JP2002177287A - Ultrasonic treatment device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an ultrasonic treatment device capable of selecting an optimum current-carrying state to make an effective treatment for the biotissue. SOLUTION: A change-over switch 64 is used to select the optimum current- carrying state between a first current-carrying state for applying a high-frequency current between an external electrode P and a forward chip 9, and a second current-carrying state for applying a high-frequency current between the external electrode P and a receiving part 11a of a receiving member 11, thereby making an effective treatment for the biotissue.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic treatment apparatus which is used in a body cavity operation such as cholecystectomy using a laparoscope, and joins and anastomoses a blood vessel or a living tissue.

[0002]

2. Description of the Related Art Conventionally, in such a surgical procedure, a clip device or an anastomosis device using a small clip or staple has been used. For example, U.S. Patent No. 46166
As shown in No. 50 or No. 4,624,254, a clip applicator is known in which a plurality of metal clips are built in, and a tube sandwiched at the tip of the clip applicator is clipped by a single operation.

[0003] In these clipping devices or anastomosis devices, there is a problem that clips or staples made of metal or resin remain in a living body. Therefore, as shown in U.S. Pat. No. 3,889,992, a tissue joining device has been developed in which a living tissue is joined using ultrasonic vibration to perform anastomosis of blood vessels and the like without using clips or staples. ing.

[0004] In this tissue joining apparatus using ultrasonic vibration, a clamping means for clamping a living tissue is provided at the distal end of an insertion portion to be inserted into the body. The holding means is constituted by a tip provided at a tip end of a vibration transmitting member for transmitting ultrasonic vibrations from an ultrasonic vibrator for generating ultrasonic vibrations, and a receiving member disposed at a distance from and facing the tip end. Is formed.

When the living tissue is joined, the living tissue to be treated is sandwiched between the distal end tip of the holding means and the receiving member, and ultrasonic vibration is applied while applying pressure to the tissue to be treated between the holding means. The living tissue held by the holding means is joined by emulsification by ultrasonic waves and heat denaturation. In this case, new living tissue is generated at the joint after the treatment, and the new living tissue is joined.

[0006]

In the above-mentioned construction, when a relatively thick blood vessel or the like is present in the tissue to be treated during the joining operation of the living tissue using ultrasonic vibration, the living tissue is Bleeding may occur at the interface between the joined and non-joined portions of the nose.

In this case, it is possible to stop bleeding at the site of bleeding even by joining the living tissues using ultrasonic vibration.
The thermal denaturation of the living tissue that occurs during the joining operation of the living tissue using ultrasonic vibration is relatively small. It may become a thing. Therefore, in such a case, it is necessary to perform a hemostatic operation on the bleeding site using a special hemostatic device separate from the tissue joining device using ultrasonic vibration, which makes the operation troublesome. There is.

The present invention has been made in view of the above circumstances, and an object thereof is to provide an ultrasonic treatment apparatus capable of selecting an appropriate energization state and performing an effective treatment on a living tissue. is there.

[0009]

According to a first aspect of the present invention, there is provided an ultrasonic treatment apparatus which is inserted into a body and performs treatment on a living tissue, an ultrasonic transducer for generating ultrasonic vibration, and the ultrasonic transducer. A probe that transmits the ultrasonic vibration, a sheath that covers the probe, and a holding member that is provided on the sheath so as to be able to hold a living tissue between the probe and a distal end of the probe, and generates a high-frequency current. A high-frequency power supply, and high-frequency power supplied from the high-frequency power supply, an external electrode that can be attached to a body, and high-frequency power supplied from the high-frequency power supply, the external electrode and the probe being usable as a pair of electrodes. A first electrode provided at the tip end, and a second electrode provided on the holding member, to which high-frequency power is supplied from the high-frequency power source and which can be used as a pair of electrodes with the external electrode. When, the flow of the first energized state to flow a high frequency current between the external electrode and the first electrode, a high-frequency current between the second electrode and the outer electrode 2
And a switch for switching between an energized state and an ultrasonic treatment state. According to the first aspect of the present invention, an appropriate energized state is selected from the first energized state and the second energized state by using a switch, and an effective treatment is performed on the living tissue. Things.

According to a second aspect of the present invention, there is provided an ultrasonic treatment apparatus which is inserted into a body and performs treatment on a living tissue, wherein the ultrasonic vibrator for generating ultrasonic vibration and the ultrasonic vibrator are connected to the ultrasonic vibrator. A probe that transmits acoustic vibration, a sheath that covers the probe, a holding member provided on the sheath so as to be able to hold a living tissue between the distal end of the probe, a high-frequency power supply that generates a high-frequency current, and the probe A first electrode provided at a tip end of which is supplied with high-frequency power from the high-frequency power supply, and high-frequency power is supplied from the high-frequency power supply, and can be used as the first electrode and a pair of electrodes;
A second electrode provided on the holding member, an external electrode to be supplied as high-frequency power from the high-frequency power supply, and usable as the first electrode and a pair of electrodes, for attaching to a body, A switch that switches between a first energized state in which a high-frequency current flows between the electrode and the second electrode and a second energized state in which a high-frequency current flows between the first electrode and the external electrode; An ultrasonic treatment apparatus characterized by comprising: According to the second aspect of the present invention, an appropriate energized state is selected from the first energized state and the second energized state by using a switch, and an effective treatment is performed on the living tissue. Things.

[0011]

FIG. 1 shows a schematic configuration of an entire ultrasonic treatment apparatus. In FIG. 1, reference numeral 1 denotes a main body of the ultrasonic treatment apparatus. The ultrasonic treatment apparatus main body 1 is provided with an insertion portion 2 to be inserted into the body and a hand-side operation portion 3 connected to a base end of the insertion portion 2.

The operation unit 3 is provided with a grip unit 4 and a trigger unit 5. Here, for example, the grip portion 4 is protrudingly provided on an ultrasonic vibrator case 7 having a horn at an end thereof and containing an ultrasonic vibrator 6 such as a bolted Langevin type.

Further, a base end of a vibration transmitting member 8 is connected to a front end of the horn of the ultrasonic vibrator 6. A screw hole is formed at the distal end of the vibration transmitting member 8, and a distal tip 9 having an arbitrary cross-sectional shape and a working surface shape at the distal end is screwed into the screw hole. The length of the vibration transmitting member 8 is set so that the amplitude of the ultrasonic vibration becomes maximum (antinode of vibration) on the working surface of the distal end of the distal tip 9.

The insertion section 2 is provided with a tubular sheath 10 through which the vibration transmitting member 8 is inserted. This sheath 1
A substantially L-shaped receiving member 11 is connected to the leading end of the “0”. The receiving portion 11a is connected to the distal end of the receiving member 11 so as to be spaced apart and opposed to the working surface of the distal end of the distal tip 9 in parallel. An insulating sheath 12 made of an insulating material is mounted on the inner peripheral surface of the sheath 10, and the insulating sheath 12 electrically insulates the vibration transmitting member 8 from the sheath 10.

Furthermore, a case 7 is provided at the base end of the sheath 10.
A slide member 13 slidably mounted along the axial direction of the insertion section 2 is connected and fixed to the insertion section 2. The slide member 13 has a trigger portion 5 protruding therefrom. The receiving portion 11a of the receiving member 11 is connected via the sheath 10 with the contact / separation operation between the grip portion 4 and the trigger portion 5.
Are moved back and forth with respect to the distal tip 9 along the axial direction of the insertion portion 2, and the living body tissue is clamped by the receiving portion 11 a of the receiving member 11 and the distal tip 9. A portion (holding means) 14 is formed.

The ultrasonic treatment apparatus main body 1 is connected to an external control unit 15. This control unit 15
Has a built-in ultrasonic vibrator drive circuit 16 and a high-frequency power supply 17.

Here, the ultrasonic transducer driving circuit 16 is connected to the ultrasonic transducer 6. Further, a drive signal generation circuit (not shown) is connected to the ultrasonic transducer drive circuit 16, and an operation switch (not shown) is connected to the drive signal generation circuit. The drive signal generation circuit is driven in accordance with the operation of the operation switch, and the drive signal output from the drive signal generation circuit is amplified by the ultrasonic vibrator drive circuit 16, and the amplified drive signal The ultrasonic vibrator 6 is driven.

Further, the vibration transmitting member 8 of the ultrasonic treatment apparatus main body 1 is connected to one terminal of the high frequency power supply 17 via a lead wire, and the sheath 10 is connected to the other terminal of the high frequency power supply 17 by a lead. Connected via wires.

Next, the operation of the above configuration will be described.
First, for example, a blood vessel,
When performing a treatment such as joining between tissues, the holding portion 13 at the distal end of the insertion portion 2 is brought close to the tissue to be treated. In this state, the trigger part 5 of the operation part 3 on the hand side is pulled, and the slide member 13 is slid toward the grip part 4 side of the case 7 by operating the trigger part 5. Thereby, the receiving member 1
Since the receiving portion 11a is drawn toward the working surface of the distal tip 9, the tissue to be treated is sandwiched between the distal tip 9 and the receiving portion 11a of the receiving member 11 with the operation of the receiving portion 11a.

Subsequently, the ultrasonic vibrator 6 is driven. When the ultrasonic vibrator 6 is driven, a signal from the drive signal generating circuit is amplified by the ultrasonic vibrator driving circuit 16, and the ultrasonic vibrator 6 is driven by the amplified drive signal. Further, the vibration transmitting member 8 is ultrasonically oscillated by the ultrasonic vibration excited by the ultrasonic vibrator 6, and the ultrasonic vibration excited by the ultrasonic vibrator 6 is transmitted through the vibration transmitting member 8 to the tip end. The tip 9 is ultrasonically vibrated.

During the ultrasonic oscillation, the living tissue is held by the ultrasonic vibration by maintaining the state where the treatment target tissue between the receiving member 11 and the distal end tip 9 is sandwiched by an appropriate pressing pressure for an appropriate time. Is emulsified, and further denatured by heat generated by the ultrasonic vibration and joined. The heat that causes this tissue degeneration is caused by ultrasonic vibration, so that protein denaturation occurs to the deep part of the tissue.
The anastomosis is completed.

Further, when bleeding occurs during joining of the living tissue, the bleeding site is sandwiched between the distal end tip 9 and the receiving portion 11a of the receiving member 11, and an appropriate high-frequency current is applied while pressing to perform the hemostatic treatment. Do. At this time, the tip 9
The living tissue may be pressed between the receiving member 11 and the receiving portion 11a of the receiving member 11, and hemostasis may be performed by a combination of coagulation and protein denaturation by high-frequency current and emulsification and protein denaturation by ultrasonic vibration.

The working surface shape of the distal tip 9 is such that when the living tissue is sandwiched between the distal tip 9 and the receiving portion 11a of the receiving member 11 and the ultrasonic vibration is applied, the tissue sandwiched by the ultrasonic vibration is removed. The distal tip 9 and the receiving portion 11a of the receiving member 11 have an arbitrary shape that does not deviate from the working surface of the distal tip 9 or an arbitrary shape that causes sufficient protein denaturation even in the deep part of the living tissue. The tissue at the site sandwiched between the two does not slide out of the working surface of the distal end tip 9, and the protein is sufficiently denatured to a deep portion, so that reliable and sufficient bonding is performed.

After the joining of the living tissues has been completed, the slide member 13 is slid in a direction away from the case 7 so that the treated living tissue is moved between the working surface of the distal end tip 9 and the receiving portion 11a of the receiving member 11. By removing from the space, the joining treatment of the living tissue is completed.

Therefore, in the above structure, the living body held between the receiving portion 11a of the receiving member 11 of the holding portion 14 and the distal end tip 9 during the joining operation of the living tissue using ultrasonic vibration. When the bleeding site of the tissue is to be stopped, the bleeding site is sandwiched between the distal end tip 9 and the receiving portion 11a of the receiving member 11, and an appropriate high-frequency current is applied while pressing to heat the bleeding site. Is stopped, so that the hemostatic treatment at the joint site can be easily performed. Therefore, it is not necessary to use a special hemostatic device different from the ultrasonic treatment apparatus main body 1 to perform the hemostatic work on the bleeding site as in the related art, so that the efficiency of the hemostatic work can be improved.

In addition, since living tissues can be joined and ligated or anastomosed without using clips or staples made of metal or resin, foreign matter does not remain in the body after the treatment. Furthermore, since the ligation and anastomosis are completed in the form of adhesion between tissues at the same time as the completion of the joining procedure of the living tissue, there is a change over time until the completion of the adhesion of the living tissue as in the case of a conventional clip device or anastomosis device. Ligature failure,
It does not cause anastomosis failure.

Further, since it is possible to immediately confirm whether or not the adhesion between the tissues after the treatment is complete, even if the adhesion is incomplete, the treatment can be immediately repeated until the adhesion is completed.

FIG. 3 shows a main configuration of an ultrasonic treatment apparatus having a configuration different from that of the ultrasonic treatment apparatus of FIG. This is provided with a pressure or stress detecting means 21 such as a strain gauge, for example, on the outer surface side of the receiving portion 11a of the receiving member 11 facing the tip 9.

The pressure / stress detecting means 21 includes, for example,
One end of a bias / output cable 22 formed of a flexible substrate or the like is connected. This bias / output cable 22 is arranged along the axial direction of the sheath 10 and is fixed to the outer peripheral surface of the sheath 10. Further, the other end of the cable 22 is connected to, for example, the external control unit 15.
Is connected to a pressure / stress detection circuit (not shown).

A high-frequency power supply 17, an ultrasonic vibrator driving circuit 16, a pressure / stress detecting circuit, and a driving time control circuit (for ultrasonic and high frequency) (not shown)
It is connected to a control unit such as U and configured to be controlled by this control unit.

Therefore, even with the above configuration, the living tissue is joined by ultrasonic vibration as in the ultrasonic treatment apparatus of FIG. 1, and the distal tip 9 and the receiving member 11 are joined together.
Between the receiving portion 11a and the bleeding site, ultrasonic vibration while compressing, or hemostasis by single action of any one of the high-frequency current, or hemostasis combined ultrasonic vibration and high-frequency current Action is taken.

In this case, the pressure applied to the sandwiched living tissue is measured by the pressure / stress detecting means 21 in each treatment. Further, the drive time control circuit sets the time for applying ultrasonic vibration or high-frequency current to an appropriate state, and performs various treatments such as joining and hemostasis.

At this time, the safety parameters of the treatment, for example, the conditions such as not perforating and preventing unnecessary protein denaturation, are affected by the action parameters relating to the joining and hemostasis of the living tissue. FIG. 4 shows a safety treatment area R at the time of joining and hemostatic work of a living tissue. Where Pmax
Is the upper limit of the compression pressure P of the living tissue, Hi max is the upper limit of the high-frequency current Hi, and Ua max is the upper limit of the ultrasonic amplitude Ua.

Then, the control unit determines whether or not each parameter is included in the safety treatment area R of FIG. 4, and if any of the parameters exceeds the upper limit value, the operator is notified of a warning. . Since the application time of the high-frequency current Hi, the ultrasonic amplitude Ua, and the compression pressure P of the living tissue is proportional to the degree of the joining / hemostatic action, the safety treatment region R is converted by the control unit for each drive time. Is used.

Therefore, when performing the joining / hemostatic treatment of the living tissue by combining various energies and changing the application time, even if the magnitude of each energy and the application time are independently set, the safety treatment is performed. There is an effect that the optimum treatment can be performed safely and reliably in the region R.

FIG. 5 (A) shows a main configuration of an ultrasonic treatment apparatus having still another configuration. This is provided with, for example, a buffer member 31 formed of a conductive elastic body or a conductive viscoelastic body on the inner surface of the receiving portion 11a of the receiving member 11.

Therefore, in the above configuration, when ultrasonic vibration is applied to the living tissue sandwiched between the buffer member 31 and the distal end tip 9, mechanical action is applied to the living tissue by the action of the buffer member 31. It is possible to prevent the occurrence of a temporary stress (for example, a cutting force). Therefore, when performing joining by ultrasonic vibration, it is possible to prevent the living tissue from being cut at the edge of the distal end tip 9 or the like, so that the joining procedure can be performed safely.

FIG. 5B shows a first modification of the ultrasonic treatment apparatus shown in FIG. 5A. This is one in which a convex curved surface 42 having a gentle spherical curvature is formed on the working surface of the buffer member 41 on the inner surface of the receiving portion 11a of the receiving member 11 which is a contact surface with the living tissue.

Therefore, in the above configuration, when the living tissue is clamped between the distal tip 9 and the receiving portion 11a of the receiving member 11, the apex of the convex curved surface 42 of the buffer member 41 and the tip of the distal tip 9 Since the greatest pressing force can act between the central portion and the central portion, it is possible to prevent a large pressing force from acting on the joining portion between the edge portion of the distal end tip 9 and the living tissue, and the living tissue can be moved to the distal end. The chip 9 can be prevented from being cut by contact with the edge portion.

FIG. 5C shows a second modification of the ultrasonic treatment apparatus shown in FIG. 5A. This means that a tapered surface 51a is formed on the outer surface of the buffer member 51 on the inner surface of the receiving portion 11a of the receiving member 11, and a tapered surface 9a having a shape corresponding to the tapered surface 51a of the buffer member 51 is formed on the distal end surface of the tip 9. It is formed.

Therefore, in the above configuration, when the living tissue is clamped between the distal end tip 9 and the receiving portion 11a of the receiving member 11, the tapered surface 51a of the buffer member 51 and the tapered surface of the distal end It is possible to prevent a tissue (for example, a tubular tissue) sandwiched between the first and second members 9a from sliding out due to ultrasonic vibration. Therefore, even in a living tissue having a smooth surface, the distal end tip 9 and the receiving portion 11a of the receiving member 11 are formed.
Can be stably sandwiched and fixed, and can be joined by ultrasonic vibration.

FIG. 5D shows a third modification of the ultrasonic treatment apparatus shown in FIG. 5A. This is the second
In this modification, a protrusion 52 is provided at the outer end of the tapered surface 51a of the cushioning member 51.

Therefore, in the above structure, when the living tissue is clamped between the distal end tip 9 and the receiving portion 11a of the receiving member 11, the tapered surface 51a of the buffer member 51 and the tapered surface of the distal end 9a can be prevented from slipping out of the tissue (for example, a tubular tissue) sandwiched by the ultrasonic vibration, and the effect of preventing the living tissue from slipping out can be further improved by the slip-out preventing projection 52 of the cushioning member 51. Can be enhanced.

FIG. 6 shows a schematic configuration of the entire ultrasonic treatment apparatus according to the first embodiment of the present invention. This means that an external electrode P is provided outside the ultrasonic treatment apparatus main body 1, a high-frequency current is supplied between the tip (first electrode) 9 and the external electrode P, and a high-frequency current is supplied. A changeover switch 64 is provided to switch between a receiving portion (second electrode) 11a of the receiving member 11 and a second energized state flowing between the external electrodes P.

In this case, the output of the high frequency power supply 17 is connected to the primary side of the insulating transformer 62 via the amplifier 61. One terminal on the secondary side of the insulating transformer 62 is connected to the external electrode P via a first coupling capacitor 63a.
It is connected to the. Further, the other terminal on the secondary side of the insulating transformer 62 is connected to a common contact 64a of the changeover switch 64 via a second coupling capacitor 63b.

The vibration transmitting member 8 is connected to one of the first switching contacts 64b of the switching switch 64 via a lead wire 65, and the other of the second switching contacts 64c is connected to the sheath via a lead wire 66. 10 are connected.

Therefore, in the above configuration, when performing hemostasis treatment with a high-frequency current, the changeover switch 64 is operated to switch the first switch so that the high-frequency current flows between the distal end tip 9 and the external electrode P. And the second energized state in which the high-frequency current flows between the receiving portion 11a of the receiving member 11 and the external electrode P, so that an appropriate energized state can be selected to provide an effective hemostatic treatment. Can be performed.

FIG. 7 shows a schematic configuration of an entire ultrasonic treatment apparatus according to a second embodiment of the present invention. Here, a common contact 64a of the changeover switch 64 is connected to one terminal on the secondary side of the insulating transformer 62 via a first coupling capacitor 63a. The sheath 10 is connected to one of the first switching contacts 64b of the switching switch 64 via a lead wire 71. further,
An external electrode P is connected to the other second switch contact 64 c of the switch 64 via a lead wire 72.
The other terminal on the secondary side of the insulating transformer 62 is connected to the second terminal.
The vibration transmitting member 8 is connected via the coupling capacitor 63b and the lead wire 73.

Therefore, in the above configuration, when performing hemostasis treatment with a high-frequency current, the switching operation of the changeover switch 64 allows the monopolar / bipolar of the high-frequency current to be selectively switched. Further, appropriate high-frequency hemostasis treatment can be performed.

It should be noted that the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention.

[0051]

According to the present invention, since an appropriate energized state can be selected, an effective treatment can be performed on a living tissue.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram of an entire ultrasonic treatment apparatus.

FIG. 2 is a longitudinal sectional view showing a distal end portion of an insertion section.

FIG. 3 is a perspective view showing a main configuration of an ultrasonic treatment apparatus different from that of FIG. 1;

FIG. 4 is a characteristic diagram showing a safe treatment area at the time of joining and hemostatic work of a living tissue.

5A is a longitudinal sectional view showing a main part configuration of an ultrasonic treatment apparatus having still another configuration, and FIG. 5B is a longitudinal section showing a first modification of the ultrasonic treatment apparatus in FIG. 5A. FIG. 5 is a sectional view, and FIG.
FIG. 6A is a longitudinal sectional view showing a second modification of the ultrasonic treatment apparatus, and FIG. 5D is a longitudinal sectional view showing a third modification of the ultrasonic treatment apparatus of FIG.

FIG. 6 is a schematic configuration diagram of the entire ultrasonic treatment apparatus according to the first embodiment of the present invention.

FIG. 7 is a schematic configuration diagram of an entire ultrasonic treatment apparatus according to a second embodiment of the present invention.

[Explanation of symbols]

 2 Insertion part 6 Ultrasonic vibrator 8 Vibration transmitting member P External electrode 9 Tip (first electrode) 11a Receiving part (second electrode) 14 Holding part (holding means) 17 High frequency power supply 64 Switching switch

Claims (2)

[Claims] 1. An ultrasonic treatment apparatus which is inserted into a body and performs treatment on a living tissue, comprising: an ultrasonic vibrator for generating ultrasonic vibration; and an ultrasonic vibrator connected to the ultrasonic vibrator for transmitting the ultrasonic vibration. A probe, a sheath covering the probe, a holding member provided on the sheath so as to be able to hold a living tissue between the distal end of the probe, a high-frequency power source for generating a high-frequency current, and high-frequency power from the high-frequency power source. An external electrode that is supplied and attachable to the body, and a high-frequency power is supplied from the high-frequency power supply, and the first electrode provided at the distal end of the probe that can be used as the external electrode and a pair of electrodes. A second electrode provided on the holding member, to which high-frequency power is supplied from the high-frequency power source and which can be used as the external electrode and a pair of electrodes; the external electrode and the first electrode; A switch for switching between a first energizing state in which a high-frequency current flows between the external electrodes and a second energizing state in which a high-frequency current flows between the external electrode and the second electrode. Ultrasonic treatment equipment. 2. An ultrasonic treatment apparatus which is inserted into a body and performs treatment on a living tissue, comprising: an ultrasonic vibrator for generating ultrasonic vibration; and an ultrasonic vibrator connected to the ultrasonic vibrator for transmitting the ultrasonic vibration. A probe, a sheath covering the probe, a holding member provided on the sheath so as to be able to hold a living tissue between the tip of the probe, a high-frequency power source for generating a high-frequency current, and a tip provided on the probe. A first electrode to which high-frequency power is supplied from the high-frequency power supply; and a first electrode provided to the holding member, to which high-frequency power is supplied from the high-frequency power supply and which can be used as the first electrode and a pair of electrodes. A second electrode, an external electrode supplied with high-frequency power from the high-frequency power supply, and usable as a pair of electrodes with the first electrode, for mounting on a body, the first electrode and the second electrode. A switch for switching between a first energizing state in which a high-frequency current flows between the first electrode and the second electrode and a second energizing state in which a high-frequency current flows between the first electrode and the external electrode. Ultrasonic treatment equipment.