JP4429522B2 - Receptoscope device - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a resectoscope apparatus 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]
For example, in Japanese Utility Model Publication No. 4-45694 as a reject scope, in order to prevent burning of the electrical insulating material, a hard heat resistance is provided so that the outer periphery of the wire is in close contact between the tip portion of the electrical insulating member and the wire. An electrode for a treatment instrument of a rigid endoscope having a member interposed therein is disclosed.
[0004]
When performing a procedure such as prostatectomy using the above-described resectoscope, the cavity is expanded by supplying D-sorbitol or the like, which is a transparent liquid having an insulating property, as a perfusate that expands the inside of the narrow cavity. Was inserted into the cavity.
[0005]
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. As a result, a current flows from the treatment electrode to the external electrode arranged outside the body through the liquid filled in the cavity by discharge, and the treatment electrode is advanced and retracted by the operation of the operation unit. Had gone.
[0006]
At this time, since the perfusate filled in the cavity is an insulating liquid, current distribution from the treatment electrode to the external electrode is prevented, and an efficient treatment can be performed.
[0007]
However, when a treatment is performed by filling the cavity with an insulating liquid, the operation time is increased because the liquid is absorbed into the blood vessels and the human body may be adversely affected due to the long treatment time. I was restricted.
[0008]
In order to cope with this problem, it is conceivable to fill the cavity with a perfusion solution such as physiological saline which is a conductive liquid. However, by filling the cavity with a conductive liquid, the treatment electrode can be replaced with an external electrode. Dispersion of the electric current that should flow toward the surface of the liquid disperses through the liquid, so that a discharge does not occur with respect to the lesion, and an effective treatment cannot be performed.
[0009]
Therefore, for example, in Japanese Patent Laid-Open No. 2000-201946, a body tissue is treated by using a high-frequency ablation current, which is disposed in the vicinity of the distal end of an elongated hollow sheath inserted into a body cavity filled with a conductive liquid. A treatment electrode, and a return electrode that is disposed in the conductive liquid and receives a current from the treatment electrode, and an insulating portion is provided on at least the body tissue non-contact surface side of the treatment electrode. Treatment in which the high-frequency current supplied to the treatment electrode disposed in the cavity filled with the liquid having the property does not leak into the liquid from the insulating portion provided on the non-contact surface side of the treatment electrode and enters the liquid We have proposed a rejectscope device that efficiently discharges from the body tissue contact surface of the electrode and flows toward the return electrode.
[0010]
[Problems to be solved by the invention]
However, since the disposition scope of the treatment electrode and the return electrode is short in the reject scope device of the above Japanese Patent Laid-Open No. 2000-201946, an excessive voltage may be caused if the current is accidentally energized in the atmosphere or in a non-conductive liquid. And there is a possibility that dielectric breakdown may occur between the electrodes.
[0011]
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 determine the electrical characteristics of perfusate and appropriately control the output.
[0012]
[Problems to be solved by the invention]
The rejectscope device of the present invention is configured to discharge a high-frequency current from a treatment electrode and a return electrode disposed in a conductive solution in a body cavity to the living tissue, and excise and coagulate the living tissue. A high-frequency current supply means for supplying the high-frequency current between the treatment electrode and the return electrode , and a resistance value around the treatment electrode and the return electrode when the treatment electrode and the return electrode are in a conductive solution. A threshold value set lower than a resistance value around the treatment electrode and the return electrode in a situation where the treatment electrode and the return electrode are in a non-conductive aqueous solution or in the atmosphere, and the treatment electrode and comparing means for comparing the resistance value in the vicinity of the return the treatment electrode was determined from the current value flowing between the electrodes and the return electrode, to a comparison result of the comparing means Hazuki constructed and control means for controlling the output of the high frequency current supply means.
[0013]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
[0014]
1 to 14 relate to an embodiment of the present invention, FIG. 1 is a configuration diagram showing a configuration of a reject scope device, FIG. 2 is a configuration diagram showing a configuration of treatment electrodes in FIG. 1, and FIG. 4 is a block diagram showing the configuration of the detection logic circuit of FIG. 3, FIG. 5 is a first diagram for explaining the operation of the connection detection circuit of FIG. 4, and FIG. FIG. 7 is a diagram showing the load characteristics of the power supplied from the output transformer circuit of FIG. 3, and FIG. 8 is a treatment by the power supplied from the output transformer circuit of FIG. FIG. 9 is a diagram for explaining the action of the electrode, FIG. 9 is a diagram showing a current flowing between the treatment electrode and the return electrode of FIG. 1 under a conductive liquid, and FIG. 10 is a treatment electrode and a return electrode of FIG. 1 under an insulating liquid. FIG. 11 is a diagram showing the current flowing between them, and FIG. 11 shows the treatment voltage of FIG. 1 under a conductive liquid and an insulating liquid. FIG. 13 is a diagram illustrating the resistance between the return electrode, FIG. 12 is a flowchart illustrating the operation of the rejectscope device of FIG. 1, FIG. 13 is a diagram illustrating a modification of the rejectscope device of FIG. It is a flowchart explaining the effect | action of a reject scope apparatus.
[0015]
As shown in FIG. 1, a reject scope apparatus 1 includes a hollow sheath 2 having a through-hole, a scope 3 for observing a lesioned part and the like, which is disposed in the hole of the sheath 2, and a treatment for the lesioned part. An electrode unit 4 provided with a treatment electrode 41 which is a wire-shaped electrode on the distal end side, a return electrode 45 disposed in the distal end hole of the sheath 2 and returning an output current from the treatment electrode 41, an operation unit And a high-frequency power supply device 7 that is a means for energizing a treatment electrode 41 of an electrode unit 4 to be described later and to which a feedback current from the return electrode 45 is fed back. It is configured. The on / off of power supply from the high frequency power supply device 7 to the treatment electrode 41 of the electrode unit 4 is controlled by a foot switch 75 connected to the high frequency power supply device 7.
[0016]
The sheath 2 is composed of, for example, an 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 a side peripheral portion of the hand main body portion 22. Is provided with a faucet 23 with a cock for feeding physiological saline having conductivity as a perfusate to the treatment section.
[0017]
The scope 3 and the electrode unit 4 are inserted and disposed in the insertion portion 21, and a distal end member formed of an insulating member such as a hard resin member at the distal end of the insertion portion 21. 24 is provided.
[0018]
The scope 3 is an elongated, rigid insertion tube 31 that is inserted into the insertion portion 21 and the distal end member 24 with a built-in observation optical system, and a proximal portion 32 that is disposed at the proximal end of the insertion tube 31. It consists of An eyepiece 33 for visual observation by an operator is provided at the proximal end of the hand 32, and a light guide (not shown) that supplies illumination light for observation to the observation site is provided on the side of the hand 32. There is provided a light guide connection portion 34 to which is detachably connected.
[0019]
As shown in FIGS. 1 and 2, the electrode unit 4 inserted and arranged in the insertion portion 21 includes a treatment electrode 41 formed on a distal end side and formed with a hard metal member in a loop shape, and the treatment electrode 41. A bifurcated arm member 43 having a rigid, through-holed one end portion that is fixedly held in a positional relationship with respect to the insertion axis of the scope 3 and a proximal end portion of the bifurcated arm member 43 is disposed at the distal end portion. It is mainly composed of an elongated metal pipe 44. The outer periphery of the metal pipe 44 is covered with an insulating tube (not shown), and the base end portion of the metal pipe 44 is exposed as an electrode connecting portion at the rear end portion of the insulating tube.
[0020]
The electrode unit 4 is disposed in the insertion portion 21 so as to be able to advance and retract, and the treatment electrode 41 is disposed so as to protrude and retract with respect to the distal end opening 25 of the sheath 2.
[0021]
The proximal end portion of the metal pipe 44 provided with the treatment electrode 41 and the bifurcated arm member 43 on the distal end side passes through the insertion portion 21 and the proximal body portion 22 and extends from the proximal end surface of the proximal body portion 22 to be described later. The slider 53 is arranged.
[0022]
The handle portion 5 is detachably connected to the proximal main body portion 22 of the sheath 2, and protrudes rearward from the rear end surface of the sheath connection portion 51 so that the insertion tube 31 is inserted therethrough. The guide pipe 52 and the substantially pipe-shaped slider 53 slidably held by the guide pipe 52 are mainly formed.
[0023]
The slider 53 is detachably provided with an electrode fixing portion 54 that is an electrical connection portion with the electrode connection portion that forms the rear end portion of the electrode unit 4 and a power cord 71 extending from the high-frequency power supply device 7. A high-frequency power connector 55 to be connected and a ring-shaped thumb hook ring 56 for hooking the operator's thumb are provided.
[0024]
The slider 53 and the sheath connecting portion 51 are connected via a leaf spring 57. That is, one end of the leaf spring 57 is fixed to a lever-shaped finger hook 58 integrally fixed to the sheath connecting portion 51, and the other end is fixed to the slider 53. Accordingly, the slider 53 is always urged toward the eyepiece 33 by the leaf spring 57.
[0025]
Accordingly, by appropriately operating the thumb ring 56 provided on the slider 53, the slider 53 is advanced and retracted, and the treatment electrode 41 of the electrode unit 4 is advanced and retracted from the distal end opening 25 of the sheath 2. It is supposed to move.
[0026]
A feedback current connector 26 to which a feedback current cord 72 extending from the high frequency power supply device 7 is detachably connected is provided on a side peripheral portion of the hand main body portion 22. The feedback current connector 26 and the return electrode 45 are electrically connected by, for example, a lead wire 46 shown by a solid line.
[0027]
On the other hand, the high frequency power connector 55 and the electrode fixing portion 54 are electrically connected by, for example, a lead wire 61 shown by a broken line. For this reason, by connecting the power cord 71 of the high frequency power supply device 7 to the high frequency power supply connector 55, the treatment electrode 41 of the electrode unit 4 is energized and the lesioned part can be treated. Note that the leakage current can be measured by obtaining the difference between the current value supplied to the treatment electrode 41 and the current value of the feedback current.
[0028]
Further, a slider positioning fixing member 62 is provided at the base end portion of the guide tube 52. The slider positioning fixing member 62 prevents the slider 53 from falling off the guide tube 52, and the guide The proximal portion 32 of the insertion tube 31 inserted into the tube 52 is integrally fixed to the slider positioning fixing member 62.
[0029]
The power cord 71 and the feedback current cord 72 are inserted into the connection cable 73 and are connected to the high frequency power supply device 7 by a connection connector (not shown) provided on the proximal end side of the connection cable 73.
[0030]
As shown in FIG. 3, the high-frequency power supply device 7 includes a control circuit 101 that receives a signal from the foot switch 75 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 a high-frequency voltage of the high-frequency power generated by the high-frequency generation circuit 103, applies the high-frequency voltage between the treatment electrode 41 and the return electrode 45, and supplies a high-frequency current to the treatment electrode 41; Current sensors 106a and 106b for detecting high-frequency currents and current sensors 106a and 106b. The sensor signal processing circuit 107 for A / D converting the detected current value and the state of the feedback current cord 72 and the connection state of a connection connector (not shown) provided on the proximal end side of the connection cable 73 are detected. The control circuit 101 is configured to control the power supply circuit 102 and the waveform circuit 104 based on the digitized current data from the sensor signal processing circuit 107 and the output of the detection circuit 108.
[0031]
As shown in FIG. 4, in the detection circuit 108, the return electrode 45 side of the output transformer circuit 105 is separated into two return lines R1 and R2 before output, and is output via a capacitor. The connection detection circuit 110 for detecting the connection state of a connection connector (not shown) provided on the base end side of the connection cable 73, and the resistance of the return electrode 45 by applying current to the two separated return lines R1 and R2. And a resistance detection circuit 113 for checking the disconnection of the two return lines R1 and R2.
[0032]
If the connection connector (not shown) provided on the proximal end side of the connection cable 73 is not connected based on the detection result of the connection detection circuit 110, the output is prohibited by the control of the control circuit 101, and before the device is used or When one or both of the two return lines R1 and R2 are found to be disconnected based on the detection result of the resistance detection circuit 113 during use, the output is stopped by the control of the control circuit 101 and a warning display and a warning sound are displayed on the operation panel. 109 is performed.
[0033]
As shown in FIGS. 5 and 6, the connection connector 121 provided on the base end side of the connection cable 73 is inserted into a connector receiver 123 provided on the exterior 122 of the high-frequency power supply device 7 formed of an insulating member. The exterior of the connector receiver 123 and the connection connector 121 is made of a conductive member such as metal. When the connection connector 121 is inserted into the connector receiver 123, the exterior of the connection connector 121 and the connector receiver 123 are electrically connected. Connected. In addition, a substantially L-shaped conductive leaf spring 124 is covered with an insulating member 125 and screwed in the vicinity of the inside of the exterior 122 of the high-frequency power supply device 7 of the connector receiver 123, and the connection connector 121 is screwed. When inserted, the recess 126 provided on the proximal end side of the connection connector 121 and the leaf spring 124 are electrically connected. The connection detection circuit 110 detects the conduction state between the connector receiver 123 and the leaf spring 124. When the connection connector 121 is inserted into the connector receptacle 123, the connector receptacle 123 and the leaf spring 124 become conductive. The connection of the connection connector 121 is detected.
[0034]
In the output transformer circuit 105, as shown in the load characteristics of FIG. 7, the control circuit 101 controls the power supply circuit 102 and the waveform circuit 104 so that the supplied power becomes maximum at the resistance R1 of the conductive liquid.
[0035]
With the power of the load characteristic of the output transformer circuit 105, the treatment electrode 41 of the reject scope 6 of the present embodiment is brought into contact with the living tissue 152 under the conductive liquid 151 as shown in FIG. When a high-frequency current is passed through the treatment electrode 41 in a state where the high-frequency current is applied, the high-frequency current flows between the treatment electrode 41 and the return electrode 45, and the treatment electrode 41 generates heat. As shown in FIG. When the conductive liquid 151 becomes a bubble 153 and covers the treatment electrode 41, the interelectrode resistance between the treatment electrode 41 and the return electrode 45 rises from the resistance R1, becomes a high resistance, and is in a substantially insulated state. The discharge rises between the treatment electrode 41 and the living tissue 152, and the treatment is performed while the living tissue is excised and coagulated by the high-frequency current generated by the discharge.
[0036]
As shown in FIG. 9, when the reject scope 6 of the present embodiment is used under the conductive liquid 151 such as physiological saline, the current flowing from the treatment electrode 41 is directly from the conductive liquid 151 as shown by the solid line. It consists of a current returning to the return electrode 45 and a current returning to the return electrode 45 via the living tissue 152 and the conductive liquid 151 in contact with the treatment electrode 41.
[0037]
Further, as shown in FIG. 10, even when the reject scope 6 of the present embodiment is used under the insulating liquid 161 such as D-sorbitol by mistake, the current flowing from the treatment electrode 41 is as shown by the broken line. It consists of a current returning directly from the insulating liquid 161 to the return electrode 45 and a current returning to the return electrode 45 via the living tissue 152 and the insulating liquid 161 in contact with the treatment electrode 41.
[0038]
However, as shown in FIG. 11, the resistance value differs between the resistance between the treatment electrode 41 and the return electrode 45 under the conductive liquid 151 and the resistance between the treatment electrode 41 and the return electrode 45 under the insulating liquid 161. In addition, since the treatment electrode 41 and the return electrode 45 are arranged close to each other, the energized voltage is increased when the energization is performed under the insulating liquid 161 with the electric power that can be energized under the conductive liquid 151, and the treatment electrode 41 and the return electrode are returned. There is a possibility that breakdown occurs between the electrodes 45 and the equipment is damaged.
[0039]
Therefore, in the present embodiment, a predetermined detection current is supplied from the output transformer circuit 105 with power that does not cause dielectric breakdown under the insulating liquid 161 or in the atmosphere, and the resistances of the treatment electrode 41 and the return electrode 45 are detected, and the detected resistances are detected. Based on this, it is determined whether the treatment electrode 41 and the return electrode 45 are in the conductive liquid 151, under the insulating liquid 161 or in the atmosphere.
[0040]
Specifically, when performing treatment using the rejectscope device 1 of the present embodiment, as shown in FIG. 12, when the foot switch 75 is turned on in step S1, first, the treatment electrode 41 is output before output. And a process of determining whether the return electrode 45 is in the conductive liquid 151 or under the insulating liquid 161 or in the atmosphere.
[0041]
That is, under the control of the control circuit 101, a predetermined detection current is passed from the output transformer circuit 105 at a power that does not cause dielectric breakdown in the output transformer circuit 105 in step S2 and the output stabilizes in step S3. In step S4, the sensor signal processing circuit 107 measures the current values detected by the current sensors 106a and 106b by A / D conversion.
[0042]
In step S5, the control circuit 101 compares the measured current data with a predetermined threshold value. When the current data is larger than the predetermined threshold value, that is, when the resistance is smaller than the predetermined value, the treatment electrode 41 and the return electrode are compared. 45 is in the conductive liquid 151, starts output from the output transformer circuit 105 with the power set in advance in step S6, starts treatment, and detects whether the foot switch 75 is turned off in step S7. If the foot switch 75 remains on, the process returns to step S6 and the output is continued. If it is detected that the foot switch 75 is turned off, the output is stopped in step S8 and the procedure is terminated.
[0043]
In step S5, if the current data is less than or equal to a predetermined threshold, that is, if the resistance is greater than or equal to a predetermined value, it is determined that the treatment electrode 41 and the return electrode 45 are under the insulating liquid 161 or in the atmosphere. In step S9, the circuit 101 prohibits output and performs a warning display and warning sound from the operation panel 109. In steps S10 and S11, the circuit 101 waits for the foot switch 75 to be turned off once and then to be turned on again. In step 12, the output is permitted and a reset process for stopping the warning display and warning sound is performed, and the process returns to step S2.
[0044]
As described above, in this embodiment, it is determined whether the treatment electrode 41 and the return electrode 45 are in the conductive liquid 151, the insulating liquid 161, or in the atmosphere before output, and the insulating liquid 161 or the atmosphere is discharged. Since the output is prohibited when it is inside, an excessive voltage is generated by accidentally conducting electricity in the atmosphere or in a non-conductive liquid, and dielectric breakdown is not caused between the electrodes.
[0045]
It should be noted that a detection current is passed between the treatment electrode 41 and the return electrode 45 to measure the current value, and whether the treatment electrode 41 and the return electrode 45 are in the conductive liquid 151, the insulating liquid 161 or in the atmosphere. As shown in FIG. 13, two return electrodes 45 are provided as shown in FIG. 13, and return lines R1 and R2 are connected to the two return electrodes 45a and 45b in step S21 as shown in FIG. Then, the resistance of the two return electrodes 45a and 45b is measured by the resistance detection circuit 113, and it is determined whether or not the resistance value measured in step S22 is smaller than a predetermined threshold value. It is determined that the electrode 45 is in the conductive liquid 151, the function current is set in step S23, and the process is terminated. Determines that the electrode 41 and the return electrode 45 is in the insulation liquid 161 or below atmospheric may be prohibited output at step S24.
[0046]
Further, a resistance detection electrode may be provided separately from the treatment electrode 41 and the return electrode 45.
[0047]
【The invention's effect】
As described above, according to the present invention, there is an effect that the electrical characteristics of the perfusate can be determined and the output can be appropriately controlled.
[Brief description of the drawings]
1 is a configuration diagram showing a configuration of a reject scope device according to an embodiment of the present invention. FIG. 2 is a configuration diagram showing a configuration of a treatment electrode in FIG. 1. FIG. 3 is a configuration of a high-frequency power supply device in FIG. FIG. 4 is a block diagram showing the configuration of the detection logic circuit in FIG. 3. FIG. 5 is a first diagram for explaining the operation of the connection detection circuit in FIG. 4. FIG. FIG. 7 is a diagram illustrating a load characteristic of power supplied from the output transformer circuit of FIG. 3. FIG. 8 is a diagram illustrating the action of the treatment electrode by the power supplied from the output transformer circuit of FIG. FIG. 9 is a diagram showing current flowing between the treatment electrode and the return electrode of FIG. 1 under a conductive liquid. FIG. 10 is a diagram showing current flowing between the treatment electrode and the return electrode of FIG. 1 under an insulating liquid. [FIG. 11] Between the treatment electrode and the return electrode in FIG. 1 under a conductive liquid and an insulating liquid. FIG. 12 is a flowchart illustrating the operation of the rejectscope device of FIG. 1. FIG. 13 is a diagram showing a modification of the rejectscope device of FIG. 1. FIG. Flow chart explaining the operation 【Explanation of symbols】
DESCRIPTION OF SYMBOLS 1 ... Rejectoscope apparatus 3 ... Scope 4 ... Electrode unit 6 ... Rejectoscope 7 ... High frequency power supply device 41 ... Treatment electrode 45 ... Return electrode 75 ... Foot switch 101 ... Control circuit 102 ... Power supply circuit 103 ... High frequency generation circuit 104 ... Waveform circuit 105 ... Output transformer circuit 106a, 106b ... Current sensor 107 ... Sensor signal processing circuit 108 ... Detection circuit 109 ... Operation panel

Claims (3)

A treatment electrode and a return electrode disposed in a conductive solution in the body cavity ;
A high-frequency current supply means for discharging the high-frequency current from the treatment electrode to the living tissue and supplying the high-frequency current between the treatment electrode and the return electrode so as to excise and coagulate the living tissue;
The resistance value in the vicinity of the treatment electrode and the return electrode when the treatment electrode and the return electrode are in a conductive solution is higher, and the treatment electrode and the return electrode are in a non-conductive aqueous solution or in the atmosphere. The resistance in the vicinity of the treatment electrode and the return electrode determined from the threshold value set lower than the resistance value in the vicinity of the treatment electrode and the return electrode in the situation A comparison means for comparing the values ;
And a control means for controlling the output of the high-frequency current supply means based on the comparison result of the comparison means. At least one of the treatment electrode and the return electrode is separated into two, and the comparison means includes measurement means for measuring a resistance value between the separated electrodes, and the comparison means uses the measured resistance value as the threshold value. The rejectscope device according to claim 1, wherein   A treatment electrode and a return electrode disposed in a conductive solution in the body cavity;
  A high-frequency current supply means for discharging the high-frequency current from the treatment electrode to the living tissue and supplying the high-frequency current between the treatment electrode and the return electrode so as to excise and coagulate the living tissue;
  The threshold value is higher than a resistance value around the treatment electrode and the return electrode in a state where the treatment electrode and the return electrode are in a conductive solution while being in contact with living tissue, and the treatment electrode and the return electrode A threshold value set lower than a resistance value around the treatment electrode and the return electrode in a state where the electrode is in a non-conductive aqueous solution while being in contact with the living tissue, and a current value flowing through the treatment electrode and the return electrode A comparison means for comparing the resistance value around the treatment electrode and the return electrode obtained from
  Control means for controlling the output of the high-frequency current supply means based on the comparison result of the comparison means;
  Rejectoscope device characterized by comprising:

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