JP3984193B2 - Electrosurgical equipment - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to an electrosurgical device, and more particularly to an electrosurgical device characterized by a high-frequency current output control portion.
[0002]
[Prior art]
In general, an electrosurgical device such as an electric scalpel is provided when performing a procedure such as incision, coagulation, and hemostasis of a living tissue in a surgical operation or a medical operation. As described above, the electrosurgical apparatus is provided with a high-frequency ablation power source and a treatment tool connected to the high-frequency ablation power source. By supplying the high-frequency current from the high-frequency ablation power source by bringing the treatment tool into contact with the patient. Perform the above procedure.
[0003]
When high-frequency power is administered to a living tissue, the tissue is denatured by heating, and then the moisture in the tissue evaporates to dry out. In this process, the tissue is solidified. If the high-frequency current continues to be administered even after the tissue has dried, tissue charring occurs and attachment of the tissue to the electrode occurs. In order to prevent the tissue from adhering to power, the supply of high frequency current should be stopped when desiccation occurs.
[0004]
As shown in FIG. 7, when high-frequency power is continuously applied to the living tissue, the tissue temperature gradually rises as the tissue is denatured and dried. On the other hand, the tissue impedance once decreases and then rapidly increases as the tissue is dried. Conventionally, control such as stopping high-frequency output has been performed when it is found that drying has occurred from tissue impedance or tissue temperature.
[0005]
Various electrosurgical devices as described above have been proposed. For example, in Japanese Patent Application Laid-Open No. 8-98845, in order to prevent carbonization of the coagulated tissue and to prevent adhesion of the tissue to the electrode, the end of coagulation is determined as tissue impedance. A technique for determining more and stopping high-frequency output is shown.
Further, in the electrosurgical device disclosed in Japanese Patent Laid-Open No. 10-225452, a technique for reducing the high-frequency output for achieving the same purpose as in Japanese Patent Laid-Open No. 8-98845 is shown.
[0006]
In order to further improve these techniques, prevent carbonization of the tissue, prevent adhesion of the tissue to electromagnetic waves, and obtain a stronger coagulation force, in the electrosurgical device disclosed in JP-A-2002-65691, There has been shown an electrosurgical device capable of supplying a large amount of electric power to a tissue while intermittently supplying a high-frequency current and keeping the tissue in a temperature range where carbonization does not occur.
[0007]
[Patent Document 1]
Japanese Patent Laid-Open No. 8-98845
[Patent Document 2]
Japanese Patent Laid-Open No. 10-225452
[Patent Document 3]
Japanese Patent Laid-Open No. 2002-65691
[Problems to be solved by the invention]
However, in the electrosurgical device disclosed in Japanese Patent Application Laid-Open No. 2002-65691, when the contact between the electrode and the tissue is not stable, it is difficult to accurately detect the coagulation state of the tissue, and the output may be greatly reduced. is there.
As a result, it may take a long time to increase the output again and coagulate the tissue.
[0011]
(Object of invention)
The present invention has been made in view of the above points. An electrosurgical apparatus capable of coagulating a tissue in a short time even when the contact between the electrode and the tissue is not stable and it is difficult to accurately detect the coagulation state of the tissue. The purpose is to provide.
[0012]
[Means for Solving the Problems]
The electrosurgical device of the present invention is a pair of high frequency power generating means capable of generating high frequency power for treating living tissue, and a pair of high frequency power generated by the high frequency power generating means capable of being applied to the living tissue. An electrode, an intermittent output control unit for controlling the high-frequency power generation means so that the high-frequency power can be intermittently output, and an impedance detection means for detecting an impedance value of the living tissue when the high-frequency power is applied An output time detection means for detecting an output time in one output period of the high-frequency power that is controlled and intermittently output by the intermittent output control section, and an impedance value of the living tissue based on a detection result of the impedance detection means Or the output time in the one output period according to the detection result of the output time detection means. When the predetermined time value is reached, the output of the high frequency power in one output period is controlled by the one output period output stop control means that controls to temporarily stop the output of the high frequency power and the one output period output stop control means. A high-frequency power value setting means for setting a high-frequency power value in the next output period, based on the impedance value of the living tissue when the output is stopped in the one output period, once stopped. To do.
[0013]
DETAILED DESCRIPTION OF THE INVENTION
Hereinafter, an embodiment of the present invention will be described with reference to the drawings.
1 to 5 relate to one embodiment of the present invention, FIG. 1 shows the overall configuration of a high-frequency ablation device according to one embodiment of the electrosurgical device of the present invention, and FIG. 2 shows the internal configuration of the high-frequency ablation power supply device. 3 shows the control procedure by the control circuit, FIG. 4 shows the details of the processing contents of step S10 in FIG. 3, and FIG. 5 shows the output step and the high-frequency output value (power value) at the time of treatment by the control circuit. FIG. 6 shows a high-frequency output and biological tissue impedance when a typical treatment is performed.
[0014]
As shown in FIG. 1, a high-frequency ablation device 1 according to a first embodiment as an electrosurgical device of the present invention includes a high-frequency ablation power supply 2 that supplies high-frequency ablation power. A connection cable 4 provided with a pair of electrodes 3 and a connector portion 5 are connected to a patient 7 placed on the bed 6 via the electrodes 3 by supplying high-frequency ablation power for treatment (surgical treatment). ).
Further, for example, a foot switch 8 for performing ON / OFF control operation of the high-frequency ablation power is connected to the high-frequency ablation power supply device 2. Note that the electrode 3 may be either a single electrode or a multi-electrode.
[0015]
As shown in FIG. 2, the high-frequency ablation power supply device 2 is connected to a commercial power supply (not shown), and is driven by a DC power supply circuit 11 that converts the DC power supply to supply this DC power supply, and a DC power supply from the DC power supply circuit 11. A high-frequency generation circuit 12 that oscillates at a high frequency to generate high-frequency power (high-frequency current) for treatment, a waveform circuit 13 that instructs the high-frequency generation circuit 12 to generate a waveform of a high-frequency current, and a high-frequency generation An output transformer 14 that outputs a high-frequency current from the circuit 12 to the electrode 3; a current sensor 15a that detects an output current output from the output transformer 14; and a voltage sensor 15b that detects an output voltage output from the output transformer 14. A / D conversion circuit 16 for A / D converting current values and voltage values detected by current sensor 15a and voltage sensor 15b, and A / D converter 1 Based on the digitized current data and a control circuit 17 for controlling the indication of the waveform generation of the DC power supply circuit 11 supply the ON / OFF and the waveform circuit 13 to from.
[0016]
Then, the connection cable 4 is connected to the connector portion 5 and a high frequency current is applied (applied) to the living tissue 18 or the like of the patient 7 through the pair of electrodes 3 so that high frequency ablation treatment can be performed.
The control circuit 17 includes a timer 17a that measures the time from the start of output of the high-frequency current supplied to the living tissue 18, and a counter 17b that measures the number of times the high-frequency current is output.
[0017]
Then, the control circuit 17 determines the coagulation state of the living tissue 18 based on the obtained current and voltage data, impedance, biological information such as the temperature of the living tissue, the number of repetitions of the high-frequency current described later, and the like. As shown, the high frequency power to be treated is switched according to the table for determining the power so that an appropriate treatment can be performed.
[0018]
For this reason, the control circuit 17 has, for example, a built-in ROM 17c in which information on the contents of the table shown in FIG. 5 is written. Then, the high frequency power to be treated is set with reference to the contents of the ROM 17c.
[0019]
The information on the coagulation state of the living tissue 18 determined by the control circuit 17 can be displayed on a monitor (not shown) as a display means or a liquid crystal panel 19 provided in the casing of the high-frequency ablation power supply device 2.
[0020]
In this embodiment, when the foot switch 8 is stepped on and high frequency power is applied to start coagulation treatment or the like, the control circuit 17 sets the high frequency power applied to the living tissue 18 within a certain range as described below. By restricting and performing intermittent output control so as to be applied intermittently, an appropriate treatment can be performed while keeping the living tissue 18 in a temperature range where carbonization does not occur.
[0021]
That is, by detecting the impedance of the living tissue 18 while applying high-frequency power to the living tissue 18, the tissue degeneration, the coagulation state, and the like are detected. If the conditions such as the set impedance and output time are met, the suspension period is temporarily stopped. Set.
[0022]
The treatment such as coagulation is performed by controlling the value of the high-frequency power applied next intermittently according to the detection condition at that time so that the treatment such as coagulation can be completed in a short time. .
[0023]
For example, in the method disclosed in Japanese Patent Laid-Open No. 2002-65691, the application time (output time) for intermittently applying high-frequency power is set by the amount of impedance change during the output period, etc. When the contact with the terminal becomes unstable temporarily and becomes a local contact, the impedance change becomes faster (due to local treatment), and the output period tends to be set shorter.
And when it returns to the stable contact state, although an output period becomes long, it takes time to solidify.
[0024]
In the present embodiment, local instability is obtained by limiting the range in which the high-frequency power to be output next intermittently is variably set according to the impedance detection result in the output period in which output is intermittent and the output result. Even if the contact condition occurs, a sudden drop in output is prevented, and when the stable contact condition is restored, the value of the high-frequency power output itself can be increased for a short time. Coagulation treatment etc. can be performed.
That is, in the present embodiment, the control circuit 17 intermittently performs output control and forms limiting means for limiting the output value intermittently output to a certain range.
[0025]
The operation performed by the high-frequency ablation power supply device 2 configured as described above will be described with reference to the flowchart of FIG.
When the foot switch 8 is stepped on, the control circuit 17 receives the operation signal and sets the output frequency N of the high-frequency current to 0 in the first step S1. In addition, the timer 17a is activated to start measuring time T from zero.
[0026]
In this case, the control circuit 17 sets the output value of the high frequency power in the initial state. Specifically, the output step 5 of FIG. 5 stored in the ROM 17c, that is, 160 W is set.
Next, in step S2, the output count N is incremented by 1 (in this case, N = 1), and high frequency output is started in the next step S3.
[0027]
In step S4, the control circuit 17 takes in the signals of the current sensor 15a and the voltage sensor 15b via the A / D converter 16, and calculates the impedance Z of the living tissue 18.
[0028]
Then, in the next step S5, it is determined whether or not the impedance Z of the living tissue 18 calculated in step S4 is larger than a predetermined value (first threshold value) 200Ω, and from this first threshold value 200Ω. If it is larger, the process proceeds to step S7, and the output is temporarily stopped.
[0029]
On the other hand, if the impedance Z of the living tissue 18 is smaller than the first threshold value 200Ω, it is determined whether or not a predetermined first time (for example, 1 second) has elapsed in step S6. If the first time has elapsed, the process proceeds to step S7, and the output is temporarily stopped.
[0030]
If the first time has not elapsed, the process returns to step S4 to repeat the same operation. After stopping the output in step S7, it is determined in step 8 whether or not a predetermined second time (0.3 seconds) has elapsed, and waits until the second time elapses. It is determined whether N has reached a predetermined value.
If the number of outputs N has reached a predetermined value, the process proceeds to step S11, and this treatment operation is terminated with the treatment being completed.
[0031]
On the other hand, if the output count N has not reached the predetermined value in the determination in step S9, the process proceeds to the determination process in step S10, and the size of this output step is determined according to the contents stored in the ROM 17c, that is, the table of FIG. Then, returning to step S2, the same operation is repeated.
[0032]
As shown in FIG. 4, in the determination process of step S10, the determination result of step S5, that is, whether or not the biological tissue impedance Z is larger than the first threshold value 200Ω is determined in step S21. If the threshold value is greater than 200Ω, the output step is lowered by two steps according to the value shown in the table of FIG. 5 as shown in step S22.
[0033]
If it is determined in step S21 that the biological tissue impedance Z is smaller than the first threshold value 200Ω, the process proceeds to step S23. In step S23, the first time has elapsed in the determination result in step S6. If the current biological tissue impedance Z is larger than the second threshold value 150Ω and smaller than 200Ω, the process proceeds to step S24, and the output step is reduced by one step according to the value shown in the table of FIG.
[0034]
Further, if the condition does not correspond to step S23, the process proceeds to step S25. In step S25, whether or not the biological tissue impedance Z is larger than the third threshold value 100Ω and smaller than the second threshold value 150Ω. If this condition is satisfied, the output is not changed as shown in step S26. Further, when the condition of step S25 is not satisfied, that is, when the biological tissue impedance Z is not more than the third threshold value 100Ω, the output step is increased by one step as shown in step S27.
[0035]
In this manner, the subsequent output change process is performed within a limited range in accordance with the previous detection state.
FIG. 6 shows changes in power (output) and biological tissue impedance Z in a typical treatment example according to the present embodiment.
In the example shown in FIG. 6, first, as shown in step S1 of FIG. 3, the treatment is performed at the output of the output step 5 in the table of FIG.
[0036]
In this case, there are two conditions for ending the output period: the impedance Z is 200Ω or more in step S5, or the output time of step S6 is a time limit of 1 second or more. In the case of FIG. 6, the output is temporarily stopped at the time (time) T1 after the output time exceeds the time limit of 1 second.
[0037]
For example, at time T2 after 0.3 seconds, in the determination process of step S10, the impedance Z at time T1 is as small as 100Ω or less, for example, so that treatment is performed with a large output by one step, that is, 200 W.
[0038]
In this case, as shown in FIG. 6, the output time limit is not provided, and the output period end condition is that the impedance Z in step S5 is 200Ω or more.
[0039]
In the case of FIG. 6, the output at 200 W causes the impedance Z to reach 200Ω at time T3, and the output is temporarily stopped.
In this way, when a thick blood vessel or the like is coagulated, when intermittent treatment is performed under normal conditions, if the detected impedance is small due to insufficient coagulation, the next intermittent is made up to compensate for this. When high-frequency power is output, the output is increased by one step until the condition for setting the detected impedance without setting the output time limit is reached.
[0040]
In this way, even when a thick blood vessel or the like is coagulated, the coagulation treatment can be performed in a short time.
In this case, a time limit may be provided as in step S6.
For example, at time T4 after 0.3 seconds, the impedance Z at time T3 is, for example, 200Ω in the determination process of step S10, so that the treatment is performed with an output that is smaller by one step, that is, 160 W.
[0041]
After that, as in the case of the first output period, the impedance Z reaches 200Ω at the time T5 before 1 second elapses from the time T4 in the case of FIG. 6, for example, in the case of FIG. It becomes.
By performing intermittent output control in this way, the contact between the living tissue 18 and the electrode 3 temporarily becomes, for example, local, and in that case, the value of the high frequency output to be applied is lowered, but the value is lowered. However, when the contact state is stable, it is limited within a certain range, but by increasing its output, a more appropriate treatment can be performed.
[0042]
In this way, intermittent output control is repeated, and when the number of repetitions reaches a predetermined value, the treatment is terminated as coagulation is completed.
In the above description, the value limited by the limiting means formed by the control circuit 17 has been described mainly in the case of high-frequency power, but it may be the output time value or both.
[0043]
According to the present embodiment, since the magnitude and output time of the high frequency power for performing treatment by intermittently applying the high frequency power are limited to a certain range, the contact between the living tissue 18 and the electrode 3 is temporary. Even when it becomes unstable and cannot be detected accurately at that time, it is possible to prevent a sudden decrease in output, and when the contact state returns to a stable contact state, the output is increased and the coagulation treatment of the living tissue 18 is performed in a short time. Is possible.
[0044]
In addition, when the contact between the living tissue 18 and the electrode 3 returns from an unstable state to a stable state due to local contact, the output is increased, but the output is made so that a quicker response is possible. Change setting may be made so that the number of output steps to be increased is not two steps but two steps.
In addition, when the above change is made, it may be limited after the power reduction setting is once made. The power reduction setting may be limited to one step or less.
[0045]
Further, the limit of the value of the power or the output time is limited especially when the decrease is set, and the selection setting that relaxes the limit when the value is increased can be made (for example, the output of the ROM 17c or the table by the selection by the user). The change contents can be selected from multiple ones), for cases where an unstable contact state occurs temporarily, or where the coagulation treatment part requires a large amount of treatment power, such as a thick blood vessel The coagulation treatment or the like may be performed more appropriately in a short time.
[0046]
Further, when intermittent output control is performed, when the output is paused intermittently and the subsequent output is changed and set, the impedance detected before the temporary stop and the history information of the output value applied to the living tissue 18 You may make it determine by.
[0047]
In this case, not only the information immediately before the temporary stop but also the information before that may be referred to, and the subsequent output change setting, output time change setting, and the like may be performed. In this way, more appropriate treatment can be performed.
[0048]
[Appendix]
1. 3. The electrosurgical device according to claim 2, wherein the limiting means operates for the second and subsequent outputs.
2. High-frequency power generating means capable of generating high-frequency power for treating living tissue; a pair of electrodes capable of applying the high-frequency power generated by the high-frequency power generating means to the living tissue;
Start control means for starting the operation of the high-frequency power generating means at a predetermined output with the high-frequency power;
An intermittent output control unit for controlling the high-frequency power generation means so that the high-frequency power can be intermittently output;
Based on the information (impedance information and output information) on the living tissue after the temporary stop by the intermittent output control unit, the magnitude and intermittent output of the high-frequency current to be output intermittently to the biological tissue thereafter Output changing means for changing at least one of the times;
Limiting means for limiting the value changed by the output changing means to a certain range;
An electrosurgical device comprising:
[0049]
3. In Supplementary Note 2, the value to be changed by the output changing means can be selected from a plurality of values.
4). In Supplementary Note 2, the value when the value changed by the output changing means is reduced (suppressed) more than the value when increasing.
[0050]
【The invention's effect】
As described above, according to the present invention, high-frequency power generating means capable of generating high-frequency power for treating living tissue,
A pair of electrodes for gripping the high-frequency power generated by the high-frequency power generating means so as to be applied to the living tissue;
Start control means for starting the operation of the high-frequency power generating means at a predetermined output with the high-frequency power;
An intermittent output control unit for controlling the high-frequency energy generating means so that the high-frequency power can be intermittently output;
In the intermittent output control unit, output changing means for changing at least one of the magnitude of the high-frequency current or the output time of each of the intermittent outputs;
Limiting means for limiting the value changed by the output changing means to a certain range;
Therefore, even when the contact between the living tissue and the electrode is not stable, a rapid decrease in output can be prevented, and the living tissue can be coagulated in a short time.
[Brief description of the drawings]
FIG. 1 is an overall configuration diagram of a high-frequency ablation apparatus according to an embodiment of the present invention.
FIG. 2 is a block diagram showing a configuration of a high-frequency ablation power supply device.
FIG. 3 is a flowchart showing a flow of control by a control circuit.
FIG. 4 is a flowchart showing details of processing contents in step S10 in FIG. 3;
FIG. 5 is a diagram showing the processing contents of FIG. 4 in a table.
6 is an explanatory diagram showing changes in power and impedance in a typical operation example by the control of FIG. 3;
FIG. 7 is an explanatory diagram showing changes in electric power, tissue temperature, and tissue impedance when a treatment is performed by a conventional high-frequency ablation apparatus.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... High frequency ablation device 2 ... High frequency ablation power supply device 3 ... Electrode 7 ... Patient 8 ... Foot switch 11 ... DC power supply circuit 12 ... High frequency generation circuit 13 ... Waveform circuit 14 ... Output transformer 15a ... Current sensor 15b ... Voltage sensor 16 ... A / D converter 17 ... control circuit 17a ... timer 17b ... counter 17c ... ROM
18 ... Living tissue 19 ... Liquid crystal panel

Claims (2)

High-frequency power generating means capable of generating high-frequency power for treating living tissue;
A pair of electrodes capable of applying the high-frequency power generated by the high-frequency power generating means to the living tissue;
An intermittent output control unit for controlling the high-frequency power generation means so that the high-frequency power can be intermittently output;
Impedance detection means for detecting an impedance value of the living tissue when the high-frequency power is applied;
Output time detection means for detecting an output time in one output period of the high-frequency power that is controlled and intermittently output by the intermittent output control unit,
When the impedance value of the living tissue reaches a predetermined value due to the detection result of the impedance detection means, or when the output time in the one output period reaches a predetermined time value due to the detection result of the output time detection means One output period output stop control means for controlling to temporarily stop the output of the high-frequency power,
When the output stop of the high frequency power in one output period is temporarily stopped by the output stop control means in one output period, the high frequency in the next output period is based on the impedance value of the living tissue when the output is stopped in the one output period. High-frequency power value setting means for setting a power value;
An electrosurgical device characterized by comprising: A setting high-frequency power value storage means for storing a setting value for setting a high-frequency power value of the high-frequency power intermittently output by the intermittent output control unit as a value of a plurality of stages;
The high-frequency power value setting means stores the set high-frequency power value storage means in the set high-frequency power value storage means based on the impedance value of the living tissue when the output is stopped in the one output period when the output of the high-frequency power in the one output period is temporarily stopped. 2. The electrosurgical device according to claim 1, wherein the high frequency power value in the next output period is set according to the stored setting values in a plurality of stages .

Images