JP2001346806A - Ultrasonic resectoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To realize an ultrasonic resectoscope capable of separating and resecting a tissue between an internal gland and an external gland of a prostate in a shorter time. SOLUTION: The ultrasonic resectoscope 1 is constituted by a sheath main body 10, an endoscope 20 and an ultrasonic probe 30. In a probe insertion part 31 of the ultrasonic probe 30, a semicircular fixed blade 35 is formed by cutting away the end side of the probe insertion part 31 so that the cross section has a semicircular shape to form a recessed part. At the end side of a sheath 11 of the sheath main body 10, a semicircular movable blade 40 is pivoted corresponding to the recessed part at the end side of the fixed blade 35. An opening/ closing means for freely rotatively opening/closing the movable blade 40 against the fixed blade 35 by opening/closing a movable handle 18 disposed on an operating part 12 of the sheath main body 10 against a fixed handle 17 is provided at the base end side of the sheath main body 10.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic resectoscope capable of exfoliating tissue between an internal gland and an external gland of a prostate under endoscopic observation.

[0002]

2. Description of the Related Art Generally, a resectoscope is used for transurethral resection (TUR) or transcervical resection (TCR), and is an elongated, hollow body inserted into a body cavity. An optical viewing tube (also referred to as a scope), which is an endoscope for observation, and a treatment tool having a treatment section for resection of living tissue are mainly provided in the sheath.

When performing a procedure such as prostatectomy using the above-mentioned resectoscope, the cavity is expanded by supplying D-sorbitol or the like, which is a transparent liquid having an insulating property, as a perfusate for expanding the narrow cavity, The sheath of the resectoscope was inserted into the cavity. Then, a metal exfoliator, for example, as a treatment tool is inserted between the inner gland and the outer gland of the prostate under the observation of an optical scope (endoscope), and the prostate tissue is exfoliated by pushing and pulling. The exfoliator was removed once and replaced with a resection tool, and the exfoliated tissue was excised.

However, after exfoliating the tissue between the internal gland and the external gland of the prostate using a metal exfoliator, excision is performed by exchanging the exfoliator and excision tool, and the excision operation is complicated. The surgery time was long.

On the other hand, for example, a resectoscope disclosed in Japanese Patent Application Laid-Open No. 1-223948 is an ultrasonic resection that is inserted into a treatment instrument channel of an optical viewing tube (endoscope) inserted into a sheath. An ultrasonic resectoscope using forceps has been proposed. The ultrasonic resection forceps used in the ultrasonic resectoscope has a cup-shaped movable blade and a fixed blade as a resection part in a treatment part.

[0006]

However, the ultrasonic resectoscope described in the above-mentioned Japanese Patent Application Laid-Open No. 1-223248 discloses a method for removing tissue between an inner gland and an outer gland of a prostate by using an ultrasonic cutting forceps. Is possible, but the dissection operation was difficult because the dissection of the resected tissue was not considered. Optical viewing tube (endoscope) inserted into the sheath
Since the ultrasonic resection forceps are inserted into the treatment instrument channel and used, the cup shape is small, and the tissue that can be resected at a time is small. In addition, the operation time was long.

The present invention has been made in view of the above circumstances, and it is an object of the present invention to provide an ultrasonic resectoscope for exfoliating and resecting tissue between an internal gland and an external gland of a prostate in a shorter time. I have.

[0008]

In order to achieve the above object, an ultrasonic resectoscope according to the present invention is connected to an ultrasonic vibrator disposed on a base end side and extended to a distal end side. A semi-cylindrical fixed blade having a recess formed by cutting off the distal end of the fixed blade, and having a shape adapted to the concave portion on the distal end of the fixed blade, and rotating the base end or its vicinity to the vicinity of the fixed blade. It is characterized by comprising a movable blade pivotally supported movably, and opening and closing means for opening and closing the movable blade rotatably with respect to the fixed blade. With this configuration, an ultrasonic resectoscope that can exfoliate and resect tissue between the inner gland and the outer gland of the prostate in a shorter time is realized.

[0009]

Embodiments of the present invention will be described below with reference to the drawings. (First Embodiment) FIGS. 1 to 6 relate to a first embodiment of the present invention, and FIG. 1 is an external view and a diagram showing an ultrasonic resectoscope according to the first embodiment of the present invention. 2 is an external view showing each part of the ultrasonic resectoscope of FIG. 1, and FIG.
FIG. 4 is an explanatory view showing the connecting portion of the movable blade, and FIGS. 5 and 6 are explanatory views for explaining the operation of the first embodiment of the present invention. Is an explanatory view when the tissue is detached, and FIG. 6 is an explanatory view when the tissue detached in FIG. 5 is excised.

As shown in FIG. 1, an ultrasonic resectoscope 1 according to a first embodiment of the present invention has a sheath 11 formed with a through-hole opening on the distal end side, and an operating section 12 on the proximal end side.
A hollow sheath body 10 provided with
Elongated insertion portion 21 extending linearly into the sheath 11
(See FIG. 2), an endoscope 20 for observing a lesion or the like with an eyepiece 22 provided on the proximal side of the insertion portion 21;
It mainly includes an ultrasonic probe 30 having a probe insertion portion 31 inserted through the sheath 11 of the sheath body 10 and protruding from the sheath 11.

As shown in FIG. 2, the ultrasonic resectoscope 1 is constructed by assembling the endoscope 20 and the ultrasonic probe 30 to the sheath body 10. The endoscope 20 mainly includes the insertion section 21 and the eyepiece section 22, and has a substantially L-shaped coupling section 23 connected and fixed to a base end side of the insertion section 21. A semicircular recess 24 is formed on the bottom surface of the connecting portion 23 along the axial direction (total length) of the connecting portion 23. In addition, a television camera (not shown) is detachably attached to the eyepiece section 22. A light guide cable 26 connected to a light source device (not shown) and a detachable light guide base 26 are provided on the top end side of the upper surface of the coupling portion 23. In addition, on the distal end surface of the coupling portion 23,
A pair of protrusions 27 for assembling with the sheath body 10
Are formed on the left and right sides on the base end side of the insertion portion 21.

The ultrasonic probe 30 has a pipe-shaped probe insertion portion 31 extending linearly as a vibration transmitting member for transmitting ultrasonic vibration to a fixed blade described later formed on the distal end side.
And a flange portion 32 connected to the proximal end side of the probe insertion portion 31 and an ultrasonic transducer 33 provided on the proximal end side of the flange portion 32. The outer diameter of the flange portion 32 is set to be substantially the same as the radius of curvature of the concave portion 24 formed in the connecting portion 23 of the endoscope 20. A cable 34 extends from the base end of the ultrasonic transducer 33, and the cable 34 is connected to a driving device (not shown) that generates a driving signal. When the cable 34 is connected to the driving device and the driving device is driven, the ultrasonic vibrator 33 receives a driving signal from the driving device and generates ultrasonic vibration. The ultrasonic vibration generated by the ultrasonic vibrator 33 is amplified by a horn (not shown), and transmitted to the distal end side of the probe insertion section 31 via the prepaid probe insertion section 31.

In the present embodiment, a concave portion is formed by notching the distal end side of the probe insertion portion 31 so as to have a semicircular cross section so that the tissue between the inner gland and the outer gland of the prostate can be easily separated. A semi-cylindrical fixed blade 35 is formed (see FIG. 4). Note that the fixed blade 35 forms an opening 35a.

A projection 36 extending along the axial direction of the probe insertion portion 31 for assembling with the sheath body 10 is provided on the distal end surface of the flange portion 32. At the base end of the ultrasonic vibrator 33, a tube 37 communicating with the lumen of the probe insertion section 31 extends so that water can be supplied to the probe insertion section 31 by connecting to a water supply device (not shown). It has become.

The sheath main body 10 includes a hollow sheath 11 formed with a through hole and extending linearly,
And an operation unit 12 provided on the base end side of the camera. The operation section 12 has an opening 13 communicating with the inner hole of the sheath 11. A perfusion mouthpiece 14 communicating with the opening 13 is provided upright on the upper surface of the operation section 12. Therefore, by connecting the perfusion tube 14 a (see FIG. 3) to the perfusion mouth 14, fluid can be sent from the perfusion mouth 14 to the inner hole of the sheath 11.
In addition, two holes 15 that can be engaged with the projections 27 of the endoscope 20 are formed on the base end face of the operation unit 12. These holes 15 are provided near the outer periphery of the opening 13, and are located on the left and right with the opening 13 interposed therebetween. The projection 36 of the ultrasonic probe 30 is located below the base end face of the operation unit 12 near the outer periphery of the opening 13.
And a hole 16 which can be engaged with the hole.

A fixed handle 17 extending downward from the base end surface of the operation section 12 to the hand side is fixed to the operation section 12. A movable handle 18 for opening and closing a movable blade 40, which will be described later, which is pivotally supported on the distal end side of the sheath 11 with respect to a fixed blade 35 of the ultrasonic probe 30, is fixed near the operation unit 12. It is rotatably connected via a pivot pin 17a penetrating the handle 17 in the lateral direction.

In the present embodiment, the movable blade 40 is formed so as to fit with the concave portion on the distal end side of the fixed blade 35, and the movable handle 18 is opened and closed with respect to the fixed handle 17. An opening and closing means for opening and closing the movable blade 40 so as to be rotatable with respect to the fixed blade 35 is provided on the proximal end side of the sheath body 10. still,
The details of the movable blade 40 will be described later.

The portion of the movable handle 18 located above the pivot pin 17a is a substantially annular ring 19 which surrounds the opening 13, the hole 15 and the hole 16 formed in the operation portion 12 from the outside. Is formed. A projecting portion 41 is formed on the inner peripheral surface of the upper end portion of the ring 19 and extends radially toward the opening 13.

As shown in FIG. 3, the projecting portion 41 extends vertically inside the projecting portion 41, the lower portion (bottom portion) is closed without being opened, and the upper portion is opened at the outer peripheral surface of the ring 19. A hole 42 is formed. In addition, a slit 43 is formed on the side wall of the protruding portion 41 so as to reach the hole 42 from the tip end surface side of the ring 19. The slit 43 has a width smaller than the inner diameter of the hole 42 and extends along the axial direction of the protrusion 41, and the upper end thereof is open at the outer peripheral surface of the ring 19.

The inner hole of the sheath 11 has the sheath 1
A rod 44 extending in the longitudinal direction at the upper part of the inside 1 and having a base end side detachably connected to the movable handle 18 is inserted and arranged. More specifically, a spherical portion 45 having a diameter larger than the outer diameter of the rod 44 is provided on the proximal end side of the rod 44, and the spherical portion 45 is engaged with the hole 42 of the protrusion 41 of the movable handle 18. Thus, the rod 44 is detachably connected to the movable handle 18. In this case, the outer diameter of the rod 44 is set smaller than the width of the slit 43, and the outer diameter of the ball portion 45 is set larger than the width of the slit 43 and smaller than the inner diameter of the hole 42. Therefore, when the rod 44 is passed through the slit 43 from the open upper end side of the slit 43 and the ball part 45 is dropped into the hole part 42 of the protruding part 41, the rod 44 is removed from the protruding part 41 in the axial direction. Movable handle 1 without
8, and moves back and forth in the axial direction with the opening and closing operation of the movable handle 18 with respect to the fixed handle 17.

A seal member 46 is provided in the proximal end of the sheath 11. This sealing member 46
Supports the insertion section 21, the rod 44, and the probe insertion section 31 of the endoscope 20 within the sheath 11 at a predetermined interval, and keeps the inner hole of the sheath 11 watertight with respect to the outside. Further, the sheath 11 is provided with a plurality of pressing members 47 that support the probe insertion portion 31 at the nodes of the ultrasonic vibration transmitted by the probe insertion portion 31. These pressing members 47 are arranged at a predetermined interval from each other along the longitudinal direction of the sheath 11 so as to prevent contact between the probe insertion portion 31 and the sheath 11. The holding member 47 is made of a heat-resistant resin such as Teflon (registered trademark), and supports the endoscope 20 together with the probe insertion section 31.

The distal end of the rod 44 is bent in an L-shape, and the connecting portion 4 extends vertically downward.
8 are formed. The connecting portion 48 is connected to the sheath 11
Movable blade (grip) 40 rotatably attached to the tip of the blade
Are detachably connected.

As shown in FIG. 4, the movable blade 40 is provided with a tip portion 50 at the tip side of an elongated rod 40a extending in the axial direction.
have. The distal end portion 50 of the movable blade 40 is formed in a half-moon shape protruding downward, and has a radius of curvature that just fits and contacts the inner surface of the opening 35 a formed in the fixed blade 35 of the probe insertion portion 31. ing. This tip 50
Has an opening 50a so as not to obstruct the visual field of the endoscope 20.
Are formed. The base end side of the rod-shaped body 40a is substantially U-shaped.
The letter-shaped base end 51 is arranged along the lumen of the sheath 11, and is rotatably connected to the sheath 11 via a pin 52.

A hole 53 is formed at the base end 51 located above the pin 52, and the connecting portion 48 of the rod 44 is engaged with the hole 53.
Accordingly, when the movable handle 18 is rotated with respect to the fixed handle 17 to move the rod 44 forward and backward in the axial direction, the movable blade 40 rotates with respect to the sheath 11 around the pin 52,
An open position of the probe insertion portion 31 away from the fixed blade 35;
The fixed blade 35 is movable between a closed position where the fixed blade 35 contacts the opening 35a (see FIG. 6).

When assembling the ultrasonic probe 30 and the endoscope 20 to the sheath body 10 configured as described above, first, the insertion section 21 of the endoscope 20 is attached to the sheath body 10.
Is inserted into the inner hole of the sheath 11 from the opening 13 on the base end side. At this time, the insertion portion 21 is inserted into the sheath 11 so as to penetrate the seal member 46 in a watertight state and to penetrate the corresponding hole of the pressing member 47. When the two projections 27 provided on the connecting portion 23 of the endoscope 20 are engaged with the holes 15 formed on the operation portion 12, the insertion portion 21 of the endoscope 20 is sealed over its longitudinal direction. It is supported by the member 46 and the pressing member 47 and is disposed above the sheath 11, and its distal end is positioned near the distal end opening of the sheath 11 so that the distal end passes through the inside of the base end 51 of the movable blade 40 (FIG. 3 and FIG. 4).

As described above, the endoscope 20 is connected to the sheath body 1.
Then, the probe insertion portion 31 of the ultrasonic probe 30 is connected to the opening 13 on the base end side of the sheath body 10.
From the inner hole of the sheath 11. At this time, the probe insertion section 31 is inserted into the sheath 11 so as to penetrate the seal member 46 in a watertight state and to penetrate a corresponding hole of the pressing member 47. The flange portion 3 of the ultrasonic probe 30 is formed by the concave portion 24 on the endoscope 20 side.
2, the projection 36 provided on the flange 32
When the probe insertion portion 31 is engaged with the hole 16 formed in the operation portion 12 on the endoscope 20 side, the probe insertion portion 31 is inserted inside the sheath 11 while being supported by the seal member 46 and the pressing member 47 over the longitudinal direction. The fixed blade 35 is positioned below the insertion portion 21 of the endoscope 20 and is positioned so that the fixed blade 35 substantially fits inside the ring of the distal end portion 50 of the movable blade 40 (FIG. 3).
And FIG. 4). Thus, an openable and closable treatment unit 60 including the movable blade 40 and the fixed blade 35 of the probe insertion unit 31 is formed on the distal end side of the sheath 11.

In such an assembled state, observation by the endoscope 20 is possible through the inside of the ring of the movable blade 40, and even if liquid is sent to the sheath 11 through the perfusion mouth 14, the liquid is sealed by the sealing member 46. Prevents leakage to the hand side.

Then, the ultrasonic resectoscope 1 assembled as described with reference to FIGS. 2 and 3 is inserted into the urethra, and the treatment section 60 reaches (approaches) the site where the prostate is located. At the same time, water is continuously supplied from a water supply device (not shown) via the perfusion tube 14 a and the perfusion mouthpiece 14, and the visual field of the endoscope 20 is secured. The insertion of the ultrasonic resectoscope 1 into the urethra is performed with the treatment section 60 closed, that is, with the movable blade 40 positioned at the closed position. In the state where the movable blade 40 is located at the closed position,
The distal end portion 50 of the movable blade 40 is in contact with the inner surface of the opening 35a, and the endoscope 20 is further viewed forward from the opening of the distal end portion 50 and inserted into the urethra.

When the treatment section 60 is located near the prostate,
The movable handle 18 is rotated so as to open with respect to the fixed handle 17 (to separate from the fixed handle 17),
Pull the rod 44 toward the hand. Thereby, the movable blade 4
The distal end portion 50 of the probe insertion portion 31 is moved to an open position separated from the fixed blade 35 of the probe insertion portion 31. That is, the treatment section 60 is opened (the state of FIG. 4). In this state, ultrasonic vibration is generated by the ultrasonic vibrator 33 this time, and the ultrasonic probe 3
The 0 fixed blade 35 is inserted between the extraprostatic gland 71 and the enlarged prostatic gland 72, which is an adenoma, and peeled off. At this time, as shown in FIG. 5, the tissue of the intraprostatic gland 72 fits into the opening 35a of the probe fixing blade 35.

With the tissue sandwiched between the distal end portion 50 of the movable blade 40 and the fixed blade 35 of the probe 4, the movable handle 18 is closed with respect to the fixed handle 17 while generating ultrasonic vibration. Then, when the distal end portion 50 is moved to the closed position approaching the probe fixing blade 35, the proximal end side of the tissue fitted into the opening 35 a of the probe fixing blade 35 receives a pressing force from the distal end portion 50. The tissue is gradually removed by the frictional heat of the ultrasonic waves. Finally, the tissue is excised as a block-shaped mass as shown in FIG. Then, the tip 50 is opened.

At this time, water is supplied from a water supply device (not shown) to the lumen of the probe insertion portion 31 through the tube 37,
The excised tissue mass (excised piece) is moved to the bladder side and moved. If the cut piece remains attached to the probe fixed blade 35, after the cut is completed, ultrasonic vibration is generated again to blow off the cut piece. Incidentally, a suction device (not shown) may be connected to the tube 37, and the cavity of the probe insertion portion 31 may be suctioned by this suction device to discharge a tissue excision piece out of the body. In this case, a trap may be provided in the suction device in front of a built-in suction pump to collect the sucked tissue excision.

When the above operation is repeated and the intraprostatic gland 72 inside the extraprostatic gland 71 is completely resected, the resected pieces accumulated in the bladder are discharged.

As a result, in the ultrasonic resectoscope 1 of the present embodiment, the peeling operation can be performed in conjunction with the excision operation, so that the operation can be performed more smoothly and the operation time can be reduced. Further, since the opening 50a is provided at the distal end portion 50 of the movable blade 40, the observation can be reliably performed without obstructing the field of view of the endoscope 20.

In the ultrasonic resectoscope 1 of the present embodiment, the ultrasonic vibration from the ultrasonic vibrator 33 is transmitted to the fixed blade 35, but using a high-frequency power source (not shown). Alternatively, the high-frequency current from the high-frequency power supply may be configured to flow through the fixed blade 35 and the movable blade 40, respectively.

(Second Embodiment) FIG. 7 shows a second embodiment of the present invention.
It is explanatory drawing which shows the movable blade which concerns on embodiment. In the first embodiment, the fixed blade 35 of the probe insertion portion 31
End portion 5 of movable blade 40 formed in a half-moon shape having a radius of curvature that just fits and contacts the inner surface of opening 35a formed in
Although one “0” is provided, the second embodiment is configured to provide two tip portions 50 of the movable blade 40.

That is, the movable blade 80 of the second embodiment
Is provided with two front ends 81 having the same shape as the front end 50 of the movable blade 40 of the first embodiment on the front end side of an elongated rod 80a extending in the axial direction. With this structure, it is possible to cut the tissue in two. Other configurations are the same as those of the first embodiment.

As a result, the movable blade 40 of the first embodiment
Since the tissue can be excised more finely, it can be smoothly discharged out of the body through the urethra.

(Third Embodiment) FIG. 8 shows a third embodiment of the present invention.
It is explanatory drawing which shows the movable blade which concerns on embodiment. In the first and second embodiments, only the distal end of the movable blade having a semicircular distal end provided on the distal end side of the rod-shaped body is pressed against the concave portion of the fixed blade 35 to sandwich the tissue and cut off. The movable blade according to the third embodiment is configured so that the tissue is sandwiched and cut off by pressing the movable blade side surface against the ridge portion of the fixed blade 35 also. The other configuration is the same as that of the first embodiment, and the description is omitted, and the same configuration is denoted by the same reference numeral.

That is, the movable blade 90 of the third embodiment
Has a pair of connecting portions 92 extending in the axial direction on the proximal side from both ends of the distal end portion 91 provided on the distal end side of the elongated rod-shaped body 90a extending in the axial direction, and is integrally formed on the proximal side. ing. A projecting portion 93 extending in the axial direction is formed on a side surface of the connecting portion 91. When the movable blade 90 is closed, the protruding portion 93 comes into contact with the upper end surface 35 b of the fixed blade 35 of the probe insertion portion 31 extending in the axial direction.

This configuration is suitable for use in excision of mesentery and omentum, which are thin walls, and in excision of large organs such as liver and prostate at once. For example, with the movable blade 90 opened in the target thin wall,
The fixed blade 35 of the probe insertion section 31 is inserted with ultrasonic vibration.

When the movable blade 90 is closed, the outer peripheral surface of the protruding portion 93 and the distal end portion 91 of the movable blade 90 presses against the end surfaces of the upper end surface 35b and the opening 35a of the fixed blade 35. The tissue sandwiched between them is gradually cut into blocks by the frictional heat of the ultrasonic vibration.

As a result, a larger tissue can be excised at a time than the movable blade of the first and second embodiments, so that the operation can be performed smoothly and the operation time can be reduced.

(Fourth Embodiment) The purpose of the fourth embodiment is to provide an ultrasonic treatment tool that can easily remove and resect tissue.

FIGS. 9 and 10 relate to a fourth embodiment of the present invention. FIG. 9 is a sectional view showing an ultrasonic treatment device according to a fourth embodiment of the present invention. FIG. 4 is an explanatory diagram when a movable blade is protruded from a sheath.

As shown in FIG. 9, the ultrasonic treatment instrument 100
It has an elongated, axially extending hollow sheath 111 having a through-hole opening on the distal end side, and an operating section 112 on the proximal end side.
A hollow sheath body 110 provided with
10 through the sheath 111, and the sheath 111
An ultrasonic probe 120 having a probe insertion portion 122 projecting a distal end portion 121 from an opening 111a of the probe, a movable blade 130 rotatable with respect to the distal end portion 121 of the probe insertion portion 122, and the movable blade 130 It mainly comprises a movable blade assembly 140 which is rotatable with respect to the distal end portion 121 of the ultrasonic probe 120 and which moves forward and backward.

The operating section 112 of the sheath body 110 is
The outer sheath 113 of the sheath 111 is connected and fixed, and is formed in a substantially cylindrical shape extending toward the hand. The operation unit 11
A fixed handle 114 extending downward is provided on the distal end side of 2. The operation unit 112 has a lumen 115, and a slit 116 is formed on the upper surface and the proximal surface of the lumen 115.
And a slit 1 near the center of the lower surface.
17 are formed.

In the outer sheath 113, there is provided an inner sheath 141 having a semicircular cross section which is slidable and which constitutes the movable blade assembly 140. The operating portion 112 is provided on the hand side of the inner sheath 141. Is provided with a flange portion 142 slidable in the inner cavity 115.

A protruding portion 143 is provided above the flange portion 142 so as to protrude toward the hand, and a slide lever 144 protruding from the protruding portion 143 beyond the slit 116 is provided. A slit 145 is formed at the center of the protrusion 143. The upper portion of the flange portion 142 protrudes into the slit 116, a concave portion 146 is formed on the proximal side, and the distal end side is rounded.

On the distal end side of the inner sheath 141, the movable blade 130 is rotatably connected to the inner sheath 141 via a pin 130a. The shape of the movable blade 130 is substantially O-shaped, and is bent in the middle (see FIG. 10). The proximal end of the movable blade 130 is connected to a rod 147, and the proximal end of the rod 147 is connected to the movable handle 148 beyond the flange portion 142. The movable handle 148 has a pin 14 at the top.
8a, it is rotatably connected to the flange portion 142, that is, the inner sheath 141. Thus, by rotating the movable handle 148, the movable blade 13
0 opens and closes.

A coil-shaped spring 149, which is an elastic member, is inserted and disposed between the distal end surface 115a of the lumen 115 and the distal end surface 142a of the flange portion 142. The outer sheath 113 is urged toward the hand.

A holding member 151 is provided at the upper end of the operation section 112 on the tip side, and the operation section 1 is provided via a pin 151a.
12 is connected. The pin 151a is provided with a coiled spring 152 so as to urge the holding member 151 clockwise. On the proximal side of the holding member 151, a convex portion 153 projecting downward and toward the front end is formed.
The inner sheath 141 has a shape that can be engaged with a concave portion 146 formed in the flange portion 142 on the hand side.

Here, when the slide lever 144 is slid toward the distal end, the upper portion of the flange portion 142 pushes the convex portion 153 on the hand side of the holding member 151 upward, and the convex portion 153 is moved into the concave portion 146. And is fixed. At this time, the movable blade 130 moves to the distal end side with respect to the outer sheath 113 together with the inner sheath 141, and the movable blade 130
Protrudes from the tip of the outer sheath 113 and is fixed at the position indicated by the two-dot chain line in FIG. That is, as shown in FIG. 10, the movable blade 130 is fixed at the same position as the tip 121 of the probe, and by rotating the movable handle 148 in this state, the movable blade 130 can be opened and closed with respect to the tip 121 of the probe. Becomes

The probe insertion portion 122 of the ultrasonic probe 120 has a solid rod-like shape extending in the axial direction, and has a spatula-shaped tip portion 121 (FIG. 10).
), And the ultrasonic vibrator 123 is connected and fixed to the hand side. The ultrasonic transducer 123 is connected to the operation unit 112.
The probe insertion portion 122 is detachably inserted into and fixed to the proximal side of the lumen 115 of the movable handle 14.
8 through the opening 148a formed in the inner sheath 1
41 extend into a lumen 115. The tip 1
21 is fixed to a position protruding from the tip of the outer sheath 113.

The ultrasonic treatment device 100 thus configured
Is inserted into the urethra in the state shown in FIG. 9, reaches the target prostate, and then ultrasonically oscillates the ultrasonic probe 120, between the external gland of the prostate and the enlarged internal gland. Insert and peel extensively. Thereafter, the slide lever 144 is slid to the distal end side, and the movable blade 130 is protruded from the distal end side of the outer sheath 113 to be fixed in the state shown in FIG. Then, the movable blade 130 is opened and closed, and the tissue of the prostatic gland separated from the distal end portion 121 of the ultrasonic probe 120 is excised.

As a result, during the peeling operation, the outer sheath 11
3, the movable blade 130 is retracted into the movable blade 13.
0 can perform the peeling operation without hindering the operation, and the operation can be performed smoothly.

(Fifth Embodiment) FIG. 11 is a sectional view showing an ultrasonic treatment device according to a fifth embodiment of the present invention. In the fifth embodiment, a recognition means for recognizing the open / closed state of the movable blade is provided, and a control means for controlling the output of the ultrasonic wave according to the information from the recognition means is provided.

As shown in FIG. 11, the ultrasonic treatment device 200 according to the fifth embodiment has a thin and long hollow sheath 211 extending in the axial direction, and has a substantially U-shaped operation at the base end. Part 21
2 and a hollow sheath main body 210 provided with the sheath 2 and inserted into the sheath 211 of the sheath main body 210, and a distal end portion 221 protrudes from an opening of the sheath 211 to transmit ultrasonic vibrations from the ultrasonic vibrator 222. Ultrasonic probe 2
20, a movable blade 230 rotatable with respect to the distal end 221 of the ultrasonic probe 220, and a movable blade 230 capable of pivotally operating the movable blade 230 with respect to the distal end 221 of the ultrasonic probe 220. It mainly comprises the blade assembly 240.

The operating section 212 has a pair of holding members 213 and 214 extending vertically toward the hand side, and has a fixed handle 215 extending downward at the distal end side. Behind the fixed handle 215, there is a movable handle 216 for opening and closing the movable blade 230.

At the base end of the ultrasonic probe 220,
An ultrasonic vibrator 222 composed of two ultrasonic vibrators 222a and 222b is connected and fixed.

This ultrasonic vibrator 222 is
13 and the holding member 214, and is connected and fixed to the sheath 211. Further, the ultrasonic vibrator 2
22a is connected to a generator 223a for giving an output to the ultrasonic vibrator, and is connected to the ultrasonic vibrator 22a.
2b is connected to a generator 223b, and both generators 223a and 224b are
25.

The movable blade 230 is rotatably connected to the distal end side of the sheath 211 via a pin 230a. The movable blade 230 is located close to the movable blade assembly 2.
40 and the pin 230
a. The rod 241 is formed in a slender rod shape extending in the axial direction.
Is connected to the movable handle 216 via the. The movable handle 216 is rotatably connected to the holding member 213 via a pin 216a.

A leaf spring 242 is provided between the fixed handle 215 and the movable handle 216. Usually, the movable handle 216 is attached to the proximal end so that the movable handle 216 is opened with respect to the fixed handle 215. I'm going. At this time, the movable blade 230 is
20 is opened with respect to the tip 221 (open state). On the other hand, when the movable handle 216 is closed to the fixed handle 215 against the urging force of the leaf spring 242,
The movable blade 230 closes with respect to the tip 221 of the ultrasonic probe 220 (closed state).

The movable handle 216 is provided with a mounting leaf spring 251.
A protrusion 252 is provided on the lower end side of 1. On the other hand, a pressure sensor 253 as recognition means for recognizing the open / closed state of the movable blade 230 is provided at a portion of the fixed handle 215 facing the convex portion 252 of the mounting leaf spring 251, and the generators 223 a and 223 are connected via a cable 254.
b is electrically connected to a control device 255 for controlling b.

That is, when the foot switch 225 is depressed with the movable handle 216 opened with respect to the fixed handle 215, that is, with the movable blade 230 opened, the generator 223a is activated and the ultrasonic vibrator 222a is turned into tissue. A vibration suitable for peeling off is generated.

When the movable handle 216 is closed to the fixed handle 215 and the convex portion 252 presses the pressure sensor 253, information from the pressure sensor 253 is input to the control device 255 via the cable 254. When the generator 223b operates, the ultrasonic vibrator 2
22b generates vibrations suitable for ablating tissue.
Thereafter, the movable blade 230 is opened, that is, the movable handle 2
16 is opened, and the projection 252 of the mounting leaf spring 251 is opened.
Moves away from the pressure sensor 253,
3 is input to the controller 255, and the generator 223a operates.

After inserting the ultrasonic treatment device 200 having such a structure into the urethra and reaching the target part, the prostate,
In a state where the ultrasonic probe 220 is ultrasonically vibrated, the ultrasonic probe 220 is inserted between the external gland of the prostate and the enlarged internal gland to perform peeling.
At the time of peeling, the foot switch 225 is depressed while the movable blade 230 is open, the generator 223a is operated to vibrate the ultrasonic vibrator 222a, and the ultrasonic probe 220
Is inserted into the target site to perform peeling.

When exfoliating the prostatic gland tissue, the movable blade 230 is closed to the distal end 221 of the ultrasonic probe 220 while the ultrasonic wave is being output, and the movable blade 230 and the distal end are closed. 221 and the generator 223b to operate the ultrasonic transducer 222b.
Is vibrated to cut off the tissue sandwiched between the movable blade 230 and the tip 221.

As a result, the ultrasonic vibration is automatically switched between the vibration suitable for exfoliation and the vibration suitable for excision, so that the operation is simple, the stress of the operator can be reduced, and the operation time can be reduced. Can be shortened.

(Sixth Embodiment) FIGS. 12 and 13 relate to a sixth embodiment of the present invention, and FIG. 12 shows an ultrasonic treatment device according to a sixth embodiment of the present invention. Sectional view,
FIG. 13 is an explanatory view for explaining the operation of the ultrasonic treatment device of FIG. 12, and FIG. 13 (a) is a cross-sectional view when the probe distal end and the opening / closing member protrude from the opening of the sheath distal end.
FIG. 3B is a cross-sectional view when the probe tip and the opening / closing member are housed in a sheath. In the sixth embodiment, a vibration transmitting means for transmitting ultrasonic vibration from the ultrasonic transducer to the sheath is provided, and the vibration between the sheath and the living tissue is caused by the ultrasonic vibration of the sheath. The ultrasonic treatment device is configured to reduce the noise.

As shown in FIG. 12, an ultrasonic treatment device 300 according to the sixth embodiment is connected to a thin and long hollow sheath 301 extending in the axial direction by supporting the proximal end side of the sheath 301. A substantially cylindrical vibration transmission cover member 302 to be fixed;
The ultrasonic probe main body 303 is inserted into the sheath 301 and protrudes from the opening of the sheath 301 at the distal end.

The ultrasonic probe main body 303 has an elongated hollow pipe shape, a probe 304 having a cup portion 304 a having a distal end portion cut off from an upper half and closed substantially in a shell shape, and a base end side of the probe 304. And an operation unit 305 provided in the printer. An insulating coating such as Teflon is applied to the portion other than the upper surface of the cup portion 304a of the probe 304.

An ultrasonic vibrator 306 for generating ultrasonic vibration and a horn 307 for amplifying the ultrasonic vibration generated by the ultrasonic vibrator 306 are provided on the hand side of the probe 304. A cable 308 extends from a base end of the ultrasonic vibrator 306, and the cable 308 is connected to a driving device (not shown) that generates a driving signal. When the driving device is driven, the ultrasonic vibrator 306 receives a driving signal from the driving device and generates ultrasonic vibration.
The ultrasonic vibration generated by the ultrasonic vibrator 306 is amplified by the horn 307 and transmitted to the probe 304, so that the cup 304a at the tip of the probe vibrates ultrasonically.

In the vicinity of the cup 304a of the probe 304, there is provided a cup-shaped opening / closing member 309 which is rotatably opened and closed with respect to the cup 304a, and a pin is provided near the rear end of the cup 304a. 309a pivotally attaches to the probe 304. This opening / closing member 30
The portion other than the portion that contacts the cup portion 304a of No. 9 is coated with an insulating coating such as Teflon. The opening / closing member 30
9 is connected to the rod 311 via a pin 309b. The rod 311 extends to the hand side through the lumen of the probe 304 and is connected to the upper part of the movable handle 312 via a pin 311a. The movable handle 312 is connected to the operation unit 305 of the ultrasonic probe main body 303 via a pin 312a, and is provided on the fixed handle 313 so as to be openable and closable. Thus, when a finger is hung on the finger hooks 314 of the movable handle 312 and the fixed handle 313, and the movable handle 312 is closed in the direction of the fixed handle 313, the rod 311 moves toward the hand side and the opening / closing member 309 is moved to the cup portion. 30
It moves to the closed position where it meshes with the upper surface of 4a. Conversely, when the movable handle 312 is opened in the direction of the fixed handle 313, the opening / closing member 309 moves to an open position apart from the cup portion 304a (see FIG. 13).

The outer surfaces of the movable handle 312 and the fixed handle 313 are coated with an insulating coating such as Teflon, and a cable 315 connected to an electric knife power supply (not shown) extends below the finger hook 314. Is out. Accordingly, when the air knife power supply is driven, a high-frequency current is supplied to the distal end cup 304a and the opening / closing member 309, and a bipolar current is supplied between the distal end cup 304a and the opening / closing member 309 so that incision and hemostasis can be performed. It has become.

A substantially cylindrical cover member 316 is connected to and fixed to the ultrasonic vibrator 306 so as to cover the ultrasonic vibrator 306 and the horn 307. The dimensional relationship is such that it can be inserted exactly into the member 302.

A groove 317 extending in the axial direction is formed on the upper surface of the cover member 316. On the other hand, a screw hole penetrating to the inner cavity is formed in the proximal flange portion 320 of the vibration transmission cover member 302 so that the fixing screw 321 can be detachably attached. When the fixing screw 321 is attached to the screw hole and tightened, the tip of the fixing screw 321 is inserted into the groove 317 of the cover member 316.
At a predetermined position. Thus, the probe 304 and the sheath 301 can be fixed in a desired positional relationship.

As described above, the sheath 301 is formed in a hollow shape, and the distal end opening of the sheath 301 is cut substantially diagonally to form a protruding portion 301a whose lower end protrudes in the distal direction. The sheath 301 is provided with a plurality of pressing members 322 (2 in the figure) as a vibration transmitting unit for transmitting the ultrasonic vibration from the ultrasonic vibrator 306.
) Can be extrapolated to the probe 304.

The holding member 322 is connected to the sheath 30
1 are arranged in the lumen of the sheath 301 at a predetermined interval from each other along the longitudinal direction, and support the probe 304 to prevent contact with the sheath 301. The holding member 322 is formed of a heat-resistant resin such as Teflon.

As shown in FIG. 13A, the pressing member 322 is moved from the opening of the sheath 301 to the probe 30.
The probe 4 is set to support the probe 304 at a node position of the ultrasonic vibration transmitted from the ultrasonic vibrator 306 in a state in which the probe 4 projects. At this time, the probe 3
04 is not transmitted to the sheath 301 even if it is ultrasonically vibrated.

On the other hand, as shown in FIG. 13B, the distal end cup portion 3 of the probe 304 is
When the probe 304a is retracted (retracted), the pressing member 322 moves the probe 304 at the antinode position of the ultrasonic vibration.
It is set to support. When the probe 304 is ultrasonically vibrated in this state, the pressing member 32
2, the sheath 301 is ultrasonically vibrated. At this time, the ultrasonic vibration of the sheath 301 has a lower output than the ultrasonic vibration of the probe 304.

The ultrasonic treatment device 300 having such a configuration is inserted into a luminal organ of a living body, for example, the urethra, and after reaching the target site, the prostate, is subjected to ultrasonic treatment. First, as shown in FIG. 13B, the distal end cup portion 304a of the probe 304 is drawn into the sheath 301 and stored therein.
The driving device is turned on with the pressing member 322 at the antinode position of the vibration, and the ultrasonic vibration from the ultrasonic vibrator 306 is applied to the probe 304. The ultrasonic vibration from the ultrasonic transducer 306 is transmitted to the sheath 301 via the pressing member 322 as described above, and causes the sheath 301 to ultrasonically vibrate. In this state, it is inserted into a luminal organ of a living body, for example, a urethra. Then, the protruding portion 301a of the sheath 301 is pressed against a living tissue, for example, between the inner gland and the outer gland of the prostate, and the like.
The inner and outer glands are separated by ultrasonic vibration.

Thereafter, the fixing screw 321 is loosened, the tip cup 304a of the probe 304 is projected from the projection 301a of the sheath 301, and the cover member 316 is moved so that the holding member 322 is positioned at the node of the ultrasonic vibration. Move to the tip side. Then, the cover member 316 and the vibration transmitting cover member 302 are fixed by tightening the fixing screw 321.

Next, the movable handle 312 is opened by putting a finger on the finger holding portion 314, and the opening / closing member 309 is attached to the cup portion 304.
In a state in which it is opened with respect to a, the detached living tissue is sandwiched. In this state, the movable handle 312 is closed and the opening / closing member 309 is closed with respect to the cup portion 304a while ultrasonically oscillating the probe 304, and the sandwiched living tissue is pressed and cut by frictional heat. Alternatively, when it is predicted that there is much bleeding, instead of cutting by ultrasonic vibration, a high-frequency current is output from an electric scalpel power supply to cut off electrically between the opening / closing member 309 and the cup 304a. Is also good.

As a result, the present embodiment has the following effects. When low-power ultrasonic vibration is applied to the sheath, the friction between the sheath and the living tissue is reduced, so that the sheath can be inserted very easily. Since exfoliation and incision coagulation can be performed with one treatment tool, there is no need to replace the treatment tool, and the operation is simplified and the operation time can be reduced. Since peeling and incision coagulation can be performed with one ultrasonic vibrator, it is not necessary to additionally provide an ultrasonic vibrator, and the ultrasonic vibrator can be manufactured at a lower cost. By slightly sliding the fixed position of the sheath and the probe, the vibration state of the sheath can be delicately changed, so that the operator can use the device more easily without changing the output setting of the driving device.

The present invention is not limited to the above-described embodiment, but can be variously modified without departing from the gist of the invention.

[Supplementary Note] (Supplementary Note 1) A semi-cylindrical shape which is connected to an ultrasonic vibrator disposed on the base end side and has a concave portion formed by cutting out the distal end side of an ultrasonic vibrating member extending to the distal end side. A fixed blade, a movable blade having a shape adapted to the concave portion on the distal end side of the fixed blade, rotatably supporting the base end or the vicinity thereof near the fixed blade, and a movable blade. An opening and closing means for opening and closing the fixed blade so as to be rotatable.

(Additional Item 2) The ultrasonic reject scope according to Additional Item 1, wherein a high-frequency current can be supplied to each of the fixed blade and the movable blade.

(Additional Item 3) An ultrasonic vibration member connected to an ultrasonic vibrator disposed on the base end side and extending to the distal end side, and rotatably with respect to a distal end portion of the ultrasonic vibration member. An opening / closing member that opens and closes, wherein the opening / closing member is relatively movable in the axial direction of the ultrasonic vibration member.

(Additional Item 4) The ultrasonic treatment instrument according to additional item 3, wherein the opening / closing member is located in a direction of the ultrasonic vibration member.

(Additional Item 5) The ultrasonic treatment instrument according to additional item 3, wherein the opening / closing member is located near the ultrasonic vibration member.

(Additional Item 6) An ultrasonic vibrating member connected to the ultrasonic vibrator disposed on the base end side and extending on the distal end side, and rotatable with respect to the distal end portion of the ultrasonic vibrating member. An opening and closing member for opening and closing, opening and closing operation means for opening and closing the opening and closing member rotatably, recognition means for recognizing the open / close state of the opening and closing member by the opening and closing operation means, and An ultrasonic treatment instrument comprising: a control unit that controls an ultrasonic vibrator.

(Additional Item 7) The ultrasonic treatment instrument according to additional item 6, wherein the opening / closing member is positioned to measure the ultrasonic vibration member.

(Additional Item 8) The ultrasonic treatment instrument according to additional item 6, wherein the opening / closing member is located near the ultrasonic vibration member.

(Additional Item 9) The ultrasonic treatment instrument according to additional item 6, wherein the opening / closing member is relatively movable in the axial direction of the ultrasonic vibration member.

(Supplementary item 10) An ultrasonic vibration member connected to the ultrasonic vibrator disposed on the base end side and extending on the distal end side,
An opening / closing member that is disposed near the distal end of the ultrasonic vibration member and that opens and closes rotatably with respect to the distal end, an outer sheath through which the ultrasonic vibration transmitting member can be inserted, and an ultrasonic vibration transmitting member. And a vibration transmitting means for transmitting vibration to the outer sheath and ultrasonically vibrating the outer sheath.

(Additional Item 11) The ultrasonic treatment instrument according to additional item 10, wherein a high-frequency current can be supplied to each of the ultrasonic transmission member and the opening / closing member.

(Additional Item 12) The ultrasonic treatment instrument according to additional item 10, wherein the ultrasonic transmission member and the opening / closing member are relatively movable in the axial direction of the outer sheath.

(Additional Item 13) A holding member which has a predetermined interval along the axial direction of the outer sheath and which is disposed in the inner cavity of the outer sheath and supports the ultrasonic transmission member is provided. The ultrasonic treatment device according to additional item 10, wherein

(Additional Item 14) When the distal end portion of the ultrasonic transmission member is projected from the opening of the outer sheath, the pressing member supports the ultrasonic transmission member at a node position of the ultrasonic vibration. Additional item 1 characterized by being set to
4. The ultrasonic treatment device according to 3.

(Additional Item 15) The holding member supports the ultrasonic transmission member at the antinode position of the ultrasonic vibration when the distal end portion of the ultrasonic transmission member is housed in the lumen of the outer sheath. Item 13 characterized by being set as follows.
8. The ultrasonic treatment device according to item 1.

(Supplementary Note 16) When the distal end portion of the ultrasonic transmission member is housed in the inner cavity of the outer sheath, the outer sheath transmits the vibration from the ultrasonic transducer via the vibration transmission means. 14. The ultrasonic treatment device according to additional item 13, wherein the ultrasonic treatment tool is transmitted by vibration and ultrasonically vibrates.

[0102]

As described above, according to the present invention, an ultrasonic resectoscope that exfoliates and resects tissue between the internal gland and the external gland of the prostate in a shorter time can be realized.

[Brief description of the drawings]

FIG. 1 is an external view showing an ultrasonic resectoscope according to a first embodiment of the present invention.

FIG. 2 is an external view showing each part of the ultrasonic resectoscope of FIG. 1;

FIG. 3 is a sectional view of the ultrasonic resectoscope of FIG. 1;

FIG. 4 is an explanatory view showing a connection portion of a movable blade.

FIG. 5 and FIG. 6 are explanatory views for explaining the operation of the first embodiment of the present invention, and FIG. 5 is an explanatory view when a tissue is detached.

FIG. 6 is an explanatory view when the tissue separated in FIG. 5 is excised.

FIG. 7 is an explanatory view showing a movable blade according to a second embodiment of the present invention.

FIG. 8 is an explanatory view showing a movable blade according to a third embodiment of the present invention.

FIG. 9 is a sectional view showing an ultrasonic treatment device according to a fourth embodiment of the present invention.

FIG. 10 is an explanatory view when the movable blade of FIG. 9 is projected from the sheath.

FIG. 11 is a sectional view showing an ultrasonic treatment device according to a fifth embodiment of the present invention.

FIG. 12 is a sectional view showing an ultrasonic treatment device according to a sixth embodiment of the present invention.

13A and 13B are explanatory diagrams illustrating the operation of the ultrasonic treatment device in FIG. 12, and FIG. 13A is a cross-sectional view when a probe distal end and an opening / closing member protrude from an opening in a sheath distal end; (B) is a cross-sectional view when the probe tip and the opening / closing member are housed in a sheath.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Ultrasonic reject scope 10 ... Sheath main body 11 ... Sheath 12 ... Operating part 17 ... Fixed handle 18 ... Movable handle 19 ... Ring 20 ... Endoscope 30 ... Ultrasonic probe 31 ... Probe insertion part 32 ... Operating part 33 ... Ultrasonic vibrator 35 ... fixed blade 40 ... movable blade 44 ... rod 48 ... connecting part 50 ... tip part 60 ... treatment part

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Ryoichi Ono 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Eiji Murakami 2-43-2 Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (72) Hideto Yoshimine, Inventor 2-43-2, Hatagaya, Shibuya-ku, Tokyo No. 2 Olympus Optical Co., Ltd., (72) Takeaki Nakamura, 2-chome Hatagaya, Shibuya-ku, Tokyo No. 43-2 F-term in Olympus Optical Co., Ltd. (reference) 4C060 GG23 JJ13 MM24 MM26

Claims (1)

[Claims] A semi-cylindrical fixed blade connected to an ultrasonic vibrator disposed on a base end side and having a concave portion formed by cutting out a distal end side of an ultrasonic vibrating member extending on a distal end side; A movable blade having a shape adapted to the concave portion on the distal end side of the fixed blade and rotatably supporting the base end or the vicinity thereof near the fixed blade; and An ultrasonic resectoscope comprising: opening and closing means for opening and closing rotatably.