JPH0994214A - Hood for endoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To safely facilitate ablation and hemostasis of a living body tissue by providing a photo-permeable material part for securing an endoscopic view in the hood body and a means for performing incision and coagulation of the living body tissue. SOLUTION: A transparent hood 5 is provided with a nearly cylindrical fixed hood 7 that is locked at the tip end of an inner cylinder 3 and with a movable hood 8; and it is also formed of a transparent material such as an acrylic resin and glass. A near wedge shaped pressing part 15 is formed at the tip end of the movable hood 8, with a first and a second electrodes 17, 18 attached to an edge 16 of its tip end. In addition, a high-frequency galvanocautery current is flowed between the first and the second electrodes 17, 18, to form a bipolar means for performing incision and coagulation on the living body tissue. Furthermore, a cord 19 connected to both the electrodes 17, 18 is put through between an inner cylinder 3 and an outer cylinder 4, guided outside through a cord inserting hole 20 formed on the rear end outer circumferential face of the outer cylinder 4, and connected to a power source unit for supplying the high-frequency galvanocautery current.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an endoscope hood detachably attached to an endoscope.

[0002]

2. Description of the Related Art Conventionally, when an endoscope is used to observe and treat a narrow lumen in a human body or a living tissue without a cavity such as a subcutaneous tissue, a hood is attached to the insertion portion of the endoscope. A technique has been developed which, when attached, prevents the observation window of an endoscope from being contaminated by biological tissue adhering to the observation window and secures a space for observing the endoscope.

As a hood to be attached to the insertion portion of the endoscope, the applicant of the present application has proposed a tubular sheath with an open tip as shown in Japanese Patent Application No. 172466 / 7-1724, and a Japanese Patent Application No. 7-1 / 1995.
As shown in Japanese Patent No. 72139, the applicant has a patent application in which the endoscope is completely covered and the shape is suitable for exfoliation of tissue.

Further, Japanese Patent Publication No. 10328/1992 discloses a hood having an opening on a side surface thereof, through which a treatment tool such as a scalpel can be used. Further, WO94 / 11052 discloses a structure in which the field of view of the endoscope is obtained during an observation procedure by opening the distal end of a tubular body through which the endoscope is inserted. There is disclosed a structure having a window for the treatment instrument of.

[0005]

In recent years, treatment of blood vessels in the human body, treatment of the spine, treatment of the esophagus, treatment of the kidney, etc.
Endoscopic procedures are performed on the part without the cavity. 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 separating the living tissue having no cavity with the hood.

[0006] By the way, when the hood hits the fascia between muscles during insertion of the endoscope, it is not possible to incise it by blunt operation with the hood and to move it forward. However, since it is very difficult, there is a problem that the tissue peeling cannot be performed smoothly. In addition, there is also a problem in that, if bleeding is inadvertent during the tissue peeling work, the bleeding must be stopped.

However, in the prior art, it is difficult to smoothly deal with the above problems when they occur. In other words, in the technique of Japanese Patent Application No. 7-172139, when performing the work of incising the fascia between muscles, only the blunt operation of press-fitting the tip of the hood into the living tissue can be performed. In addition to the problem that it is difficult to improve, it is necessary to perform a troublesome work of inserting another hemostatic means in parallel between the tissues when stopping the bleeding at the bleeding site.

Further, in the technique disclosed in JP-A-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, it is not effective for incising and removing the living tissue in front of the endoscope, and since it has no hemostatic means, it effectively stops the bleeding site. There is a problem that cannot be done.

Furthermore, in the techniques of Japanese Patent Application No. 7-172466, Japanese Patent Publication No. 4-17648 and WO94 / 11052, a treatment instrument for incision and hemostasis is inserted into the body through a treatment instrument channel of an endoscope. However, it is possible to deal with these, but in this case, there is a problem that the operation of inserting and removing the treatment tool to and from the treatment tool channel of the endoscope becomes complicated.

In the case of WO94 / 11052, since the tube body through which the endoscope is inserted is not transparent, it is necessary to perform the peeling work blindly, which makes the work difficult and is safe. There is also a problem with sex.

The present invention has been made by paying attention to the above circumstances, and its purpose is to safely and easily detach a living tissue while visually confirming a treatment target portion of the living tissue with an endoscope.
An object of the present invention is to provide an endoscope hood that can perform hemostasis work.

[0012]

SUMMARY OF THE INVENTION The present invention relates to an endoscope hood having a hood body that covers at least the tip of the insertion portion of the endoscope to be inserted into the body. A translucent material portion for ensuring a visual field and an incision coagulation means for incising and coagulating a living tissue are provided.

With the above structure, the incision and coagulation are performed by incising and coagulating the biological tissue by the incision coagulation means while visually confirming the treatment target portion of the biological tissue through the transparent material portion endoscopically. The invention makes it possible to easily dissect and remove difficult living tissue and also to easily stop the bleeding in case of unexpected bleeding.

[0014]

BEST MODE FOR CARRYING OUT THE INVENTION 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 of this embodiment and a rigid endoscope 2 inserted into the sheath 1.

In addition, the sheath 1 with a transparent hood has an inner cylinder 3
And a double cylinder including an outer cylinder 4 arranged on the outer peripheral surface of the inner cylinder 3. Here, the inner cylinder 3 is set to be longer than the length of the outer cylinder 4. Both ends of the inner cylinder 3 extend outside the both ends of the outer cylinder 4.

Further, a transparent hood (hood body) 5 is provided at the tip of the inner cylinder 3, and an endoscope fixing portion 6 is provided at the rear end of the inner cylinder 3.
Are provided respectively. The inner diameter of the inner cylinder 3 is set so that the endoscope 2 can be inserted over the entire length.

Further, the transparent hood 5 is provided with a substantially cylindrical fixed hood 7 fixed to the tip 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) such as acrylic,
It is made of a resin material such as polycarbonate or polysulfone, or glass. Then, in a state where the endoscope 2 is inserted inside the inner cylinder 3, the wall surface of the transparent hood 5 can be transmitted to allow observation by the endoscope 2.

Further, the fixed hood 7 is formed with a notch 9 in the lower portion 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 cutout portion 9 of the cylindrical body of the fixed hood 7. Furthermore, the movable hood 8
The base end portion of is rotatably connected to the fixed hood 7 by a hinge 11 formed of a rotation pin.

A rod connecting portion 12 is provided on the outer peripheral surface of the movable hood 8 so as to project therefrom. A tip 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 base end portion of the operation rod 13 is fixed to the outer peripheral surface of the tip end portion of the outer cylinder 4.

The tip of the movable hood 8 is shown in FIG.
As shown in (A), a substantially wedge-shaped pressing portion 15 is formed. A first electrode 17 is attached to an edge portion 16 at the tip edge of the pressing portion 15. Further, a second electrode 18 is attached near 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. Further, a bipolar type incision coagulation means is formed between the first electrode 17 and the second electrode 18 to inject and coagulate a biological tissue by passing a high frequency ablation current.

Further, the cord 19 connected to both electrodes 17 and 18 passes between the inner cylinder 3 and the outer cylinder 4 and comes out from the cord insertion hole 20 formed in the outer peripheral surface of the rear end portion of the outer cylinder 4. And is connected to a power supply device (not shown) for energizing a high frequency cauterizing current.

Further, as shown in FIG. 2 (C), a flange portion 21 is formed at the inner end portion of the engaging portion 10 of the movable hood 8 which is disengageably engaged with the notch portion 9 of the fixed hood 7. There is. A rubber member such as silicon rubber is attached to the flange portion 21, and sealing means 22 coated with grease or the like is provided. When the movable hood 8 is engaged with the fixed hood 7 in the state in which the cutout 9 is closed, the sealing means 22 keeps the fixed hood 7 and the movable hood 8 airtight.

Further, the endoscope fixing portion 6 is provided with an inner cylinder connecting portion 23 which is fitted onto the rear end of the inner cylinder 3. A tubular 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 protruding portion 25 is provided on the outer peripheral surface of the rear end portion of the inner cylinder connecting portion 23 in a direction orthogonal to the axial direction of the inner cylinder 3. A screw member 26 for tightening the seal member 24 is attached to the protruding portion 25. After the endoscope 2 is inserted into the inner cylinder 3, the screw member 26 is squeezed to fix the sealing member 24 to the outer peripheral surface of the endoscope 2 and fix the endoscope 2 in an airtight manner. It is supposed to be fixed.
An air supply port 27 communicating with the inner 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.

An inner cylinder fixing portion 28 is provided at the rear end of the outer cylinder 4.
Is provided. The inner cylinder fixing portion 28 is provided with an outer cylinder connecting portion 29 which is fitted onto the rear end of the outer cylinder 4. A tubular seal 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 tube connecting portion 29. Further, a protruding portion 31 is provided on the outer peripheral surface of the rear end portion of the outer cylinder connecting portion 28 in a direction orthogonal to the axial direction of the outer cylinder 4. A screw member 32 for tightening the seal member 30 is attached to the protruding portion 31.

After the inner cylinder 3 is inserted into the outer cylinder 4, the screw member 32 is squeezed to seal the seal member 3
0 is squeezed and fixed on the outer peripheral surface of the inner cylinder 3, so that the inner cylinder 3 is airtightly fixed. In addition, in a state in which the screw member 32 is rotated in the direction opposite to the tightening direction to loosen the tightening of the seal member 30 on the outer peripheral surface of the inner cylinder 3, the seal member 30 of the outer cylinder 4 is moved along the inner cylinder 3. It can be slid. Thereby, the fixed position of the outer cylinder 4 with respect to the inner cylinder 3 can be adjusted to any 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. At the rear end of the airtight member 33, a ring-shaped seal member 34 is attached which is airtightly slidable on the outer peripheral surface of the outer cylinder 4. This sealing member 3
4 is fixed to the rear end of the airtight member 33 in a state of being sandwiched between the fixing member 35 screwed to the rear end of the airtight member 33 and the airtight member 33. Further, a pair of thread hooks 36 are provided on the outer peripheral surface of the rear end of the airtight member 33.

Next, the operation of this embodiment having the above configuration will be described. Here, the procedure for performing the observation procedure of the spine Y by inserting the endoscope 2 from the skin of the patient through the muscle layer into the living tissue X in the body as shown in FIGS. 2B and 2C. It will be explained based on.

First, after inserting the endoscope 2 into the sheath 1 with the transparent hood, the screw member 26 is tightened and fixed. Then, a small incision, that is, an incision is formed to the extent that the transparent hooded sheath 1 can be inserted into the skin of the patient, and the muscle layer in the body is exposed. In this state, when the edge portion 16 of the transparent hood 5 of the transparent hood-equipped sheath 1 is pushed in along the direction of the muscle fibers from the cut end of the patient's skin, the muscle tissue is peeled off, as shown in FIG. 2 (B). Then, the tip of the transparent hooded sheath 1 is inserted into the living 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 performed while confirming the running of blood vessels. You can Note that FIG. 2D
FIG. 3 shows an observation image of the living tissue X observed by the endoscope 2 through the transparent wall surface of the transparent hood 5 during the insertion work of the sheath 1 with a transparent hood.

When the distal end of the transparent hood 5 hits the fascia or hard tissue during the insertion operation of the distal end of the transparent hooded sheath 1, the first electrode 17 and the second electrode 1
A high frequency ablation current is applied to 8. This is the first electrode 1
7 is a bipolar system in which a current is passed between the second electrode 18 and the second electrode 18, and is safe because a current flows between both electrodes 17, 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 high. Therefore, the living tissue X can be intensively cauterized on the first electrode 17 side. Thereby, the living tissue X is incised and coagulated, and the fascia and hard living tissue can be peeled off.

Since the first electrode 17 is near the edge portion 16 at the tip edge of the movable hood 8, the portion of the cauterized living tissue X can be easily peeled off at the edge portion 16. Therefore, the peeling operation can be proceeded 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 there is an incision of about 3 mm on the patient's skin, the diameter is 10 m
It has been experimentally confirmed that a substantially wedge-shaped pressing portion 15 of the transparent hooded sheath 1 having a size of about m can be inserted into the body. Therefore, it becomes possible to insert the transparent hooded sheath 1 into the body with a smaller incision and coagulation with respect to the living tissue X of the patient. Furthermore, during the work of inserting the transparent hood-equipped sheath 1 into the body, the state of incision and coagulation of the living tissue X can be confirmed by the endoscope 2 in the sheath 1 through the transparent wall surface of the transparent hood 5, which is safe.

Further, even in the case of bleeding, it is possible to stop the bleeding by applying the first electrode 17 and the second electrode 18 at the tip of the transparent hood 5 to the bleeding part. Therefore, the peeling work of the living tissue X can be smoothly carried out.

Further, in a state where the engaging portion 10 of the movable hood 8 is engaged with the notch portion 9 of the fixed hood 7, the sealing means provided on the flange portion 21 at the inner end portion of the engaging portion 10 of the movable hood 8. Since it is possible to prevent blood from entering the inside of the transparent hood 5 from the joint between the fixed hood 7 and the movable hood 8 by 22, the endoscope 2 in the sheath 1 with a transparent hood can be kept clean.

When the transparent cap-equipped sheath 1 reaches the spine Y, the airtight member 33 is slidably moved along the outer peripheral surface of the outer cylinder 4 toward the distal end portion to surround the skin incision. Press on. In this state, a suture is used to sew between the thread hooking portion 36 and the skin to fix the airtight member 33 to the skin.

Next, the outer cylinder 4 is moved rearward with respect to the inner cylinder 3. At this time, the operation rod 13 is pulled backward with the movement of the outer cylinder 4. 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 sent into the body through the inner cylinder 3 from the air supply port 27 on the hand side of the transparent hooded sheath 1. As a result, the portion separated by the opening operation of the movable hood 8 is further expanded by the supply of this gas, and the spine Y is observed as shown in FIG. 2 (C).
The body space S required for the treatment is secured. At this time, since the movable hood 8 is opened downward with respect to the fixed hood 7, it is possible to directly observe the spine Y by the endoscope 2 in the sheath 1 without passing through the transparent wall surface of the transparent hood 5. Therefore, a clear visual field of the endoscope 2 can be obtained. 2E shows an observation image of the spine Y directly observed by the endoscope 2 inside the sheath 1 without passing through the transparent wall surface of the transparent hood 5.

Furthermore, when observing the living tissue X in the body through the transparent wall surface of the transparent hood 5 by the endoscope 2 in the sheath 1, the living tissue X closely attached to the transparent hood 5 is observed.
Can be clearly observed, but the living tissue X far from the transparent hood 5 has a markedly deteriorated visual field.
Becomes difficult to observe. Therefore, it is sufficient for the living tissue X to be directly observed by the endoscope 2 by opening the movable hood 8 downward with respect to the fixed hood 7 as in the present embodiment. It is important for observing and treating.

If 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, the CO is opened with the movable hood 8 of the transparent hood 5 slightly opened.
By sending ₂ gases or the like, it is possible to effectively remove fogging on the glass surface of the observation optical system.

It is known that spraying a dry gas onto the glass surface of the observation optical system at the tip of the endoscope 2 prevents fogging, but as in the present embodiment, the transparent hood 5 is used. By surrounding the tip of the endoscope 2 with
By supplying a small amount of dry gas into a small space formed in the transparent hood 5, the glass surface of the observation optical system at the tip of the endoscope 2 can be efficiently exposed to the dry gas,
The effect of removing and preventing fogging can be further improved.

Therefore, the following effects can be obtained with the above-mentioned structure. That is, since the bipolar first electrode 17 and the second electrode 18 forming the incision solidification means are provided on the edge portion 16 of the movable hood 8 of the transparent hood 5, during the work of inserting the endoscope 2 into the body, A high-frequency cauterizing current is passed between the first electrode 17 and the second electrode 18 to dissect and coagulate the living tissue X, and the living tissue X can be efficiently separated.

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 ablation of the living tissue X can be intensively performed on the first electrode 17 side. Therefore, the biological tissue X can be removed efficiently with a small incision and coagulation range.

Further, the sheath 1 is used when the biological tissue X is peeled off.
Since the living body tissue X can be directly visually confirmed through the transparent wall surface of the transparent hood 5 by the endoscope 2 inside, it is possible to safely and easily perform the peeling operation of the living body tissue X and the hemostasis work. .

Further, after the living tissue X is peeled off, the movable hood 8 is opened downward with respect to the fixed hood 7 so that the living body tissue X to be observed can be directly observed by the endoscope 2. The spine Y can be directly observed by the internal 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.

Further, since CO ₂ gas or the like is fed into the body through the inner cylinder 3 with the movable hood 8 opened with respect to the fixed hood 7, the peeling portion is further expanded by the supply of this gas, It is possible to sufficiently secure the internal space S necessary for observation and treatment of the spine Y. Furthermore, by sending CO ₂ gas or the like into the body through the inner cylinder 3, it is possible to remove or prevent the fogging of the glass surface or the like of the observation optical system of the endoscope 2.

In this embodiment, the bipolar type first electrode 17 and the second electrode 18 for forming the incision solidification means are provided on the edge portion 16 of the movable hood 8 of the transparent hood 5, but the same is true. Alternatively, the incoagulation means may be formed by a monopolar type having one electrode with the above structure.

Further, in the present embodiment, the structure in which the first electrode 17 and the second electrode 18 of the bipolar system are fixed directly to the surface of the movable hood 8 of the transparent hood 5 is shown, but heat insulation of fluororesin, ceramics, etc. The material may be inserted between the movable hood 8 and the electrodes 17, 18. At this time, if a transparent heat insulating member such as fluororesin is used, the field of view by the endoscope 2 is not blocked. Further, the same effect can be obtained by attaching an antenna that generates a microwave instead of the electrodes 17 and 18.

Further, 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.

The transparent sheath 41 has a sheath body (hood body) 42 formed of an integrally molded cylindrical body having a closed tip. Closure surface 43 at the tip of the sheath body 42
Is formed by an inclined surface that is cut out obliquely with respect to the axial direction of the sheath body 42.

Further, on the outer peripheral surface of the sheath body 42, a projecting portion 44 extending in the axial direction is projected. The protruding portion 44 is arranged at a portion corresponding to the tip edge portion of the inclined surface of the tip closing surface 43 of the sheath body 42.

A laser fiber insertion hole 45 is provided in the protruding portion 44. A laser fiber (dissection coagulation means) 46 that guides laser light can be inserted into the laser fiber insertion hole 45.

Therefore, in the case of the above-described structure, the sheath main body 42 is pushed in while the distal end edge portion of the inclined surface of the distal end closing surface 43 of the sheath main body 42 of the transparent sheath 41 is pressed against the living tissue, and the living body is pushed. The tissue can be detached.
Further, during the work of peeling the living tissue at the tip of the sheath body 42, if the living tissue is hard to peel or bleeds, the living tissue is peeled by irradiating laser light from the laser fiber 46. It is possible to continue the work of keeping up and to stop the bleeding.

Further, FIG. 3B shows a third embodiment of the present invention. This is a structure in which the laser fiber 46 is embedded in the peripheral wall portion of the sheath body 42 in the transparent sheath 41 of the second embodiment by previously inserting and integrally molding the laser fiber 46 into the peripheral wall portion of the sheath body 42. It was done.

Therefore, in addition to the effects similar to those of the second embodiment, the above-mentioned structure can further simplify the entire structure of the sheath body 42 of the transparent sheath 41 in the present embodiment. Therefore, it is suitable for making the entire transparent sheath 41 disposable.

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

That is, the transparent sheath 51 of the present embodiment.
The sheath main body 52 is formed of a cylindrical body formed of a transparent material with its tip closed in a substantially conical shape. A heat generating member (dissection / coagulation means) 53 is attached to the tip of the sheath body 52. As the heat generating member 53, for example, a heater around which a heater is heated when an electric current is applied and which is coated with fluororesin to prevent burning is used.

Further, the heat generating member 53 is connected to a connector 55 connected to the power source side via a lead wire 54 arranged 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 arranged inside the sheath body 52.

Therefore, in the case of the above-mentioned structure, the living body tissue can be peeled off by pushing the sheath body 42 while the tip of the sheath body 52 of the transparent sheath 51 is in contact with the living tissue. Furthermore, by applying an electric current to the heat generating member 53 at the tip of the sheath body 42, it is possible to perform operations such as cauterization of living tissue and hemostasis.

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

Further, FIG. 3D shows a fifth embodiment of the present invention. The present embodiment is provided with an ultrasonic sheath 61 which is adapted to perform incision and coagulation of biological tissue using ultrasonic vibration.

An elongated pipe-shaped probe 6 into which an endoscope 62 can be inserted is inserted into the ultrasonic sheath (dissection / coagulation means) 61.
3 are provided. An ultrasonic transducer 64 is connected to the base end of the probe 63. This ultrasonic transducer 6
An endoscope insertion hole 65 into which the endoscope 62 can be inserted is formed at 4. A transparent hood (hood body) 66 is attached to the tip of the probe 63.

Therefore, in the above structure, 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, Coagulation can take place.

FIG. 3 (E) shows the sixth embodiment of the present invention. This is a modification of the fifth embodiment. That is, in the present embodiment, a notched portion 71 is formed at the tip of the probe 63 of the fifth embodiment, the notched portion 71 being obliquely cut with respect to the axial direction of the probe 63, and the notched portion 71 at the tip of the probe 63. A transparent member (hood body) 72 as a hood for an endoscope is disposed inside the.

Therefore, in the above-described structure, since the probe 63 can directly perform the incision and coagulation of the living tissue, the ultrasonic vibration can be efficiently transmitted to the living tissue. Note that the transmission efficiency of ultrasonic vibration is greatly affected by the material of the probe 63. Therefore, when the probe 63 is directly brought into contact with the living tissue as in the present embodiment, the ultrasonic vibration from the probe 63 is transmitted through the transparent hood 66 like the ultrasonic sheath 61 of the fifth embodiment. It is possible to more effectively perform work such as exfoliation of the biological tissue and hemostasis as compared with the case of transmitting the biological tissue.

Further, FIG. 4 shows a seventh embodiment of the present invention. In the present embodiment, the sheath body 82 of the transparent sheath 81 is provided with an endoscope insertion hole 83 having a closed tip and a treatment instrument hole 84 having both ends opened, and the endoscope insertion hole 83 is provided with an endoscope. 85 is inserted and the treatment tool hole 84
The ultrasonic probe (dissection coagulation means) 86 is inserted into the above.

Therefore, in the above-described structure, since the living tissue can be directly dissected and coagulated by the ultrasonic probe 86, the ultrasonic vibration can be efficiently transmitted to the living tissue.

Further, FIGS. 5A to 5D show the eighth embodiment of the present invention.
FIG. In this embodiment, the outer sheath 91 made of a transparent material is used as the hood for the endoscope.
And a transparent inner sheath 9 inserted in the outer sheath 91.
A transparent sheath 93 composed of a double cylinder composed of 2 and 3 is provided.

Here, a closed wedge-shaped pressing portion 94 is formed at the tip of the outer sheath 91. Further, as shown in FIG. 5C, a streak portion 95 extending in the axial direction of the outer sheath 91 is provided on the outer peripheral surface of the outer sheath 91 on the distal end side.
Is provided.

The tip of the inner sheath 92 is the outer sheath 9
It is held in a state in which it is inserted up to a position near the first pressing portion 94. An endoscope 96 can be inserted into the inner sheath 92.

Therefore, in the case of the above configuration, FIG.
As shown in (B), the distal end portion of the inner sheath 92 is the outer sheath 9
The endoscope 96 in the transparent sheath 93 allows the outer sheath 91 to be inserted by inserting the endoscope 96 into the inner sheath 92 while being held in a state of being inserted up to the position near the pressing portion 94 of 1. The state of the living tissue can be observed through the transparent wall surface of the pressing portion 94. At this time,
Since the streak 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 the liquid from entering the inside of the outer sheath 91.

The inner sheath 92 is different from the outer sheath 91.
Slide forward, the muscle carved portion 9 of the outer sheath 91
5 part is destroyed, and as shown in FIG. 5 (D), the inner sheath 9
2 projects. Therefore, in this case, the transparent sheath 93
The living tissue can be directly observed by the inner endoscope 96 without passing through the transparent wall surface of the pressing portion 94 of the outer sheath 91, and a clear visual field of the endoscope 96 can be obtained.

At this time, the distal end of the endoscope 96 is slightly retracted from the distal end of the inner sheath 92 toward the inner side of the inner sheath 92, so that the endoscope 9 can be opened even when the outer sheath 91 is open.
It is possible to prevent 6 from coming into contact with living tissue and becoming soiled.

It is to be noted that, instead of providing the streak portion 95 of the outer sheath 91, a slit may be formed in the peripheral wall portion of the outer sheath 91 and the slit portion may be sealed with a sealing agent such as rubber or an adhesive. The effect is obtained.

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

The sheath body 102 of this transparent sheath 101
A lower surface opening 103 is formed at the tip of the. Further, the transparent shutter member 1 is provided in the lower surface opening 103.
04 is mounted so that it can 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. The shutter member 104 is fitted in the shutter guide groove 105. It should be noted that rubber or a space between the shutter guide groove 105 and the shutter member 104,
Watertightness is secured by a watertight member such as grease.

The tip of the operating rod 106 is fixed to the shutter member 104. This operating rod 1
The base end of 06 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 rearward, the shutter member 104 is moved to the position shown in FIG.
The sheath body 1 is slid backward as shown in (B).
The lower surface opening 103 of 02 is opened.

Therefore, in the present embodiment, as shown in FIG. 6A, the inside of the sheath body 102 is perspectively viewed with the lower surface opening 103 of the sheath body 102 of the transparent sheath 101 closed by the shutter member 104. Of a living body tissue through a transparent wall surface of the shutter member 104 by a perspective-type or side-viewing type endoscope inside the transparent sheath 101 by inserting a side-viewing type or a side-viewing type endoscope. it can. At this time, since 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, the inside of the sheath body 102 can be held in a watertight state.
Therefore, it is possible to prevent the liquid from entering the inside of the sheath body 102.

Further, by sliding the operation ring 107 rearward and sliding the shutter member 104 rearward as shown in FIG. 6B, the lower surface opening 103 of the sheath body 102 is opened. Therefore, in this case, the biological tissue can be directly observed through the lower surface opening 103 of the sheath main body 102 with a perspective-type or side-viewing type endoscope inside the transparent sheath 101, so that the shutter member 104 is transparent. It is possible to obtain a clear visual field of a perspective-type or side-viewing type endoscope without penetrating the wall surface.

At this time, the distal end of the perspective or side-viewing endoscope is housed inside the sheath body 102.
The distal end portion of a perspective or side-viewing endoscope is the sheath body 1
Since it is not projected to the outside of 02, even when the shutter member 104 is operated to be opened, it is possible to prevent the perspective-type or side-viewing endoscope from contacting and contaminating the living tissue.

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

The present invention is not limited to the above embodiment, and it goes without saying that various modifications can be made without departing from the gist of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows.

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

(Supplementary Note 2) In an endoscope hood for covering at least the tip of an endoscope having an observation window near the tip, the hood has a transparent portion, and energy for cutting and coagulating tissue is provided. A hood for an endoscope, comprising an output means and an energy supply means for supplying energy to the output means.

(Additional Item 3) The additional item 2 is characterized in that 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 Notes 3 and 4) It is possible to obtain a clear visual field without using a transparent portion. (Additional Item 5) In the additional item 4, when the opening is open, the endoscope has a portion that can be directly observed without going through the transparent portion within the visual field range of the endoscope. Hood.

(Additional Item 6) In the additional item 5, a hood for an endoscope is characterized in that the opening has a watertight means for preventing liquid from entering the inside. (Additional Item 7) In the additional items 2 to 6, the energy supply unit has an electrode for supplying a high frequency ablation current.

(Additional Item 8) In the additional item 7, the means for supplying the high frequency ablation current has a bipolar electrode. (Additional Item 9) In Additional Item 7, the means for supplying the high frequency ablation current has a monopolar electrode.

(Additional Item 10) In the additional items 2 to 6, the energy supply means is a laser emitting means. (Additional Item 11) In the additional items 2 to 6, the energy supply means has a member that electrically generates heat.

(Additional Item 12) The additional items 2 to 6 are characterized in that the energy supplying means has an ultrasonic vibration generating means. (Additional Item 12-2) In the additional items 2 to 6, the energy supply means has a means for transmitting a microwave.

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

(Additional Item 14) Additional Items 7, 8, 9, 13
In any one of the above, 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 that of the other.

(Additional Item 16) In Additional Item 15, the hood for an endoscope has an edge portion, and the electrode having a smaller surface area is provided near the edge portion. (Additional Item 17) In any one of the additional items, the hood for an endoscope has an air / water supply unit.

(Additional Item 18) In an endoscope hood that covers at least the tip of an endoscope having an observation window in the vicinity of the tip, the hood has a transparent portion and an openable / closable opening. The hood for an endoscope, wherein the opening has a portion that can be directly observed without going through the transparent portion within the field of view of the endoscope when the opening is open.

(Additional Item 19) In the additional item 18, there is provided a watertight means for preventing the liquid from entering the inside of the opening, which is a hood for an endoscope. (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 molded member, and the opening is opened by breaking a part thereof.

(Additional Item 23) In an hood for an endoscope, which covers at least the tip of an endoscope having an observation window near the tip, the hood has a transparent member and an opening, and observation through the transparent member is performed. And a hood for an endoscope characterized in that observation from the opening can be selectively performed.

(Problems to be Solved by the Techniques of Additional Items 18 to 23) In recent years, it has been proposed to perform treatments on a part without a cavity, such as treatment of blood vessels, treatment of spine, treatment of esophagus, treatment of kidneys. Therefore, a procedure is performed in which the endoscope is inserted while separating the tissues using the hood and the openable sheath to secure a cavity. WO83 / 03
189 and WO94 / 11052 are blind because the scope tip is covered as the scope is inserted into tissue. In Japanese Patent Publication No. 4-17648, although there is an opening for inserting a treatment tool, 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 visibility becomes worse as much as the food is passed through. In addition, when the scope is inserted into the tissue by using the above-mentioned three conventional techniques, when bleeding occurs, blood may infiltrate the inside of the hood through a gap or an opening, stain the scope, and deteriorate the visual field. Japanese Patent Application No. 7-17246
No. 6 has an open hood portion, which cannot be said to be the optimum shape for peeling, and has the same problem at the time of bleeding as described above. In Japanese Patent Application No. 7-172139, the hood always covers the scope, and there is the same problem as in Japanese Patent Publication No. 4-17648. Observation with an endoscope is to always obtain a clear field of view.
It is essential for treatment.

(Purpose of Supplementary Notes 18 to 23) The endoscope can be easily inserted while separating the tissues, the endoscope can be prevented from being soiled during that time, and the operation can be performed under a mirror. An object of the present invention is to provide a hood for an endoscope that can obtain a clearer field of view when a space is created between them.

(Functions of Supplementary Items 18 to 23) When inserting into tissue while performing a peeling operation, the endoscope is completely covered to prevent the endoscope from being soiled and to be observed from the transparent portion. You can do it. Further, by opening the opening after the peeling operation, observation can be performed without going through the hood and a clear visual field can be obtained. Further, by providing a watertight means in the opening, the invasion of blood is prevented.

(Effects of Supplementary Items 18 to 23) The endoscope can be easily inserted while peeling between the tissues, the endoscope can be prevented from being soiled during that time, and the operation can be performed under a mirror. If there is a space between the hood and the hood, a clearer view can be obtained.

[0101]

According to the present invention, since the hood body is provided with the translucent material portion for ensuring the field of view of the endoscope and the incision coagulating means for incising and coagulating the living tissue, the translucent property is obtained. While confirming the target part of the living tissue with the endoscope through the material part, work to safely and easily remove the living tissue and stop bleeding, and insert the endoscope into the living tissue for observation treatment of the endoscope. Easy to do.

[Brief description of drawings]

FIG. 1 is a schematic configuration diagram of a sheath with a transparent hood and an endoscope according to a first embodiment of the present invention.

FIG. 2A is a perspective view showing a distal end portion of the transparent hooded sheath of the first embodiment, and FIG. 2B is a main part showing a tissue detached state by using the transparent hooded sheath of the same embodiment. (C) is a longitudinal sectional view of a main part showing a state in which the hood is opened after the tissue is ablated by using the transparent hooded sheath of the same embodiment, and (D) is an endoscopic image of (B). The top view shown, (E) The top view which shows the endoscopic image of (C).

FIG. 3A is a perspective view showing a transparent sheath according to a second embodiment of the present invention, and FIG. 3B is a sectional view of a distal end portion of the transparent sheath according to a third embodiment of the present invention. Perspective view,
(C) is a perspective view showing a transparent sheath according to the fourth embodiment of the present invention, (D) is a longitudinal sectional view showing an ultrasonic sheath according to the fifth embodiment of the present invention, and (E) is the present invention. FIG. 16 is a vertical cross-sectional view of a main part showing an ultrasonic sheath of the sixth embodiment of the present invention.

FIG. 4 is a vertical sectional view showing a transparent sheath according to a seventh embodiment of the present invention.

5A is a perspective view showing a transparent sheath according to an eighth embodiment of the present invention, and FIG. 5B is a longitudinal sectional view showing a closed state of a distal end opening of the transparent sheath according to the same embodiment, C) is a transverse cross-sectional view showing a streak portion of the transparent sheath of the same embodiment, (D)
FIG. 4 is a vertical cross-sectional view showing an open state of a distal end opening of the transparent sheath of the same embodiment.

FIG. 6A is a longitudinal sectional view showing a closed state of a shutter member of a transparent sheath according to a ninth embodiment of the present invention, and FIG.
FIG. 4 is a vertical cross-sectional view showing an open state of a shutter member of the transparent sheath of the same embodiment.

FIG. 7 is a sectional view taken along line 7-7 of FIG.

FIG. 8A is a vertical cross-sectional view showing an observation state through an opening of a transparent sheath according to a tenth embodiment of the present invention,
FIG. 6B is a vertical cross-sectional view showing an observation state through the transparent member of the transparent sheath of the same embodiment.

[Explanation of symbols]

2, 62, 85, 96 ... Endoscope, 5, 66 ... Transparent hood (hood body), 17 ... First electrode (dissection coagulation means), 1
8 ... 2nd electrode (dissection coagulation means), 42, 52, 82 ... sheath main body (hood main body), 46 ... laser fiber (dissection coagulation means), 61 ... ultrasonic sheath (dissection coagulation means), 72 ... transparent member ( 86. Ultrasonic probe (dissection coagulation means).

Claims (1)

[Claims] 1. A hood for an endoscope, comprising a hood main body that covers at least a tip portion of an insertion portion of an endoscope to be inserted into a body, wherein the hood main body has a transparent body for ensuring a field of view of the endoscope. A hood for an endoscope, which is provided with an optical material portion and an incision coagulation means for incising and coagulating a biological tissue.