JP3010265B2 - Vascular coagulation hemostasis device - Google Patents

Description

Description: BACKGROUND OF THE INVENTION The present invention relates to a device for stopping bleeding from blood vessels during neurosurgery, orthopedic surgery and general surgery, and more particularly to a blood vessel having a blood vessel cutting function. The present invention relates to a coagulation / hemostatic device.

[Conventional technology and its problems]

Conventionally used bipolar blood vessel coagulation devices rely on high-frequency currents, and spark-gap devices of a high frequency generation in the range of 0.5 to 3 MHz are often used. This bipolar electrode is provided at both ends of the hand held by both the active and inactive electrodes, and energizes only the living tissue sandwiched between the tips of the armature, causing the electrical invasion of the patient to coagulate. It is possible to completely stop the hemostasis from the blood vessel without damaging other tissues. That is, hemostasis is performed by coagulation of blood vessels by local heating caused by high-frequency current flowing through living tissue.

However, in most cases, the material of the conventional set has been made of stainless steel, and recently, a lightweight, corrosion-resistant, lightweight titanium is also made. These metal cores have high thermal conductivity and tend to conduct heat easily. As a result, the heat of the locally heated blood vessel is transferred to the metal centrifugal conversely, and the tip of the centrifuge gradually increases in temperature as it is used, causing a burn between the metal and the blood vessel at both ends of the centrifuge, Is attached to the tip of the centrifuge. As a result of this adhesive force being larger than the coagulation force of the blood vessels, when the blood vessel is coagulated and the tip of the centrifuge is opened, even the coagulated part of the blood vessel is often peeled off and removed. There was the inconvenience of opening the blood again and failing to stop bleeding. In addition, it is necessary to clean off the adhered matter on the contact part (electrode) surface in preparation for the next use, and to remove the substance, change the shape of the tip of the centrifuge due to the polishing work, and decrease the accuracy. It was a big problem. Not only that, it was very uneconomical to prepare multiple sessile pieces for one operation.

Another problem is that during surgery, it is necessary to stop many blood vessels, cut the center of the blood vessels, and go deeper. It is necessary to cut off the hemostatic portion of the stopped blood vessel by performing the operation of returning to the scissors. In this case, there is a problem that the surgeon must frequently change from the settler to the scissors, which is very complicated and causes a longer operation time.

[Means for solving the problem]

To solve the above problems, the most effective means
A contact member such as zirconia, alumina, silicon nitride, etc., having a low thermal conductivity is provided so that a living body does not scorch or adhere to the holding portion at the tip of the armature. By exposing the electrode formed of the conductive adhesive, the temperature is prevented from rising, the heat from the blood vessel is prevented from being transmitted to the distal end of the armature, and a reliable coagulation and hemostatic action is provided.

In addition, the electrodes are used for both coagulation and hemostasis and for cutting, and the coagulation and hemostasis of blood vessels are cut and cut, while the work of hemostasis and cutting is continuously performed with a single armature. This eliminates the hassle of cleaning or switching to scissors to cut blood vessels, greatly reducing the operation time.

〔Example〕

 Hereinafter, embodiments of the present invention will be described with reference to the drawings.

FIG. 1 shows the overall configuration of a bipolar vascular coagulation / hemostatic device, in which 1 is a pair of armatures for clamping and coagulating blood vessels to stop the bleeding. The gripping portion of the armature 1 is covered with an electrically insulating coating S. 2 and 3, the distal end A of the centrifuge 1 is composed of a pair of metal vessel clamping portions 10, 10 made of metal such as stainless steel or titanium. Of the inner surface, that is, the contact members 10a, 10a actually contacting the blood vessel B are made of an electrically insulating sintered body.
a is an exposed electrode 10b, 1 made of a conductive adhesive F
The exposed electrodes 10c are formed to act for coagulation and hemostasis. Among them, the exposed electrode 10c formed on the most distal end side of the armature 1 is also used for cutting blood vessels.
Reference numeral 2 denotes a power supply for generating a high-frequency current,
The power supply 2 turns on and off the power supply to the armature 1 to which the cord 4 is connected by stepping on the foot switch 3.
Or switch to both the coagulation hemostasis mode and the cutting mode. That is, when cutting a blood vessel, a high-grade wave current having a sharp rising waveform is applied to the exposed electrode 10c, and a gradual rising waveform current is applied to both the exposed electrodes 10b and 10c for coagulation and hemostasis. Has become. As the conductive adhesive, a conductive resin "Doitite" (trademark) manufactured by Fujikura Kasei Co., Ltd. was used. It uses high-purity silver powder as the conductive filler and epoxy resin with excellent heat resistance as the resin.It is a 100% solids, solvent-free, one-part adhesive. Those shown in Table 1 were used.

By the way, the gripping portions of the blood vessel holding portions 10, 10 are surrounded by an electric insulator S such as a synthetic resin, and the distal end portions are provided with insulating contact members 10a, 10a by a conductive adhesive F. The contact members 10a, 10a are made of a sintered body (ceramic) such as electrically insulating zirconia, and these sintered bodies are made of a material having a high corrosion resistance and a very high hardness. is there.

For example, the thermal conductivity of zirconia sintered body is 0.009c at 20 ° C
al ・ cm / cm ²・ sec ・ ℃, stainless steel 0.039 cal ・ c
The value is much smaller than m / cm ² · sec · ° C. and 0.04 cal · cm / cm ² · sec · ° C. of titanium, and the heat conductivity is smaller than these metallic materials. Therefore, the exposed electrodes 10b, 10
The heat generated by the flow of high-frequency current from b, 10c, and 10c to the blood vessel is transmitted through the abutting members 10a, 10a made of sintered body, and the degree of heat dissipation is extremely small, so that a portion of the tissue of the cauterized blood vessel Does not stick to the surfaces of the contact members 10a, 10a.

In this case, a number of small holes are formed in the insulating contact member 10a made of a sintered zirconia body, and the small hole is filled with the conductive adhesive F, and the contact member 10a is connected to the distal end of the blood vessel clamping portion 10. If the ratio of the electrode area of the exposed electrode 10b formed by being exposed to the small hole on the front side and the electrode area of the exposed electrode 10c at the same time as the area of the contact member 10a is 60% or more, It was confirmed by use experiments that the mechanical strength of the contact member 10a made of ceramic was low, and that if it was 5% or less, good cauterization and hemostasis could not be obtained.

Further, in order to enhance the effect, the contact member 10 made of an insulating sintered body should be avoided as much as possible to avoid a local rise in temperature.
It is necessary to make small holes in a state where many are dispersed in a and 10a, and in particular, it is necessary to expose a large number of exposed electrodes 10b and 10b to make contact with blood vessels. As a method of easily exposing the exposed electrode to this small hole, the material of the exposed electrode 10b, 10b and 10c, 10c itself is made of a conductive adhesive F or the like, so that the contact members 10a, 10a are connected to the blood vessel holding portions 10, 10. Can be achieved at the same time, resulting in a very high productivity.

In addition, the hardness of zirconia ceramics is Vickers hardness of 1250 kg / mm ² or more, and it is incomparably high due to metal materials such as stainless steel and titanium. Even in the case where a part of the tissue was strongly burned, it was possible to easily scrape off the attached matter without damaging the contact surface by rubbing with a knife edge or the like. The material of the contact member 10a is not limited to zirconia ceramics, but may be alumina, silicon nitride,
Ceramics such as mullite and silicon carbide may be used.

Further, unlike the exposed electrodes 10b, 10b at the tips of the contact members 10a, 10a, the exposed electrode 10c provided at the foremost portion has a substantially vertically long rectangular plate shape having a larger area than the other point-shaped exposed electrodes 10b. A power supply line 10e separate from the power supply line 10d to 10b is connected, and this power supply line 10e is covered with an electric insulating coating S1. The switching between the two power supply lines 10d and 10e is operated by the foot switch 3 as an example. For the operation of coagulation and hemostasis, a high-frequency current with a gentle rising waveform is applied to both exposed electrodes 10b and 10c.However, in the case of a blood vessel cut, the exposed electrode 10b is turned off and a pulse current with a sharp rising waveform is applied only to the exposed electrode 10c. Grant. The exposed electrode 10c, which is used for both hemostasis and cutting, is also the electrode 1.
Similarly to 0b, it is desirable to form with the conductive resin adhesive F described above (Table 1).

Thus, according to this embodiment, the operator does not need to switch from scissors to scissors as in the prior art for cutting blood vessels following coagulation and hemostasis by the cutting action of the exposed electrode 10c. Provide the convenience that can be

Although the preferred embodiment and the developed embodiment of the present invention have been described above, the following is a further embodiment of the present invention.

a) Instead of using a metal material as a set, it is made of plastics or ceramics, and a conductive wire or a conductive pattern is embedded in the inside to make it conductive.

b) In consideration of moldability, the blood vessel abutment member is formed not only in the blood vessel abutment member but also in a range that covers the entire armature.

c) Instead of applying a pulse current with a sharp rise to an exposed electrode having a cutting action, cutting is performed by applying a high-frequency current having a large current power.

〔The invention's effect〕

As described above, the bipolar clotting and hemostasis device of the present invention provided with the centrifuge has the following effects.

Since the hemostasis operation during the operation can be reliably performed, the operation time can be significantly reduced.

The amount of hemostasis can be reduced, and the surgical invasion can be reduced for the patient.

Not only is the work of scraping off the sticking matter sticking to the end of the armature not only broken, but also in the event that it sticks, it can be easily scraped off, and because of its high hardness, there is no risk of shape change and high accuracy It can be maintained for a long time.

By using a conductive adhesive as an electrode, it is possible to easily form a complicated electrode shape, and the productivity is extremely high.

Since the thermal stress generated by the difference in the thermal expansion coefficient between metal and ceramic during heating during autoclave sterilization can be absorbed by the adhesive layer of the conductive adhesive containing metal powder, the ceramic constituting the contact part It can withstand long-term use, such as preventing damage to the autoclave, and can be autoclaved regardless of the gas sterilization method. As a result, the sterilization time can be significantly reduced.

According to the developed embodiment, it is possible to cut blood vessels in addition to hemostasis of blood vessels by using a single centrifuge. Therefore, scissors are not required, and a holding operation is not required. This can be evaluated particularly in the reduction of the operation work and the operation time in a long operation.

[Brief description of the drawings]

FIG. 1 is a view showing the overall configuration of a vascular coagulation / hemostatic device according to the present invention, and FIG. 2 is an enlarged perspective view of a portion A in FIG. FIG. 3 is a sectional view taken along line XX in FIG. 1: armature, 2: power supply, 3: foot switch, 4: cord, 10: vessel clamping member, 10a: contact member, 10b: exposed electrode, 10c: exposed electrode, B: blood vessel

Claims (1)

(57) [Claims] 1. A bipolar coagulation hemostasis device for causing a high-frequency current to flow between two armatures from a power supply device, cauterizing a blood vessel sandwiched between the two armatures, and coagulating and stopping the hemostasis. The armature is provided with an electrically insulating sintered body having a low thermal conductivity at least at a blood vessel holding portion that comes into contact with a blood vessel, and the surface of the electrically insulating sintered body has a contact portion area of 5 to 60 of the blood vessel holding portion. %
A blood vessel coagulation / hemostatic device wherein a plurality of exposed electrodes are formed, and among these exposed electrodes, the electrode located at the foremost end of the armature has a function of coagulating hemostasis and cutting.