CN105873533B - 泌尿科器械 - Google Patents

泌尿科器械 Download PDF

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CN105873533B
CN105873533B CN201580003477.8A CN201580003477A CN105873533B CN 105873533 B CN105873533 B CN 105873533B CN 201580003477 A CN201580003477 A CN 201580003477A CN 105873533 B CN105873533 B CN 105873533B
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M·沃尔特
J·B·朗霍茨
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Olympus Winter and Ibe GmbH
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    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
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Abstract

一种泌尿科器械，该泌尿科器械具有在充有液体的膀胱中能承受高频的工作电极(5)和以相对于该工作电极的固定距离布置的温度传感器(14，15)，其特征是，该温度传感器(14，15)具有两个彼此以固定间距设置的且能被置于液体接触中的测量电极(14，15)，这两个测量电极被连接至电阻测量仪(18)。

Description

泌尿科器械
技术领域
本发明涉及一种泌尿科器械。
背景技术
在DE102011121792A1中示出根据前言的泌尿科器械。该泌尿科器械在此是具有承受高频的工作电极的电切镜，其在处于膀胱内的液体中工作。利用该工作电极，身体组织例如在缩小肥大的前列腺时通过切割或蒸发被除去。
在当今的高功率装置中，为了加快手术而投入很多能量来工作，所述能量由工作电极释放至环境，因此导致膀胱内的液体有很高温度。该温度可能起到损伤组织的作用。因此，需要监测膀胱内温度的措施。
为此目的，该已知结构规定了用耐热镍铬合金材料工作的温度传感器，其紧邻工作电极设置且可借助设置用于监测手术区的光学部件来光学读取。
已知的结构有一系列缺点，尤其是费力的测量方法，其由外科医生通过观察传感器并与颜色表比对来执行。
US6197021B1示出一种外科手术的发热工作电极，其温度用电传感器如热偶元件或热敏电阻来紧邻地确定。虽然在此情况下利用精确工作的电测量法，但估计这种电动工作装置在液体环境如在膀胱内最易出故障。
所有已知的根据前言的温度传感器还有另一个严重缺点，即基本是点状测量，其在液体中导致剧烈搅动作用。在强烈发热的工作电极附近，在膀胱液体内出现大的局部温差，其被流动例如冲洗流搅动。该测量结果因此大多与流速和偶然事件相关，即与在感兴趣的位点处的有效温度相关。
发明内容
本发明的任务是找寻一种泌尿科器械，其允许精确说明膀胱内的温度。该任务利用本发明第一方面的特征来完成。
本发明基于以下认识，即液体导电率明显取决于液体温度。因此，本发明的泌尿科器械利用电阻测量仪确定在两个测量电极之间的膀胱内液体的电阻，进而确定液体传导性。在此使这些测量电极保持固定间距且接触液体。为此可以确定测量电极之间液体的电阻，其倒数即导电率在感兴趣的测量范围内基本与液体温度线性相关。可借此实现简单精确的温度测量。不存在伴随液体的电气问题，相反，该测量电极接触液体甚至是测量所需要的。本发明无需担心已知测温装置的搅动作用，这是因为它完成在两个测量电极之间即在测量体积内的测量，在该测量体积内，点状温差关于测量体积被抹平。即，也出现很稳定的测量。
为了维持测量电极之间的准确距离，根据本发明第二方面，测量电极有利地固定在绝缘距离保持件上，该距离保持件保证所述距离。
电阻测量仪可布置在测量电极附近，但根据本发明第三方面，有利地远离布置且通过测量线来连接。尤其是它远离膀胱地干燥安置。
根据本发明第四方面，如此有利地构成泌尿科器械，该测量电极与工作电极固定连接。因此，当外科医生不断进行工作电极的位置更换时，该测量电极始终留在发热元件附近。
在具有保持工作电极的托臂的泌尿科器械中，根据本发明第五方面，在其中一个托臂上有利地设置各一个测量电极。因此，它们由根据本发明第二方面用作距离保持件的托臂以精确距离保持在工作电极附近并且总是随之运动。
附图说明
在附图中示意性举例示出本发明，其中：
图1是具有工作电极的泌尿科电切镜的远端区域的非常示意性的视图，以及
图2示出图1的工作电极区域的放大局部。
具体实施方式
图1以立体图示出呈泌尿电切镜形式的泌尿科器械的远端区域，其基本对应于DE102011121792A1的结构。
在图1中示出电切镜的柄管1的远端区域，其在图1所示的例子中一直敷设到虚线所示的膀胱2中。两个托臂3、4延伸穿过柄管1，这些托臂相互平行布置且在它们的远端之间承载一个工作电极5。工作电极由非绝缘的导电金属丝构成。如此构成的电极组件3、4和5通过连接电缆6、7被连接至高频发生器8，高频发生器可利用常见的脚踏开关9来切换。
计构型中以U形环圈形式构成。在承受高频时，工作电极切过组织并且例如可以被用来切掉肿瘤10。为此必须在接通高频发生器8的情况下借助托臂3和4以适当方式使该电极组件切割地进行运动。
在所示实施例中示出双极电切镜，即这样的电切镜，其中两个电极相互分开地连接至高频发生器8的两个极，其中在这些电极之间有电流流过膀胱2内的液体。
为此，尤其如图2的工作电极5的远端区域的放大图所示，在工作电极5的远端区域内设有对电极11，其以相对于工作电极5的近侧距离布置在托臂3、4之间。
两个托臂3、4以由绝缘材料构成的杆的形式构成，或者也以绝缘管形式构成。第一电导体12在托臂3内延伸，该第一电导体在其远端区域内超出托臂3并在那里形成环圈形工作电极5。它尤其如图2所示在其另一端通过第一绝缘体19与穿过托臂4的第二导体13的远端相连。
对电极11与第二导体13导电相连，但没有与第一导体12导电相连，相对于第一导体只存在借助第二绝缘体20的绝缘连接。即，对电极11只与第二导体13电连接，而工作电极5只与第一导体12电连接。
因此在电极组件的远端区域内有两个在电方面相互分开的电极5、11，它们分开地通过导体12、13被连接。导体12、13如图1所示与连接电缆6、7相连且延伸至高频发生器8的分开的极。
如果高频发生器8被接通，则在电极5、11处存在不同的电压极，因此电流在其之间流过膀胱2内的导电液体。该双极工作技术装置因其高工作功率而在近年来越来越受欢迎，但也使得很大能量输入膀胱2。
因此，为了保护膀胱2区域内的患者组织而应监测膀胱内的温度。为此设有测温装置。
本发明的测温装置如图1所示。它具有两个测量电极14、15。每个测量电极分别安置在两个托臂3、4之一上，确切说在所示实施例中呈简单的、夹紧在各自托臂上的金属片套形式。测量线16、17通向远离测量电极安放在膀胱2以外的电阻测量仪18，利用该电阻测量仪来测量并显示测量电极14、15之间的电阻。
这些托臂3、4总是在测量电极14、15区域内保持固定不动且相互间隔固定距离。对电极11也有助于此。托臂3、4和对电极11构成保持测量电极14、15之间距离的距离保持件。
电阻测量仪18可以按照商业常见方式将电流源和测量仪以及在测量电极14、15之间的测量段前后串联相连。出现了借助流过位于其间的液体的电流的测量电极14、15之间电阻的测量。
试验表明，在商业常见的冲洗液体(含有如常在泌尿科手术中被用于冲洗的生理盐成分)的导电率(即电阻的倒数)例如在20-45摄氏度的温度范围内从15-25mS/cm线性增大。即，在这里存在着在测量技术上可良好控制且可重现的状况。
附图标记列表
1 柄管
2 膀胱
3 托臂
4 托臂
5 工作电极
6 连接电缆
7 连接电缆
8 高频发生器
9 脚踏开关
10 肿瘤
11 对电极
12 第一导体
13 第二导体
14 测量电极
15 测量电极
16 测量线
17 测量线
18 电阻测量仪
19 第一绝缘体
20 第二绝缘体

Claims (4)

1.一种泌尿科器械，该泌尿科器械具有在填充有液体的膀胱中能承受高频的工作电极(5)和相对于该工作电极以固定距离布置的温度传感器，其特征是，所述温度传感器具有两个彼此以固定间距设置的且能被置于液体接触中的测量电极(14，15)，这两个测量电极被连接至电阻测量仪(18)，这些测量电极(14,15)固定在绝缘的距离保持件(3，4，11)上。
2.根据权利要求1所述的泌尿科器械，其特征是，这些测量电极(14，15)通过测量线(16，17)被连接至远离布置的电阻测量仪(18)。
3.根据前述权利要求中任一项所述的泌尿科器械，其特征是，这些测量电极(14，15)与所述工作电极(5)刚性相连。
4.根据权利要求3所述的泌尿科器械，其中所述工作电极(5)被两个平行地间隔设置的刚性托臂(3，4)保持，其特征是，这些托臂(3,4)分别承载其中一个所述测量电极(14，15)。
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