JPH10243946A - Laser medical treatment device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To move only an inner sheath, to make a laser irradiating position variable and to prevent a urethra, etc., from being damaged by means of an outer sheath by constituting the inner sheath to be move foreward and backward as against the outer sheath. SOLUTION: When laser medical treatment is executed in a lesion in terms of a urethra diameter, for example, the inserting part 4a of an optical view tube 4 is inserted to the inner sheath 2 at first. At this time, the optical view tube 4 is positioned and fixed to the inner sheath 2 in a state where the tip of the inserting part 4a is projected from the tip of the inner sheath 2 by a prescribed quantity. Then, a laser probe 6 is inserted to the inner sheath 2 through an insertion mouth piece 12 and the laser beam emitting end of the laser probe 6 is positioned in the front part of the tip of the inserting part 4a in the optical view tube 4. After that, the inner sheath 2 is put into the outer sheath 8, the laser beam is irradiated from the laser probe 6 so as to execute medical treatment and the inner sheath 2 is moved forewards and backwards at the time of changing an irradiating position.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a laser treatment apparatus for performing treatment by irradiating a living tissue with laser light under observation by an optical viewing tube.

[0002]

2. Description of the Related Art Conventionally, a cystourethroscope used in laser TUR (transurethral resection of the prostate by laser) is
As shown in FIG. 3, the optical viewing tube 106 and the laser probe 1
02 are integrally combined by an inner sheath 100. In this case, the optical viewing tube 106 is positioned and fixed to the inner sheath 100 in a state where the insertion portion 106a is inserted into the inner sheath 100 and the observation portion at the tip of the insertion portion 106a protrudes by a predetermined amount from the tip of the inner sheath 100. Further, the laser probe 102 is provided with an insertion base 105 provided on the near side of the inner sheath 100.
Through the inner sheath 100 so as to be able to advance and retreat. Further, in order to form a passage for a fluid for cleaning and cooling the affected part, the inner sheath 100 includes:
The outer sheath 108 is covered from the outside. In this case, the outer sheath 108 is fixedly attached to the inner sheath 100, and the outer sheath 108 and the inner sheath 1
A fluid passage is formed by the space between the fluid passages.

When laser treatment is performed using a cystourethroscope having such a configuration, first, as described above, the inner sheath 10 to which the optical viewing tube 106 is fixedly attached is used.
0, the laser probe 102 through the insertion base 105.
Is inserted, and the laser beam emitting end of the laser probe 102 is positioned in front of the distal end observation section of the insertion section 106a of the optical viewing tube 106 (state in FIG. 3). Then, in this state, the inner sheath 100 is inserted into the outer sheath 108, and the inner sheath 100 and the outer sheath 108 are fixedly attached.

[0004] Next, the cystourethroscope set as described above is inserted into the body transurethrally, and under observation by the optical viewing tube 106 (the region irradiated with the laser light exists within the visual field of the optical viewing tube 106. The laser probe 102 is applied to the affected tissue.
The treatment is performed by irradiating a laser beam from

[0005]

By the way, the above-mentioned conventional cystourethroscope includes the optical viewing tube 106 and the inner sheath 10.
Because the relative position of the outer sheath 108 and the outer sheath 108 in the axial direction is determined, that is, since the inner sheath 100 and the outer sheath 108 are fixedly attached,
When changing the irradiation position by the laser probe 102 after insertion into the body, the laser probe 102 is moved in the inner sheath 100 or the outer sheath 10 is moved.
The entire urethoscope, including 8, must be moved within the urethra.

However, generally, the laser probe 1
02 has a long diameter and a small diameter.
It is difficult to change the irradiation position by moving only the inner sheath 100 within the inner sheath 100. Therefore, especially when the moving amount is large, it is common practice to move the entire urethoscope including the outer sheath 108 in the urethra.

However, if the entire urethoscope including the outer sheath 108 is moved in the urethra, the outer sheath 108 (particularly, the beak 108a at the tip) may damage the mucous membrane of the urethra.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a laser treatment apparatus which can solve the above-mentioned problem by changing the irradiation position without moving the whole. It is in.

[0009]

In order to solve the above-mentioned problems, a laser treatment apparatus according to the present invention is provided with a laser which is optically connected to a laser light source and has at its tip an emission part for emitting laser light from the laser light source. A probe, an optical viewing tube having an observation optical system, an inner sheath into which the laser probe and the optical viewing tube are integrally inserted, and a fluid passage between the inner sheath and an outer sheath of the inner sheath. And a means for sliding the inner sheath relative to the outer sheath with the fluid passage formed between the outer sheath and the inner sheath sealed against the outside.

[0010]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 shows a laser treatment apparatus 1 according to one embodiment of the present invention. Of FIG.
As shown in FIG. 2B, the laser treatment apparatus 1 includes an optical viewing tube 4.
And an inner sheath 2 into which the laser probe 6 is inserted,
And an outer sheath 8 into which the inner sheath 2 is inserted. Note that the inner sheath 2 and the outer sheath 8 are formed so as to be inserted into a lumen such as the urethra.

The optical viewing tube 4 is composed of a long insertion portion 4a having an observation optical system at the distal end thereof, and a structure 11 provided continuously on the hand side of the insertion portion 4a. Further, the optical viewing tube 4 has the insertion portion 4a inserted into the inner sheath 2 and the insertion portion 4a.
Is positioned and fixed to the inner sheath 2 in a state in which the distal end projects a predetermined amount from the distal end of the inner sheath 2. The structure 11 of the optical viewing tube 4 includes an eyepiece 1 having an eyepiece.
0 is provided.

The laser probe 6 is optically connected to a laser source (not shown), and has a laser light emitting section at its tip. In addition, the laser probe 6 is inserted into the inner sheath 2 so as to be able to advance and retreat through an insertion base 12 provided on the hand side of the inner sheath 2. In this case, as shown in FIG. 1C, a cylindrical friction member 13 is attached to the insertion base 12. Then, the laser probe 6 is inserted into the inner sheath 2 through the inner hole of the friction member 13, and is held so as to advance and retreat by frictional contact of the friction member 13. That is, if the laser probe 6 is pushed and pulled by overcoming the frictional force between the laser probe 6 and the friction member 13,
The laser probe 6 can be moved forward and backward in the inner sheath 2.
The relative position of the laser probe 6 with respect to the inner sheath 2 is fixed by the friction member 13 unless it is pushed and pulled by a force that overcomes the frictional force with the inner sheath 2.

In the inner sheath 2, there is provided a fluid supply passage (not shown) through which a fluid for cleaning and cooling the affected part is supplied. When the outer sheath 8 is covered on the inner sheath 2 from the outside, a fluid discharge passage is formed between the outer sheath 8 and the inner sheath 2. Therefore, when the fluid is supplied to the fluid supply passage in the inner sheath 2, the fluid flows out from the distal end opening of the inner sheath 2 to the affected part through the fluid supply passage,
Thereafter, the fluid is recovered through the fluid discharge passage formed between the outer sheath 8 and the inner sheath 2. That is,
The fluid supply passage and the fluid discharge passage form a fluid return passage.

As shown in FIG. 1A, a friction seal member 20 composed of an O-ring or the like is provided at the proximal side of the outer sheath 8, specifically, at the insertion opening 19 of the outer sheath 8 into which the inner sheath 2 is inserted. Is provided. The friction seal member 20 seals between the inner sheath 2 and the inner sheath 2 so as not to leak fluid (ie, seals a fluid discharge passage formed between the outer sheath 8 and the inner sheath 2 to the outside in a liquid-tight manner). And inner sheath 2
By applying a pressing force or a frictional force to the inner sheath 2, the inner sheath 2 inserted into the outer sheath 8 is slidably held. That is, the friction seal member 20
If the inner sheath 2 is pushed and pulled by overcoming the pressing force or frictional force of the inner sheath 2, the inner sheath 2 can be advanced and retracted in the outer sheath 8.
If the inner sheath 2 is not pushed or pulled with a pressing force of 0 or a force that overcomes the frictional force, the relative position of the inner sheath 2 with respect to the outer sheath 8 is determined by the friction seal member 2.
Fixed by 0. The friction seal member 20 liquid-tightly seals a fluid discharge passage formed between the outer sheath 8 and the inner sheath 2 to the outside and guides the inner sheath 2 inserted into the outer sheath 8 slidably. It may be just one. That is, the inner sheath 2 may not be held by the pressing force or the frictional force.

When performing laser treatment of an affected part, for example, transurethrally by the laser treatment apparatus 1 having the above-described configuration, first, the insertion portion 4a of the optical visual tube 4 is inserted into the inner sheath 2. In this case, the tip of the insertion portion 4a is
The optical viewing tube 4 is positioned and fixed to the inner sheath 2 in a state where the optical viewing tube 4 protrudes by a predetermined amount from the front end of the optical sheath. Next, the laser probe 6 is inserted into the inner sheath 2 through the insertion base 12,
The laser beam emitting end of the laser probe 6 is positioned in front of the distal end of the insertion section 4a of the optical viewing tube 4 (the state shown in FIG. 1B). Then, in this state, the inner sheath 2 is inserted into the outer sheath 8, and the laser beam emitting end of the laser probe 6 protruding from the tip of the inner sheath 2 is caused to protrude from the tip opening of the outer sheath 8 by a predetermined amount (state in FIG. 2).

The laser treatment apparatus 1 set as described above
Is inserted into the body transurethrally, and the laser light from the laser probe 6 is applied to the diseased tissue under observation by the optical tube 4 (in a state where the laser beam is irradiated within the visual field of the optical tube 4). Irradiate to treat. At this time, a fluid for cleaning and cooling the affected part is supplied to the fluid supply passage in the inner sheath 2 as necessary. This fluid flows out of the distal end opening of the inner sheath 2 to the affected part through the fluid supply passage, and is thereafter collected by a suction pipe (not shown) through the fluid discharge passage formed between the outer sheath 8 and the inner sheath 2.

When the irradiation position of the laser probe 6 is changed after the laser treatment device 1 is inserted into the body to treat a predetermined site, the inner sheath 2 is connected to the outer sheath 8.
(See the broken line in FIG. 2). Thereby, the laser probe 6 moves forward and backward together with the inner sheath 2, and the irradiation position can be changed. Further, in this case, since the optical viewing tube 4 advances and retreats together with the inner sheath 2, the irradiation position of the laser probe 6 can be reliably captured by the optical viewing tube 4.

As described above, according to the laser treatment apparatus 1 of the present embodiment, the laser irradiation position can be changed by moving only the inner sheath 2 without moving the outer sheath 8. It does not damage the inner wall of the lumen or the mucous membrane. Further, since the relative position of the inner sheath 2 with respect to the outer sheath 8 is fixed by the friction seal member 20, the irradiation range does not change at the time of laser beam irradiation, and irradiation treatment of only the affected part can be reliably performed. Further, the friction seal member 20 not only allows the inner sheath 2 to advance and retreat with respect to the outer sheath 8, but also
Since the fluid discharge passage formed between the outer sheath 8 and the inner sheath 2 is sealed to the outside in a liquid-tight manner, leakage of fluid for cleaning and cooling of the affected part is prevented.

In the operation of prostatic hypertrophy (BPH), resection (TURP) using an electric scalpel having a loop electrode is generally performed. Recently, a laser TUR utilizing coagulation and transpiration by a laser beam has been developed.
(Transurethral resection of the prostate) has also attracted attention.

[0020] However, TURP has a drawback that although it can be reliably resected, bleeding is relatively large. Laser TUR, on the other hand, suffers from very little bleeding, but has the disadvantage that it is inferior to TURP in ablation ability.

Therefore, a resection device with a small amount of bleeding and capable of performing a sufficient resection will be disclosed below. FIG. 4 shows such an ablation device. The illustrated resectoscope device 30 includes an elongated sheath 32 inserted into the urethra.
A main body 33 connected to the rear of the sheath 32, a handle 34 connected to the main body 33, an observation scope (optical viewing tube) 35 inserted into the sheath 32 from behind the handle 34, An electrode 36 inserted into the sheath 32 from the handle 34 and a laser probe 60 are combined.

The main body 33 is provided with a water supply port 38 with a cock 38a communicating with the sheath 32. The reflux liquid is supplied to the water supply port 38, and the supplied reflux liquid is supplied to the bladder through the sheath 32, for example. Also, body 3
3 is provided with a fitting opening 33a into which the connecting portion 39 of the handle 34 is fitted, and a detachable button 40 for fixing and disconnecting, for example, a click mechanism for fixing the connecting portion 39 of the handle 34 in the fitting opening 33a. I have.

The distal end of the connecting portion 39 of the handle 34 has a scope guide pipe 41 through which the insertion portion 35a of the scope 35 is inserted and an electrode guide pipe 4 through which the electrode 36 is inserted.
2 (see also FIG. 7). The insertion section 43 is inserted into the sheath 32. Also, the connecting portion 39 of the handle 34
A guide shaft 44 protrudes from the base end in the axial direction. Further, a scope connection portion 45 is fixed to the base end of the guide shaft 44.

On the other hand, a slider 46 that slides in the axial direction along the guide shaft 44 is provided between the connection portion 39 of the handle 34 and the scope connection portion 45. The slider 46 is constantly urged in a direction in which it comes into contact with the scope connection portion 45 by a spring 48 provided between the slider 46 and the connection portion 39 of the handle 34. Finger hooks 49a and 49b are protruded above and below the connecting portion 39 of the handle 34, and a thumb hanging ring 50 extending downward is provided on the base end surface of the slider 46.

The slider 46 is provided with an electrode fixing portion 47 for detachably fixing the base end of the electrode 36 inserted from the front. The slider 46 has a connector 51 for supplying a high-frequency current from a high-frequency ablation power source (not shown) to the electrode 36 connected to the electrode fixing portion 47.
Is protruding. The distal end side of the electrode 36 whose base end is fixed to the electrode fixing portion 47 of the slider 46 is
Is inserted into an insertion hole formed in the connection portion 39 and an electrode guide pipe 42 extending forward from the connection portion 39, and protrudes from the distal end of the electrode guide pipe 42 into the distal end side portion of the sheath 32. (See also FIG. 7).

The scope 35 includes a main body 35b and a main body 35.
b, an elongated insertion portion 35a, a light guide connector 35c, and an eyepiece 35d. In the scope 35, a light guide fiber for guiding illumination light to the tip of the insertion section 35a and an image transmission optical system for transmitting an observation image from the tip of the insertion section 35a to the eyepiece 35d are provided. The scope 35 is detachably inserted and connected to a scope connection portion 45 of the handle 34. Then, the insertion portion 35a of the connected scope 35 is inserted into the scope guide pipe 41 from the connection portion 39 of the handle 34, and protrudes from the distal end of the scope guide pipe 41 (see also FIG. 7). .

As shown in detail in FIGS. 6 and 7, the electrode 36 includes a shaft 52a inserted into the sheath 32, and a bifurcated portion 52b bifurcated at the distal end of the shaft 52a.
And an arc-shaped (loop-shaped) cut-out portion 52c formed by bending the tip of the forked portion 52b downward substantially perpendicularly to the shaft portion 52a.
(Tip electrode). In this configuration, when a high-frequency current is supplied from a power source (not shown) to the resection unit 52c, the affected tissue in contact with the resection unit 52c is resected and cut off, or the bleeding part is stopped.

A cylindrical stabilizer 58 is fixed to the distal end of the shaft 52a of the electrode 36, specifically, to the distal end of the pipe covering the shaft 52a, by soldering, brazing, bonding, or the like. . The stabilizer 58 prevents the entire electrode 36 from being rotationally twisted, and the electrode 3
6 smooth forward and backward movement is ensured. In addition, stabilizer 5
Numeral 8 is made of a material such as metal or plastic, so that the insertion portion 35a of the scope 35 can be inserted into its inner hole. A probe insertion tube 5 into which the laser probe 60 can be inserted is provided above the stabilizer 58.
9 is fixed.

The laser probe 60 is mounted on the slider 4
6 is led into the sheath 32 through a base 62 projecting therefrom. As shown in FIG. 5, the base 62
It comprises a base body 67 integral with the slider 46, a nut 64 screwed to the base body 67, and a cylindrical elastic member 63 inserted between the nut 64 and the base body 67. A through hole 65 for guiding the laser probe 60 toward the sheath 32 is formed in the base body 67 and the slider 46. In this configuration, the laser probe 60 is connected to the elastic member 6.
When the nut 64 is inserted into the inner hole and the through hole 65 and screwed into the base body 67, the nut 64 causes the elastic member 6.
4 is pressed, the inner diameter of the elastic member 64 contracts, and the laser probe 60 inserted into the elastic member 64 is tightened and fixed.

The distal end side of the laser probe 60 inserted into the base 62 (slider 46) is inserted into an insertion hole formed in the connection portion 39 of the handle 34, so that the sheath 3
2 is introduced. And sheath 3
The distal end of the laser probe 60 introduced into 2 is inserted into and held by a probe insertion tube 59 provided above the stabilizer 58. In this case, the tip of the laser probe 60 is set so as to be closer to the hand than the cutout 52c of the electrode 36. That is, the laser probe 60 is inserted into the sheath 32 through the base 62, and the tip of the laser probe 60 is
The nut 64 is tightened in a state where the laser probe 60 is located close to the hand c, and the laser probe 60 is fixed. This allows
The relative position of the laser probe 60 with respect to the electrode 36 (the positional relationship between the cutting portion 52c and the tip of the laser probe 60) is fixed, and this state does not change even if the slider 46 is slid.

In the resectoscope device 30 set in the state shown in FIG. 4, when the slider 46 is slid, the electrode 36 is connected to the sheath 32 while the upper outer periphery of the stabilizer 58 is in contact with the inner peripheral surface of the sheath 32. And moves back and forth with respect to the insertion portion 35a of the scope 35. The reciprocating movement causes the resection portion 52c to protrude and retract from the distal end opening of the sheath 32. At this time, the tip of the laser probe 60 fixed to the slider 46 is separated from the cut portion 52c of the electrode 36 by a predetermined distance toward the hand side (the positional relationship between the cut portion 52c and the tip of the laser probe 60). Is held) and moves back and forth together with the electrode 36, and the distal end protrudes and retracts from the distal end opening of the sheath 32.

When the affected part in the urethra is to be resected using the resectoscope device 30 configured as described above, first, the sheath 32 is inserted into the urethra, and the distal end of the sheath 32 is inserted into the affected part. Locate nearby. Then, in this state, the slider 46 is slid forward to position the emission end (tip) of the laser probe above the affected part 70 (see FIG. 8A). Then, when the slider 46 is slid toward the hand while irradiating the affected part 70 with the laser light from the emission end of the laser probe 60, the affected part irradiated with the laser is sequentially removed by the removal part 52c of the electrode 36 (FIG. 8). (B)). That is, the affected part 70
The incision is made by the electrode 36 while being burned by the laser.

As described above, the resectoscope device 30 first coagulates the affected part by laser irradiation, and then incises the affected part by the electrode 36, so that the bleeding is small. That is, not only is the affected part removed using both the laser probe 60 and the electrode 36, but also the laser probe 60 is used.
Is configured so that the incision by the electrode 36 is performed after the laser irradiation by the laser beam, the disadvantages of the laser probe 60 and the electrode 36 are covered, and only the advantages of the laser probe 60 and the electrode 36 are utilized. That is, sufficient excision can be performed with little bleeding.

Note that, as shown in FIG.
The laser probe 60 connected to the power supply and the electrode 36 connected to the high frequency power supply 74 are inserted into the body through the endoscope 72, and after the laser irradiation by the laser probe 60, the electrode 3
The same operation and effect can be obtained even if the incision is made by the step S6. In this case, the positional relationship between the probe 60 and the electrode 36 may not be fixed. That is, the probe 60 and the electrode 36 may be configured separately, and the laser probe 60 and the electrode 36 may be moved separately. In the figure, reference numeral 75 denotes a foot switch for controlling operations of the laser light source 73 and the high-frequency power supply 74.

When performing a laser TUR, if the laser probe is positioned below the optical viewing tube, there is a problem that the laser probe obstructs the visual field of the optical viewing tube (particularly, the irradiation site). Therefore, as shown in FIG. 11, irradiation treatment is performed with the laser probe 80 positioned above the optical viewing tube 90. However, when the laser probe 80 is positioned above the optical viewing tube 90, the irradiation state can be grasped by the optical viewing tube 90.
Therefore, the irradiation direction and the degree of deterioration of the probe tip cannot be confirmed in the visual field. Of course,
This disadvantage can be solved by positioning the laser probe below the telescope, but in this case, the visual field of the telescope is obstructed as described above. Therefore, hereinafter, a laser irradiation apparatus capable of safely and reliably irradiating the side laser without greatly obstructing the field of view (particularly, the irradiation site) will be disclosed.

FIG. 10 shows such a laser irradiation apparatus. As shown in FIG. 10A, the laser irradiation device 82 is configured by integrally incorporating an optical viewing tube 90 and a laser probe 80 in a sheath 81. In this case, the distal end portion of the laser probe 80 is held in a state of protruding forward by a predetermined distance from the distal end of the optical viewing tube 90, and is bent downward at least so as to enter the visual field of the optical viewing tube 90. ing. As shown in FIG. 10B, the tip of the laser probe 80 is formed as a tip 84 having a laser light emitting end. The tip chip 84 has a reflection surface 85 that reflects the laser light guided from the near side. The reflecting surface 85 extends from the bent tip of the laser probe 80 to the laser probe 8.
It is inclined so that laser light can be emitted downward substantially perpendicular to the 0 axis direction.

According to the laser irradiation device 82 having such a configuration, as shown in FIG. 10C, the laser emitting end (tip 84) of the probe 80 is located within the visual field of the optical viewing tube 90.
Therefore, the side laser irradiation can be performed safely and reliably in a sufficient field of view (particularly, the irradiation site 89) while checking the irradiation direction and the degree of deterioration of the probe tip in the field of view.

According to the technical contents described above, the following various configurations can be obtained. 1. In a laser treatment apparatus having an inner sheath into which an optical viewing tube and a laser probe can be inserted, and an outer sheath into which the inner sheath can be inserted, the inner sheath is movable in the axial direction with respect to the outer sheath. Laser treatment device. 2. 2. The laser treatment apparatus according to claim 1, further comprising sealing means for preventing water leakage from a gap between the inner sheath and the outer sheath.

3. 3. The laser treatment apparatus according to claim 1, wherein the inner sheath has means for restricting axial movement of the optical viewing tube and the laser probe. 4. The laser treatment apparatus according to any one of claims 1 to 3, wherein the inner sheath is formed longer than the outer sheath. 5. What is claimed is: 1. An endoscope in which an electrode and a laser probe constituting an electric scalpel for resection are insertable, wherein the laser probe is positioned so as to be able to irradiate a laser with respect to a range to be cut by the electrode.

6. 6. The endoscope according to claim 5, wherein a laser emission end of the laser probe is located closer to a hand than a distal end cut portion of the electrode. 7. 7. The endoscope according to claim 5, wherein a relative positional relationship between the laser probe and the electrode is fixed. 8. The endoscope according to any one of claims 5 to 7, wherein the laser probe and the electrode are movable with respect to the endoscope.

9. In a medical device having observation optical means (endoscope, etc.), a laser probe, and an electrode for resection (electric scalpel), a laser probe is positioned so as to be able to irradiate a laser with respect to a resection range of the electrode. Medical device. 10. 10. The medical device according to claim 9, wherein a laser emission end of the laser probe is located closer to a hand than a distal end excision part of the electrode. 11. 11. The medical device according to claim 9, wherein a relative positional relationship between the laser probe and the electrode is fixed.

12. 9. The laser probe and the electrode are capable of moving back and forth with respect to the observation optical means.
12. The medical device according to claim 11, 13. 13. The medical device according to any one of items 9 to 12, wherein energization of the electrode and laser irradiation are simultaneously controlled. 14． 14. The medical device according to any one of claims 9 to 13, wherein the tissue to be excised is coagulated by laser irradiation, and then excised with an electrode.

15. A laser endoscope having a laser probe introduced from above the optical viewing tube, wherein the laser probe is bent so that the vicinity of its emission end is at least within the visual field of the optical viewing tube, and a laser light A laser endoscope having a tip tip that reflects light laterally. 16. 16. The laser endoscope according to claim 15, wherein the laser beam is emitted substantially at right angles to the long axis of the optical viewing tube due to the bending of the probe and the reflection of the tip. 17． The sum of the angle formed by the long axis of the telescope and the axis of the bent portion of the probe and the angle formed by the axis of the bent portion of the probe and the axis of the irradiated laser beam is approximately 90 degrees. Item 17. The laser endoscope according to Item 15 or 16.

[0044]

As described above, in the laser treatment apparatus of the present invention, since the inner sheath can be advanced and retracted with respect to the outer sheath, the laser irradiation position can be obtained by moving only the inner sheath without moving the outer sheath. Can be changed. Therefore, the inner wall of the lumen such as the urethra and the mucous membrane are not damaged by the outer sheath.

Further, since the fluid passage formed between the outer sheath and the inner sheath is sealed to the outside in a liquid-tight manner, leakage of the fluid for cleaning and cooling of the affected part is prevented.

[Brief description of the drawings]

FIG. 1A is a side sectional view schematically showing a main part of a laser treatment apparatus according to one embodiment of the present invention, and FIG. 1B is a schematic sectional view of the laser treatment apparatus according to one embodiment of the present invention. (C) is a cross-sectional view of a base portion for introducing a laser probe into the inner sheath.

FIG. 2 is a diagram showing an operation state of the laser treatment apparatus of FIG.

FIG. 3 is a perspective view of a conventional laser treatment apparatus.

FIG. 4 is a side view of a resectscope.

FIG. 5 is a cross-sectional view of a base for introducing a laser probe into a sheath of the resectoscope of FIG. 4;

6A is a side view of an electrode constituting the resectoscope of FIG. 4, and FIG. 6B is a perspective view of the electrode of FIG.

7A is a side sectional view of the distal end of the resectoscope of FIG. 4, and FIG. 7B is a front elevational view of the distal end of the resectoscope of FIG.

8 irradiates the tissue with the resectoscope of FIG.
It is a figure which shows a mode that it cuts.

9 is a system diagram schematically showing an endoscope configuration capable of obtaining the same operation and effect as the resectoscope of FIG. 4;

FIG. 10A is a side view of a tip side of a laser irradiation apparatus,
(B) is an enlarged view of a bent portion of a tip of a laser probe constituting the laser irradiation device of (a), and (c) is an observation image obtained by an optical viewing tube constituting the laser irradiation device of (a).

FIG. 11 is a diagram showing a positional relationship between an optical viewing tube and a laser probe in a conventional laser irradiation apparatus.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Laser treatment apparatus 2 ... Inner sheath (inner sheath) 4 ... Optical viewing tube 6 ... Laser probe 8 ... Outer sheath (outer sheath) 20 ... Friction seal member

Claims (1)

[Claims] 1. A laser probe optically connected to a laser light source and having at its tip an emission part for emitting laser light from the laser light source, an optical viewing tube having an observation optical system, the laser probe and the optical vision An inner sheath in which a tube is integrally inserted, an outer sheath covered on an outer periphery of the inner sheath, and forming a fluid passage between the inner sheath and the inner sheath; and an outer sheath formed between the outer sheath and the inner sheath. Means for sliding the inner sheath with respect to the outer sheath while the fluid passage is sealed to the outside.