JP2000005191A - High-frequency therapeutic device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a high-frequency therapeutic device which can sufficiently heat a large range at a time without repeating sticking of an electrode into an organism. SOLUTION: This high-frequency therapeutic device has a plurality of electrodes to be stuck into an organism and a high-frequency power supply 2 for supplying high-frequency current to the electrodes, and at least heats an organism tissue A stuck with the electrodes by supplying the high-frequency current to the electrodes. The high-frequency power supply, during supplying the high-frequency current to at least one electrode, stops supplying the high-frequency current to at least the other one electrode.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a high-frequency treatment apparatus used for treating a prostate or the like.

[0002]

2. Description of the Related Art Prostatic hyperplasia is a common case in men over the age of 50. Prostatic hypertrophy causes obstruction of the urethra, followed by symptoms such as pollakiuria, decreased urine output, pain and discomfort. In this case, drug therapy is often given at an early stage, but in severe cases,
It is common to perform a surgical procedure such as insertion of a high-frequency electrode through the urethra to the prostate site to resect the prostate. However, when the prostate is surgically removed, damage to the urethral mucosa is unavoidable, and complications such as bleeding and infertility often become problems.

[0003] In order to solve such a problem, two needle electrodes are punctured in the prostate, a high-frequency current is applied to the needle electrodes to heat the affected part of the prostate, and the temperature is measured by a temperature sensor. A high-frequency treatment apparatus that measures the temperature of a site and applies heat only to the prostate to perform treatment has been proposed (Japanese Patent No. 2647557,
U.S. Pat. No. 5,554,110).

[0004]

By the way, in the high frequency treatment apparatus having two puncturing electrodes, only the prostate site around the electrodes is heated. The size of the prostate varies among individuals. Therefore, in the treatment using the high-frequency treatment device, when the prostate is large, it is impossible to heat the entire necessary range by one electrode puncture. Therefore, it is necessary to change the puncturing position of the electrode with respect to the prostate and perform puncturing and heating again. However, such operations are very cumbersome and also increase the damage of the urethral mucosa.

In order to prevent such a problem from occurring, it is conceivable to increase the number of electrodes so that a necessary range can be heated at a time. Therefore, there is a problem that sufficient heating cannot be performed and a difference in heating occurs due to a difference in impedance.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a high-frequency treatment apparatus capable of sufficiently heating a wide area at a time without repeatedly puncturing the living body with electrodes. To provide.

[0007]

In order to solve the above-mentioned problems, the present invention comprises a plurality of electrodes pierced into a living body and a high-frequency power supply for supplying a high-frequency current to the electrodes, and supplies a high-frequency current to the electrodes. A high-frequency power supply for supplying at least one electrode with a high-frequency current while supplying a high-frequency current to at least one other electrode in the high-frequency treatment apparatus for heating at least the living tissue with the punctured electrode. Is stopped.

[0008]

Embodiments of the present invention will be described below with reference to the drawings. 1 to 5 show a first embodiment of the present invention.
Is shown. As shown in FIG. 1, the high-frequency treatment device according to the present embodiment includes a probe 1 that can be inserted into the urethra B and a high-frequency power supply 2. Probe 1
Is electrically connected to the high frequency power supply 2 via the electrode cable 4. The high frequency power supply 2 includes a foot switch 18 for controlling the output of the high frequency power supply 2 and a probe 1.
And a counter electrode plate 17 for collecting a high-frequency current output from electrodes 9 and 10 to be described later.

FIG. 3 shows a front panel of the high frequency power supply 2. As shown in the figure, an operation mode selection switch 19 for selecting a treatment mode, that is, resection or heating, an output mode setting switch 20 for setting an output type and electric power, and a heating mode Temperature setting switch 21 for selecting the set temperature of the output, an output setting indicator 22 for displaying the output power value set by the output mode setting switch 20, and the set temperature at the time of heating set by the temperature setting switch 21 , A heating electrode connection port 13 to which the electrode cable 4 is connected, and a counter electrode connection port 16 to which the counter electrode plate 17 is connected.
And an ablation electrode connection port 24 to which an unshown ablation electrode is connected. Heating electrode connection port 1
3 is provided with high-frequency output terminals 11 and 12 and a temperature measuring terminal 15. The high-frequency power supply 2 includes an output unit that outputs high-frequency power, and a control unit that controls the output unit.

As shown in FIG. 2, the probe 1 has two channels 5 and 6. The distal ends of the channels 5 and 6 extend obliquely with respect to the central axis of the probe 1 and open at the side surfaces of the distal end of the probe 1. In particular, in the present embodiment, each of the channels 5 and 6 is opened on the same side with respect to a plane passing through the central axis of the probe 1. In each of the channels 5 and 6, an electrode 9,
10 is provided so as to be able to advance and retreat. The tips of the electrodes 9 and 10 are bifurcated and have a sharp needle shape. Note that operation switches 7 and 8 for independently moving the electrodes 9 and 10 in the respective channels 5 and 6 are provided on the hand side of the probe 1. Further, a temperature sensor 13 is disposed at the tip of the probe 1.

Two power supply lines extending from the electrodes 9 and 10 extend through the probe 1 and the electrode cable 4, and when the electrode cable 4 is connected to the heating electrode connection port 3 of the high frequency power supply 2, They are connected to the high-frequency output terminals 11 and 12 (see FIG. 3) of the heating electrode connection port 3, respectively. A signal line 14 extending from the temperature sensor 13 extends through the probe 1 and the electrode cable 4. When the electrode cable 4 is connected to the heating electrode connection port 3 of the high-frequency power supply 2, the heating electrode connection is established. It is connected to the temperature measuring terminal 15 of the port 3.

Next, a case of performing a prostate treatment using the high-frequency treatment apparatus having the above-described configuration will be described with reference to a flowchart of FIG. 4 and output waveforms of FIG. When performing heat treatment on the prostate, as shown in FIG. 1, the return electrode 17 is attached to the patient, and the return electrode 17, the probe 1, and the foot switch 18 are connected to the high frequency power supply 2. Next, the processing mode (operation mode) is selected by the operation mode selection switch 19 on the front panel of the high frequency power supply 2, and the output power is set by the output mode setting switch 20 (S1 in FIG. 4). Here, heating is selected by the operation mode selection switch 19. The control unit built in the high-frequency power supply 2 recognizes the operation mode set by the operation mode selection switch 19 (S2). If the set mode is the heating mode, the output mode setting switch 20 changes the output mode. The setting is disabled, and the power output from the output unit is limited to a maximum of 20 W (S3). That is, the output mode setting switch 20 cannot set power exceeding 20 W. Thereafter, the temperature at the end of the heating is set by the temperature setting switch 21, and the setting preparation is completed.

When the output setting by the front panel is completed, the probe 1 is inserted into the urethra B and the tip of the probe 1 is positioned near the prostate A. And probe 1
By operating the switches 7 and 8 provided on the near side of the device, the electrodes 9 and 10 are made to protrude from the openings of the channels 5 and 6 to puncture the prostate A. In this state, when the foot switch 18 is depressed once (the pedal pressure may be released thereafter), the control unit recognizes this (S4) and outputs high-frequency power from the output unit (S5). At this time, the control unit
At the timing shown in FIG. 5, the power displayed on the output setting indicator 22 is transmitted from the output unit to the high frequency output terminals 11 and 12.
Output alternately.

The high-frequency power output to the high-frequency output terminals 11 and 12 is supplied to each of the electrodes 9 and 10 through the above-mentioned power supply line, whereby the prostate A is heated. In this case, two electrodes 9, 10 are used, and each electrode 9, 10,
Since the tip of the fork 10 is bifurcated, the prostate A is heated uniformly over a very wide range, and power is alternately supplied from the output section to the high-frequency output terminals 11 and 12 (therefore, the electrodes 9 and 10). Since the output is performed, the density of the high-frequency current does not decrease. In addition, the control unit includes the temperature measuring terminal 15.
The temperature of the treatment site is monitored through the detection signal from the temperature sensor 13 connected to the device, and the temperature of the treatment site exceeds the set temperature indicated by the temperature setting indicator 23 (S6).
Then, the high frequency output is stopped.

On the other hand, when the prostate A is to be resected, first, a resection electrode (not shown) is connected to the resection electrode connection port 24 of the high frequency power supply 2. Subsequently, the processing mode (operation mode) is selected by the operation mode selection switch 19 on the front panel of the high frequency power supply 2, and the output type and output power are set by the output mode setting switch 20 (S1 in FIG. 4). Here, the operation mode selection switch 19 selects monopolar or bipolar according to the electrode used. The control unit built in the high-frequency power supply 2 recognizes the operation mode set by the operation mode selection switch 19 (S2), and when the set mode is the cutting mode, that is, when the monopolar or the bipolar is selected. In accordance with the output type set by the output mode setting switch 20, the power output from the output unit is limited to a maximum of about 200 to 300W (S7). That is,
200 to 300 W depending on the output mode setting switch 20
Cannot be set (up to about 300 W to 200 W depending on the type of output).

After the output setting by the front panel is completed, the excision electrode is inserted into the urethra B and the tip of the probe 1 is positioned near the prostate A. In this state, when the foot switch 18 is depressed, the control unit recognizes the depression (S8), and outputs high frequency power from the output unit (S9).
At this time, the control unit is different from the one for heating,
The high frequency power is output from the output unit only while the step 8 is being depressed (S10, S12). If the output is continued for 60 seconds, it is determined that there is an abnormality, and the high frequency output is stopped (S11, S12). .

As described above, according to the high frequency treatment apparatus of the present embodiment, two electrodes 9 and 10 are used, and the tips of the electrodes 9 and 10 are bifurcated. Since the signals are alternately output to the electrodes 9 and 10, the wide range of the prostate A can be uniformly heated at once without reducing the density of the high-frequency current. Therefore, there is no need to repeatedly puncture the electrodes 9 and 10 with respect to the living body,
In addition, damage to the urethral mucosa can be minimized.
Further, according to the high-frequency treatment apparatus of the present embodiment, both the heating and the excision can be performed by the high-frequency power supply 2 itself.

FIGS. 6 to 8 show a second embodiment of the present invention. The high-frequency treatment device of the present embodiment includes the probe 25 shown in FIG. 6 and a high-frequency power supply substantially the same as that of the first embodiment. The probe 25 is electrically connected to a high frequency power supply via an electrode cable.

As shown in FIG. 6, the probe 25 has two channels 28 and 29. Each channel 2
The distal ends of the probes 8 and 29 extend obliquely with respect to the central axis of the probe 25 and open at the distal end of the probe 25. In particular, in the present embodiment, each channel 28, 29
The openings are provided on opposite sides of a plane passing through the central axis of the probe 25. In addition, sheaths 26 and 27 formed of an insulating material are provided in the channels 28 and 29, respectively.
Are provided so that they can advance and retreat. The distal end of each of the sheaths 26 and 27 has a sharp needle shape. Also, on the proximal side of the probe 25, the sheath 26,
An operation switch is provided for independently operating the advancing / retreating 27.

As shown in FIG. 7, the sheath 26 (27) has two channels 30, 31 (32, 33). The distal end of each channel 30, 31 (32, 33) extends obliquely with respect to the central axis of the sheath 26 (27) and opens at the distal end of the sheath 26 (27). Particularly, in the present embodiment, each of the channels 30, 31 (3
2, 33) are open on opposite sides with respect to a plane passing through the central axis of the sheath 26 (27). Electrodes 34, 35 (36, 37) made of a conductive material are respectively provided in the channels 30, 31 (32, 33) so as to be able to advance and retreat. Each of the electrodes 34, 35 (36, 37)
The tip is formed in a sharp needle shape, and each channel 30, 31 (32, 3) is operated by an operation switch (not shown).
It is operated independently in 3).

The two power supply lines extending from the electrodes 34 and 35 extend through the sheath 26 and the electrode cable, respectively. When the electrode cable is connected to the heating electrode connection port (see FIG. 3) of the high frequency power supply. Are connected to the corresponding high-frequency output terminals of the heating electrode connection port, respectively. Two power supply lines extending from the electrodes 36 and 37 also extend through the inside of the sheath 27 and the inside of the electrode cable. When the electrode cable is connected to the heating electrode connection port of the high-frequency power supply, the heating electrode connection port is used. Are respectively connected to corresponding high frequency output terminals.

The sheath 26 (27) is bendable over substantially the entire length excluding the distal end. Sheath 26
At the tip of (27), a temperature sensor 39 (40) is installed. Signal line 41 extending from temperature sensor 39 (40)
Extends through the sheath 26 (27) and the electrode cable. When the electrode cable is connected to the heating electrode connection port of the high-frequency power supply, it is connected to the temperature measuring terminal of the heating electrode connection port. The other configuration is the same as that of the first embodiment.

Next, a case in which prostate treatment is performed using the high-frequency treatment apparatus having the above configuration will be described. When the prostate is to be heated, the return electrode is attached to the patient and the return electrode, the probe 25, and the foot switch are connected to a high-frequency power supply, as in the first embodiment. Next, each switch on the front panel of the high-frequency power supply is operated to perform the same output setting as in the first embodiment. In this setting,
The output restriction and the like by the control unit are performed in the same manner as in the first embodiment.

When the output setting by the front panel is completed, the probe 25 is inserted into the urethra B and the tip of the probe 25 is positioned near the prostate A. Then, by operating a switch provided on the proximal side of the probe 25, the sheaths 26 and 27 are made to protrude from the openings of the channels 28 and 29 and puncture the prostate A. Following this,
By operating the switch, the electrode 3 of each sheath 26 (27) is
Channels 4, 35 (36, 37) to channels 30, 31 (3
The prostate A is punctured by protruding from the opening in (2, 33).

In this state, when the foot switch is depressed once (the pedal pressure may be released thereafter), the control unit of the high frequency power supply recognizes this and outputs the high frequency power from the output unit. At this time, the control unit transmits the power displayed on the output setting indicator from the output unit to each high-frequency output terminal (accordingly, each electrode 34, 35, 3
6, 37). That is, the control unit sequentially supplies power to each of the electrodes 34, 35, 36, and 37 through the output unit, and then stops the output for a certain period of time. Detect (measure) the temperature.

The operation control after the heating mode and the operation control in the cutting mode are the same as those in the first embodiment. As described above, according to the high frequency treatment apparatus of the present embodiment, the four electrodes 34, 35, 36, 37
And the electrodes 34, 35, 36, and 37 are diffused and punctured into the prostate in a branched state together with the sheaths 26 and 27, and high-frequency power is applied to each of the electrodes 34, 35, and 3.
6 and 37 are sequentially output, so that a wide range of the prostate A can be uniformly heated at once without lowering the density of the high-frequency current. Therefore, the electrodes 34, 3 for the living body
There is no need to repeat 5,36,37 punctures and damage to the urethral mucosa can be minimized. That is,
A small puncture allows for a wide range of warming.

In the high-frequency treatment apparatus according to the present embodiment,
No high frequency output during temperature measurement. Therefore, it is not affected by high frequency (noise) during temperature measurement.
Therefore, it is not necessary to add a circuit configuration for removing noise, and the circuit configuration is simplified.

In the second embodiment, the sheath 26 (27) and its electrodes 34, 35 (36, 37)
May be configured as shown in FIG. That is, the loop-shaped electrode 43 is housed in the tubular sheath 42 so as to be able to advance and retreat. In this case, the electrode 43 is provided with a spreading property so as to expand when the electrode 43 protrudes from the sheath 42. In such a configuration, when the loop-shaped electrode 43 is punctured into the prostate A and the electrode 43 is energized, the prostate tissue is cut, for example, by the electrode 43. As the incision proceeds, the electrode 43
Changes from a contracted state shown by a dotted line in the figure to an expanded state shown by a solid line due to its expanding behavior.

According to the technical contents described above, the following various configurations can be obtained. 1. In a heating device including a plurality of electrodes that perform heating by puncturing a living body and being supplied with a high-frequency current, and a high-frequency power supply that supplies a high-frequency current to the electrodes, the high-frequency power supply includes a plurality of electrodes. A heating device comprising at least two or more high-frequency current supply means for supplying a high-frequency current in a time-division manner.

2. An electrode that performs heating by puncturing a living body and being supplied with a high-frequency current, and a heating device that includes a high-frequency power supply that supplies a high-frequency current to the electrode,
The high-frequency power supply is provided with a heating type selecting means for heating and ablation or coagulation, and a means for stopping the output after outputting for a predetermined time when ablation or coagulation is selected.

3. In a heating device that includes a high-frequency power supply that has an output setting unit and supplies a high-frequency current to the electrode, the high-frequency power supply includes: A heating device comprising: output type selecting means for heating and ablation or coagulation; and means for changing a settable range depending on the output type.

4. In a heating apparatus including a plurality of electrodes that perform heating by puncturing a living body and being supplied with a high-frequency current, a unit that measures the temperature of the living body, and a high-frequency power supply that supplies a high-frequency current to the electrodes, A heating device characterized in that it supplies divided high-frequency current and measures temperature.

5. A probe having a lumen that opens to the side near the tip, a sharp sheath having a tip and having at least one lumen and a tip inside the lumen of the probe that is arranged to be able to protrude and retract with respect to the opening, A puncture electrode comprising at least one current-carrying electrode having a distal end portion protruding and retracting in the lumen of the sheath with respect to the opening of the lumen, wherein the sheath is insulated from the electrode; A puncture electrode characterized in that, when protruding from the sheath, it spreads larger than the outer diameter of the sheath.

6. The puncture electrode according to claim 5, wherein the electrode has a shape that expands in a loop shape when protruding from the sheath. 7. The puncture electrode according to claim 5, wherein the sheath is made of an insulating material.

[0035]

As described above, the high frequency treatment apparatus of the present invention can sufficiently heat a wide area at a time without repeatedly puncturing the living body with the electrode.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram of a high-frequency treatment apparatus according to a first embodiment of the present invention.

FIG. 2 is a sectional view of a probe constituting the high-frequency treatment apparatus of FIG. 1;

FIG. 3 is a front view of a front panel of a high-frequency power supply included in the high-frequency treatment apparatus of FIG. 1;

FIG. 4 is a flowchart illustrating output control of a high-frequency power supply.

FIG. 5 is a time chart of output high-frequency power.

FIG. 6 is a cross-sectional view of a distal end of a probe constituting a high-frequency treatment apparatus according to a second embodiment of the present invention.

7 is a cross-sectional view showing a state in which a sheath protruding from the probe of FIG. 6 has been punctured into prostate tissue.

FIG. 8 is a timing chart of high-frequency output and temperature measurement.

FIG. 9 is a diagram related to a modification of the second embodiment.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Probe 2 ... High frequency power supply 9, 10, 34, 35, 36, 37 ... Electrode

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor Takahiro Ogasaka 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Inventor Yasuhiko Kikuchi 2-43-2 Hatagaya, Shibuya-ku, Tokyo Within Olympus Optical Co., Ltd. (72) Kazuya Hijii 2-43-2, Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Naoki Sekino 2-43-2, Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Inventor Masatoshi Somura 2-43-2 Hatagaya, Shibuya-ku, Tokyo In-line Olympus Optical Co., Ltd. (72) Inventor Hideto Yoshimine 2-chome Hatagaya, Shibuya-ku, Tokyo 43-2 Inside Olympus Optical Co., Ltd. (72) Inventor Takeaki Nakamura 2-43-2 Hatagaya, Shibuya-ku, Tokyo Ori Path Optical Industry Co., Ltd. in the F-term (reference) 4C060 KK09 KK20 KK25

Claims (1)

[Claims] 1. A high-frequency device comprising: a plurality of electrodes punctured into a living body; and a high-frequency power supply for supplying a high-frequency current to the electrodes, wherein the high-frequency current is supplied to the electrodes to heat at least the living tissue into which the electrodes are punctured. In the treatment apparatus, the high-frequency power supply stops supplying the high-frequency current to at least one other electrode while supplying the high-frequency current to at least one electrode.