JP4637327B2 - Heat treatment device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention inserts an insertion portion into a living body lumen or lumen such as blood vessels, digestive tracts such as esophagus and rectum, urethra, and abdominal cavity, and applies energy such as laser light, microwaves, radio waves, and ultrasonic waves to living tissue. The present invention relates to a heat treatment apparatus for performing heat treatment by irradiating toward the surface.
[0002]
[Prior art]
A heat treatment device inserts a long insertion part from a small incision made in a living body cavity or living body, selectively irradiates the lesion site of the living body with energy such as laser light, and warms the tissue of the lesion site It is known to disappear, heal by degeneration, necrosis, coagulation, cauterization or transpiration. Such a heat treatment apparatus is generally configured to irradiate a lesion site located in the surface layer of a living tissue or in the vicinity thereof with laser light.
[0003]
In addition, for example, a technique for irradiating a deep portion of a living tissue with laser light for the purpose of treating a lesion site located deep in the living tissue, that is, a deep lesion site, such as heat treatment for prostatic hypertrophy, is also known. .
[0004]
The prostate is located at the bottom of the male bladder, surrounding the posterior urethra, and transurethral techniques are often used for heat treatment of benign prostatic hyperplasia. In the transurethral technique, an insertion portion of a heat treatment apparatus is inserted into the urethra, and energy is irradiated to a living lesion site. The heat treatment apparatus has an endoscope for confirming a biological lesion site and performing energy irradiation.
[0005]
In the insertion part 90 of the conventional heat treatment apparatus, as shown in FIG. 8, there is an emission part 92 in the front part of the endoscope 91, and a front view cannot be secured. Thus, the biological lesion site is confirmed from the side of the insertion portion 90 through the window 94 of the housing 93 and the light-transmitting cover member 95. For this reason, in the conventional heat treatment apparatus, the front cannot be observed. There is a problem that it takes time to position the insertion position and the energy irradiation position of the insertion portion 90 because the biological lesion site cannot be observed while looking forward.
[0006]
[Problems to be solved by the invention]
The present invention has been made in view of such conventional problems, and an object of the present invention is to provide a heat treatment apparatus capable of performing forward observation and side observation using an endoscope.
[0007]
[Means for Solving the Problems]
The above object of the present invention is achieved by the following means.
[0008]
(1) A heat treatment apparatus according to the present invention includes a long insertion part that can be inserted into a living body, and heat treatment apparatus that irradiates energy toward a living tissue from an emission part installed in the insertion part. An endoscope that is inserted into the insertion portion and for observing a living tissue, and a front observation window and a side observation window that allow the front and side of the insertion portion to be observed by the endoscope, respectively. It is characterized by having.
[0009]
(2) It has a moving means which moves the position of the said emission part along the longitudinal direction of the said insertion part, and changes the emission angle of the said emission part with the movement along the said longitudinal direction of the said emission part.
[0010]
(3) It further has an endoscope guide lumen that supports the endoscope so as to be movable from the proximal end side of the insertion portion to the vicinity of the front observation window.
[0011]
(4) It further has a regulating means for regulating contact of the endoscope with the front observation window.
[0012]
(5) The restricting means has a tapered structure formed toward the front observation window, and a diameter of a tip side of the tapered structure is smaller than a diameter of the endoscope.
[0013]
(6) The said front observation window is formed in the front-end | tip cap provided in the said insertion part front-end | tip, and the said front-end | tip cap has a rounded smooth shape.
[0014]
(7) The tip cap includes a perfusate outlet that flows out a perfusate for washing the outer periphery of the front observation window, and the insertion unit guides the perfusate to the perfusate outlet. Is provided.
[0015]
(8) The insertion portion includes a cooling fluid passage that guides a cooling liquid that cools the emission portion and the surface of the insertion portion, and the perfusion fluid passage and the cooling fluid passage are independently formed in the insertion portion. ing.
[0016]
(9) The tip cap is integrally molded with the front observation window.
[0017]
(10) The cap is formed of a member that shields laser light in a portion of the tip cap excluding the vicinity of the front observation window.
[0018]
(11) The front observation window is inclined from the vertical within a range perpendicular to the optical axis of the endoscope or smaller than a predetermined angle.
[0019]
(12) The energy is laser light.
[0020]
(13) The endoscope has a filter that blocks the passage of the laser light.
[0021]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
[0022]
(First embodiment)
FIG. 1 is a perspective view of the laser irradiation apparatus 1 (heat treatment apparatus), and FIG. 2 is a diagram illustrating the internal structure of the insertion portion 100 of the laser irradiation apparatus 1. 3 is a cross-sectional view taken along line AA in FIG.
[0023]
The laser irradiation device 1 includes a long main body 20, a drive device 30, a cam box 40, a shock absorber 50, and an endoscope 15.
[0024]
An insertion portion 100 to be inserted into the living body is formed at the tip of the main body 20. The insertion unit 100 includes a housing 101, a cover member 102, and a tip cap 150. The housing 101 is made of a rigid tubular body having a side window 104 for laser beam emission and side observation, and is covered with a cover member 102 having good laser beam transmission. Further, a pair of wall members 103 are fixedly disposed inside the housing 101 and define an internal space of the housing 101. In order to make the inside of the housing 101 a closed system, the housing 101 is brought into close contact with the tip cap 150. The tip cap 150 includes a front observation window 155 for confirming the front of the insertion unit 100.
[0025]
An optical fiber 16 that transmits laser light is disposed inside the main body 20 and the housing 101. The proximal end of the optical fiber 16 is connected to a laser light generator (not shown) via an optical connector.
[0026]
In the housing 101, an emission unit 110 for irradiating the side of the insertion unit 100 with laser light is included. One end of an arm 120 is connected to the emitting unit 110. A connection point between the emitting part 110 and the arm 120 forms a hinge mechanism. The other end of the arm 120 is connected to a cam mechanism in the cam box 40. The cam mechanism converts the rotational motion of the drive device 30 into the reciprocating motion of the main body 20 in the longitudinal direction. Accordingly, the arm 120 reciprocates by driving the driving device 30, and the emission unit 110 also reciprocates in conjunction with the reciprocation. The drive device 30 is supplied with electric power from a power supply device (not shown) via the cable 31.
[0027]
In addition, the emitting portion 110 has a pair of protrusions 112 formed on both side surfaces. The protrusion 112 is slidably fitted into a pair of rail grooves 105 provided on the wall member 103 of the housing 101. The rail groove 105 is not parallel to the reciprocating direction of the arm 120. Therefore, the angle of inclination of the emitting portion 110 is changed by the position of the arm 120 and the rail groove 105.
[0028]
The emitting unit 110 has a smooth reflecting surface 111 on one side for reflecting laser light. Laser light is irradiated from the optical fiber 16 toward the reflecting surface 111, and the reflected laser light passes through the side window 104 and is irradiated to the lesion site.
[0029]
The tip of the optical fiber 16 is connected to the arm 120 by a connecting member 115. Therefore, while the optical fiber 16 and the arm 120 are integrally reciprocated, the relative positional relationship between the reflecting surface 111 and the tip of the optical fiber 16 is kept substantially constant.
[0030]
The shock absorber 50 accommodates the optical fiber 16 in a loop shape and fixes the base portion. Therefore, the reciprocating motion of the optical fiber 16 in the housing 101 and the main body 20 is converted into the contraction and expansion motion of the loop inside the shock absorber 50. That is, since the movement and load of the optical fiber 16 are absorbed, the optical fiber 16 does not move outside the laser irradiation apparatus 1.
[0031]
The endoscope 15 is fixed in a linear shape by being covered with a protective pipe made of stainless steel, except for a distal end portion located in the internal space of the housing 101, and is prevented from being damaged and curved. The endoscope 15 is inserted into the endoscope guide lumen 21 (21a, 21b) via the endoscope introduction tube 17. Here, the endoscope guide lumen 21 includes an endoscope guide lumen 21a formed on the main body 20 side and an endoscope guide lumen 21b formed on the distal end cap 150 side. This is a passage for leading to the vicinity of the front observation window 155 and the side observation window 104.
[0032]
The endoscope 15 is movable with respect to the longitudinal direction of the main body 20. Since the endoscope 15 moves in a straight shape without being bent, the endoscope 15 is not detached from the guide lumen 21 even through the internal space of the housing 101 between the endoscope guide lumens 21a and 21b.
[0033]
The endoscope 15 has a field of view suitable for observing the inside of the living body from the side window 104 and the front observation window 155. Therefore, if the endoscope 15 is disposed in the vicinity of the side window 104, the side of the insertion portion 100 can be observed, and if it is disposed in the vicinity of the front observation window 155, the front can be observed. Therefore, observation of the surface layer of the living tissue, positioning of the housing 101 based on the observation, and visual confirmation of the laser light irradiation position can be easily performed.
[0034]
The endoscope 15 has a filter function for cutting the wavelength range of the laser light irradiated by the optical fiber 16. This filter function is provided between the endoscope 15 and a monitor that displays an image of the endoscope 15 or in the endoscope 15. Therefore, it is possible to prevent the laser light from entering the eyes during in vivo observation with an endoscope.
[0035]
Next, a specific structure of the tip cap 150 will be described.
[0036]
FIG. 4A is a cross-sectional view around the tip cap 150, and FIG. 4B is a cross-sectional view showing a modification of the tip cap 150. 4 (a) and 4 (b), the perfusate flush lumen 22 does not appear in the actual cross section, but is shown by a broken line in order to help understanding.
[0037]
The tip cap 150 has a smooth substantially hemispherical portion 151 so that it can be easily inserted into a living body, and has a shape that does not cause a step with the housing 101. Further, the housing 101 is covered with a cover member 102.
[0038]
The distal end cap 150 includes a front observation window 155 that enables forward observation with the endoscope 15. The front observation window 155 is disposed in a notch 152 formed in a part of the substantially hemispherical part 151 of the tip cap 150. The notch 152 is formed so as to expand from the front observation window 155 toward the outside of the tip cap 150 so as not to obstruct the visual field of the endoscope 15 through the front observation window 155. In addition, since the tip cap 150 and the front observation window 155 are integrally molded with a transparent material that does not obstruct the field of view of the endoscope 15, the number of parts can be reduced. However, the tip cap 150 and the front observation window 155 may be formed separately and fixed. In this case, only the front observation window 155 can be made of a transparent material that does not disturb the visual field.
[0039]
Further, the tip cap 150 includes a perfusate flush port 153 for removing blood, biological tissue fluid, bubbles, and the like attached to the outside of the front observation window 155. The perfusate flush port 153 is formed so as to directly discharge the perfusate to the front observation window 155, and can efficiently clean the front observation window 155 and its surrounding environment. Therefore, the dirt on the front observation window 155 can be removed, and observation with the endoscope 15 can be performed satisfactorily.
[0040]
As shown in FIG. 4A, the perfusate flush port 153 is connected to the perfusate flush lumen 22 positioned in parallel to the longitudinal direction of the insertion portion 100. The perfusate flush lumen 22 is formed in the wall member 103 of the housing 101 as shown in FIG. The perfusate is injected from the perfusate inlet 23 shown in FIG. The perfusate is preferably colorless and transparent and has no harm to the living body, such as purified water or physiological saline.
[0041]
The distal end cap 150 is formed with an endoscope guide lumen 21b. The endoscope guide lumen 21b is a path that guides the endoscope 15 to the vicinity of the front observation window 155. The endoscope guide lumen 21b has no problem if the endoscope 15 is shorter than the main body 20 if the endoscope 15 is simply guided to the front observation window 155, but if it is longer, the endoscope guide lumen 21b There is a risk of causing damage to the front observation window 155 due to the butting. As a structure for preventing this breakage, the endoscope guide lumen 21b is tapered in the vicinity of the front observation window 155 so that the diameter decreases toward the front observation window 155.
[0042]
Due to the taper, the diameter of the endoscope guide lumen 21 b is smaller than the diameter of the endoscope 15 in the vicinity of the endoscope 15. Therefore, the endoscope 15 hits the inner wall of the endoscope guide lumen 21b and stops until it hits the front observation window 155. As described above, the endoscope guide lumen 21 b has a structure (tapered structure) that prevents the front observation window 155 from being damaged by the abutment of the endoscope 15. The taper range is not particularly limited as long as it is inside the tip cap 150. The taper gradient is not particularly limited as long as the endoscope 15 does not hit the front observation window 155.
[0043]
The front observation window 155 is configured by a uniform and transparent plane. Further, the front observation window 155 has a structure having an angle that is perpendicular or nearly perpendicular to the optical axis of the endoscope 15 in order to prevent halation due to the endoscope guide light. The near-perpendicular angle is an angle indicated by θ in FIG. 4B, and the front observation window 155 is inclined to the main body 20 side with respect to the perpendicular of the optical axis of the endoscope 15. The angle θ is preferably 0 ° to 27 ° when the viewing angle of the endoscope 15 is 60 °, the material of the front observation window is acrylic, and the coolant is water, and is preferably 10 ° to 15 °. More desirable. Even in the case where the viewing angle, the material, and the coolant are different, the antihalation angle θ is similarly set as appropriate. As described above, since the angle of the front observation window 155 is set, halation of the endoscope 15 can be prevented and the field of view of the endoscope 15 can be kept good.
[0044]
Next, the cross-sectional structure of the main body 20 will be described with reference to FIG.
[0045]
FIG. 5 is a cross-sectional view taken along line BB in FIG. In FIG. 5, the operating part, the housing 101 and the cover member 102 are omitted for the sake of explanation.
[0046]
An arm lumen 24, an optical fiber lumen 25, a coolant inflow lumen 26, a coolant outflow lumen 27, an endoscope guide lumen 21 a, and a perfusate flush lumen 22 are formed inside the main body 20. The arm lumen 24 is parallel to the axis of the main body 20, and the arm 120 is inserted so as to be able to reciprocate. The optical fiber lumen 25 is parallel to the axis of the main body 20, and an optical fiber 16 covered with a protective pipe is inserted in a reciprocating manner.
[0047]
The coolant inflow lumen 26 and the coolant outflow lumen 27 are for inflow and outflow of the coolant. The cooling liquid inflow lumen 26 is connected to a cooling liquid circulation device (not shown) through a tube 28 shown in FIG. 1 and the cooling liquid outflow lumen 27 is connected to a cooling liquid circulation device (not shown). The coolant inflow lumen 26 and the coolant outflow lumen 27 communicate with the internal space (see FIG. 2) of the housing 101 in which the emitting portion 110 is disposed. Therefore, the coolant fed from the coolant circulation device is introduced into the internal space of the housing 101 via the tube 28 and the coolant inflow lumen 26, and the surface of the living tissue irradiated with the laser light, the emitting unit 110 and the laser. The device components such as the cover member 102 through which light is transmitted are cooled. Thereafter, the coolant is returned to the coolant circulating apparatus via the coolant outlet lumen 27 and the tube 29.
[0048]
The endoscope guide lumen 21a is inserted so that the endoscope 15 can reciprocate.
[0049]
The perfusate flush lumen 22 carries the perfusate injected from the perfusate inlet 23 shown in FIG. The perfusate flush lumen 22 is communicated from the main body 20 to the wall member 103 of the housing 101. The perfusate flush lumen 22 does not open in the internal space of the housing 101 and opens for the first time at the perfusate flush port 153 of the tip cap 150. Therefore, the perfusate flush lumen 22, the coolant inflow lumen 26, and the coolant outflow lumen 27 are completely independent. As a result, the perfusate and the cooling liquid can be guided separately.
[0050]
In addition, it is desirable to prevent a back flow of the coolant toward the cam box 40 by providing a check valve (not shown) in each lumen 21a, 24 and 25.
[0051]
Next, a specific use situation and operation of the laser irradiation apparatus 1 will be described with reference to FIG.
[0052]
FIG. 6 is a schematic diagram for explaining a usage situation of the laser irradiation apparatus 1.
[0053]
First, the insertion part 100 of the main body 20 of the laser irradiation apparatus 1 is inserted into the body cavity 200. At this time, the endoscope 15 is arranged in the vicinity of the front observation window 155, and the approximate position of the lesion site is searched for while looking forward. Then, the housing 101 in which the emitting unit 110 is accommodated is brought into close contact with a lesion site, that is, a surface layer in the vicinity of the target site 201 that is a target heating site.
[0054]
Then, the endoscope 15 is appropriately moved along the endoscope guide lumen 21, and forward observation from the front observation window 155 or side observation from the side window 104 is performed to directly confirm the vicinity of the target portion 201. The target part 201 is specified accurately. When the target site 201 is specified, when the position of the housing 101 is adjusted with respect to the longitudinal direction of the body cavity 200, the entire laser irradiation apparatus 1 is moved in the longitudinal direction of the main body 20. When the position of the housing 101 is adjusted with respect to the circumferential direction of the body cavity 200, the entire laser irradiation device 1 is rotated.
[0055]
When the heat treatment for the target portion 201 is started, a coolant whose temperature has been adjusted in advance is supplied to the laser irradiation device 1 from a coolant circulation device (not shown) via the tube 28, and the laser light generator is operated. The generated laser light is introduced into the laser irradiation apparatus 1 via a connector (not shown).
[0056]
The laser light is further guided to the insertion portion of the laser irradiation apparatus 1 via the optical fiber 16, reflected by the reflecting surface 111 of the emitting portion 110 in the housing 101, passes through the side window 104, and passes through the cover member 102. Then, the target part 201 is irradiated. At this time, the emitting unit 110 changes the irradiation angle while reciprocating in the axial direction at a period of 1 to 6 Hz. The optical path of the laser light is continuously changed, but all intersect at the target site 201.
[0057]
As a result, the target region 201 in the living tissue 202 and the vicinity thereof generate a large amount of heat due to the continuously irradiated laser light. Accordingly, the target portion 201 reaches a desired temperature.
[0058]
On the other hand, irradiation of laser light onto the region above the target portion 201, for example, the surface layer 203 of the living tissue 202, becomes intermittent and generates a small amount of heat. Similarly, the irradiation of the laser beam to the region below the target portion 201 becomes intermittent and generates a small amount of heat. That is, the peripheral part (normal part) other than the target part 201 is maintained at a relatively low temperature. In particular, even when the target part 201 exists at a deep position in the living tissue, the target part 201 can be effectively heated while preventing or reducing damage to parts other than the target part 201. Therefore, safety for patients is high. In addition, a desired region is heated by changing the position of the target portion 201 and irradiating it with laser light.
[0059]
The laser beam to be used is not particularly limited as long as it has a biological depth. However, the wavelength of the laser light is preferably about 750 to 1300 nm or about 1600 to 1800 nm.
The diameter of the insertion portion of the laser irradiation apparatus 1, that is, the outer diameter of the main body 20 is not particularly limited as long as it can be inserted into the body cavity 200. However, the outer diameter of the main body 20 is preferably about 2 to 20 mm, and more preferably about 3 to 8 mm.
[0060]
As described above, according to the heat treatment apparatus 1 of the present invention, the lesion site can be observed from the front observation window 155 and the side window 104, and the housing 101 can be positioned easily and quickly.
[0061]
Further, since the endoscope guide lumen 21b is tapered, the endoscope 15 does not hit the front observation window 155.
[0062]
Furthermore, the heat treatment apparatus 1 according to the present invention heats only the inside of the prostate even when normal tissues such as the urethra and rectum are present in the vicinity of the prostate, such as prostate diseases such as prostatic hypertrophy and prostate cancer. Can be treated.
[0063]
(Second Embodiment)
FIG. 7 is a view showing a tip cap 750 of the laser irradiation apparatus 1 according to the second embodiment.
[0064]
Since only the tip cap 750 is different from the first embodiment described above, the tip cap 750, which is a difference, will be described below with reference to FIG. The same components as those in the first embodiment are denoted by the same reference numerals, and the description thereof is omitted.
[0065]
In FIG. 7, the tip cap 750 is formed of a material that blocks laser light supplied from the optical fiber 16. The tip cap 750 has a smooth substantially hemispherical body 751 so as to be easily inserted into the living body, and has a shape that does not cause a step with the housing 101. The tip cap 750 includes a front observation window 755.
[0066]
The front observation window 755 is formed of a transparent material that does not obstruct the field of view of the endoscope 15. The front observation window 755 is disposed in a notch 752 formed in a part of the substantially hemispherical body 751 of the tip cap 750. The notch 752 is formed so as to expand from the front observation window 755 toward the outside of the tip cap 750 so as not to obstruct the field of view of the endoscope 15 through the front observation window 755.
[0067]
As described above, since the tip cap 750 is formed of a material that shields the laser beam, the laser beam can be used even when the emitting unit 110 is damaged and the laser beam travels straight without being reflected. There is no leakage outside.
[0068]
The first and second embodiments described above are not described to limit the present invention, and various modifications can be made by those skilled in the art within the technical idea of the present invention.
[0069]
Further, the laser beam has been exemplified and explained as the energy irradiated toward the living tissue, but the present invention is not limited to this. The energy may be, for example, a microwave, a radio wave, an ultrasonic wave, or the like.
[0070]
【The invention's effect】
In the first aspect of the invention, since the front and side of the insertion portion can be observed, the insertion portion can be positioned quickly and accurately in the living body.
[0071]
In the second aspect of the invention, the angle at which the energy is irradiated is changed depending on the position where the emission unit has moved, and the energy can be concentrated only on a specific target site, such as normal tissue other than the specific target site. The site can be kept at a low temperature. Thereby, damage to parts other than the target part can be prevented or reduced. Particularly, even when the target part is located in a deep part, damage to the surface layer part can be prevented, so that safety to the patient is high.
[0072]
In the invention described in claim 3, since the endoscope is supported so as to be movable, the inside of the living body can be observed over a wide range.
[0073]
In invention of Claim 4 and Claim 5, the damage of the said front observation window by the endoscope contacting a front observation window can be prevented.
[0074]
In the invention described in claim 6, since the tip cap has a rounded smooth shape, it is easy to insert the insertion portion into the living body.
[0075]
In the seventh aspect of the present invention, dirt on the front observation window can be removed and observation with an endoscope can be performed satisfactorily.
[0076]
In invention of Claim 8, a cooling fluid and a perfusate can be guide | induced separately.
[0077]
In the invention according to claim 9, the number of parts can be reduced.
[0078]
In the invention according to claim 10, the laser beam does not leak from the tip cap.
[0079]
In the invention according to the eleventh aspect, it is possible to prevent halation of the endoscope and to maintain a good field of view of the endoscope.
[0080]
In the invention described in claim 12, appropriate treatment can be performed by laser light.
[0081]
In invention of Claim 13, a laser beam is not output outside the endoscope.
[Brief description of the drawings]
FIG. 1 is a perspective view of a laser irradiation apparatus.
FIG. 2 is a diagram illustrating an internal structure of an insertion portion of a laser irradiation apparatus.
3 is a cross-sectional view taken along line AA in FIG.
4A is a cross-sectional view around the tip cap 150, and FIG. 4B is a cross-sectional view showing a modification of the tip cap 150. FIG.
5 is a cross-sectional view taken along line BB in FIG.
FIG. 6 is a schematic diagram for explaining a usage state of the laser irradiation apparatus 1;
FIG. 7 is a view showing a tip cap of a laser irradiation apparatus.
FIG. 8 is a view showing a conventional laser irradiation apparatus.
[Explanation of symbols]
1 ... Laser irradiation device,
15 ... Endoscope,
16: optical fiber,
21a, 21b ... endoscope guide lumen,
22 ... perfusate flush lumen,
26 ... Coolant inflow lumen,
27. Coolant outflow lumen,
100 ... insertion part,
101 ... Housing,
110 ... emitting part,
153 ... perfusate flush port,
150, 750 ... tip cap,
155, 755 ... Front observation window.

Claims (13)

In a heat treatment apparatus that includes a long insertion portion that can be inserted into a living body and irradiates energy toward a living tissue from an emitting portion installed in the insertion portion,
An endoscope that is inserted into the insertion portion and for observing a living tissue;
A front observation window and a side observation window that allow observation of the front and side of the insertion portion with the endoscope, respectively;
An endoscope guide lumen for supporting the endoscope movably from the proximal end side of the insertion portion to the vicinity of the front observation window;
The heat treatment apparatus characterized by having. Moving means for moving the position of the emitting portion along the longitudinal direction of the insertion portion;
The heat treatment apparatus according to claim 1, wherein an emission angle of the emission unit is changed as the emission unit moves along the longitudinal direction. The endoscope guide lumen further includes a main body provided on a proximal end side of the insertion portion and a distal end cap provided on a distal end of the insertion portion, and the endoscope guide lumen is formed on the main body side. And an endoscope guide lumen formed on the distal end cap side .   The heat treatment apparatus according to claim 1, further comprising a restricting unit that restricts contact of the endoscope with the front observation window.   The heat treatment according to claim 4, wherein the restricting unit has a tapered structure formed toward the front observation window, and a diameter of a distal end side of the tapered structure is smaller than a diameter of the endoscope. apparatus.   The said front observation window is formed in the front-end | tip cap provided in the said insertion part front-end | tip, The said front-end | tip cap has a rounded smooth shape, The one of Claims 1-5 characterized by the above-mentioned. Heat treatment device. The tip cap includes a perfusate outlet for flowing out a perfusate for washing the outer periphery of the front observation window,
The heat treatment apparatus according to claim 6, wherein the insertion unit includes a perfusate passage that guides perfusate to the perfusate outlet. The insertion portion includes a coolant passage that guides a coolant that cools the emission portion and the surface of the insertion portion.
The heat treatment apparatus according to claim 7, wherein the perfusate passage and the coolant passage are formed independently in the insertion portion.   The heat treatment apparatus according to any one of claims 6 to 8, wherein the tip cap is integrally formed with the front observation window.   The heat treatment apparatus according to claim 6, wherein the cap is formed of a member that shields laser light in a portion of the tip cap excluding the vicinity of the front observation window. The heat treatment apparatus according to claim 1, wherein the front observation window is inclined with respect to the optical axis of the endoscope so as to be perpendicular to the optical axis or prevented from halation .   The heat treatment apparatus according to claim 1, wherein the energy is laser light.   The heat treatment apparatus according to claim 12, wherein the endoscope includes a filter that blocks passage of the laser light.

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