JP2016030119A - Hematoma removal method - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a method for safely and efficiently removing hematomas.SOLUTION: For safe and efficient removal of hematomas, a liquid 13 is jetted to a hematoma 24 to soften the hematoma where the liquid was jetted is sucked and removed. The liquid is jetted from a jetting pipe 3 and the hematoma is sucked through a suction pipe, and the jetting pipe is contained in the suction pipe. Thus the suction pipe is positioned facing the hematoma softened by the jetted liquid to thereby reduce the distance of moving the suction pipe, allowing the hematoma to be removed efficiently.SELECTED DRAWING: Figure 6

Description

  The present invention relates to a method for removing hematoma.

  When bleeding occurs in the brain due to trauma or stroke, the blood solidifies into a hematoma. And the brain is pressed by the hematoma. Therefore, treatment to remove hematoma is necessary. Patent Document 1 discloses a method for removing a hematoma with a suction device. According to it, hematoma was removed with a cleaning tool because hematoma was not confirmed with an endoscope.

JP 2004-57520 A

  A hematoma is a clot or clot that cannot be removed easily by aspiration. And when it sucks only with a suction tube like before, it is difficult to take a hematoma cleanly. For this reason, the operation time becomes long, or the hematoma cannot be removed neatly. In addition, since the stronger the blood is, the stronger the suction is required, there is a possibility that the normal brain tissue near the hematoma is also sucked. Therefore, a method capable of removing hematoma safely and efficiently has been desired.

  The present invention has been made to solve the above-described problems, and can be realized as the following forms or application examples.

[Application Example 1]
A method for removing a hematoma according to this application example is characterized in that a liquid is ejected onto the hematoma, and the hematoma at the place where the liquid is ejected is sucked and removed.

  According to this application example, the liquid is ejected to the hematoma. The pressure of the fluid softens the hematoma by stress. Then, the softened hematoma is removed by suction. A liquid is sprayed to soften the hematoma. Since the pressure of the liquid to be ejected is low, it is possible to prevent the tissue from being damaged. And since the hematoma is softened, it can be easily sucked and removed. Therefore, hematoma can be removed completely and efficiently.

[Application Example 2]
In the hematoma removal method according to the application example, the liquid is ejected from an ejection tube, the hematoma is sucked into a suction tube, and the ejection tube is inserted into the suction tube.

  According to this application example, the injection tube is inserted into the suction tube. Liquid is ejected from the ejection tube, and the hematoma is aspirated from the suction tube. Therefore, the suction tube is located at a location facing the hematoma softened by the jetted liquid. Therefore, since the distance for moving the suction tube is reduced, the hematoma can be sucked efficiently.

[Application Example 3]
In the hematoma removal method according to the application example described above, the liquid contains a drug that dissolves the hematoma.

  According to this application example, the liquid contains a drug that dissolves the hematoma. Therefore, the hematoma can be reliably softened by the ejected liquid.

[Application Example 4]
In the hematoma removal method according to the application example, the liquid to be ejected is a pulse flow, and the pulse flow is formed by flowing the liquid into a liquid chamber and changing a pressure in the liquid chamber. And

  According to this application example, the liquid is ejected in a pulse flow. By using a pulse flow, a large pressure can be applied discretely to the hematoma, and compared to a continuous flow at a constant pressure, liquid can be driven into the hematoma and softened easily. The liquid flows in the liquid chamber. The pressure varies in the liquid chamber. Accordingly, since the pressure of the liquid fluctuates when flowing in the liquid chamber, the liquid can be surely pulsed. Further, the intensity and cycle of the pulse flow can be easily controlled by controlling the fluctuation of the pressure in the liquid chamber.

In relation to the first embodiment, (a) is a block diagram showing a configuration of the liquid ejecting apparatus, (b) is a schematic side sectional view showing a structure in the vicinity of the nozzle, and (c) is an illustration of the liquid ejecting apparatus. The partial model side view which shows the structure of a nozzle. (A) is a schematic cross section which shows the internal structure of a pulsation provision part, (b) is a graph which shows transition of the volume of a liquid chamber. The electric control block diagram of a liquid ejecting apparatus. The flowchart which shows the hematoma removal method. The schematic diagram for demonstrating the hematoma removal method. The schematic diagram for demonstrating the hematoma removal method. The schematic diagram for demonstrating the hematoma removal method. The schematic diagram for demonstrating the hematoma removal method in connection with 2nd Embodiment. The schematic diagram for demonstrating the hematoma removal method in connection with 3rd Embodiment. The schematic diagram for demonstrating the hematoma removal method in connection with 4th Embodiment.

  In the present embodiment, a characteristic example of a liquid ejecting apparatus and a method for removing hematoma using the liquid ejecting apparatus will be described with reference to the drawings. Hereinafter, embodiments will be described with reference to the drawings. In addition, each member in each drawing is illustrated with a different scale for each member in order to make the size recognizable on each drawing.

(First embodiment)
In the present embodiment, a liquid ejecting apparatus that is a surgical instrument and a method for removing hematoma using the liquid ejecting apparatus will be described with reference to FIGS. FIG. 1A is a block diagram illustrating a configuration of the liquid ejecting apparatus. FIG.1 (b) is a principal part schematic sectional side view which shows the structure of a nozzle vicinity. FIG. 1C is a partial schematic side view showing the structure of the nozzle of the liquid ejecting apparatus. The liquid ejecting apparatus 1 according to the present embodiment is a medical device used in a medical institution, and has a function of softening and removing an affected part by ejecting a fluid onto the affected part. It can also be used to dissect other bodies for the treatment of animals other than humans.

  As shown in FIG. 1A, the liquid ejecting apparatus 1 includes a handpiece 2. The handpiece 2 is an instrument that is operated by a surgeon in his / her hand when performing an operation. In scenes other than surgery, the surgeon is also called an operator. The handpiece 2 is provided with an ejection pipe 3 that is a fluid flow path. A nozzle 4 that ejects fluid is installed at one end of the ejection pipe 3. The handpiece 2 is provided with a suction tube 5 surrounding the injection tube 3. A pulsation imparting section 6 is installed at the other end of the ejection pipe 3. A filter 8, a first flow meter 9, a first electromagnetic valve 10, and a first pump 11 are connected to the pulsation imparting unit 6 through a tube 7 in this order. The pulsation imparting unit 6 is a part that makes the fluid passing through it a pulse flow.

  The filter 8 has a function of removing foreign substances, bacteria, bubbles and the like in the fluid. The first flow meter 9 measures the flow rate of the fluid flowing through the tube 7. As the first flow meter 9, a hot wire flow meter, an impeller flow meter, or the like can be used. The first electromagnetic valve 10 is a valve whose opening and closing is controlled by an electrical signal. The first electromagnetic valve 10 may be a valve that opens and closes with a motor or an electromagnet.

  The first pump 11 can be a syringe pump or a tube pump. In the case of a syringe type, it is preferable to install a device for supplying fluid into the syringe. Thereby, the liquid ejecting apparatus 1 can be continuously driven.

  The first pump 11 is provided with a water inlet pipe 11 a, and one end of the water inlet pipe 11 a is connected to the water storage tank 12. The water tank 12 contains a liquid 13. For example, physiological saline is used as the liquid 13. Since physiological saline is not harmful to the living body, it can be used for surgery.

  A second flow meter 15, a second electromagnetic valve 16, and a second pump 17 are connected to the suction pipe 5 via a tube 14 in this order. The second flow meter 15 is the same as the first flow meter 9, and the second electromagnetic valve 16 is the same as the first electromagnetic valve 10. The second pump 17 is the same as the first pump 11.

  A drain pipe 17 a is installed in the second pump 17, and one end of the drain pipe 17 a is connected to the water storage tank 18. The water tank 18 contains the liquid 13.

  The liquid ejecting apparatus 1 includes a control device 20 as control means, and the control device 20 controls the operation of the liquid ejecting apparatus 1. The pulsation imparting unit 6, the first flow meter 9, the first electromagnetic valve 10, and the first pump 11 are connected to the control device 20 by a cable 21. Further, the second flow meter 15, the second electromagnetic valve 16 and the second pump 17 are connected to the control device 20 by a cable 21.

  The control device 20 is provided with a suction switch 22, an injection switch 23, and the like. The suction switch 22 is a switch for switching whether or not the liquid 13 is sucked from the suction pipe 5. The ejection switch 23 is a switch for switching whether or not the liquid 13 is ejected from the nozzle 4. The suction switch 22 and the injection switch 23 are switches that are operated by an operator by stepping on their feet.

  When the operator turns on the switch for starting the liquid ejecting apparatus 1, the control apparatus 20 is initialized. Then, the surgeon turns on the injection switch 23. The first pump 11 is activated, and the first pump 11 causes the liquid 13 to flow to the first electromagnetic valve 10. And when the control apparatus 20 opens the 1st solenoid valve 10, the liquid 13 with a high pressure turns into a fluid, and advances the tube 7. FIG. Then, the first flow meter 9 detects the flow rate of the fluid traveling through the tube 7 and outputs it to the control device 20. The control device 20 controls the flow rate passing through the first flow meter 9 to be a target flow rate.

  The fluid traveling through the tube 7 passes through the filter 8. The filter 8 removes dust, bubbles, crystals of salt, and the like from the liquid 13. The liquid 13 that has reached the pulsation imparting unit 6 is subjected to pulsed pulsation by the pulsation imparting unit 6. A pulsed pulsating flow is called a pulse flow. The liquid 13 that has passed through the pulsation imparting section 6 passes through the ejection pipe 3 and is ejected from the nozzle 4. The liquid 13 passing through the nozzle 4 is ejected in a pulse flow.

  The control device 20 controls whether or not to drive the pulsation imparting unit 6. When the pulsation imparting unit 6 is driven, a pulse flow is ejected from the nozzle 4. When the pulsation imparting unit 6 is not driven, a continuous flow is ejected from the nozzle 4. In addition, by applying a pressure fluctuation weakly applied to the liquid 13 by the pulsation imparting unit 6, it is possible to inject a continuous flow having a variable flow rate without being intermittently injected.

  As shown in FIG. 1B, when the liquid 13 is ejected from the nozzle 4 to the hematoma 24, the liquid 13 collides with the collision point 24 a of the hematoma 24. A liquid pool 25 in which the liquid 13 is accumulated is formed around the collision point 24a. Then, around the collision point 24a, the hematoma 24 is impacted and becomes soft. At the collision point 24a, part of the hematoma 24 is crushed and the binding force between the cells is weakened. Then, the liquid 13 is driven into the hematoma 24, and the distance between the tissues increases and softens. The softened tissue is referred to as soft hematoma 26 as a hematoma. The soft hematoma 26 can be easily sucked from the suction port 27 located at the tip of the suction tube 5.

  The injection tube 3 is inserted into the suction tube 5. Liquid 13 is ejected from nozzle 4 at the tip of ejection tube 3, and soft hematoma 26 is aspirated from suction tube 5. Accordingly, since the suction port 27 is located at a position facing the soft hematoma 26 softened by the jetted liquid, the operator can efficiently suck the soft hematoma 26 by reducing the amount of movement of the suction port 27. .

  The suction pipe 5 is provided with a suction adjustment hole 5a. The operator can adjust the area where the finger 28 closes the suction adjustment hole 5a. When the surgeon completely closes the suction adjustment hole 5a, the liquid ejecting apparatus 1 increases the suction force. Air enters the suction tube 5 from the suction adjustment hole 5a when the surgeon closes the suction adjustment hole 5a. For this reason, the suction force that the liquid ejecting apparatus 1 sucks from the suction port 27 is reduced.

  Further, the suction pipe 5 and the injection pipe 3 are made of resin or metal, and need rigidity to improve operability. It is desirable that the suction pipe 5 and the injection pipe 3 have a certain degree of elasticity so that the relative positions of the suction pipe 5 and the injection pipe 3 can be shifted. Furthermore, the suction tube 5 is preferably made of resin and transparent. A state in which the soft hematoma 26 passes through the suction tube 5 can be confirmed.

  As shown in FIG. 1C, the injection tube 3 has a tubular shape centered on the nozzle 4. A pulsed liquid 13 is ejected from the nozzle 4. The injection tube 3 is inserted into the suction tube 5, and the suction port 27 is located on the circumference centering on the nozzle 4. The nozzle 4 has a small diameter to increase the flow rate. The suction port 27 is large enough to suck the soft hematoma 26.

  Fig.2 (a) is a schematic cross section which shows the internal structure of a pulsation provision part. The pulsation imparting unit 6 is provided with an inlet channel 29, a liquid chamber 30, and an outlet channel 31 through which the liquid 13 supplied from the tube 7 passes. The inlet channel 29 and the outlet channel 31 are formed in the first case 32. The diaphragm 33 is installed so that the liquid chamber 30 is sandwiched between the first case 32 and the diaphragm 33. The tube 7 is connected to the inlet channel 29, and the injection pipe 3 is connected to the outlet channel 31.

  On the right side of the first case 32 in the drawing, a cylindrical second case 34 is installed in contact with the first case 32. The diaphragm 33 is a disk-shaped metal thin plate, and the outer peripheral portion of the diaphragm 33 is sandwiched and fixed between the first case 32 and the second case 34. A third case 35 is installed on the right side of the second case 34 in the drawing in contact with the second case 34. Between the diaphragm 33 and the third case 35, a piezoelectric element 36, which is a laminated piezoelectric element, is disposed. One end of the piezoelectric element 36 is fixed to the diaphragm 33, and the other end is fixed to the third case 35. The piezoelectric element 36 is connected to the control device 20 by the cable 21.

  When a drive voltage is applied from the control device 20, the piezoelectric element 36 changes the volume of the liquid chamber 30 formed between the diaphragm 33 and the first case 32. When the drive voltage applied to the piezoelectric element 36 increases, the piezoelectric element 36 expands, and the diaphragm 33 is pushed by the piezoelectric element 36 and bends toward the liquid chamber 30 side in the first direction 37 in the drawing. When the diaphragm 33 is bent in the first direction 37, the volume of the liquid chamber 30 is reduced. Then, the fluid in the liquid chamber 30 is pushed out of the liquid chamber 30. The inner diameter of the outlet channel 31 is larger than the inner diameter of the inlet channel 29. That is, the fluid resistance of the outlet channel 31 is smaller than the fluid resistance of the inlet channel 29. Since the inlet channel 29 is closer to the first pump 11 than the outlet channel 31, the water pressure in the inlet channel 29 is higher than the water pressure in the outlet channel 31. Accordingly, most of the fluid in the liquid chamber 30 is pushed out of the liquid chamber 30 through the outlet channel 31.

  On the other hand, when the drive voltage applied to the piezoelectric element 36 decreases, the piezoelectric element 36 contracts, and the diaphragm 33 is pulled by the piezoelectric element 36 and bends toward the third case 35 in the second direction 38 in the drawing. The piezoelectric element 36 is contracted to increase the volume of the liquid chamber 30, and fluid is supplied from the inlet channel 29 into the liquid chamber 30.

  Since the drive voltage applied to the piezoelectric element 36 is repeatedly turned on (maximum voltage) and turned off (0 V) at a high frequency (for example, 300 Hz), the expansion and reduction of the volume of the liquid chamber 30 are repeated. Pulsation is given to the fluid by the pressure fluctuation. The fluid pushed out from the liquid chamber 30 is ejected as a pulse flow from the nozzle 4 at the tip of the ejection tube 3. The pulse flow injection means that the flow rate or the flow velocity is injected with fluctuation, and is not limited to repeating the fluid injection and the stop. That is, various injection forms such as a form in which the injection is completely interrupted between injections and a form in which a low-pressure flow exists between the injections are included.

  FIG. 2B is a graph showing the transition of the volume of the liquid chamber. In FIG. 2B, the vertical axis indicates the volume of the liquid chamber 30, and the upper side in the figure is smaller than the lower side. The horizontal axis shows the transition of time, and the time transitions from the left side to the right side in the figure. The volume transition line 41 shows the transition of the volume when the volume of the liquid chamber 30 is changed.

  The volume transition line 41 is repeated at the period 42. One cycle 42 is divided into a rising section 43, a falling section 44, and a rest section 45. In the rising section 43, the volume transition line 41 has a shape similar to a sine waveform. At this time, a voltage is applied to the piezoelectric element 36 and the piezoelectric element 36 expands. As a result, the diaphragm 33 moves in the first direction 37 and the volume of the liquid chamber 30 decreases. Then, the liquid 13 in the liquid chamber 30 moves to the outlet channel 31.

  In the falling section 44, the volume transition line 41 has a shape similar to a sine waveform. At this time, the voltage applied to the piezoelectric element 36 decreases and the piezoelectric element 36 contracts. As a result, the diaphragm 33 moves in the second direction 38 and the volume of the liquid chamber 30 increases. Then, the liquid 13 flows from the inlet channel 29 into the liquid chamber 30. The falling section 44 is longer than the rising section 43. Thereby, the liquid 13 vigorously flows out into the outlet channel 31 and flows in from the inlet channel 29 at a low speed. The rest section 45 is a section in which the piezoelectric element 36 maintains a contracted state. The period 42 can be adjusted by changing the length of the pause section 45.

  The volume change amount in the volume transition line 41 is defined as a volume change amount 41a. The controller 20 controls the piezoelectric element 36 so that the volume change amount 41a can be adjusted. As described above, a pulse flow is formed in the pulsation imparting unit 6.

  FIG. 3 is an electric control block diagram of the liquid ejecting apparatus 1. In FIG. 3, the liquid ejecting apparatus 1 includes a control device 20 that controls the operation of the liquid ejecting apparatus 1. The control device 20 includes a CPU 46 (central processing unit) that performs various types of arithmetic processing as a processor, and a memory 47 that stores various types of information. The pump drive device 48, the first flow meter 9, the second flow meter 15, and the pulsation imparting unit 6 are connected to the CPU 46 via the input / output interface 49 and the data bus 50. Further, the suction switch 22, the injection switch 23, the pulsation amount input device 51, the output device 52, and the input device 53 are also connected to the CPU 46 via the input / output interface 49 and the data bus 50.

  The pump driving device 48 is a device that drives the first pump 11, the second pump 17, the first electromagnetic valve 10, and the second electromagnetic valve 16. The pump drive device 48 receives an instruction signal from the CPU 46. Then, the pump driving device 48 drives the first pump 11 under the pressure and flow rate conditions indicated in the instruction signal. Further, the pump driving device 48 drives the first electromagnetic valve 10 to open and close the valve. In addition, the pump driving device 48 drives the second pump 17 under the conditions of pressure and flow rate indicated in the instruction signal. Further, the pump driving device 48 drives the second electromagnetic valve 16 to open and close the valve.

  The suction switch 22 is a switch that drives the second pump 17. When the suction switch 22 is turned on, the second pump 17 is activated. And after the pressure of the tank with which the 2nd pump 17 is provided becomes low, the 2nd solenoid valve 16 opens and the soft hematoma 26 is attracted | sucked from the suction port 27. FIG.

  The injection switch 23 is a switch that drives the first pump 11. When the surgeon turns on the injection switch 23, the first pump 11 and the pulsation imparting unit 6 are driven. Then, after the water pressure of the liquid 13 becomes high, the first electromagnetic valve 10 is opened and the liquid 13 is ejected from the nozzle 4.

  The pulsation amount input device 51 is a device through which an operator inputs the fluctuation amount of the pulsation of the liquid 13. The pulsation amount input device 51 is a device for setting the volume change amount 41 a of the liquid chamber 30, for example. The pulsation amount input device 51 can be composed of, for example, a variable resistor and a circuit or switch that converts the resistance value of the variable resistor into a voltage.

  In addition to the liquid crystal display device, the output device 52 includes a light and speaker for notifying abnormality, a device that performs wired and wireless communication with an external computer, and the like. Accordingly, the control device 20 can display and output the state of the liquid ejecting apparatus 1 and the setting state set by the operator.

  The input device 53 includes a device that performs wired and wireless communication with an external computer in addition to a keyboard, a mouse-type input device, and a pen-type input device. Various data are input to the memory 47 by these input devices 53.

  The memory 47 is a concept including a semiconductor memory such as a RAM and a ROM, and an external storage device such as a hard disk and a DVD-ROM. Functionally, in order to store a storage area for storing program software 54 in which the control procedure of the operation of the liquid ejecting apparatus 1 is described, and supply amount data 55 that is data used when calculating the supply amount of the liquid 13. Storage area is set. In addition, a storage area for storing suction-related data 56 that is data related to the pressure sucked from the suction port 27 is set. In addition, a storage area for storing pulsation data 57 that is data of driving conditions when driving the pulsation imparting unit 6 is set. In addition, a work area for the CPU 46, a storage area that functions as a temporary file, and other various storage areas are set.

  The CPU 46 performs control for ejecting the liquid 13 from the nozzle 4 of the handpiece 2 and control for sucking the soft hematoma 26 from the suction port 27 in accordance with the program software 54 stored in the memory 47. The CPU 46 has a pump control unit 58 as a specific function realizing unit. The pump control unit 58 outputs an instruction signal to the pump driving device 48 to drive the first pump 11 and control the liquid 13 to flow. The pump control unit 58 inputs the flow rate of the liquid 13 detected by the first flow meter 9 and controls the flow rate of the liquid 13 to be ejected. Further, the pump control unit 58 opens and closes the first electromagnetic valve 10 to control the flow and stop of the liquid 13. In addition, the pump control unit 58 performs control for driving the second pump 17 to suck the hematoma 26 and the liquid 13 from the suction port 27. The pump control unit 58 inputs the flow rate of the soft hematoma 26 and the liquid 13 detected by the second flow meter 15 and controls the flow rate of the soft hematoma 26 and the liquid 13 to be sucked. Further, the pump control unit 58 controls the flow and stop of the liquid 13 by opening and closing the second electromagnetic valve 16.

  In addition, the CPU 46 includes a pulsation control unit 61. The pulsation control unit 61 inputs pulsation data 57 set by the pulsation amount input device 51 from the memory 47. Then, the pulsation controller 61 controls the volume change amount 41 a of the liquid chamber 30 by controlling the piezoelectric element 36 of the pulsation imparting unit 6 using the pulsation data 57. As the liquid chamber 30 fluctuates, the liquid 13 is ejected in a pulse flow.

  In addition, the CPU 46 includes a suction amount calculation unit 62. The suction amount calculation unit 62 inputs suction related data 56 from the memory 47. Then, the flow rate data detected by the second flow meter 15 is input. The difference between the flow rate data and the flow rate target value is calculated, and the calculation result is output to the pump control unit 58. The pump control unit 58 drives the second pump 17 based on the calculation result.

  In addition, the CPU 46 includes a supply amount calculation unit 63. The supply amount calculation unit 63 inputs supply amount data 55 from the memory 47. Then, the flow rate data detected by the first flow meter 9 is input. The difference between the flow rate data and the flow rate target value is calculated, and the calculation result is output to the pump control unit 58. The pump control unit 58 drives the first pump 11 based on the calculation result, and controls the flow rate to approach the flow rate target value. In the present embodiment, each function described above is realized by program software using the CPU 46. However, when each function described above can be realized by a single electronic circuit (hardware) that does not use the CPU 46, It is also possible to use such an electronic circuit.

  Next, a hematoma removal method for sucking and removing the hematoma 24 using the liquid ejecting apparatus 1 described above will be described with reference to FIGS. FIG. 4 is a flowchart showing the hematoma removal method. 5 to 7 are schematic diagrams for explaining the hematoma removing method. The location and type of the hematoma 24 are not particularly limited, but in this embodiment, for example, an example of removing the hematoma 24 from the brain surface is shown. The brain surface shows the skull side of the cerebrum. In the treatment of hematoma removal in the brain, it is necessary to prevent damage to normal tissues such as important blood vessels and nerves more than necessary. When the hematoma 24 is stiff at the tissue boundary, the risk of damaging normal tissue is increased.

  In the flowchart of FIG. 4, step S <b> 1 corresponds to a hematoma exposure process, which is a process of incising the affected area to expose the hematoma 24. Next, the process proceeds to step S2. Step S2 corresponds to an injection preparation process. This step is a step of moving the liquid ejecting apparatus 1 to a location facing the hematoma 24. Next, the process proceeds to step S3. Step S3 corresponds to a liquid ejecting process. This step is a step of softening the hematoma 24 by jetting the liquid 13 to the hematoma 24. Next, the process proceeds to step S4. Step S4 corresponds to a hematoma suction step. This step is a step of sucking the softened soft hematoma 26. Next, the process proceeds to step S5. Step S5 corresponds to a stitching process. This step is a step of suturing tissues such as the skull and the epidermis. The removal of the hematoma is completed by the above steps.

  Next, the hematoma removal method will be described in detail with reference to FIGS. 5 to 7 in association with the steps shown in FIG. FIG. 5A and FIG. 5B are diagrams corresponding to the hematoma exposure step of step S1. As shown in FIG. 5A, the operator cuts out the head soft tissue 64. The head soft tissue 64 has a five-layer structure of an epidermis (scalp), a subcutaneous tissue, a cap aponeurosis, a cap aponeurosis subtissue, and a periosteum. Next, a part of the skull 65 is removed, and the meninges 66 and the buffy coat 67 are incised. The meninges 66 are composed of a dura and a spider.

  Thereby, the brain surface 68a of the cerebrum 68 can be exposed. In the cerebrum 68, the hematoma 24 to be removed is located. As shown in FIGS. 5A and 5B, a blood vessel 69 is stretched around the cerebrum 68. In this embodiment, the hematoma 24 is present in the normal tissue 70 of the cerebrum 68. A blood vessel 69 is close to the hematoma 24. In this step, the hematoma 24 is exposed.

  FIG.5 (c) is a figure corresponding to the injection preparation process of step S2. As shown in FIG. 5C, the operator moves the handpiece 2 so that the nozzle 4 is located at a location facing the hematoma 24. The handpiece 2 is preferably installed so that the extending direction of the ejection tube 3 is in the normal direction of the brain surface 68a. The momentum of the ejected liquid 13 can be applied to the hematoma 24 efficiently. The surgeon activates the liquid ejecting apparatus 1 to drive the first pump 11.

  FIG. 6A is a diagram corresponding to the liquid ejecting step of step S3. As shown in FIG. 6A, the operator operates the injection switch 23 to open the first electromagnetic valve 10. Then, the surgeon ejects the liquid 13 from the nozzle 4 toward the hematoma 24. In the place where the liquid 13 collides, the hematoma 24 becomes soft and becomes a soft hematoma 26. Then, the surgeon operates the handpiece 2 and applies the liquid 13 to all locations of the hematoma 24. Since the hematoma 24 is covered with the normal tissue 70, the liquid 13 may also be applied to the periphery of the hematoma 24 exposed on the brain surface 68a.

  As the liquid 13 to be ejected, for example, physiological saline is used. Thereby, it is possible to suppress the hematoma 24 from being chemically damaged. The jet of the liquid 13 is so strong that it does not penetrate the hematoma 24. Even if there is a blood vessel 69 inside the hematoma 24, the blood vessel 69 is not damaged because the jet is not stronger than necessary.

  The liquid 13 is ejected in a pulse flow. By making the pulse flow, the pressure fluctuation applied to the hematoma 24 can be increased. The greater the pressure fluctuation, the more easily the portion where the cells are connected to each other breaks down due to fatigue, so the hematoma 24 becomes the soft hematoma 26. When the hematoma 24 is not hard, a continuous flow may be jetted onto the hematoma 24. You may adjust so that hematoma 24 may become the hardness which is easy to suck.

  FIG. 6B to FIG. 7B are diagrams corresponding to the hematoma suction step in step S4. As shown in FIG. 6B, the operator operates the suction switch 22 to open the second electromagnetic valve 16. Then, the operator sucks soft hematoma 26 from the suction port 27. Soft hematoma 26 is hematoma 24 softened in step S3 and can be easily sucked even if it is not strong suction. Further, the surgeon can suck the soft hematoma 26 by operating the suction adjusting hole 5a and adjusting the suction force as appropriate. The hematoma 24 is a mixture of hard and softened parts. By softening in step S3, the soft part becomes softer and sucked. The hard part of the hematoma 24 falls apart and can be removed as a relatively large piece.

  As shown in FIG. 7A, the operator may perform the ejection of the liquid 13 and the suction of the soft hematoma 26 at the same time. The operator may spray the liquid 13 onto the hematoma 24 in a place where it is difficult to suck while sucking the hematoma 24 and the soft hematoma 26. Further, the operator may alternately perform the ejection of the liquid 13 and the suction of the soft hematoma 26 alternately. Depending on the hardness and location of the hematoma 24, the ejection of the liquid 13 and the suction of the soft hematoma 26 may be switched. As shown in FIG. 7B, the hematoma 24 is removed from the cerebrum 68. Then, after removing the hematoma 24, hemostasis of the damaged blood vessel 69 is performed if necessary.

  Steps S1 to S4 may be performed by confirming the affected part with the naked eye, or may be enlarged using an optical device such as a microscope. When the hematoma 24 includes the blood vessel 69, it is preferable to confirm the enlarged affected area.

  In the suturing step of step S5, the buffy coat 67, the meninges 66, the skull 65, and the head soft tissue 64 are returned and sutured to finish the operation.

As described above, this embodiment has the following effects.
(1) According to this embodiment, the liquid 13 is ejected to the hematoma 24. As a result, the hematoma 24 becomes soft and becomes a soft hematoma 26. The soft hematoma 26 is removed by suction. Since the liquid 13 is ejected to soften the hematoma 24, the pressure of the ejected liquid 13 may be low. Therefore, damage to the normal tissue 70 can be prevented. And since the hematoma 24 is softened, it can be easily sucked and removed. Therefore, hematoma 24 can be removed safely and efficiently.

  (2) According to the present embodiment, the injection tube 3 is inserted into the suction tube 5. The liquid 13 is ejected from the nozzle 4 at the tip of the ejection tube 3, and the hematoma 24 and the soft hematoma 26 are aspirated from the suction tube 5. Therefore, since the suction port 27 of the suction tube 5 is located at a location facing the hematoma 24 softened by the jetted liquid 13, the distance for moving the suction tube 5 can be shortened. Therefore, hematoma 24 and soft hematoma 26 can be efficiently aspirated.

  (3) According to this embodiment, the liquid 13 is ejected in a pulse flow. A large pressure can be discretely applied to the hematoma 24 by using a pulse flow. Thereby, compared with the continuous flow of a fixed pressure, the liquid 13 can be driven into the hematoma 24 and can be easily softened. The liquid 13 flows in the liquid chamber 30. The volume of the liquid chamber 30 varies. Accordingly, since the pressure of the liquid 13 varies when flowing in the liquid chamber 30, the liquid 13 can be surely turned into a pulse flow. Further, by controlling the fluctuation of the volume of the liquid chamber 30, the intensity and cycle of the pulse flow can be easily controlled.

(Second Embodiment)
Next, an embodiment for removing the hematoma 24 will be described with reference to the schematic diagram for explaining the hematoma removing method of FIG. This embodiment is different from the first embodiment in that a mantle tube is used. Note that description of the same points as in the first embodiment is omitted.

  That is, in this embodiment, as shown in FIG. 8A, the hematoma 24 is located deeper than the brain surface 68a. At this time, the surgeon installs the outer tube 73 on the cerebrum 68 using a dedicated blade in the injection preparation process of step S2. The inside of the outer tube 73 is hollow. Then, as shown in FIG. 8B, the handpiece 2 and the endoscope 74 are installed inside the outer tube 73. The handpiece 2 may be configured to be attachable to the endoscope 74.

  Next, the operator ejects the liquid 13 from the nozzle 4 to the hematoma 24 while observing the hematoma 24 using the endoscope 74. As a result, the hematoma 24 is softened to form a soft hematoma 26. Next, the soft hematoma 26 is sucked from the suction port 27.

As described above, this embodiment has the following effects.
(1) According to this embodiment, the handpiece 2 and the endoscope 74 are guided to the deep part of the cerebrum 68 by the outer tube 73. Therefore, even when the hematoma 24 is in the deep part of the cerebrum 68, the hematoma 24 can be removed safely and efficiently.

(Third embodiment)
Next, an embodiment for removing the hematoma 24 will be described with reference to a schematic diagram for explaining the hematoma removal method of FIG. This embodiment is different from the first embodiment in that the injection tube 3 and the suction tube 5 are separate. Note that description of the same points as in the first embodiment is omitted.

  That is, in this embodiment, the nozzle 78 is installed at the tip of the injection pipe 77, and the injection pipe 77 is connected to the first pump 11. Then, the surgeon ejects the liquid 13 from the nozzle 78 toward the hematoma 24. As a result, the hematoma 24 is softened to become the soft hematoma 26 at the place where the liquid 13 is applied. Further, a suction port 80 is provided at the tip of the suction pipe 79, and the suction pipe 79 is connected to the second pump 17. The operator sucks soft hematoma 26 from the suction port 80.

  The injection pipe 77 and the suction pipe 79 are separated and can be operated separately. The surgeon ejects the liquid 13 toward the hematoma 24 from a location away from the hematoma 24. Then, the hematoma 24 can be removed while the suction tube 79 is in contact with the hematoma 24 and the suction state is confirmed.

  The operator can land the liquid 13 near the suction port 80 by operating the ejection tube 77. Therefore, the surgeon can efficiently suck the hematoma 24 by linking the operation of the ejection tube 77 and the operation of the suction tube 79.

(Fourth embodiment)
Next, an embodiment for removing the hematoma 24 will be described with reference to a schematic diagram for explaining the hematoma removal method of FIG. This embodiment is different from the first embodiment in that the liquid 13 contains a medicine. Note that description of the same points as in the first embodiment is omitted.

  That is, in this embodiment, as shown in FIG. 10, the nozzle 4 is installed at the tip of the injection pipe 3, and the injection pipe 3 is connected to the first pump 11. Then, the surgeon ejects the liquid 83 from the nozzle 4 toward the hematoma 24. The liquid 83 contains a drug that dissolves the hematoma. The drug is a thrombolytic drug, and for example, plasmin can be used. Plasmin is a proteolytic enzyme and has a function of dissolving a thrombus that has already been formed.

  The liquid 83 contains a drug that dissolves the hematoma 24. Therefore, the hematoma 24 can be reliably softened in a short time by the jetted liquid 83.

Note that the present embodiment is not limited to the above-described embodiment, and various changes and improvements can be added by those having ordinary knowledge in the art within the technical idea of the present invention. A modification will be described below.
(Modification 1)
In the first embodiment, the example in which the hematoma 24 in the cerebrum 68 is removed has been described. However, the method similar to that of the present embodiment may be used when removing the hematoma 24 in other parts. . The treatment target may be limited to animals other than humans. Further, the hematoma 24 is not limited to a living body and may be a part of a corpse. Even in these cases, the hematoma 24 can be softened by jetting the liquid 13, and therefore the hematoma 24 can be easily removed.

  3 ... jet tube, 4 ... nozzle, 5 ... suction tube, 13, 83 ... liquid, 24 ... hematoma, 26 ... soft hematoma as hematoma, 30 ... liquid chamber.

Claims (4)

Spray liquid on the hematoma,
A method for removing a hematoma, comprising sucking and removing the hematoma at a place where the liquid is ejected. The hematoma removal method according to claim 1,
The method for removing a hematoma, wherein the liquid is ejected from an ejection tube, the hematoma is sucked into a suction tube, and the ejection tube is inserted into the suction tube. The hematoma removal method according to claim 1 or 2,
The method for removing a hematoma, wherein the liquid contains a drug that dissolves the hematoma. It is a hematoma removal method as described in any one of Claims 1-3,
The liquid to be jetted is a pulse flow;
The pulse flow flows the liquid into a liquid chamber,
A method for removing hematoma, wherein the method is formed by changing the pressure in the liquid chamber.

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