JP2004041431A - Calculus treatment apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a calculus treatment apparatus capable of crushing even a large calculus in a short time to discharge the same from the body. <P>SOLUTION: First and second probes different in calculus crushing capacity are arranged coaxially to constitute an integral single calculus treatment apparatus and the proper calculus crushing treatment corresponding to the state of a calculus is treated by the calculus treatment apparatus without replacing a probe. <P>COPYRIGHT: (C)2004,JPO

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to a calculus treatment device that crushes a calculus generated in a body cavity.
[0002]
[Prior art]
Conventionally, as a treatment means for crushing a calculus generated in a body cavity, a method of crushing a calculus by ultrasonic vibration of an ultrasonic probe and a method of crushing a calculus by electric discharge are known. In the method of crushing stone by ultrasonic vibration, an ultrasonic vibrator is provided in the probe body, and the ultrasonic vibration generated by this vibrator is transmitted to the calculus by a vibration transmitting member to crush stone. In the method of crushing stones by electric discharge, a pair of electrodes are provided at the tip of a discharge probe, and crushed stones are discharged between the electrodes.
[0003]
[Problems to be solved by the invention]
However, each of the conventional methods has advantages and disadvantages, and it is common to select the most suitable calculus crushing device according to the hardness, size, progress of crushing stone, etc. of stones, and to use different types of crushing devices. It was a target. As described above, conventionally, different types of calculus crushing devices are prepared in advance, and different calculus crushing devices are used alternately, so that the usual lithotripsy work is complicated.
[0004]
In view of this, there has been proposed a device in which discharge crushing stone and ultrasonic crushing stone can be used in a single device, such as a calculus crushing device disclosed in Japanese Patent Publication No. 57-8617.
However, according to this calculus crushing apparatus, ultrasonic lithotripsy is further performed by another ultrasonic lithotripsy probe after the discharge lithotripsy by the discharge lithotripsy probe. For this reason, it was necessary to perform the procedure of extracting the discharge lithotripsy probe from the sheath after the discharge lithotripsy and then inserting the ultrasonic lithotripsy probe into the sheath.
As described above, in the calculus crushing apparatus capable of using both the discharge crushing stone and the ultrasonic crushing stone, it is necessary to exchange the lithotripsy means (replace the probe with respect to the sheath) during the operation. Frequent replacement of the lithotripsy means an extremely complicated operation, which is a major factor in increasing the treatment time of the lithotripsy treatment.
[0005]
In a general calculus crushing device, since only a single ultrasonic vibration generated by the vibrator is transmitted to the calculus via the vibration transmission rod, for example, when the calculus is relatively hard, the There is a problem that the ability to crush stones due to ultrasonic vibration tends to be insufficient, and stones cannot be reliably crushed.
[0006]
Conventionally, a method of crushing stones using two types of ultrasonic probes is also known. However, in this method, stones are crushed by the same type of ultrasonic probe, and there is a problem that large stones cannot be crushed.
[0007]
Furthermore, a mechanical impact lithotripter of the type of crushing stones by applying a mechanical impact to calculi is also known, but such a method has a high ability to crush stones, especially large calculi. However, they lacked the ability to crush stones to the point where they could suck stones from the body.
[0008]
The present invention has been made in view of the above problems, and an object of the present invention is to provide a calculus treatment apparatus capable of crushing a large calculus in a short time and discharging the calculus from the body.
[0009]
[Means for Solving the Problems]
The invention according to claim 1 is connected to a first probe capable of receiving a first mechanical energy to crush a calculus by the energy and a member of the first probe, A first mechanical energy generating means for generating energy, a second probe capable of receiving a second mechanical energy different from the first mechanical energy and crushing a calculus with the second mechanical energy, A second mechanical energy generating means connected to a member of the second probe and generating the second mechanical energy, wherein the first probe and the second probe are substantially A calculus treatment apparatus characterized in that the first probe is formed hollow so as to be coaxially disposable.
[0010]
In the invention according to claim 2, one of the mechanical energy generating means generates mechanical energy by magnetic force, and the other of the mechanical energy generating means generates mechanical energy by ultrasonic vibration. The calculus treatment device according to claim 1, wherein:
[0011]
According to a third aspect of the present invention, in the calculus treatment device for crushing a calculus, a first probe capable of crushing a calculus by receiving a first mechanical energy generated by a magnetic force and an ultrasonic vibration are generated. A second probe capable of receiving the first mechanical energy to crush the calculus is provided substantially coaxially, within a movement range of the tip of the first probe due to the first mechanical energy or at least one of the two. A calculus treatment device, characterized in that the tip of the second probe is located at the portion.
[0012]
BEST MODE FOR CARRYING OUT THE INVENTION
(1st Embodiment)
A calculus treatment device according to a first embodiment of the present invention will be described with reference to FIGS.
[0013]
FIG. 1 shows the entire calculus treatment apparatus according to the present embodiment. The lithotripsy treatment device 1 combines an ultrasonic lithotripter probe 2 and a mechanical lithotripsy probe 3 to form an integrated single device.
[0014]
The ultrasonic lithotripter probe 2 includes a gripping portion 4 for the operator to grip and a long insertion portion 5 to be inserted into a body cavity, and the insertion portion 5 projects straight from the gripping portion 4. The gripper 4 has a cylindrical case 6, in which a Langevin type vibrator 7 for generating ultrasonic vibration energy is installed. The Langevin type vibrator 7 overlaps the piezoelectric element 8 and the electrode 9, sandwiches them between a horn 10 as a front metal block and a rear metal block 11, connects the horn 10, and connects the rear metal block 11 to the horn 10. By screwing a nut 13 to the rear end of the penetrating bolt 12, the stacked piezoelectric elements 8 are tightened. Further, the electrode 9 is connected to a power cord 15 led out.
[0015]
Only the front end of the case 6 of the gripping portion 4 is tightly fitted to the maximum outer peripheral portion of the horn 10, and supports the horn 10 coaxially. A male screw 4a is formed on the outer periphery of the front end of the case 6, and the base end of the exterior cap 14 that covers the horn 10 is screwed into the male screw 4a. Between the horn 10 and the outer cap 14, a flange 10a formed at the maximum outer peripheral portion of the horn 10 is sandwiched, and the horn 10 is positioned and fixed. Thereby, the positional relationship between the horn 10 and the exterior cap 14 is determined. The outer peripheral surface of the horn 10 is covered with the outer cap 14 in a non-contact manner.
[0016]
An elastic O-ring 16 is provided between the outer periphery of the distal end of the horn 10 and the inner surface of the exterior cap 14, and the elastic O-ring 16 tightly seals the gap between the two, and at the same time, the distal end of the horn 10 Is elastically supported. At the tip of the horn 10, a vibration transmission member 17 made of a metal hollow pipe constituting the insertion portion 5 is fixedly attached. The horn 10 and the vibration transmitting member 17 are coaxially connected so that the ultrasonic vibration (mechanical energy) amplified by the horn 10 is transmitted to the vibration transmitting member 17.
[0017]
An inner hole (hollow hole) 18 of the vibration transmitting member 17 communicates with a through hole 19 formed so as to penetrate the center of the horn 10 and the bolt 12 so as to pass back and forth. The through hole 19 forms a suction path for sucking and discharging the crushed calculus. The rear end of the through hole 19 is connected to a hollow connecting member 20 fixedly attached to the rear end of the case 6 of the grip portion 4. A suction base 21 is provided on a side wall of the connecting member 20. A suction tube 22 is connected to the suction base 21, and the suction tube 22 is extended to a suction pump 23 shown in FIG. 1 and connected to the suction pump 23.
[0018]
The mechanical crushed stone probe 3 is detachably connected to the connecting member 20. The mechanical crushed stone probe 3 is detachably fixed to the rear end of the gripping portion 4 of the ultrasonic crushed stone probe 2 by a detachable connecting means such as a screw type or a bayonet type. Specifically, a coil fixing member 25 on the mechanical lithotripsy probe 3 side is detachably attached to the rear end of the connecting member 20 in the ultrasonic lithotripter probe 2 by screw connection.
[0019]
At the rear end of the connecting member 20 in the ultrasonic lithotripter probe 2 is provided a bearing member 27 formed of an O-ring that supports the rear end of the long lithotripsy probe 26 so as to be able to advance and retreat in the longitudinal direction thereof. The crushed stone probe 26 has a distal end portion extending, penetrating through the vibration transmitting member 17, and protruding from the distal end of the vibration transmitting member 17 to the outside.
[0020]
Further, the rear end of the crushed stone probe 26 is attached and fixed to an electric insulating relay member 28 for preventing leakage current arranged in the coil fixing member 25. By fixing a metal ring 29 to the rear end of the relay member 28, the relay member 28 and the ring 29 form an integrated block. A coil spring 30 is interposed between the front end of the relay member 28 and the connecting member 20 located forward of the relay member 28, and the coil spring 30 urges the metal ring 29 rearward. .
[0021]
As shown in FIG. 1, the ring 29 is urged together with the crushed stone probe 26 and the relay member 28 by the urging force of the coil spring 30 in the backward direction, and is normally attached to the coil fixing member 25. And stops at that position and waits. The coil spring 30 has a free length (height) set so that the ring 29 comes into contact with the cushioning material 31.
[0022]
The rear end portion of the coil fixing member 25 is attached and fixed to a frame 33a of an electromagnetic coil 33 mounted on a hollow iron core 32. Here, the iron core 32 is freely movable in the axial direction, and when the electromagnetic coil 33 is excited, the magnetic force causes the iron core 32 to reciprocate back and forth to generate mechanical energy. This mechanical energy is transmitted to the crushed stone probe 26. The front end of the iron core 32 penetrates into the coil fixing member 25 and is fixed to the metal ring 29 by, for example, a screw connection, and the front protrusion of the iron core 32 penetrates into the ring 29 to fix the coil. It is connected to the member 25. That is, the iron core 32 and the crushed stone probe 26 are movable in the front-rear direction.
[0023]
On the other hand, the power cord 34 and the power cord 15 connected to the electromagnetic coil 33 are led to the power supply control device 35 shown in FIG. 1 and are connected to the drive circuit of the power supply control device 35, respectively.
[0024]
FIG. 2 is a block diagram of a circuit for driving and controlling the calculus treatment device 1. The energization control device 35 includes a US driving circuit 36 for driving the ultrasonic lithotripter probe 2 and a calculus for sucking calculus to a state where the lithotripsy probe 2 driven by the US driving circuit 36 can suck. A pump drive circuit 37 and a solenoid drive circuit 38 for driving the mechanical crushed stone probe 3 are provided.
[0025]
Further, a foot switch 39 as a drive operation means is connected to the power supply control device 35, and a switch 39a for operating the US drive circuit 36 and the pump drive circuit 37 and a switch for operating the solenoid drive circuit 38 in the foot switch 39. By selecting and operating one of the crushed stone probes 39b, any crushed stone probe 2, 3 can be selectively driven.
[0026]
Next, the relationship between the tip position of the ultrasonic lithotripter 2 and the tip position of the mechanical lithotripter 3 will be described with reference to FIG.
[0027]
In order to increase the crushing efficiency and shorten the crushing time by using the functions of both the ultrasonic crushing probe 2 and the mechanical crushing probe 3, the moving stroke of the tip of the mechanical crushing probe 3 during crushing is generally used. It is desirable to arrange the tips of the probes 2 and 3 so that the stroke width of the ultrasonic vibration at the tip of the ultrasonic crushing probe 2 overlaps at least partially or entirely within the width.
[0028]
Therefore, the relationship will be described on the assumption that the vibration movement amount L1 of the ultrasonic lithotripter probe 2 is 0.1 mm or less and the movement amount L2 of the mechanical crusher probe 3 is 1 mm. When both the ultrasonic lithotripter probe 2 and the mechanical lithotripter probe 3 are turned off, the tip surface of the mechanical lithotripter probe 3 is flush with the tip surface of the ultrasonic lithotripter probe 2 or as shown in FIG. It should be in a position retracted 2 mm in the hand direction. In this state, driving power for roughly crushing the calculus A is supplied to the mechanical lithotripsy probe 3. Then, the distal end surface of the mechanical lithotripter probe 3 projects 1 mm to 0.8 mm from the distal end surface of the ultrasonic lithotripter probe 2 as shown in FIG. 3B, and the calculus A can be crushed mechanically.
[0029]
Power is subsequently supplied to the ultrasonic lithotripter probe 2 in order to finely crush the calculus thus coarsely crushed to a size that can be discharged outside the body. Then, the distal end face of the ultrasonic lithotripter probe 2 moves about 0.1 mm at the position shown in FIG. 3 (A), and crushes the calculus A to a level at which the calculus A can be discharged by the ultrasonic vibration. At this time, the distal end surface of the mechanical lithotripter probe 3 is at a position that does not interfere with the lithotripsy action due to the ultrasonic vibration.
[0030]
When the ultrasonic lithotripter probe 2 and the mechanical lithotripter probe 3 are driven simultaneously, the distal end surface of the mechanical lithotripter probe 3 is located behind the distal end surface of the ultrasonic lithotripter probe 2 as shown in FIG. It is preferable to do so.
[0031]
Next, FIG. 4 shows types of the tip portion of the mechanical crushed stone probe 3. In FIG. 2A, a crushed stone probe 3 is constituted by a pipe 40, and a plurality of slits 41 are formed at the end of the pipe 40 to form an abutting portion 42 for striking a calculus A. In particular, the tip of the mechanical crushed stone probe 3 may be formed in a projection shape as shown in FIGS. That is, FIG. 2B shows a single knife-like shape, FIG. 2C shows a plurality of sharp projections formed at the center, and FIG. 2D shows a plurality of sharp projections arranged around the periphery. FIG. 7E shows a number of small projections, and FIG. 7F shows a mountain-shaped projection with a blade. FIG. 5 (G) shows a structure in which the probe 3 is constituted by a pipe 40 and the cooling liquid can be flowed by opening the tip of the pipe. In the case shown in FIG. 7G, the calculus or waste fluid in the body cavity may be sucked through the hollow hole 43. Alternatively, the operation may be such that only the ultrasonic lithotripsy probe 2 is driven depending on the state of the calculus A to crush the calculus A.
[0032]
According to the present embodiment, it is possible to configure a single calculus treatment device by combining two or more types of probes having different lithotripsy capabilities, and to efficiently perform appropriate lithotripsy processing without replacing two or more types of probes. Became. Further, it is possible to set the crushing ability of one probe so that the crushed stone can be finely crushed to a level that can be sucked through the suction path of the other probe, and the crushed stone can be efficiently sucked. In addition, even a large calculus A is crushed in a short time and the calculus is discharged from the body.
[0033]
In the present embodiment, the electromagnetic coil 33 is excited to reciprocate the iron core 32 back and forth by the magnetic force to generate mechanical energy transmitted to the crushed stone probe 26. Is fixed, and the electromagnetic coil 33 is excited by using the ring 29 as a magnet (magnetic material) to cause the ring 29 to reciprocate and vibrate by the magnetic force, thereby transmitting the mechanical energy to the crushed stone probe 26. You may.
[0034]
(Second embodiment)
A calculus treatment device according to a second embodiment of the present invention will be described with reference to FIGS.
[0035]
In the present embodiment, the position of the ultrasonic lithotripter probe 2 and the mechanical lithotripsy probe 3 is reversed in the front-rear direction as compared with the above-described first embodiment. The components having the same functions as those of the first embodiment are denoted by the same reference numerals, and the description of the individual portions will be simplified.
[0036]
The ultrasonic lithotripter 2 has an insertion section 5 formed in a pipe shape and its lumen is used as a suction path for sucking crushed calculus, and the crushed calculus is discharged outside the body via a suction mouthpiece 21.
[0037]
The insertion portion 3a of the mechanical lithotripter probe 3 is also formed in a pipe shape, and the insertion portion 5 of the ultrasonic lithotripter probe 2 is inserted into the hollow hole of the insertion portion 3a so as to be coaxially combined. It is. The ultrasonic lithotripter is connected to the rear end of the gripping portion 24 of the mechanical lithotripter probe 3 by connecting the front end of the case 6 of the gripping portion 4 of the ultrasonic lithotripter probe 2 with a detachable connecting means such as a screw type or a bayonet type. The mechanical crushed stone probe 3 can be detachably connected to the probe 2 and fixed.
[0038]
FIG. 6 shows the relationship between the tip position of the ultrasonic lithotripter probe 2 and the tip position of the mechanical lithotripter probe 3. Assuming that the vibration movement amount L1 of the ultrasonic lithotripter probe 2 is 0.1 mm or less and the movement amount L2 of the mechanical lithotripter probe 1 is 1 mm, the relationship between the movement amounts will be described below.
[0039]
When both the ultrasonic lithotripsy probe 2 and the mechanical lithotripsy probe 3 are off, as shown in FIG. 6 (A), the distal end face of the mechanical lithotripsy probe 3 and the distal end face of the ultrasonic lithotripsy probe 2 are the same or mechanical. The tip surface of the crushed stone probe 3 is set at a position where it is retracted in the direction of the hand by 0.3 mm. In this state, when power is supplied to the mechanical lithotripsy probe 3 to roughly crush the calculus A, the distal end face of the mechanical lithotripsy probe 3 is 1 mm from the distal end face of the ultrasonic lithotripsy probe 2 as shown in FIG. The calculus A can be crushed by protruding by 0.8 mm.
[0040]
When power is supplied to the ultrasonic lithotripter probe 2 in order to crush the crushed calculus so that it can be discharged outside the body, the tip surface of the ultrasonic lithotripter probe 2 moves back and forth by 0.1 mm at the position shown in FIG. The stone can be finely crushed to a level at which the stone can be discharged. At this time, it is desirable that the distal end surface of the mechanical lithotripsy probe 3 is located at a position that does not interfere with the calculus. When the ultrasonic lithotripter probe 2 and the mechanical lithotripter probe 3 are driven simultaneously, the distal end surface of the mechanical lithotripter probe 3 is located forward of the distal end surface of the ultrasonic lithotripter probe 2 as shown in FIG. Alternatively, the calculus A may be crushed at the same time by being positioned so that the calculus A comes into contact with the tips of both probes 2 and 3.
[0041]
Although the calculus treatment device 1 in each of the above-described embodiments has a configuration in which the ultrasonic lithotripter probe 2 and the mechanical lithotripsy probe 3 are coaxially arranged in front of and behind, the meaning of the coaxial is mathematically understood. It does not show a strict relationship but includes cases where the cores are displaced or parallel.
Further, the present invention is not limited to the above-described embodiments, and can be applied to other embodiments. For example, as a means for generating mechanical energy of the mechanical crushed stone probe 3, a driving type in which a vibration plate is vibrated by a magnetic force of a solenoid and the probe is vibrated by the vibration plate may be used.
[0042]
According to the above description, the items listed below and the items obtained by arbitrarily combining the items listed below can be obtained.
[0043]
1. A first probe capable of receiving a first mechanical energy and crushing a calculus by the energy, and a first machine connected to a member of the first probe and generating the first mechanical energy Energy generating means, and a hollow hole for coaxially arranging the first probe member, and receiving a second mechanical energy different from the first mechanical energy to form a calculus by this energy. A second probe capable of crushing stones, and second mechanical energy generating means connected to the member of the second probe and generating the second mechanical energy. Stone treatment device.
2. One of the probes in the first paragraph is an ultrasonic crushing probe driven by mechanical energy generating means by ultrasonic vibration, and the other is a mechanical crushed stone probe driven by mechanical energy generating means generated by magnetic force. A medical treatment tool, characterized in that:
3. In the medical treatment tool according to the second aspect, the ultrasonic crushing probe tip may be entirely or at least partially overlapped with the stroke width of the ultrasonic vibration within the movement stroke width of the mechanical crushing probe tip during crushing. The tip is arranged.
[0044]
4. 3. A calculus treatment device according to claim 1, wherein a suction path for sucking and discharging the calculus with one probe is formed in the other probe.
5. 4. A medical treatment tool according to claim 4, wherein the calculus crushed by one probe is discharged without passing through a housing such as a case supporting the other probe.
[0045]
6. 2. The medical treatment tool according to claim 1, wherein one of the two or more types of probes is a crushed stone probe driven by magnetic force.
7. 7. The medical treatment tool according to item 6, wherein the tip of the probe comprises a ridge or a sharp projection. 2. A medical treatment tool, wherein a power supply for controlling two or more types of probes according to claim 1 is provided in one case such as a case.
[0046]
9. 2. The medical treatment tool according to claim 1, wherein the two types of probes are ultrasonic probes, and a crushed stone probe driven by magnetic force is coaxially arranged in the outer cylinder.
10. 2. The medical treatment tool according to claim 1, wherein the two types of probes are crushed stone probes whose outer cylinder is driven by magnetic force, and in which an ultrasonic probe is coaxially arranged.
11. In a medical treatment tool having a probe for lithotripsy in a device main body, two or more probes having different lithotripsy capabilities are provided coaxially, and an ultrasonic wave is applied to a stroke range of a tip of a lithotripsy probe driven by magnetic force or a part thereof. A medical treatment instrument, wherein the tip of a crushed stone probe is located.
[0047]
【The invention's effect】
As described above, according to the calculus treatment apparatus of the present invention, two or more types of probes having different lithotripsy capabilities are provided on the same axis, so that the appropriate lithotripsy treatment according to the condition of the calculus can be performed without replacing the probes. Can be performed efficiently in a short time. Therefore, there is an effect that fatigue can be reduced for both the operator and the patient.
[Brief description of the drawings]
FIG. 1 is an explanatory view of the entire calculus treatment device according to a first embodiment of the present invention.
FIG. 2 is a circuit diagram for driving the calculus treatment device.
FIG. 3 is an explanatory diagram of a relationship between a tip position of an ultrasonic lithotripter and a tip position of a mechanical lithotripter of the calculus treatment device according to the first embodiment of the present invention.
FIG. 4 is an explanatory diagram of various tip shapes of the mechanical crushed stone probe.
FIG. 5 is a longitudinal sectional view of the calculus treatment device according to the first embodiment of the present invention.
FIG. 6 is an explanatory diagram of a relationship between a tip position of an ultrasonic lithotripter and a tip position of a mechanical lithotripter in the calculus treatment device according to the first embodiment of the present invention.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Calculus treatment apparatus 2 ... Ultrasonic lithotripter 3 ... Mechanical lithotripsy probe 5 ... Insertion part 7 ... Langevin type vibrator 17 ... Vibration transmission member 18 ... Inner hole 19 ... Through hole 20 ... Connection member 21 ... Suction base 22 ... Suction tube 24 ... Grip part 25 ... Coil fixing member 26 ... Crushed stone probe 27 ... Member 28 ... Relay member 29 ... Ring 30 ... Coil spring 32 ... Iron core 33 ... Electromagnetic coil 35 ... Electrification control device

Claims (3)

A first probe capable of receiving a first mechanical energy and crushing a calculus by the energy;
First mechanical energy generating means connected to the first probe member and generating the first mechanical energy;
A second probe capable of receiving a second mechanical energy different from the first mechanical energy and crushing a calculus by the second mechanical energy;
A second mechanical energy generating means connected to the member of the second probe and generating the second mechanical energy;
With
A calculus treatment device, wherein the first probe is formed hollow so that the first probe and the second probe can be disposed substantially coaxially. 2. The mechanical energy generating means according to claim 1, wherein one of the mechanical energy generating means generates mechanical energy by magnetic force, and the other mechanical energy generating means generates mechanical energy by ultrasonic vibration. Stone treatment equipment. In a calculus treatment device for crushing calculi,
A first probe capable of crushing a calculus by receiving a first mechanical energy generated by a magnetic force;
A second probe capable of receiving a first mechanical energy generated by ultrasonic vibration and crushing a calculus is provided substantially coaxially, and a tip of the first probe by the first mechanical energy is provided. The calculus treatment device, wherein the tip of the second probe is located within or part of the movement range of the calculus.

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