JP2010207455A - Sheath and endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To easily perform operation in a stable attitude on a heart surface even in a state that the heart is kept to beat. <P>SOLUTION: A sheath 1 includes a cylindrical sheath body 12 which has flexibility and in which a medical device is inserted inside along a longitudinal direction, a wing part 13 provided to the distal end part of the sheath body 12 so as to be retractable in a radial direction, and an operation part 14 for protruding/retracting the wing part 13 at proximal end side of the sheath body 12. Thus, the rotation of the distal end part of the sheath body 12 is limited by the wing part 13 protruded in the direction along the heart surface and the attitude of the distal end part of the sheath body 12 is stabilized with respect to the heart surface. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a sheath and an endoscope.

  Conventionally, a tube-shaped medical instrument is known that is inserted into a patient's body up to the affected area and temporarily placed therein, and a medical device is inserted along the internal lumen and guided to the affected area (for example, Patent Documents). 1). In addition, endoscopes are widely used as means for directly diagnosing and treating lesion sites in the body with minimal invasiveness.

US Pat. No. 6,231,514

  However, when an object having a circular or elliptical cross section, such as the instrument or endoscope of Patent Document 1, is to be inserted into the pericardium while the heart is moving, the instrument or The endoscope is moved violently. In particular, because the instrument or endoscope is in contact with the heart surface in a curved surface, it is rotated in the circumferential direction by movement of the heart in a twisting direction, the posture becomes extremely unstable, and the heart surface is easily rolled. The position moves or twists and winds a tuna. As a result, it is very difficult to run an instrument or endoscope along the heart surface in a desired direction, or to temporarily place it at a desired position on the heart surface for treatment or examination. There is.

  The present invention has been made in view of the above-described circumstances, and a sheath and an endoscope that can be easily operated with a stable posture on the surface of the heart even when the heart is beating. The purpose is to provide.

In order to achieve the above object, the present invention provides the following means.
The present invention relates to a tubular sheath body that is flexible and into which a medical device can be inserted along the longitudinal direction, and a wing section that is provided at the distal end of the sheath body so as to be able to project and exit in the radial direction. And a sheath provided with an operation part for projecting and retracting the wing part on the proximal end side of the sheath body.

According to the present invention, when the sheath main body is inserted into the body from the distal end with the wings accommodated and is left in a desired position, and the medical device is inserted along the inside of the sheath main body, the medical device Can be smoothly guided to a desired position.
In this case, by accommodating the wing portion, the sheath can be easily inserted and removed by running without damaging the insertability while keeping the distal end portion of the sheath body along the shape of the body.

  In addition, when the wing part is caused to appear and disappear on the tissue surface in the body and the wing part is projected in the direction along the tissue surface by the operation part, the rotation of the distal end of the sheath body in the circumferential direction is restricted by the wing part with respect to the tissue surface. Is done. That is, even if the tip of the sheath body is on the heart surface that beats, the posture is stabilized with the wings along the heart surface, and the heart surface is rolled or twisted according to the beat. Is prevented. Thereby, the distal end portion of the sheath body can be easily advanced in a desired direction even in the pericardium, and the distal end of the medical device is stably supported by the sheath body stably placed on the heart surface. Treatment and medical examination can be done.

In the above-described invention, the wing portion may be provided so as to be able to protrude and protrude on both sides with the sheath body sandwiched in the radial direction.
By doing in this way, the attitude | position of the front-end | tip part of a sheath main body can be stabilized more.

Moreover, in the said invention, the said wing | blade part is provided with the rod-shaped member provided so that rocking | swiveling was possible between the position along the side surface of the said sheath main body, and the position spaced apart in the radial direction outward from the said side surface. Also good.
By doing in this way, a wing | blade part can be comprised simply and it can be made to make it appear and disappear easily in the radial direction of a sheath main body only by rotating the other end of a rod-shaped member.

Further, in the above invention, the wing portion has a tip fixed to a side surface of the sheath body, a substantially linear shape along the side surface of the sheath body, and a curved shape curved outward in the radial direction of the sheath body. A linear member that is deformable between, and the operation portion is connected to the other end of the linear member and extends to the proximal end side along the longitudinal direction of the sheath body, and extends in the longitudinal direction of the sheath body. It is good also as providing the wire member provided so that a movement was possible.
By doing in this way, a linear member can be projected and retracted or accommodated only by operating a wire member in the front-back direction, and a wing | blade part can be comprised and operated easily.

Further, in the above invention, the wing portion is provided on an outer surface of the sheath body, and is dimensioned in a direction perpendicular to the radially outward direction in a transverse cross section of the sheath body, outward in the radial direction of the sheath body. A balloon that can be inflated while maintaining a substantially constant flow rate, wherein the operating portion communicates with the balloon and extends along the longitudinal direction of the sheath body, and supplies the fluid into the flow path and the flow path. It is good also as providing the supply / discharge means which discharges the fluid from the inside.
By doing so, the balloon can be inflated or deflated by a simple operation of simply supplying or discharging the fluid, and can appear or retract.

Further, the present invention provides an insertion portion to be inserted into the body, a wing portion provided at a distal end portion of the insertion portion so as to be able to protrude and retract in a radial direction, and the wing portion to be protruded and retracted at a proximal end side from the insertion portion. Provided is an endoscope provided with an operating unit.
According to the present invention, by storing the wing part, the endoscope can be easily inserted into and removed from the body while maintaining the running performance of the insertion part in the body. In addition, by letting the wings in and out of the body, the tip of the insertion part can easily run in a desired direction while stabilizing the posture, even on the beating heart surface, and can be stabilized in a desired position. It can be easily placed for medical examination and treatment.

In the above-described invention, the wing portion may be provided so as to be able to protrude and retract on both sides with the insertion portion in the radial direction.
Moreover, in the said invention, the said wing | blade part is provided with the rod-shaped member provided so that rocking | swiveling was possible between the position which followed the side surface of the said insertion part, and the position spaced apart in the radial direction outward from the said side surface. Also good.

  In the above invention, the wing portion has a tip fixed to a side surface of the insertion portion, a substantially linear shape along the side surface of the insertion portion, and a curved shape curved outward in the radial direction of the insertion portion. The operation portion is connected to the other end of the linear member and extends to the proximal end side along the longitudinal direction of the insertion portion, and extends in the longitudinal direction of the insertion portion. It is good also as providing the wire member provided so that a movement was possible.

  In the above invention, the wing portion is provided on an outer surface of the insertion portion, and is a dimension in a direction perpendicular to the outer side in the radial direction in a cross section of the insertion portion, radially outward of the insertion portion. A balloon that can be inflated while maintaining a substantially constant flow rate, and the operation section communicates with the balloon and extends along the longitudinal direction of the insertion section to the proximal end side, and a fluid flows into the flow path. Supply or discharge means for discharging the fluid from the supply or the flow path may be provided.

Moreover, in the said invention, it is good also as the said insertion part having a curved part which can be bent so that the direction of the front end surface may be changed, and the said wing | blade part is provided ahead of the said curved part. .
By doing so, the posture is further stabilized in front of the bending portion of the endoscope, so that a narrower visual field can be examined in more detail in a more stable state.

Moreover, in the said invention, it is good also as the said insertion part having a curved part which can be bent so that the direction of the front end surface may be changed, and the said wing | blade part is provided behind the said curved part. .
By doing so, it is possible to examine a wider range without stabilizing the movement of the bending portion by the wing portion while stabilizing the posture of the distal end portion of the insertion portion behind the bending portion.

  Further, the present invention is separated from the insertion portion to be inserted into the body, the bending portion that can be bent so as to change the direction of the distal end surface of the insertion portion, and the direction that intersects the bendable direction of the bending portion. An endoscope is provided that includes at least two protrusions projecting forward from the distal end surface.

  According to the present invention, when the insertion portion is inserted along the heart surface and the bending portion is bent so that the distal end surface is directed toward the heart surface, the most distal portion of the protrusion is temporarily fixed on the heart surface, The circumferential rotation of the endoscope with respect to the heart surface is limited. That is, even if the heart is beating, the distal end portion of the endoscope can be placed while stabilizing the posture with respect to the heart surface, and a desired position can be easily examined or treated.

In the above-mentioned invention, the most advanced part of the projection part may be arranged within the range of the depth of field.
By doing so, the distal end surface of the endoscope gets too close to the surface of the observation site and is contaminated, or an appropriate distance is not secured between the distal end surface of the endoscope and the surface of the observation site. Can be prevented from becoming unclear.

Moreover, in the said invention, the said protrusion part is good also as providing in the channel which was formed in the said insertion part along the longitudinal direction and opened to the said front end surface so that it can swell forward from the said front end surface. .
In this way, when the examination or treatment is not performed, the projection can be housed to facilitate the operation of the endoscope.

  According to the present invention, there is an effect that the posture can be stabilized and easily operated on the surface of the heart even when the heart is pulsated.

It is the side view and (b) front view which show the (a) whole structure of the sheath which concerns on the 1st Embodiment of this invention. It is the (a) side view and (b) front view which show the modification of the sheath of FIG. It is (a) side view and (b) front view which show another modification of the sheath of FIG. It is a figure which shows the example of an endoscope provided with a wing | blade part, and has shown the case where the wing | blade part is provided in the front of (a) curved part, and the case where it is provided in the back of (b) curved part. It is (a) whole block diagram and (b) the enlarged view of the front-end | tip part of the endoscope which concerns on the 2nd Embodiment of this invention. It is a figure explaining the usage method of the endoscope of FIG. 5, (a) The time of insertion in the pericardium and (b) The time of fixation to the heart surface are each shown. It is a figure which shows the modification of the endoscope of FIG. It is a figure which shows another modification of the endoscope of FIG.

The sheath 1 according to the first embodiment of the present invention will be described below with reference to FIGS.
As shown in FIG. 1A, the sheath 1 according to the present embodiment has a cylindrical sheath body 12, a rod-shaped member (wing part) 13 provided at the distal end of the sheath body 12, and a distal end. And a wire (operation unit) 14 connected to the rod-like member 13 and extending to the base end side.

  The sheath body 12 is flexible so that it can be bent along the tissue shape in the body, and the lumen 12a has an inner diameter through which another medical device can be inserted in the longitudinal direction. Further, a groove 12b is formed on the outer surface of the distal end portion of the sheath body 12 along the longitudinal direction at a position substantially symmetrical with respect to the central axis of the sheath body 12, and the sheath 12b has a sheath 12b on the inner wall on the proximal end side. A small-diameter hole 12c formed in the longitudinal direction in the side wall of the main body 12 is opened.

The rod-like member 13 is disposed along the longitudinal direction in each groove 12b, and the tip is attached to the inner wall of the groove 12b so as to be rotatable in the radial direction of the sheath body 12.
In the groove 12b, both ends are fixed to the base end of the rod-shaped member 13 and the inner wall on the base end side of the groove 12b, and the base end of the rod-shaped member 13 is elastically biased outward in the radial direction of the sheath body 12. A member, for example, a spring 15 is provided.

  The wire 14 is movably inserted into the air core portion of the spring 15 and the hole 12c, and the base end is connected to a handle or the like (not shown) and is operated in the front-rear direction by the operator. Moreover, the wire 14 has the flexibility which can deform | transform according to the shape of the spring 15 at least in the front-end | tip part.

  When the operator operates the wire 14 forward, the other end of the rod-shaped member 13 is swung in a direction away from the side surface of the sheath body 12 in the radial direction by the urging force of the spring 15, and the sheath body 12 is moved from the inside of the groove 12b. It appears in the radial direction and spreads in a substantially plane with respect to the sheath body 12 (see the two-dot chain line in FIGS. 1A and 1B). When the operator operates the wire 14 backward, the proximal end of the rod-shaped member 13 is swung in a direction approaching the side surface of the sheath body 12 while the spring 15 is contracted, and the spring 15 and the rod-shaped member 13 are grooved. It is accommodated in 12b.

The operation of the sheath 1 configured as described above will be described below.
In order to treat the heart surface with another medical device using the sheath 1 according to the present embodiment, the distal end of the sheath 1 is moved from the xiphoid process of the patient to the pericardial membrane with the wire 14 operated to the rearmost position. Is inserted into the pericardium. Then, the distal end of the sheath 1 is further moved forward to a desired position in a state where the wire 14 is operated forward in the pericardium and the rod-like member 13 is spread along the heart surface. Indwell 1

  Subsequently, when the medical device is inserted along the lumen 12a of the sheath body 12, the distal end of the medical device is guided to a desired position on the heart surface. When the treatment on the surface of the heart is completed, the medical device is removed from the body, and when the sheath 1 is removed while the rod 14 is housed in the groove 12b by operating the wire 14 backward, the heart is beaten. Can be treated with a condition.

  In this case, according to the present embodiment, even if a circumferential rotational force is applied to the distal end portion of the sheath 1 by repeating contraction and expansion while rotating in the direction in which the heart twists, the shape of the heart 1 in the pericardium is obtained. The rod-shaped member 13 that spreads substantially flat along the length limits the range in which the distal end of the sheath 1 can be rotated and maintains a constant posture with respect to the heart surface.

  Therefore, the tip of the sheath 1 is prevented from rolling or twisting around the heart surface and winding the tuna, and the sheath 1 can be easily moved along the heart surface in a desired direction. On the other hand, there is an advantage that it can be stably placed at a desired position while maintaining a certain position and orientation. In addition, since the sheath body 12 stably supports the direction and position of the tip of the medical device with respect to the affected part, there is an advantage that diagnosis and treatment can be facilitated and accuracy thereof can be improved.

Further, by housing the rod-like member 13 in the sheath body 12, the running performance of the sheath 1 is maintained without the rod-like member 13 being obstructed outside the pericardium, and the sheath 1 can be easily inserted into and removed from the body. There is an advantage that you can.
Further, since the cylindrical sheath body 12 only needs to be provided with a simple configuration of the rod-shaped member 13, the spring 15 and the wire 14, the size of the sheath 1 can be kept small, and the patient can be reduced in the same manner as a conventional procedure using a sheath. It can be treated invasively.

  In the above-described embodiment, the distal end of the rod-shaped member 13 is rotatably attached to the sheath body 12, but instead, the proximal end of the rod-shaped member 13 is rotatably attached to the sheath body 12. It is good to be. Even if it does in this way, the attitude | position of the front-end | tip part of the sheath 1 can be stabilized by the structure and operation similar to the said embodiment.

In the above embodiment, the sheath 1 is arranged in the longitudinal direction of the sheath body 12 and can be bent outward in the radial direction as shown in FIGS. 2A and 2B instead of the rod-shaped member 13. A linear member (wing portion), for example, a shape memory alloy wire 16 in which an arc shape is stored at the tip portion may be provided.
The shape memory alloy wire 16 has a distal end portion disposed on the outer peripheral surface of the sheath body 12, the distal end fixed to the side surface of the sheath body 12, and the other portion formed in the side wall of the sheath body 12 in the longitudinal direction. It is inserted into the small-diameter hole 12c so as to be movable in the longitudinal direction. In this case, the hole 12c opens to the outer peripheral surface on the tip side.

  When the proximal end of the shape memory alloy wire 16 is operated forward, the distal end portion exposed to the outside of the sheath body 12 is bent into a memorized shape and protrudes in the radial direction of the sheath body 12 (FIGS. 2A and 2B). (Refer to the two-dot chain line in b).) Further, when the proximal end of the shape memory alloy wire 16 is operated backward, the distal end portion thereof extends substantially linearly along the side surface of the sheath body 12. By doing in this way, the effect similar to the said embodiment can be acquired only by simple structure and operation.

Moreover, in the said embodiment, the sheath 1 replaced with the rod-shaped member 13, and the balloon (wing | wing part) 17 provided in the outer surface of the sheath main body 12 was shown as FIG. 3 (a), (b). It is good also as providing.
The balloon 17 is inflatable in the transverse cross section of the sheath body 12 outward in the radial direction while maintaining the dimension in the direction perpendicular to the outer radial direction substantially constant.

  Further, in this case, the sheath body 12 has a flow path that communicates with the inside of the balloon 17 and extends toward the proximal end, for example, a second lumen 12d and an opening from the second lumen to the outside at the proximal end. Supply / discharge port 12e. By connecting a supply / exhaust means (operation unit) 18 such as a pump or a syringe to the supply / exhaust port 12e, a fluid is supplied into the second lumen 12d or discharged from the second lumen 12d. 17 can be expanded or contracted. Even in this case, the posture of the distal end portion of the sheath 1 can be stabilized only with a simple configuration and operation.

In the above embodiment, the sheath 1 is provided with the above-described wing portion at the distal end thereof, but instead of this, the endoscope is provided with the above-described wing portion at the distal end portion of the insertion portion. Also good.
The insertion portion of the endoscope has an elongated shape with a substantially circular cross section like the sheath 1 and is easily rolled by receiving a rotational force in the circumferential direction from a beating heart when inserted into the pericardium. Or twisted.

  Therefore, by providing the wing portion at the distal end portion of the insertion portion, the distal end of the endoscope can be easily moved in a desired direction with the heart surface leaning while stabilizing the posture with respect to the heart surface. In addition, the position and direction of the endoscope can be stabilized even if the distal end of the endoscope is placed on the heart surface. Therefore, when observing the heart surface with an endoscope, the field of view of the endoscope is instantaneously moved and desired. Thus, a stable image of a desired position on the surface of the heart can be obtained without losing sight of the observation site or rotating the visual field violently on the screen. Moreover, by doing in this way, a medical examination and the treatment by the treatment tool with which an endoscope is equipped can be made easier, and those precision can be improved.

In this case, as shown in FIG. 4A, the endoscope may be provided with a wing portion, for example, a rod-shaped member 13 in front of the curved portion 22, as shown in FIG. As shown, a wing part may be provided behind the curved part 22.
When the wing portion is provided in front of the curved portion 22, rotation is restricted at a portion closer to the tip surface, so that the posture of the tip surface is further stabilized. Therefore, when a limited narrow visual field such as a lesion site is examined, the image of the visual field can be more stabilized and examined in more detail.

In addition, when the wing part is provided behind the bending part 22, the movement of the bending part 22 is not limited by the wing part, so that it is suitable for observing an unspecified or wide range while moving the visual field. is there.
In addition, it is preferable that a wing | blade part is made to protrude in the left-right direction with respect to the visual field of an endoscope.
In addition, the endoscope may include a wing portion on both the front and rear sides of the bending portion 22, and may cause the wing portion at a desired position to appear and disappear according to the purpose.

An endoscope 2 according to a second embodiment of the present invention will be described below with reference to FIGS.
In addition, about the structure which is common in 1st Embodiment, suppose that the same code | symbol is attached | subjected.
As shown in FIG. 5A, the endoscope 2 according to this embodiment includes a flexible thin insertion portion 21 and a bending portion 22 provided at a distal end portion of the insertion portion 21. , An operation portion 23 for operating the bending portion 22 on the proximal end side, and a protrusion 24 provided at the distal end of the insertion portion 21.

The insertion portion 21 has flexibility that can be bent along the tissue shape in the body.
The bending portion 22 can be bent at least in the vertical direction with respect to the field of view of the endoscope 2. When the operator operates the operation unit 23, the bending unit 22 is bent and the direction of the distal end surface of the insertion unit 21 is changed.

As shown in FIG. 5B, the protruding portion 24 is a curved plate that is curved with substantially the same curvature as the distal end portion of the insertion portion 21, and the insertion portion is located above the field of view of the endoscope 2. 21 is provided along the curvature of the side surface. Further, the protrusion 24 protrudes from the distal end surface of the insertion portion 21 to the front in the range of the depth of field of the endoscope 2. The protrusion 24 has a sufficiently high rigidity that cannot be deformed by the force received from the beating heart A, and the most distal end of the protrusion 24 is formed with rounded corners.
The image acquired by the endoscope 2 is sent to the monitor 25 through a fiber bundle or the like and displayed, and the operator operates the endoscope 2 while observing the endoscopic image on the monitor 25. It is like that.

The operation of the endoscope 2 configured as described above will be described below.
In order to examine or treat the surface of the heart A using the endoscope 2 according to the present embodiment, the distal end of the insertion portion 21 is inserted from the xiphoid process of the patient, and the pericardial membrane B is punctured to insert the intrapericardial C. Insert into. In the pericardial C, as shown in FIG. 6 (a), the distal end of the insertion portion 21 runs to a desired position along the surface of the heart A in such a direction that the surface of the heart A is arranged below the visual field. Let Then, when the bending portion 22 is bent below the visual field by the operation portion 23, the distal end surface of the insertion portion 21 is directed to the surface of the heart A as shown in FIG. A frontal image is projected and the surface of the heart A can be examined or treated.

  In this case, according to the present embodiment, when the bending portion 22 is bent below the visual field, the most distal portion of the protrusion 24 is pressed against the surface of the heart A and temporarily fixed to the surface of the heart A. The Thereby, even if the rotational force in the circumferential direction is applied by the beating heart A, the distal end portion of the insertion portion 21 is moved integrally with the heart A while maintaining a constant posture without rotating with respect to the surface of the heart A. . That is, since the distal end surface of the insertion portion 21 is stationary with respect to the heart A surface, even if the heart A is beating, an endoscopic image of the heart A surface with a stable position and orientation of the visual field can be obtained. There is an advantage that a diagnosis or treatment can be easily performed.

  Further, by disposing the most distal portion of the projection 24 within the depth of field of the endoscope 2, the distal end surface of the insertion portion 21 and the heart A when the distal end surface of the insertion portion 21 is directed toward the heart A surface. An appropriate distance from the surface is ensured, and a clear image focused on the surface of the heart A can be obtained. In addition, it is possible to prevent inconvenience that the distal end surface is in close contact with the surface of the heart A and is contaminated with body fluids and the image becomes unclear. Further, by forming the corners of the most distal portion of the protrusion 24 round, it is possible to make contact while protecting the surface of the heart A.

  In the above-described embodiment, the protrusion 24 is provided on the side surface of the insertion portion 21. Alternatively, the protrusion 24 may be provided so as to be slidable in the longitudinal direction of the insertion portion 21. By doing so, the protrusion 24 is arranged at a position that does not protrude from the distal end of the insertion portion 21 except when the distal end portion of the insertion portion 21 is fixed to the surface of the heart A, and the operation of the insertion portion 21 is made easier. be able to.

Moreover, in the said embodiment, the protrusion part 24 is good also as being provided in the channel formed in the insertion part 21 in the longitudinal direction so that it can protrude and retract.
In this case, the protrusion 24 has a shape that can be accommodated in the channel and has a sufficiently high rigidity, and is at least 2 separated in the left-right direction of the field of view of the endoscope 2 when being projected and retracted from the channel. Project the part forward from the tip.

  For example, as shown in FIG. 7, a round bar-like member 24a made of a rigid material is provided in each channel 21a formed at a position separated in the horizontal direction of the visual field. The round bar-like member 24a is provided with a spherical protection member 25 at the most distal end portion, and can be brought into contact with the heart A while protecting the surface of the heart A.

In this case, the channel 21a is formed at a position farther away in the radial direction of the insertion portion 21, and the width between the most distal portions of each round bar-like member 24a is substantially the same as or wider than the radial dimension of the insertion portion 21. Is preferred.
By doing so, the protrusion 24 can be housed in the insertion portion 21 except when the distal end portion of the insertion portion 21 is fixed to the surface of the heart A, and the operation of the insertion portion 21 can be made easier.

  Moreover, in the said embodiment, although the endoscope 2 was provided with the projection part 24, it replaces with this and is provided with the treatment tool 26 which is provided in the channel 21a so that it can protrude and expand and spreads in the radial direction at the time of protrusion. It is good.

  The treatment instrument 26 has a forceps-like shape. For example, as shown in FIG. 8, when the distal end portion is housed in the channel 21a, the treatment tool 26 is disposed at a position along the longitudinal direction, and the treatment tool 26 is allowed to appear and disappear from the channel 21a. If it is done, it will open to the radial direction to the dimension wider than the outer diameter dimension of the insertion part 21. FIG. The treatment instrument 26 has sufficiently high rigidity that it cannot be deformed by an external force due to the pulsation of the heart A. In addition, the treatment instrument 26 is provided with a spherical protective member 25 at the most distal portion.

  Even in this case, when treating the surface of the heart A using the endoscope 2, the posture of the endoscope 2 is set to the surface of the heart A by moving the treatment tool 26 in and out and fixing it to the surface of the heart A. It is stabilized and treatment with other treatment tools can be easily performed.

DESCRIPTION OF SYMBOLS 1 Sheath 2 Endoscope 12 Sheath main body 12a Lumen 12b Groove 12c Hole 12d 2nd lumen 12e Supply / exhaust port 13 Sponge-like member (wing part)
14 Wire (operation part)
15 Spring 16 Shape Memory Alloy Wire (Linear Member, Wing)
17 Balloon (wing)
18 Supply / discharge means (operation unit)
21 Insertion part 21a Channel 22 Bending part 23 Operation part 24 Protrusion part 24a Round bar-like member 25 Monitor 26 Treatment tool A Heart B Pericardial membrane C Intrapericardial cavity

Claims (15)

A cylindrical sheath body having flexibility and capable of inserting a medical device therein along the longitudinal direction;
A wing provided in a distal direction of the sheath body so as to be able to appear and disappear in a radial direction;
A sheath provided with an operation part for projecting and retracting the wing part on the proximal end side of the sheath body.   The sheath according to claim 1, wherein the wing portion is provided so as to protrude and protrude on both sides of the sheath body in the radial direction.   The sheath according to claim 1, wherein the wing portion includes a rod-like member provided so as to be swingable between a position along the side surface of the sheath body and a position spaced radially outward from the side surface. The wing portion has a distal end fixed to a side surface of the sheath body, and is deformable between a substantially linear shape along the side surface of the sheath body and a curved shape curved outward in the radial direction of the sheath body. Provided with a member,
The operation section includes a wire member that is connected to the other end of the linear member, extends to the proximal end side along the longitudinal direction of the sheath body, and is movably provided in the longitudinal direction of the sheath body. The sheath according to 1. The wing portion is provided on the outer surface of the sheath body, and expands outward in the radial direction of the sheath body while maintaining a substantially constant dimension in a direction perpendicular to the radially outward direction in a cross section of the sheath body. With possible balloons,
The operation unit includes a flow path communicating with the balloon and extending along a longitudinal direction of the sheath body, and supply / discharge means for supplying fluid into the flow path and discharging the fluid from the flow path. Item 2. The sheath according to Item 1. An insertion part to be inserted into the body,
A wing provided at the distal end of the insertion portion so as to be able to appear and disappear in a radial direction;
An endoscope including an operation unit that causes the wing portion to appear and retract on a proximal side from the insertion portion.   The endoscope according to claim 6, wherein the wing portion is provided so as to protrude and retract on both sides of the insertion portion in the radial direction.   The endoscope according to claim 6, wherein the wing portion includes a rod-shaped member that is swingable between a position along the side surface of the insertion portion and a position spaced radially outward from the side surface. . The wing portion has a distal end fixed to the side surface of the insertion portion, and is deformable between a substantially linear shape along the side surface of the insertion portion and a curved shape curved outward in the radial direction of the insertion portion. Provided with a member,
The operation portion includes a wire member that is connected to the other end of the linear member, extends to the proximal end side along the longitudinal direction of the insertion portion, and is movably provided in the longitudinal direction of the insertion portion. 6. The endoscope according to 6. The wing portion is provided on an outer surface of the insertion portion, and expands radially outward of the insertion portion while maintaining a dimension in a direction orthogonal to the outer side in the radial direction within a cross section of the insertion portion. With possible balloons,
The operation portion communicates with the inside of the balloon and extends to the proximal end side along the longitudinal direction of the insertion portion, and supply / discharge for supplying fluid into the passage or discharging fluid from the passage The endoscope according to claim 6, further comprising: means. The insertion portion has a bending portion that can be bent so as to change the direction of the distal end surface;
The endoscope according to claim 6, wherein the wing portion is provided in front of the curved portion. The insertion portion has a bending portion that can be bent so as to change the direction of the distal end surface;
The endoscope according to claim 6, wherein the wing portion is provided behind the curved portion. An insertion part to be inserted into the body,
A bending portion that can be bent so as to change the direction of the distal end surface of the insertion portion;
An endoscope comprising: a protruding portion that protrudes forward from the distal end surface at least two places separated in a direction intersecting a bendable direction of the bending portion.   The endoscope according to claim 13, wherein a most distal portion of the protrusion is disposed within a range of depth of field.   The endoscope according to claim 13, wherein the protruding portion is provided in a channel formed in the insertion portion along the longitudinal direction and opened to the distal end surface so as to protrude forward from the distal end surface.

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