in FIG. (A) is a longitudinal cross-sectional view which shows the observation state through the opening part of the transparent sheath of the 10th Embodiment of this invention, (B) is the observation state through the transparent member of the transparent sheath of the embodiment. FIG.

Explanation of symbols

  2, 62, 85, 96 ... endoscope, 5, 66 ... transparent hood (hood main body), 15 ... pressing part (peeling means), 17 ... first electrode (incision coagulation means), 18 ... second electrode (incision) Coagulation means), 42, 52, 82 ... sheath body (hood main body), 46 ... laser fiber (incision coagulation means), 61 ... ultrasonic sheath (incision coagulation means), 72 ... transparent member (hood main body), 86 ... super Sonic probe (incision coagulation means).

Claims (2)

The endoscope is inserted so as to cover at least the distal end of the insertion portion of the endoscope , and at least a portion covering the observation optical system of the endoscope is made of a translucent material, and a wall surface of the translucent material is formed. A hood body that is transmitted and can be observed by the observation optical system;
Provided at the tip of the hood body, and a pressing unit for pressing the living body and peeling the living tissue;
A first electrode provided in the vicinity of the edge at the tip of the pressing portion;
Provided with a larger surface area than the first electrode on the rear end side with respect to the first electrode of the pressing portion, and supplies a current for coagulating / incising the living tissue with the first electrode A second electrode for
An endoscope hood characterized by comprising: An insertion portion that is inserted into the body and includes an observation optical system at the tip;
It is provided so as to cover at least the tip of the insertion portion, and at least a portion covering the observation optical system is made of a translucent material, and can be observed by the observation optical system through the wall surface of the translucent material. The hood body,
Provided at the tip of the hood body, and a pressing unit for pressing the living body and peeling the living tissue;
A first electrode provided in the vicinity of the edge at the tip of the pressing portion;
The pressing portion is provided on the rear end side with respect to the first electrode with a larger surface area than the first electrode, and an electric current for coagulating / dissecting the living tissue with the first electrode is provided. A second electrode for energization;
An endoscope characterized by comprising:

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