DE3328039C2 - FACILITIES FOR THE CONTACTLESS SMASHING OF A CONCERMENT IN THE BODY OF A LIVING BEING - Google Patents

Description

The invention relates to a device for contactless Smashing a concrement in the body of a living being with the features of the preamble of the claim 1 or claim 2.

Facilities of this type are used in medicine, e.g. B. to destroy stones in the kidney of humans. they are particularly advantageous because they have any interference in the Avoid body. It is not necessary to operate surgically. Also the introduction of probes and devices to the calculus not applicable. A risk from infection or injury, e.g. B. when inserting the probe or during operations, can non-contact smashing does not occur.

A device of the type mentioned is in DE-AS 23 51 247. Here in a focusing chamber, which is designed as a semi-circular ellipsoid of revolution, in a first focus a spark discharge between two Electrodes brought about. This causes a shock wave whose wavefront is on all sides, d. H. spherical spreads.  On the wall of the ellipsoid of revolution, the Waves reflected. They gather in the second focus of the ellipsoid of revolution. In this second focus, in which the concrement is placed, meet the reflected waves at the same time. Under the bundled Impact of the shock waves becomes the calculus destroyed. The coupling between the one half of the ellipsoid and the body in which the concrement is is done via a thin film that has no air gap fits the body. The focus chamber is filled with water.

This device has the disadvantage that Changes in the shock wave energy are only slight Limits and only with considerable equipment by changing the distance of the underwater electrodes possible are. A further disadvantage is that the mutual distance between the electrodes to generate high-intensity shock waves usually some Must be millimeters, which creates the shock wave source has no punctiform geometry and aberrations can arise during focusing. Furthermore use the underwater electrodes with each discharge greatly, so their lifespan is limited to what regular maintenance of the facility is required makes.

The above circumstances are already in the DE-OS 25 38 960 recognized. According to this document, the disadvantages cited are eliminated in that instead of the spark gap one outside the focusing chamber giant pulse laser used becomes. Its beam is expanded by a beam splitter and then through one in the wall of the focusing chamber lens system in focus  of the rotational elliptical focusing chamber. Here a shock wave is triggered, e.g. B. by Concentration of the energy bundle on an absorbent Pen or a highly absorbent liquid. This device also becomes difficult to manufacture rotationally elliptical reflection body used. In addition, the degree of effectiveness of such a facility to be regarded as low with laser. Furthermore must be mentioned that the radiation geometry is a for is always determined, and that the evasion of z. B. Ribs or other bones is not possible, so adaptation to the anatomy of the body is limited is possible.

DE-OS 29 02 331 describes a device for transcutaneous, bloodless obliteration of small reticular and spider vein varices described. As wave generators are used simultaneously controllable ultrasound elements, which are parabolically arranged so that their sound energies in a focal point where the one to be destroyed Varice is placed. The entire arrangement of the Ultrasonic elements is by means of a worm drive and a set screw can be moved longitudinally. Hereby can have different distances from the focal point from the applicator end can be set. This device is the Power of ultrasound crystals to smash Concretions in the deep inside of a human body unsatisfactory. The exact setting of each Ultrasonic transducer both in terms of location and the energy is therefore also not critical. A shutdown individual ultrasonic crystals for the purpose of adjusting the There is no provision for ultrasonic energy in the focal point.

In DE-OS 31 19 295 is a device for destruction of concretions in body cavities with the help a large area ultrasonic transducer as  Vibration generator described. There comes a more focused one Ultrasonic transducers with a pulse peak power of at least 100 kW for use. Here there is the possibility of different Zones of the body that are on the sound path to the concrement lying and disturbing, by changing the radiation area hide. An embodiment is also shown at the single ring-shaped ultrasonic elements that form the transducer, are arranged on a spherical surface. The idea of an ultrasonic transducer is also disclosed use, which initially generates flat shock waves, which by means of be focused with an acoustic lens. Also are a device for receiving and processing acoustic Signals generated by the interaction of an acoustic Transmission signals with the body of the living being or the coupling medium arise, and a device for sending the acoustic Transmitted signals provided, it is in the establishment to send around the ultrasonic transducer itself or one according to DE-AS 27 22 252 additionally provided ultrasonic transducers acts. About a change in performance accordingly nothing is said about the type and depth of the concretion. In addition, the effort for such a facility, especially with regard to the formation of the annular Ultrasonic elements, be considerable.

It should also be noted that in such ultrasonic devices only limited peak power of the radiated sound energy possible are. In addition, such a device a large number of ultrasonic transducers required what high assembly and control effort required. In addition, at Ultrasonic transducers an undesirable undershoot to watch that only with considerable effort is reduce.

In DE-AS 27 22 252 is a device for spatial Location of concretions described, the establishment is integrated into a pulverizer of concrements. This the so-called lithotripter comprises a coupling device in the form of a  Ellipsoids with a shock wave source in focus. At the Wall of the coupling device are both ultrasonic transmitters and Ultrasound receiver arranged. The ultrasound machines are like that aligned that the common intersection of their radiating Waves in the second focal point of the body Intersect ellipsoids.

In DE-OS 29 13 251 is a device for smashing described by kidney stones or the like. The shock wave generator is in a closed, filled with water Housing housed. A reflector reflecting the shock wave is assigned to the shock wave generator. The coupling The shock wave to the patient's body takes place via a deformable, resilient sack or pouch. The sack is with a medium that conducts the shock wave well, e.g. B. water filled. The device described comprises a reflector, at which aberrations are not improbable.

In the magazine "Akustische Beihefte", 1962, Issue 1, pages 185 to 202, is the construction of a so-called "shock wave tube", as used in principle in the present invention is described. In front of a flat coil, through an insulating film separated, there is a copper membrane. To this Copper membrane connects to a tube filled with water. By Apply a voltage in the range of 2 to 20 kV to the Flat coil, a magnetic field is induced in the copper membrane, which causes repulsive forces that separate the membrane from the coil push away. This creates a flat shock wave, which in the water-filled pipe becomes a steep shock wave and on Pipe end is available for experiments. Is used such a shock tube z. B. to substance tests in the Chemistry.

The object of the present invention is a device of the type mentioned to indicate the location device for the concrement inside the living being, which in connection with a particularly advantageous  selected shock wave generator particularly expedient and accurate is working.

This object is achieved according to the invention in a device according to the preamble according to a first embodiment by the characteristics of the characteristic part of the Claim 1 solved.

According to a second embodiment, this object is achieved according to the invention by the characteristics of the characteristic part of the Claim 2 solved.

The location device according to these two embodiments enables the concrement to be found at the same time Focusing the shock wave tube on the concrement. Here can be used more than one shock wave tube. The Adjustment effort on the shock tube is reduced, what at the same time saving time when treating patients means.

The invention is based on the following description of exemplary embodiments and based on the drawings explained in more detail.

Show it:

Fig. 1 is an elevation of a fragmentation device according to the invention with eight shock tubes and with an ultrasonic positioning system,

Fig. 2 shows a section along the line II-II through the device of FIG. 1,

Fig. 3 is a section along the line III-III through the device of FIG. 1,

Fig. 4 is a shock wave tube according to the prior art,

Fig. 5 shows a longitudinal section through a shock tube, to which a lens has to accompany,

Fig. 6 is a longitudinal section through several shock wave tubes, which is associated with a common lens, and

Fig. 7 shows a section corresponding to Fig. 3 with a standing patient and with a shock wave decoupling device.

Figs. 1 to 3 show a section of a device for contactless disintegration of a concretion located in the body 1 of a living being. The device comprises two arcuate lines 2 a and 2 b, each with four shock wave tubes 3 known per se. The two lines 2 a, 2 b lie on a spherical surface, and the shock wave tubes 3 are placed next to one another, for which purpose a holding frame 4 can be used. However, they are not too tight, so that a mechanical fine adjustment device 5 , z. B. several guides with a smooth spindle, can be conveniently accommodated and operated. When arranging several identical, cylindrical shock wave tubes 3 , care should be taken that the extensions of their center axes 7 meet at a common intersection 11 and that the shock wave tubes 3 are equidistant from this intersection 11 . The outlet openings 12 of the shock wave tubes 3 thus lie on a circle around the intersection 11 . The central axes of the shock waves originating from the shock wave tubes 3 run along the center axes 7 . Depending on the embodiment, the shock waves arrive at the intersection 11 at the same time, which is preferred for some applications, or staggered or offset in time. The latter embodiment can be advantageous if the concrement 1 is to be exposed to a longer period of action overall.

The fine adjustment device 5 includes the possibility of individually displacing each shock wave tube 3 in the direction of the center or longitudinal axis 7 . As a result, the distance between the shock wave tube opening 12 and the common intersection 11 of the individual longitudinal axes 7 changes . This is indicated by an arrow 5 a.

In order to adjust the depth of the intersection 11 in the body of the patient 19 , the fine adjustment 5 also enables the holding frame 4 to be displaced with all the shock wave tubes 3 mounted on it. A double arrow 5 c indicates this.

At the intersection 11 mentioned , the concrement 1 is arranged. In the case shown, it is a stone in a kidney 15 . A solid line 17 symbolizes the body surface of the patient 19 , who is placed in front of the smashing device.

Each shock wave tube 3 comprises a flat coil 21 which is connected to a common ground 23 . The other connection of the flat coil 21 is, combined with the corresponding connections of other flat coils 21 of the same arc 2 a or 2 b, to a first electrode 25 a or 25 b of a suitable switching device, such as. B. a spark gap 27 a or 27 b or a vacuum or SF6 switch connected. A second electrode 29 a and 29 b of the spark gap 27 a and 27 b is applied to a capacitor 31 a, 31 b. A first resistor 33 a and 33 b is connected in parallel with the capacitor 31 a, 31 b. A charging voltage U _a or U _{b is applied} to this parallel connection via a second resistor 35 a, 35 b connected in series. Between the two electrodes 25 a, 25 b and 29 a, 29 b of the spark gap 27 a and 27 b is a control electrode 37 a and 37 b, with the help of which the spark gap 27 a, 27 b is ignited.

Between the two parallel lines 2 a, 2 b of shock wave tubes 3 there is a locating device 39 which is suitable for receiving and transmitting ultrasonic signals. This is used to find the position of the calculus 1 without contact. In the present example, it is an ultrasound localization device. The locating device 39 comprises a parallel arrangement 41 of ultrasound elements (see FIGS . 1 and 3), which is connected to a transmitting and / or receiving device 43 via a signal line 42 . The arrangement 41 is pivotally mounted on a tripod with a holding rod 43 a, through which the signal lines 42 can be guided to and from the ultrasonic transducer elements at the same time. As a result, the arrangement 41 can be rotated about its longitudinal axis, which is shown by a double arrow 44 . An alternative embodiment to this arrangement 41 of the ultrasound elements consists in that the ultrasound elements are assigned directly to each individual shock wave tube 3 . Another possibility is to design the ultrasonic transducer elements as a surface array.

With the aid of the locating device 39 , the patient 19 is placed in such a way that the calculus 1 to be destroyed is located at the intersection 11 of the central axes 7 of the shock wave tubes 3 . The coupling between the shock wave tube opening 12 and patient 19 is via a with a coupling medium z. B. water 47 filled, flexible bag 49 (see. Fig. 3). This can in particular consist of an elastic material with an acoustic impedance that is similar to that of water. EPDM rubber is preferred. The bag 49 is preferably attached to the circumference of the shock tube 3 . Care should be taken to ensure that the bag 49 rests against the patient's body 19 without an air gap. The request can be checked for accuracy by acoustic controls with the help of the ultrasound device. In order to keep the adjustment effort on the shock wave tubes 3 as low as possible, it is expedient to design the wall of the sack 49 in such a way that folds 51 are present on the sides. These folds 51 have a bellows-like function and make it possible to place the shock wave tubes 3 closer or further away from the patient 19 and to absorb tilting movements in all directions. The position of the intersection point 11 in the patient 19 thus changes accordingly. An individual change of adjustment of the shock wave tubes 3 itself is not necessary. This advantage is considered to be particularly significant.

The coupling can also take place via a water bath 52 in a tub in which the patient 19 is located. The shock wave tube arrangement is inserted in a recess in the wall 52 a of the tub ( Fig. 2).

If the concrement 1 is at said intersection 11 , the shock waves can be triggered simultaneously. The number of connected shock wave tubes 3 depends on the size and consistency of the calculus 1 as well as the geometry given by the patient's anatomy and is set accordingly. The individual shock waves pass through the water bag 49 and the body to the intersection 11 on separate paths. There they meet at the same time and release part of their energy to the concrement 1 through the push and pull effect. This will destroy or at least damage it. The possibility of receiving the locating device 39 for the calculus 1 can be used to control the success of the smashing process on the basis of the reflected shock wave.

Applications are conceivable in which the shock waves are allowed to run through the predetermined volume range in which the concrement 1 lies in an adjustable chronological sequence. The adjustment of the time shift is possible via the fine adjustment device 5 by changing the distance along the double arrow 5 a. Another variant of this is a delayed triggering of the individual shock waves. Fig. 3 this shows an embodiment in which the control electrodes 37 a, 37 b are different from each separately connected to a control unit 53. The control unit 53 gives voltage pulses to the control electrodes 37 a and 37 b of the individual shock wave tubes 3 of the rows 2 a and 2 b in the desired order and thereby causes the ignition processes. The setting of the distance between the concrement 1 and the shock wave tube opening 12 is therefore not carried out here via the mechanical fine adjustment device 5 , but rather by triggering the individual shock waves at different times. As a result, the arrangement of the shock wave tubes 3 on an arc can be omitted. The alignment of the shock wave tubes 3 on the concrement 1 must, however, still be given.

The time offset can e.g. B. be realized in that each shock wave tube 3 is assigned its own circuit with its own switching device 54 and control components, the common control unit 53 are operated. The control unit 53 also enables the amplitude and pulse shape of the individual shock waves to be set. This also makes it possible to locate the calculus 1 directly with the aid of the shock wave tube 3 by setting the amplitude of the shock wave to be correspondingly small. For this purpose, two switching devices 54 a, 54 b are shown in FIG. 3.

It is particularly advantageous in the present invention that, as a rule, not all shock wave tubes 3 always have to be switched on. This enables a selection of the participating shock wave tubes 3 so that only those with an optimal radiation path are preferred. Shock wave tubes 3 , where obstacles such. B. bones, can be observed in the shock wave path are not switched on when the shock wave is emitted.

Fig. 4 shows a longitudinal section through a typical embodiment of a shock wave tube 3. The capacitor 31 is connected to ground 23 , its other connection is connected to the second electrode 29 of the spark gap 27 . The first electrode 25 of the spark gap 27 is connected to the start of the flat coil 21 . The end of this flat coil 21 is connected to ground 23 . Prior to the flat coil 21, an insulating film 55 is disposed, which has a copper diaphragm 57 is electrically insulated from the flat coil 21st The copper membrane 57 is on the edge with a liquid, for. B. water-filled cylindrical pipe section 59 connected. The end of the pipe section 59 is referred to as the shock wave pipe opening 12 . The water bag 49 can connect directly here.

The control electrode 37 is located between the first and second electrodes 25 and 29 of the spark gap 27 . If a voltage pulse is applied to this control electrode 37 , the spark gap 27 is ignited and thus conductive. The energy stored in the capacitor 31 discharges into the flat coil 21 , which thus quickly builds up a magnetic field. In the copper diaphragm 57 an opposing field is induced, which causes the copper membrane is repelled 57 of the flat coil 21st This knocking out of the copper membrane 57 creates a pressure wave in the water. The pressure wave continues up to the shock wave tube opening 12 , the gradient increasing through the tube piece 59 and then the wave front.

With a suitable dimensioning of the components of the shock wave tubes 3 , the pressure amplitude of the shock waves in the target area 1 is large enough to achieve the desired effect of the crushed stone.

FIG. 5 shows a section along a shock wave tube 3 according to FIG. 4, at the opening 12 of which an acoustic converging lens 61 is mounted. The converging lens 61 can thus be displaceable in the direction of the double arrow 63 along the center or longitudinal axis 7 of the shock wave tube 3 . With this displaceable arrangement of the converging lens 61 , fine regulation of the entire shock wave tube 3 according to double arrow 5 a in FIG. 1 can then be dispensed with. By moving the converging lens 61 , its focal points 65 are also shifted accordingly, the distance from the shock wave tube opening 12 can thus be varied. The concretion 1 to be crushed is located in the focal point 65 of the converging lens 61 on the body side. This arrangement of the converging lens 61 is expediently carried out on all shock wave tubes 3 . Alternatively, there is the possibility that several or all shock wave tubes 3 are in front of a common converging lens 66 . An arrangement for this is shown in FIG. 6. Between four parallel shock wave tubes 3 and the body of the patient 19 there is a single collecting lens 66 . Their diameter is large enough to capture all the plane waves emitted. Respect to the position of the focal point 65 of lens 66 and its displaceability, the same applies as such for the arrangement of Fig. 5. The advantage of this solution is that not every shock tube 3 needs to be aligned individually, but only a Parrallelstellung all shock tubes 3 is necessary. The overall arrangement has only one focal point 65 , which is aligned with the concrement 1 .

Fig. 7 shows an overall view of the smashing device with a coupling device for the shock waves. The area of the patient 19 that is suitable for the entry and exit of the shock waves is covered with a lower third 67 . The abdominal bandage 67 lies against the body of the patient 19 without air gaps and is filled with a filling, e.g. B. provided with water that conducts the shock waves well. On the side facing away from the body, the shock waves are collected by a planar ultrasound receiver 69 for transmission. The shock wave tubes 3 are fastened to an angled support arm frame 71 , which allows pivoting on all sides. This is advantageous in order to track the common intersection point 11 in the event of the destruction of extensive concrements or during patient movements during the treatment. The holding arm frame 71 can be firmly connected to a wall of the treatment room. This holding arm 71 can also include, for example, the parts of the fine adjustment 5 which allow the displacement along the double arrow 5 c.

Claims (6)

1.Device for the contactless smashing of a concrement located in the body of a living being, which can be aligned with a shock wave generator that generates plane shock waves, to a target area in the body, with an acoustic lens assigned to the shock wave generator, which focuses the shock waves via a coupling medium into a focus Focused target area, and with a device for receiving and processing acoustic signals that result from the interaction of an acoustic transmission signal with the body of the living being and / or with the coupling medium, the shock wave generator being provided as a transmitter for the acoustic transmission signal, characterized in that that a shock wave generator ( 3 ) with electrical flat coil ( 21 ) and membrane ( 57 ) arranged in front of it is provided as a shock wave generator which is known per se and which produces substantially flat shock waves. 2.Device for the contactless smashing of a concrement located in the body of a living being, which can be aligned with a shock wave generator that generates plane shock waves to a target area in the body, with an acoustic lens assigned to the shock wave generator, which focuses the shock waves via a coupling medium in a focus Target area focused, with a device for receiving and processing acoustic signals that result from the interaction of an acoustic transmission signal with the body of the living being and / or with the coupling medium, wherein an ultrasonic transducer is provided as a transmitter for the acoustic transmission signal, characterized in that As a shock wave generator, a shock wave tube ( 3 ) which is known per se and which generates substantially flat shock waves is provided with an electrical flat coil ( 21 ) and a membrane ( 57 ) arranged in front of it. 3. Smashing device according to claim 2, characterized in that the device for receiving and processing acoustic signals comprises a parallel arrangement ( 41 ) of ultrasonic elements (ultrasonic array) which is rotatably adjustable about its longitudinal axis ( Fig. 3). 4. Shattering device according to one of claims 1 to 3, characterized in that the device for receiving and processing acoustic signals is arranged next to the shock wave tube ( 3 ) aligned with the target area ( 1 ) ( Fig. 3). 5. Shattering device according to one of claims 1 to 3, characterized in that the device for receiving and processing acoustic signals comprises an ultrasonic receiver ( 69 ) for transmission (surface array) ( Fig. 7). 6. Smashing device according to one of the claims 1 to 4, characterized in that the device for receiving and processing acoustic Signals an area array covered for reflection.