JP3837082B2 - Receptoscope device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a reject scope device that performs incision, excision, transpiration, and the like of body tissue by electroablation under an endoscope.
[0002]
[Prior art]
In general, a resectoscope is used for transurethral resection (TUR) and transcervical resection (TCR), and is observed in an elongated hollow sheath inserted into a body cavity. An optical endoscope (also referred to as a scope), which is an endoscope for medical use, and an electrode unit for excising a living tissue are mainly provided.
[0003]
There are two types of rejectscope devices: a type capable of performing treatment in a non-conductive solution and a type capable of performing treatment in a conductive solution.
[0004]
When performing a procedure such as prostatectomy using a type of resectoscope device that can be processed in a non-conductive solution, D-sorbitol, which is a transparent liquid having an insulating property as a perfusate for expanding in a narrow cavity, etc. To expand the cavity and insert the sheath of the rejectscope into the cavity. Then, a high-frequency current was applied to the treatment electrode of the electrode unit arranged at the distal end opening of the sheath while observing the surface of the lesioned part with a scope arranged in the sheath. The high-frequency current flows from the treatment electrode through the body tissue to a counter electrode plate as an external electrode arranged outside the body. The surgeon performs the treatment of the lesioned part by moving the treatment electrode back and forth by operating the operation part.
[0005]
When a treatment such as prostatectomy is performed using a type of resectoscope apparatus that can be processed in a conductive solution, a physiological saline that is a conductive liquid is used as the perfusate. For example, in the technique disclosed in Japanese Patent Application Laid-Open No. 2000-201946, a return electrode is disposed in the vicinity of a slender and hollow sheath tip that is inserted into a body cavity filled with a conductive liquid. The structure in which the high-frequency current from is recovered through its return electrode is shown.
[0006]
[Problems to be solved by the invention]
In the conventional treatment with the return electrode under the conductive liquid, the return electrode is energized to generate bubbles of the conductive liquid around the return electrode. When the entire circumference of the electrode is covered with bubbles, the electrical resistance between the electrode, the physiological saline solution, and the living tissue rapidly increases and a high voltage is applied, so that discharge occurs. The heat generated by this discharge enables tissue excision, transpiration, and discharge coagulation.
[0007]
In order to warm the physiological saline and generate bubbles, a large amount of electric power is required according to the entire length of the return electrode. Therefore, it is conceivable to reduce the required power by reducing the diameter of the treatment portion of the return electrode. For example, in the case of the treatment portion of the return electrode having a conventional diameter, the treatment that has been completed, such as five resections, If the diameter of the treatment portion of the return electrode is simply reduced, such as requiring 10 treatments by reducing the diameter, the area that can be removed by one treatment is reduced and the treatment capability is reduced. There is.
[0008]
The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a reject scope device that can be discharged with a smaller electric power and can perform treatment efficiently.
[0009]
[Means for Solving the Problems]
The reject scope device of the present invention includes a high-frequency power generating means for generating high-frequency power capable of treating a biological tissue, a first electrode capable of applying the high-frequency power generated by the high-frequency power generating means to the biological tissue, A liquid feeding means for feeding a conductive solution around the electrode, and a high-frequency power applied to the living tissue from the first electrode disposed in the conductive solution fed by the liquid feeding means is fed back. The first electrode comprises two parallel parallel lead members, and a treatment electrode connected to a tip of the parallel lead member, and A first line segment parallel to the existing plane and having the maximum width of the treatment electrode; and a distance between the intersection of the first line segment perpendicular to the first line segment and the treatment electrode is maximum And the length a of the first line segment and Serial and length b of the second line segment with satisfying the a> 2 · b becomes relevant, as the diameter of the treatment electrode is maximized at the intersection part of the treatment electrode of the second segment It is formed.
[0010]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
[0011]
1 to 15 relate to a first embodiment of the present invention, FIG. 1 is a configuration diagram showing a configuration of a reject scope device, FIG. 2 is a side view showing a configuration of the reject scope of FIG. Is an assembly view for explaining the structure of the reject scope 1 in FIG. 2, FIG. 4 is a perspective view for explaining the structure of the electrode unit inserted and arranged in the inner sheath in FIG. 3, and FIG. FIG. 6 is a first diagram illustrating the operation of the treatment electrode of FIG. 4, FIG. 7 is a second diagram illustrating the operation of the treatment electrode of FIG. 4, and FIG. FIG. 9 is a fourth diagram illustrating the operation of the treatment electrode of FIG. 4, FIG. 10 is a fifth diagram illustrating the operation of the treatment electrode of FIG. 11 is a diagram for explaining the tip shape of the treatment electrode of FIG. 4, and FIG. 12 is the tip of the first modification of the treatment electrode of FIG. FIG. 13 is a diagram for explaining the tip shape of the second modification of the treatment electrode of FIG. 4, FIG. 14 is a diagram for explaining the tip shape of the third modification of the treatment electrode of FIG. FIG. 15 is a view for explaining the tip shape of a fourth modification of the treatment electrode of FIG .
[0012]
FIG. 1 shows a state in which transurethral resection is performed using a rejectoscope device. The reject scope device includes a reject scope 1 and a high frequency power supply device 2. The reject scope 1 includes a high frequency power supply device 2 for supplying a high frequency cauterization current (hereinafter referred to as an active current) to a treatment electrode of an electrode unit, which will be described later, and collecting a return current (hereinafter referred to as a return current). It is connected. The distal end of the reject scope 1 is inserted into the patient 3 transurethrally. Control of power supply from the high frequency power supply device 2 to the treatment electrode is performed by turning on and off the foot switch 4 connected to the high frequency power supply device 2. When the foot switch 4 is turned on, a high-frequency current from the high-frequency power supply device 2 is supplied to the treatment electrode of the reject scope 1 via the cable 5, and a return current is collected by the high-frequency power supply device 2.
[0013]
In FIG. 1, a physiological saline having conductivity as a perfusate is supplied from a physiological saline pack 7 through a sterilization tube 8 to a body cavity such as a bladder. After filling the body cavity with physiological saline, the surgeon inserts the reject scope 1 into the body cavity, and treats the surface of the body tissue that performs incision, excision, etc. while viewing the image of the endoscope for observation. The electrode is moved, the foot switch 4 is turned on, and incision is performed.
[0014]
Next, the configuration of the reject scope 1 will be described with reference to FIGS. FIG. 2 is a side view showing the configuration of the reject scope 1. FIG. 3 is an assembly diagram for explaining the configuration of the reject scope 1. FIG. 4 is a perspective view for explaining the configuration of the treatment electrode.
[0015]
The reject scope 1 includes a hollow outer sheath 11 having a through-hole that is a mantle tube, a scope 12 that is similarly disposed in the through-hole of the outer sheath 11, a handle portion 13 that is an operation portion, and an outer sheath 11. Electrode unit 14 (see FIG. 4) disposed in the through hole.
[0016]
The outer sheath 11 is composed of, for example, a hollow insertion portion 21 that is inserted into a body cavity via the urethra, and a hand main body portion 22 provided at the rear end of the insertion portion 21, and the distal end of the insertion portion 21 is open. Part 23. Two fluid conduits 22 a and 22 b are provided on the side periphery of the hand main body 22. Specifically, the fluid pipe line 22a includes a cock 28 and a liquid feeding base 24 for feeding a physiological saline having conductivity as a perfusate to the treatment portion. The fluid conduit 22b has a cock 25 and a drainage cap 26 for discharging physiological saline and the like.
[0017]
A tube for liquid feeding is connected to the liquid feeding base 24 that is a tube connecting means, and similarly, a tube for draining is connected to the drainage base 26 that is a tube connecting means. By moving the cocks 28 and 25, liquid feeding and draining can be controlled.
[0018]
As shown by a dotted line 27 in FIG. 3, the inner sheath 31 is inserted through the opening on the rear side of the hand main body portion 22 and is disposed in the insertion portion 21. The inner sheath 31 is an insulating member provided at the distal end of the insertion portion 32, a hollow insertion portion 32 inserted into the outer sheath 11, a hand main body portion 33 provided at the rear end of the insertion portion 32. For example, it is comprised with the front-end | tip member 34 formed with the hard resin member. The tip of the tip member 34 has an opening 35. As shown by a dotted line 36 in FIG. 3, the scope 12 is inserted together with the electrode unit 14 from the opening on the rear side of the hand main body 33 and is disposed in the inner sheath 31.
[0019]
In some cases, the outer sheath 11 is not used and only the inner sheath 31 is attached.
[0020]
The scope 12 is a thin and long insertion tube 41 with a built-in observation optical system, inserted into the inner sheath 31, a guide tube 42 that passes through the insertion tube 41, and a proximal end of the guide tube 42. It is comprised by the provided hand part 43. FIG. At the proximal end of the hand portion 43, an eyepiece portion 44 on which an operator visually observes is provided. A light guide connection portion 45 to which a light guide (not shown) for supplying illumination light for observation to the observation site is connected is provided on the side portion of the hand portion 43.
[0021]
As shown in FIG. 4, the electrode unit 14 inserted and arranged in the inner sheath 31 includes a treatment electrode 61 that is a hard metal member located on the distal end side, and a parallel lead member 62 that connects the treatment electrode 61 to the distal end. And a slender metal pipe 63 in which the base end portion of the parallel lead member 62 is disposed at the tip end portion. The treatment electrode 61 is an elongated wire-shaped electrode. The parallel lead member 62 is a bifurcated member having a portion substantially parallel to the insertion axis direction of the scope 12. Both end portions of the treatment electrode 61 are connected to the distal end portion of the parallel lead member 62. The treatment electrode 61 has, for example, an arc shape. Furthermore, the treatment electrode 61 and the parallel lead member 62 have a hook shape at the tip of the electrode unit 14 as an active electrode, and the plane including the arc-shaped treatment electrode 61 and the insertion axis of the scope 12 are determined in advance. With a given angle.
[0022]
The outer periphery of the metal pipe 63 is covered with an insulating tube (not shown), and the base end portion of the metal pipe 63 is exposed as an electrode connecting portion at the rear end portion of the insulating tube.
[0023]
The electrode unit 14 that is an active electrode is disposed in the inner sheath 31 so that the treatment electrode 61 can advance and retract in the insertion direction of the inner sheath 31 at the opening 35 of the distal end member 35 of the inner sheath 31.
[0024]
The proximal end portion of the metal pipe 63 provided with the treatment electrode 61 and the parallel lead member 62 on the distal end side extends through the insertion portion 32 and the proximal body portion 33 of the inner sheath 31 and extends from the proximal end surface of the proximal body portion 33. Then, it is fixed to a slider 46 described later.
[0025]
Returning to FIG. 3, the handle portion 13 includes a sheath connection portion 47 that is detachably connected to the hand main body portion 33 of the inner sheath 31, and a rear projection from the rear end surface of the sheath connection portion 47. A guide tube 48 through which the tube 41 is inserted and a substantially pipe-shaped slider 46 in which the guide tube 48 is slidably held are mainly formed.
[0026]
An electrode fixing portion (not shown) that becomes an electrical connection portion with the electrode connection portion at the rear end portion of the electrode unit 14 and a power cable 5 extending from the high-frequency power supply device 2 are detachably attached to the slider 46. A high-frequency power connector 49 to be connected and a ring-shaped thumb ring 50 for hanging the surgeon's thumb are provided.
[0027]
The slider 46 and the sheath connecting portion 47 are connected in a state where a force is applied so as to be separated from each other by an elastic member (not shown) such as a spring. That is, the slider 46 is always urged toward the eyepiece 44 by the elastic member.
[0028]
Accordingly, the surgeon appropriately grasps the distance between the finger hooking portion 51 and the ring 50 while holding the finger hooking portion 51 of the sheath connection portion 47 and the thumb hooking ring 50 provided on the slider 46 by hand. By operating, the slider 46 is moved in the distal direction of the scope 12 with respect to the guide tube 48, and the treatment electrode 61 of the electrode unit 14 is moved so as to protrude in the distal direction with respect to the insertion tube 41. In a state where no force is applied to the finger rest 51 and the ring 50, the treatment electrode 61 and the distal end portion of the insertion tube 41 are at substantially the same position in the insertion direction of the scope 12. However, if the force is applied to the finger hook 51 and the ring 50 to reduce the distance in the direction indicated by the arrow a in FIG. 3, the insertion tube 41 does not move, but the processing electrode 61 is moved in the direction indicated by the arrow b. The scope 12 moves so as to protrude in the distal direction.
[0029]
On the other hand, the high frequency power connector 49 and the above-described electrode fixing portion are electrically connected by, for example, a lead wire. For this reason, by connecting the cable 5 from the high frequency power supply device 2 to the high frequency power supply connector 49, the treatment electrode 61 of the electrode unit 14 is energized, and the lesioned part can be treated.
[0030]
The rejectscope device can measure the leakage current by obtaining the difference between the current value supplied to the treatment electrode 61 and the current value of the return current.
[0031]
As shown in FIG. 5, the high-frequency power supply device 2 includes a control circuit 101 that receives a signal from the foot switch 4 and controls power supply, a power supply circuit 102 that is controlled by the control circuit 101 and generates DC power, A high frequency generation circuit 103 that generates high frequency power by switching DC power from the circuit 102, and a waveform circuit 104 that supplies the high frequency generation circuit 103 with a high frequency power waveform signal that is controlled by the control circuit 101 and generated by the high frequency generation circuit 103. An output transformer circuit 105 that amplifies the high-frequency voltage of the high-frequency power generated by the high-frequency generation circuit 103 and applies the high-frequency current to the treatment electrode 61 by applying the high-frequency voltage between the treatment electrode 61 terminal and the return current terminal; From the voltage sensor 110 that detects the high-frequency output voltage output from the transformer circuit 105, and from the output transformer circuit 105 Current sensors 106a and 106b that detect a high-frequency current that is applied, and a sensor signal processing circuit 107 that A / D converts the current value detected by the voltage sensor 110 and the current value detected by the current sensors 106a and 106b. The control circuit 101 calculates the impedance of the living tissue based on the digitized voltage data and current data from the sensor signal processing circuit 107, and controls the power supply circuit 102 and the waveform circuit 104.
[0032]
As shown in FIG. 6, the treatment electrode 61 is protruded from the distal end of the reject scope 1, and the high-frequency current output from the treatment electrode 61 is collected by the outer sheath 11 through living tissue and physiological saline.
[0033]
7 to 10 show a state in the vicinity of the treatment electrode 61 arranged at the distal end of the reject scope 1 at this time. When energization of the high-frequency current to the treatment electrode 61 is started (FIG. 7), the physiological saline in the vicinity of the treatment electrode 61 is warmed by the energy, and generation of bubbles starts (FIG. 8). Furthermore, if energy is continuously input, the amount of bubbles increases and the entire circumference of the treatment electrode 61 is covered (FIG. 9). When the entire circumference of the treatment electrode 61 is covered with bubbles (FIG. 10), the electrical resistance between the treatment electrode 61, physiological saline, and living tissue suddenly rises and a high voltage is applied, so that discharge occurs. The heat generated by the discharge enables excision, transpiration, and discharge coagulation of the living tissue.
[0034]
Next, the treatment electrode 61 at the tip of the electrode unit 14 will be described with reference to FIG.
[0035]
As shown in FIG. 11, the treatment electrode 61 has, for example, a substantially semicircular shape, a line segment 151 that is parallel to the surface where the parallel lead member 62 exists and has the maximum width of the treatment electrode 61, and the line segment 151. In the line segment 152 that is perpendicular to the line segment 151 and the distance between the intersection point of the line segment 151 and the treatment electrode 61 is the maximum, the relationship between the length a of the line segment 151 and the length b of the line segment 152 is a> 2 · b. Meet.
[0036]
That is, for example, in a treatment electrode 161 having a semicircular shape similar to the conventional one as shown in FIG. 12, the relationship between the length a of the line segment 151 and the length b of the line segment 152 is a = 2 · b. In this embodiment, since a> 2 · b, the treatment electrode 61 of this embodiment has a shorter overall length than the treatment electrode 161, and discharge is generated with a smaller electric power. Even if it makes it, the area which can be treated by sweeping the treatment electrode 61 can be increased, and an efficient treatment can be performed.
[0037]
Note that the shape of the treatment electrode 61 is not limited to that shown in FIG. 11, and the length a of the line segment 151 and the length b of the line segment 152 need only satisfy the relationship of a> 2 · b. The shape shown in FIG.
[0038]
In addition, the treatment electrode 61 has a substantially semicircular shape. However, the treatment electrode 61 is not limited to this, and it is sufficient that the length a of the line segment 151 and the length b of the line segment 152 satisfy the relationship of a> 2 · b. For example, the shape shown in FIG. 14 or 15 may be used.
[0039]
Moreover, the electrode unit 14 having the treatment electrode 61 of FIGS . 11 to 15 can be disposed in the inner sheath 31 in a replaceable manner, and has the treatment electrode 61 having an appropriate shape with respect to the treatment portion. The electrode unit 14 can be selectively disposed in the inner sheath 31.
[0040]
FIG. 16 is a view for explaining the tip shape of the treatment electrode according to the second embodiment of the present invention.
[0041]
Since the second embodiment is almost the same as the first embodiment, only different points will be described, and the same components are denoted by the same reference numerals and description thereof will be omitted.
[0042]
As shown in FIG. 16 , the treatment electrode 61 of the present embodiment is formed such that the lower end portion having a substantially semicircular shape has a diameter φB larger than the diameter φA of the other portion and the lower end portion is thick.
[0043]
Therefore, in the present embodiment, in addition to the effects of the first embodiment, the diameter φB of the lower end portion of the substantially semicircular shape of the treatment electrode 61 is larger than the diameter φA of the other portions. Even if the affected part is excised by supplying a higher frequency current, the possibility of excision of the lower end portion of the treatment electrode 61 can be made equal to the possibility of excision of other parts.
[0044]
Wear due to excision at the lower end portion of the treatment electrode 61 makes the diameter of this portion thin and easily breaks, and the life of the treatment electrode 61 depends on the diameter of the lower end portion of the treatment electrode 61. In the embodiment, since the diameter φB is larger than the diameter φA of other portions, the life of the treatment electrode 61 can be extended.
[0045]
The present invention is not limited to the above-described embodiments, and various changes and modifications can be made without departing from the scope of the present invention.
[0046]
【The invention's effect】
As described above, according to the present invention, there is an effect that it is possible to perform treatment efficiently by discharging with smaller electric power.
[Brief description of the drawings]
FIG. 1 is a block diagram showing the configuration of a reject scope according to a first embodiment of the present invention. FIG. 2 is a side view showing the configuration of the reject scope shown in FIG. 1. FIG. FIG. 4 is an assembly diagram for explaining the configuration of the scope 1. FIG. 4 is a perspective view for explaining the configuration of an electrode unit inserted and arranged in the inner sheath of FIG. 3. FIG. FIG. 6 is a first diagram illustrating the operation of the treatment electrode of FIG. 4. FIG. 7 is a second diagram illustrating the operation of the treatment electrode of FIG. 4. FIG. FIG. 9 is a fourth diagram illustrating the operation of the treatment electrode of FIG. 4. FIG. 10 is a fifth diagram illustrating the operation of the treatment electrode of FIG. FIG. 12 is a diagram for explaining the tip shape of the treatment electrode. FIG. 12 is a diagram for explaining the tip shape of the first modification of the treatment electrode in FIG. FIG. 13 is a diagram for explaining a tip shape of a second modification of the treatment electrode of FIG. 4. FIG. 14 is a diagram for explaining a tip shape of a third modification of the treatment electrode of FIG. FIG. 16 is a diagram for explaining the tip shape of a fourth modification of the treatment electrode of FIG. 16. FIG. 16 is a diagram for explaining the tip shape of the treatment electrode according to the second embodiment of the present invention.
DESCRIPTION OF SYMBOLS 1 ... Rejectoscope 2 ... High frequency power supply device 3 ... Patient 4 ... Foot switch 5 ... Cable 7 ... Saline pack 8 ... Sterilization tube 11 ... Outer sheath 12 ... Scope 13 ... Handle part 14 ... Electrode unit 31 ... Inner sheath 61 ... Treatment electrodes 151, 152 ... Line segments

Claims (1)

High-frequency power generating means for generating high-frequency power capable of treating living tissue;
A first electrode capable of applying high-frequency power generated by the high-frequency power generating means to the living tissue;
A liquid feeding means for feeding a conductive solution around the electrode;
A second electrode disposed in the conductive solution fed by the liquid feeding means and for returning high-frequency power applied to the living tissue from the first electrode;
The first electrode includes two parallel parallel lead members and a treatment electrode connected to a tip of the parallel lead member,
A first line segment that is parallel to the surface on which the parallel lead member exists and has the maximum width of the treatment electrode, and an intersection of the first line segment perpendicular to the first line segment and the intersection of the treatment electrode in the second line segment distance is maximum, with satisfying the first segment of length a and length b of the second line segment a> 2 · b becomes relation, said treatment A rejectscope device characterized in that the diameter of the electrode is maximized at the intersection of the treatment electrodes of the second line segment .

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