CN101489499B - 电极装置 - Google Patents
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Abstract
已公开了一种电极装置,尤其是中性电极,特别是在单极电外科治疗的情况下用于将高频治疗电流通过皮肤部分引入到人或者动物的身体中,该电极装置包括:至少一个主电极,用于将治疗电流引入到身体中;阻抗测量装置,用于测量主电极和身体之间的阻抗并且用于产生阻抗信号;以及与阻抗测量装置相连的分析装置,用于产生与阻抗相关或与身体或皮肤部分的升温相关的分析信号。为了改进已公开的装置,提出了为电极装置配备有至少一个与主电极间隔设置的测量电极,并且设置有阻抗测量装置,该阻抗测量装置包括至少一个与主电极和测量电极相连的测量电流发生器用于产生高频测量电流,该高频测量电流在测量电极与主电极之间流动。
Description
本发明涉及一种电极装置,尤其是涉及一种用于引入高频治疗电流的中性电极。
在电外科手术中尤其是使用所谓的单极器具,其中引入到组织中的治疗电流通过身体流入所谓的中性电极中。在图1和2中在原理上示出了这种布置。该布置包括发生器1,该发生器提供高频电流(通常为350kHz),在该生成器上一侧连接有电外科手术器具2而另一侧连接有中性电极3。中性电极3借助导电胶的中间层被粘合到要治疗的患者的皮肤层上。
在EP 1173095B1中公开了一种中性电极,其具有与根据图1和2的结构对应的结构。中性电极3具有支承膜9,在该支承膜上安置有主电极10,该主电极可以通过接线片13与发生器1连接。围绕主电极10设置有导电环11,该导电环以间隙12与主电极10分离。这种导电环导致改进电流在接触的皮肤部分或者其下的组织上的分配。在此要考虑的是,不同的组织类型具有极为不同的电阻率。肌肉具有0.2mΩcm的电阻率(在1MHz的情况下),而血液的电阻率为0.16mΩcm左右以及脂肪的电阻率为3.3mΩcm左右。此外,所粘合的中性电极尤其是会容易从边缘脱落,使得接触被局部中断。
为了确定正确的电极安设,现在提出了许多建议。于是例如在EP 0390937B1中提出了一种用于监视中性电极在高频外科手术中的应用的装置,其中借助两个相同大小的电极来工作,并且测量这两个电极之间的差分电阻(Differenzwiderstand)。根据测量结果推断出电极的正确的或者错误的安设。
在EP 1051949B1中公开了一种带有前面提及的类型的阻抗测量装置的中性电极,然而其中该出版物中未公开关于电极的结构的更确切的说明。
在所有情况下,迄今的电极结构或者迄今的方法都只是有条件地适于以合理的开销保证通过中性电极正确地引入高频治疗电流。
本发明的任务是,提出一种前面所述类型的用于监视接触和高频电流流动及其空间分布的电极装置和方法,使得在改进电流引入特性的情况下保证了提高的安全性。
该任务在装置方面通过根据本发明实施例的电极装置来解决而在方法方面通过根据本发明实施例的方法来解决。
特别地,该任务通过尤其是在单极电外科治疗时的一种电极装置、特别是用于通过皮肤部分将高频治疗电流引入到人或者动物身体中的中性电极来解决,该电极装置具有:至少一个主电极,用于将治疗电流引入到身体中;阻抗测量装置,用于测量主电极与身体或辅助电极之间的阻抗;与阻抗测量装置相连的分析装置,用于产生与阻抗有关和/或与身体和/或皮肤部分的至少可能的升温有关的分析信号;其中设置有至少一个与主电极间隔设置的测量电极,并且阻抗测量装置包括至少一个与主电极和测量电极相连的、用于产生高频测量电流的测量电流发生器,该测量电流在测量电极与主电极之间流动。
因此,本发明的一个要点在于,一方面设置单独的测量电极而另一方面使用单独的、与实际处理电流无关的测量电流,以对测量电极与主电极之间的阻抗进行测量。于是,在发生器与测量电极之间实际仅仅流动测量电流。如果阻抗升高,则这是电极面的一部分至少部分与在其下面的皮肤部分失去接触的标志。由于伴随着这种接触失去同时也导致与治疗电流相关的电流密度提高,所以通过该测量也同时确定在电极下面的皮肤部分或组织部分是否会预期升温。
优选地,测量电流具有与治疗电流不同的频率或者相位,使得测量电流可以通过滤波装置与治疗电流分离。在此,测量电流也是高频电流,如与电外科手术设备相关的规定要求的那样。由于测量电流和治疗电流都通过相应的电路部件来限定,所以可以构建带宽非常窄的滤波器(例如借助PLL电路)使得能够预期非常精确的测量。
优选地,测量电流的频率比治疗电流的频率低。由此,测量电流并未进入例如由于在电外科手术时形成光弧而产生的谐波的频率范围中。
阻抗测量装置优选具有电压测量装置,用于在测量电流导通时测量主电极与测量电极之间的电压降。也就是说,用于产生测量电流的发生器只须被构建为具有恒定幅度的交流源,这能够在电路技术上被非常容易地实现。
此外,阻抗测量装置优选地具有用于在治疗电流流动时测量主电极与测量电极之间的电压降的电压测量装置。由此,可以以简单的方式生成测量值,该测量值在组织或皮肤部分的预期升温方面具有意义。
测量电极(或者多个测量电极)优选构建为导电环,从而同时承担上面已经描述的并且在根据EP 1173095B1的现有技术中所公开的、减小电流密度并且由此降低组织的升温的功能。
在一种优选的实施形式中,设计有特别是分别形成导电环的多个测量电极和多个阻抗测量装置。分析装置被构建为使得可以确定治疗电流从主电极至测量电极的电压降的分布。借助这种布置,可确定在该电极装置之下组织在其电阻率方面的不均匀性。此外,借助这种布置可特别容易地确定电极装置的脱落。
分析装置优选构建为使得当由于治疗电流引起的至测量电极的电压降超过预先确定的阈值(与RUEB有关)时发出报警信号。由此提高了电极装置的可靠性。
在此所要求保护的用于引入高频治疗电流的方法被相应地构建。
以下参照附图更为详细地阐述本发明的优选实施形式。其中:
图1示出了已公开的电极装置的俯视图,
图2示出了沿着线II-II通过根据图1的电极装置的剖面,
图3以与根据图1的视图相应的视图示出了本发明的第一优选实施形式的俯视图,
图4以与根据图3的视图相应的视图示出了本发明的第二实施形式,
图5以与根据图3的视图相应的视图示出了本发明的第三实施形式,
图6以与根据图3的视图相应的视图示出了本发明的第四实施形式,
图7以象征性图示示出了通过主电极和位于其下的组织的部分剖面,
图8示出了与根据图7的视图对应的但具有附加的等电位电极的图示,
图9示出了具有附加绘出的电阻情况的与根据图8的视图对应的图示,
图10示出了通过具有为此绘出的外围部件的、根据图3的本发明的实施形式的剖面,
图11示出了与根据图10的视图对应的但在组织中具有不同情况的图示,以及
图12示出了与根据图10的视图对应的具有附加的导电环的图示。
在以下描述中,对相同的和起相同作用的部分使用相同的参考数字。
在图3中所示的本发明的实施形式中(如在现有技术中那样),主电极10设置在电极布置的中心。导电环11以间隙12与主电极10分离,该导电环一方面环绕主电极10而另一方面以指形部(仍然还是在以间隙12分离的情况下)延伸进主电极10中。主电极10设置有接线片13,而在此情况下形成测量电极14的导电环通过接线片13’如以下还将描述的那样与电路连接。
根据图4的实施形式与根据图3的实施形式不同之处在于,除了测量电极14之外,导电环11环绕主电极10和测量电极14(以间隙分离)。于是,导电环14不具有接线片。根据图5的实施形式与根据图4的实施形式不同之处在于,图4中设置的导电环11现在被构建为另外的测量电极15,即具有接线片13”,通过该接线片可以实现连接到外围部件上。
根据图6的实施形式与根据图5的实施形式的不同之处在于,设置有总共四个测量电极14、15、16和17,这些测量电极全部以分别距主电极越来越远的距离环绕主电极,并且通过间隙分别与主电极分离以及彼此分离。
在此存在的问题的一个重要的方面以下参照图7-9来更为详细地阐述。
当基于“简单的”布置、即该布置仅具有通过导电胶18粘合到皮肤部分5上的唯一的主电极10时,治疗电流IHF从(在此未示出的)外科手术器具流入要治疗的患者的组织6中。在组织6中,该电流继续流动并且通过皮肤部分5经导电胶8流入主电极10中,并且从那里流至所使用的(未示出的)高频发生器的相应的对应极。治疗电流IHF总是选择最短的路径,使得在主电极10的如下部分上的电流密度最高:该部分对于治疗位置而言(在该治疗位置中治疗电流流入组织6中)是最高的。此外,在主电极10的边缘上总归始终发生电流集中。这在图7中示意性地借助剖面图示出。
图8中所示的布置与根据图7的布置不同点在于图8中设置的导电环11。由于存在图9中以简单形式示出的电阻情况,所以当治疗电流的一部分流入导电环11中并且(尤其是通过导电胶8)从那里出来进入主电极10时,通过导电环11实现对组织的“减负”。由此产生了电流密度的降低,如示意性地在图8的图中表明的那样。
在图10所示的本发明的实施形式中,该布置类似根据图9的布置,然而图9中所设置的导电环在此形成第一测量电极14。
设置有阻抗测量装置20,在该阻抗测量装置中设置有测量电流发生器32,该测量电流发生器在一侧用其输出端与主电极10相连,而在另一侧与测量电极14相连。测量电流发生器32提供了恒定的测量电流IM,其频率低于治疗电流IHF的频率。当治疗电流IHF的频率为350kHz时,对测量电流发生器合适的频率是(大约)70kHz。测量电流发生器32可以由分析装置30通过相应的控制线路来控制。
与测量电流发生器32并联地设置有电压测量装置35,在该电压测量装置上游连接有滤波器34。该滤波器34在其通过频率上与测量电流IM的频率协调,使得电压测量装置35仅仅反映如下电压分量的幅度:该电压分量在测量电流IM流动时通过测量电流IM在主电极10与测量电极14之间的测量段上的降低而产生。相应的测量电压信号被输送给分析装置30。
此外,阻抗测量装置20包含第二电压测量装置,该第二电压测量装置的上游连接有滤波器33,该滤波器的通过频率与治疗电流IHF的频率(350kHz)协调。于是,第二电压测量装置的被输送给分析装置30的输出信号反映了如下电压降:该电压降由于在测量电极14与主电极10之间流动的治疗电流而产生。
分析装置30与显示器或信号产生装置31相连。
在工作时,在电极装置粘合到患者的皮肤部分5上之后,连续地或者间断地通过发生器32来产生测量电流IM。通过电压测量装置35测量的电压由此(在恒定的测量电流IM情况下)反映了测量电极14与主电极10之间存在的阻抗的度量。如果阻抗相对于可预先给定的(或根据前面的试验确定的)“正常值”升高,则由此可以推断出,测量电极14和组织6之间的电阻和/或主电极10和组织6之间的电阻非常高或升高了。据此又可以认识到存在接触故障,即电极脱落或者由于其他原因而在主电极10和/或测量电极14与皮肤部分5或在其下面的组织6之间存在过高的电阻。相应地,可以通过分析装置30在显示装置或者信号产生装置31上输出相应的显示,以便提醒操作人员:现在存在过高的电流密度并且由此存在组织或皮肤部分5的过大的升温的危险。
此外,当在治疗电流IHF流动时通过第二电压测量装置36确定电压降超过预先确定的阈值时,则由此又可以推断出,存在不正确的电阻情况。由此也可以推断出电流密度过高并且由此存在过大的升温的危险。
借助刚才所示的本发明的实施形式(如在图11中所示)也可以确定另一问题。于是也就是说,当管7经过电极10或与其关联的皮肤部分5下方附近时(组织6此外可能也包括较多的脂肪),由于现有的不均匀的电阻情况而产生管7的区域与主电极10之间的增大了的电流。于是在这样的情况下,在用作导电环的测量电极14与主电极10之间的电流减小,这由第二电压测量装置36确定并且“通知”分析装置30。在这样的情况下,可以通过显示装置31输出信号,该信号通知操作人员:基于现有的电阻情况,应当预计到局部提高的电流密度,该电流密度已知会导致组织6或者在主电极10下面的皮肤过大的升温。
在图12中所示的实施形式中,设置有多个构建为导电环的测量电极14、15。此外,也设置有多个第二电压测量装置36、36’,使得可以确定治疗电流IHF在主电极10与第一测量电极14以及第二测量电极15之间流动时的电压降的分布。根据电压降的分布,可以比在根据图11的实施形式中更好地确定组织6中或发生器1与主电极10之间的整个电流路径中是否存在不均匀性。此外,还可以更好地、更精确地以及在其意义上可更为容易地、可估计地确定电极装置在边缘侧的脱落。例如,当测量电极14和15之间的电压降虽然用信号表示脱落,但在主电极10和测量电极14之间还存在正确的值时,则由此可以推断出对患者还不存在“危险”,但可能现在应检查中性电极的正确安置。
以下参数可以通过分析电路来确定:
IM 用于测量接触电阻RUEB的测量电流
UM,Ring 导电环与内表面之间的由于IM引起的电压降,该电压降结合
IM被考虑用来计算接触电阻
UHF,Ring 主电极和导电环之间的高频电压(350kHz)。与接触电阻一
起是“流经”导电环的电流的度量。
IHF 总电流,该总电流经中性电极流至发生器
RUEB 用于确定接触质量和计算在环上分布的电流的接触电阻
IHF,Ring 流动并且分布到导电环上的高频电流
PHF,Ring 在主电极的边缘转换成热量的功率
PHF,innen 在导电环上转换成热量的功率
Rv 在中性电极之下的组织的虚拟电阻,高频电流的一部分流经
该虚拟电阻,该部分并未分布在环上。用作功率计算的辅助
量
根据两个计算出的功率PHF,innen和PHF,Ring可以估计中性电极的边缘处的温度升高,因为这些功率在几何形状近似已知的区域中被转换。对此,可以一般地假设位于其下的组织的导热性,因为一方面从大小来看受影响的区域是极为有限的,并且另一方面在该电极下面不会出现直接的空气流或者其他外部影响。
根据上面的描述,如下优点是特别重要的:
通过本发明能够实现更好地识别电极装置在边缘处的脱落。在“中性电极”的每个边缘处以相同的精度识别与皮肤的脱离。由于在边缘区域也出现最大的电流密度,所以在此需要准确的监视。与此相对,在迄今的电极形式中,与平行于胶桥(Gelbruecke)的情况相比,垂直于胶桥地识别这些重要参数更不精确。该缺点尤其在市场上可买到的、两部分的中性电极(参见例如EP 0390937B1)中是重要的。
通过测量导电环与主电极之间的高频电压,可以借助于已知的接触电阻确定被导电环分配的电流。由此,可以得知总电流与导电环上的电流的关系并且由此确定导电环的分配作用效果如何。
通过测量技术上对位于环之下的组织与导电环之间的电流分配进行确定也可以推断出较深的、传导电流的组织层的电阻情况。
当在中性电极的导出治疗电流IHF的区域下方有小面积的导电非常好的组织,例如在皮肤表面下方附近的大的血管(可能被脂肪组织包围)时,电流的大部分在其上流动,这由于小的面积而会导致高的电流密度并且由此会导致在这些部位处的烧伤。过去已公开了这样的情况。在所描述的布置或所描述的方法中可以通过以下方式来识别该问题:仅仅还有非常少量的治疗电流IHF流经导电环。因此,剩余的治疗电流必须能够在具有较低的导电性的路径上到达主电极下方。
借助已知的电流和电阻情况可以计算关联的损耗功率。由此,可以得知在电极的边缘区域中的可能的温度升高,在该边缘区域中温度升高也是最大的。组织的准确的热特性因情况而异,然而由于涉及电极下方的几何上受到极大限制的区域,所以很可能以良好的精度估计不允许的温度升高。
根据本发明的电极相对于手术区域的取向几乎是无意义的(除接线片之外)。按照原理,不对称的治疗电流IHF不再可能出现,因为只有单个的传导治疗电流的面(主电极10)。由此避免了由于不正确地指向手术区域的中性电极引起的可能的错误。
参考标记表
1高频发生器
2电外科手术器具
3中性电极
5皮肤部分
6组织/身体
7管
8导电胶
9支承膜
10主电极
11导电环
12间隙
13接线片
14测量电极
15测量电极
16测量电极
17测量电极
20阻抗测量装置
30分析装置
31显示/信号产生装置
32测量电流发生器
33,33’滤波器(IHF)
34滤波器(IM)
35电压测量装置(UM)
36,36’电压测量装置(UHF)
Claims (11)
1.一种电极装置,用于将高频治疗电流(IHF)通过皮肤部分(5)引入到人或者动物的身体(6)中,该电极装置包括:
-至少一个主电极(10),用于将治疗电流(IHF)引入到身体(6)中,
-阻抗测量装置(20),用于测量主电极(10)和身体(6)之间的阻抗并且用于产生阻抗信号,
-与阻抗测量装置(20)相连的分析装置(30),用于产生与阻抗相关和/或与身体(6)的至少可能的升温相关的分析信号,
其特征在于,
设置有至少一个与主电极(10)间隔设置的测量电极(14-17),并且阻抗测量装置(20)包括至少一个与主电极(10)和测量电极(14-17)相连的测量电流发生器(32)用于产生高频测量电流(IM),该高频测量电流在测量电极(14-17)与主电极(10)之间流动,
其中阻抗测量装置(20)包括第一电压测量装置(36,36’),用于在治疗电流(IHF)流动时测量主电极(10)与测量电极(14-17)之间的第一电压降(UHF)。
2.根据权利要求1所述的电极装置,其特征在于,测量电流(IM)具有与治疗电流(IHF)不同的频率或者相位,使得测量电流(IM)与治疗电流(IHF)能够通过滤波装置(33,34)分离。
3.根据权利要求1或2所述的电极装置,其特征在于,测量电流(IM)的频率比治疗电流(IHF)的频率低。
4.根据权利要求1或2所述的电极装置,其特征在于,阻抗测量装置(20)包括第二电压测量装置(35),用于在测量电流(IM)通过时测量主电极(10)与测量电极(14-17)之间的第二电压降(UM)。
5.根据权利要求1或2所述的电极装置,其特征在于,测量电极(14-17)的边缘以等距离绕着主电极(10)的边缘设置。
6.根据权利要求1或2所述的电极装置,其特征在于,测量电极(14-17)构建为导电环。
7.根据权利要求1或2所述的电极装置,其特征在于,设置有分别形成导电环的多个测量电极(14-17)和多个阻抗测量装置(20,20’), 并且分析装置(30)构建为使得能够确定治疗电流(IHF)从主电极(10)至测量电极(14-17)的第一电压降(UHF)的分布。
8.根据权利要求1或2所述的电极装置,其特征在于,分析装置(30)构建为使得当由于治疗电流(IHF)引起的至测量电极(14-17)的第一电压降(UHF)超过预先确定的阈值时发出报警信号。
9.根据权利要求1所述的电极装置,其特征在于,所述电极装置是中性电极。
10.根据权利要求1所述的电极装置,其特征在于,所述电极装置用于在单极电外科治疗的情况下将高频治疗电流(IHF)通过皮肤部分(5)引入到人或者动物的身体(6)中。
11.根据权利要求1所述的电极装置,其特征在于,所述分析装置(30)用于产生与皮肤部分(5)的至少可能的升温相关的分析信号。
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PCT/EP2007/006215 WO2008009385A1 (de) | 2006-07-19 | 2007-07-12 | Elektrodeneinrichtung |
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- 2007-05-02 DE DE102007020583A patent/DE102007020583B4/de not_active Expired - Fee Related
- 2007-07-12 US US12/374,265 patent/US8449536B2/en not_active Expired - Fee Related
- 2007-07-12 CN CN2007800269355A patent/CN101489499B/zh not_active Expired - Fee Related
- 2007-07-12 EP EP07786043A patent/EP2043539B1/de not_active Expired - Fee Related
- 2007-07-12 JP JP2009519835A patent/JP5127829B2/ja not_active Expired - Fee Related
- 2007-07-12 WO PCT/EP2007/006215 patent/WO2008009385A1/de active Application Filing
Patent Citations (3)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4416276A (en) * | 1981-10-26 | 1983-11-22 | Valleylab, Inc. | Adaptive, return electrode monitoring system |
DE3206947A1 (de) * | 1982-02-26 | 1983-09-15 | Erbe Elektromedizin GmbH, 7400 Tübingen | Neutrale elektrode fuer die hochfrequenz-chirurgie |
EP0262888A2 (en) * | 1986-09-27 | 1988-04-06 | Ronald Davidson Clark | Surgical diathermy apparatus |
Also Published As
Publication number | Publication date |
---|---|
DE102007020583A1 (de) | 2008-01-31 |
WO2008009385A1 (de) | 2008-01-24 |
JP2009543624A (ja) | 2009-12-10 |
US20090281539A1 (en) | 2009-11-12 |
EP2043539A1 (de) | 2009-04-08 |
JP5127829B2 (ja) | 2013-01-23 |
US8449536B2 (en) | 2013-05-28 |
CN101489499A (zh) | 2009-07-22 |
DE102007020583B4 (de) | 2012-10-11 |
EP2043539B1 (de) | 2012-09-26 |
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