JPH01151450A - Extracorporeal type lithotrite - Google Patents

Abstract

PURPOSE:To suitably locate a calculus to crush the same even when its position can not be detected by an ultrasonic wave without using an X-ray apparatus possibly having the exposure danger of X-rays, by mounting a shock wave generated by a shock wave generator to coincide with the detected position of the calculus. CONSTITUTION:After a calculus 2 is fixed by a catheter 3, an ultrasonic shock wave is emitted to the leading end of said catheter 3 from an ultrasonic shock wave generator 11 and the pressure thereof is detected by a pressure sensor 4 or 5 and the sound pressure thereof is measured by a shock pressure observation apparatus 13 through an amplifier 12. Then, the position where the outputs of the pressure sensors 4, 5 become max. is detected by a position detector 14 and the position of the calculus 2 present at the intermediate position thereof to be outputted to a position control apparatus 15. On the basis of this output signal, said position control apparatus 15 moves the shock wave generator 11 up and down, before and behind, and left and right through a shock wave generator moving apparatus 16 so as to allow the position of the calculus 2 to coincide with the converging point of the shock wave.

Description

[Detailed Description of the Invention] [Industrial Field of Application] The present invention is an extracorporeal lithotripter, more specifically, a shock wave generator that directs ultrasonic shock waves generated outside the body to affected areas such as stones inside the body. This invention relates to an extracorporeal lithotripter that performs intensive lithotripsy treatment.

[Prior Art] Generally, an extracorporeal lithotripter uses a shock wave generator, a stone position detection device using and a positioning device for adjusting the position. Among these, ultrasonic rock crushing equipment uses an ultrasonic shock wave generating body formed by arranging a large number of ultrasonic vibrators made of piezoelectric elements in a spherical mosaic pattern to an ultrasonic propagating liquid such as water. It is configured to contact the surface of the human body through a water bag filled with ultrasonic shock waves to focus ultrasonic shock waves on stones formed in the kidney, liver, gallbladder, bile duct, etc., and crush them. The ultrasonic shock waves are generated by applying a pulsed voltage to the ultrasonic vibrator. Furthermore, the location of the stone is confirmed using an X-ray device, an ultrasonic n1 device, or the like.

[Problems to be Solved by the Invention] However, the stone position detection means using an X-ray device in the conventional external lithotripter described above inevitably has an adverse effect on the human body due to X-ray exposure, and therefore it is not possible to use an ultrasonic observation device. However, because the screen of this ultrasound observation device is not clear, it is easy to miss small stones, especially lower ureteral stones.A.

As stated in U, A (American Urological Association) and other academic conference reports, it is almost impossible to detect the location.

Additionally, when treating multiple stones, the lower stones must be crushed first, and then the upper stones must be crushed. The crushed stone fragments may fall around the lower stone, making it difficult for the observation device to fix its position, and the fragments may overlap the lower stone, making it impossible for the energy of the shock wave to be effectively concentrated on the lower stone. It has been reported from clinical experience with extracorporeal shock wave lithotripters that this is the case.

That is, with the conventional ultrasonic lithotripter, it is not possible to individually differentiate a large number of adjacent stones, and therefore it is impossible to selectively crush stones from the lower level. Therefore, there is a problem in that stones may become stuck in the ureter, so-called "5tone 5treet", and as a result, fever etc. may occur.

Therefore, in view of the above-mentioned problems, it is an object of the present invention to
In addition, even if it is impossible to detect the position using ultrasound, it is possible to appropriately capture and crush stones, and even in the treatment of large numbers of stones in close proximity, it is possible to prevent stone retention in the ureter etc. after crushing. There are no external lithotripsy devices available.

c.Means and effects for solving the problems The present invention has the following features:
In order to achieve the above purpose, an extracorporeal lithotripter that performs treatment by focusing ultrasonic shock waves generated outside the body by a shock wave generator toward the affected area of the body, such as stones, is inserted into the body cavity to the treatment site. a stone capturing means provided at the distal end of the catheter; and a stone capturing means provided in the catheter near the capturing means,
a pressure sensor for detecting the pressure of the ultrasonic shock waves generated by the shock wave generator; a means for detecting a stone position based on a signal from the pressure sensor; The present invention is characterized by comprising a control means for aligning the focal points of the generated ultrasonic shock waves.

[Example] Hereinafter, the present invention will be explained based on illustrated embodiments.

FIG. 1 is a schematic diagram showing the overall configuration of an extracorporeal lithotripter according to a first embodiment of the present invention, and FIG. 2 is an enlarged sectional view of a catheter in the extracorporeal lithotripter shown in FIG. 1. . 1st. In FIG. 2, 1 is a human body, 2 is a stone in the human body, 3 is a catheter, 4 and 5 are piezoelectric pressure sensors provided at the tip of the catheter 3, and 6 and 7 are pressure sensors 4, 5. Balloons 8 are disposed in the catheter 3 and are fluid passages for inflating the balloons 6 and 7. Balloons 8 are provided adjacent to each other on the rear and front sides, and are fluid passages for the same fluid. A check valve provided on the proximal side of the passage, 10 a connector for the catheter 3, 11 an ultrasonic shock wave generator, 12 an amplifier, 13 an impact pressure observation device, 14 a position detection device, 15 a position control device, 16 is a shock wave generator moving device, 17 is a powerful ultrasonic drive circuit, and 18 is a water bag filled with an ultrasonic transmission medium 19 such as water.

The pressure sensors 4 and 5 are made of a cylindrical piezoelectric material such as P, V, D, F (polyvinylidene fluoride), as shown in FIG.
Ultrasonic shock waves converging at each position in the movement range indicated by dotted chain lines 20 and 21 are detected. The ultrasonic shock wave generator 11 is a well-known device in which a large number of ultrasonic transducers made of piezoelectric elements are arranged in a spherical mosaic pattern, and is driven by the powerful ultrasonic drive circuit 17. Ultrasonic shock waves are focused on a focal point F of the spherical shell. A water bag 18 made of soft resin or the like is placed between the ultrasonic shock wave generator 11 and the human body 1 and filled with an ultrasonic transmission medium 19 such as water.

The extracorporeal lithotripter of this embodiment configured as described above operates as follows. First, the catheter 3 is inserted into the body cavity of the human body 1 in which the stone 2 is located through a channel of an endoscope (not shown). Next, under optical observation using an endoscope, the catheter 3 is manipulated so that the stone 2 is located between the balloons 6 and 7. Next, an inflation liquid is injected into the balloon 6.7 through the fluid passage 8 using a syringe (not shown) or the like, and the balloon 6.
．． The calculus 7 is inflated and brought into close contact with the inner wall of the body cavity, so that the calculus 2 is immobilized at an intermediate position.

After fixing the stone 2 with the catheter 3 in this way,
An ultrasonic shock wave is emitted from the ultrasonic shock wave generator 11 toward the tip of the catheter 3, the pressure of the shock wave is detected by the pressure sensor 4 or 5, and the pressure of the shock wave is detected by the shock pressure observation device 13 via the amplifier 12. Measure sound pressure. and,
The position detecting device 14 detects the positions where the outputs of the pressure sensors 4 and 5 are maximum, calculates the position of the stone 2 located in the middle, and outputs this to the position controlling device 15. Based on this output signal, the same position control device 15 moves the shock wave generator 11 up and down, back and forth, right and left, through the shock wave generator moving device 16, so that the position of the calculus 2 and the focal point of the shock wave coincide. move it to When the focal point of the shock wave moves away from the position of the calculus 2, the above operation is repeated to achieve continuous focusing.

In addition, in order to detect the location of a calculus before focusing for the first time, the output of the ultrasonic shock wave is lowered to a level that does not have the same effect on other biological tissues, and the ultrasound is used to detect the location of the stone.

In this way, the extracorporeal lithotripter of this embodiment selectively crushes only the stones placed in the front and rear balloons without using any X-ray equipment that has a negative effect on living tissue. This allows stones to be crushed from the lower part of the ureter, eliminating the possibility of stones remaining in the body cavity.

FIG. 3 is a side view of a catheter in an extracorporeal lithotripsy device showing a second embodiment of the present invention. This extracorporeal lithotripter has almost the same structure as the extracorporeal lithotripter shown in FIG. 1 above, except for the catheter as a stone capture means, so the same components will be simply given the same reference numerals and their explanations will be given below. Omitted.

In the extracorporeal lithotripter in this embodiment, the first
The only difference is that the catheter 3 for capturing the stone 2 in the extracorporeal lithotripter shown in the figure is constituted by a basket catheter 23. The above basket catheter 2
The basket 24 of No. 3 is provided between the pressure sensors 4 and 5, and is capable of capturing the stone 2.
Similar to the extracorporeal lithotripter in the first embodiment, the focal point of the ultrasonic shock wave and the stone 2 can be aligned. In addition, in FIG. 3, the reference numeral 25 indicates the operation section of the basket.

The extracorporeal lithotripter equipped with the basket catheter 23 configured as described above captures the stone 2 in the basket 24, crushes the stone 2 using a shock wave, and crushes the stone 2.
can be easily removed from the body by the basket 24. The basket catheter 23 of this embodiment cannot be pulled out when it cannot be used alone endoscopically to crush or remove stones, for example, when the stones are too large, or because they are adhered to the body cavity wall. This is particularly effective in such cases.

FIG. 4 is a sectional view of a catheter in an external lithotripter showing a third embodiment of the present invention. This catheter 31
The catheter 3 has substantially the same structure as the catheter 3 in the first embodiment shown in FIG. 2 above, except for a part of the structure. Therefore, the same reference numerals are given to the same constituent members, and the explanation thereof will be omitted. Catheter 3 in this example
In addition to the balloon inflation fluid passage 8, another stone dissolving agent supply passage 32 is provided in parallel with the balloon inflation fluid passage 8, and the tip of the supply passage 32 is connected to the balloon 6 of the catheter 31. A spout 33 provided on the outer peripheral surface between .
The rear end is connected to a stone dissolving agent injection port 34 provided on the connector 10 side. The rest of the structure is exactly the same as the catheter 3 of the first embodiment shown in FIG. 2 above.

Catheter 31 in this embodiment configured in this way
also acts in exactly the same way as the catheter 3 in FIG. 2, and after capturing the stone 2 between the balloons 6.7,
From the injection port 34 to the supply passage 32. If a stone dissolving agent is injected through the spout 33 and then an ultrasonic shock wave is applied, the effect of stone crushing and removal can be further improved by using the dissolving agent together.

[Effects of the Invention] As explained above, according to the present invention, since a catheter equipped with a pressure sensor is used as a stone positioning means, (1) the stone position cannot be detected by conventional ultrasonic observation means; Lithotripsy treatment can be performed even in these cases.

(2) Since only the stones captured by the catheter can be selectively crushed, there is no risk that the stones will remain in the body cavity after the stones are crushed and cured by extracorporeal shock waves.

(3) The structure is much simpler than conventional observation devices such as X-rays and ultrasonic waves dedicated to extracorporeal lithotripters.

In addition to solving the problems of conventional extracorporeal lithotripters, it is possible to provide a more convenient extracorporeal lithotripter.

[Brief explanation of the drawing]

1 is a schematic diagram showing the overall configuration of an extracorporeal lithotripter according to a first embodiment of the present invention; FIG. 2 is an enlarged sectional view of a catheter in the extracorporeal lithotripter shown in FIG. 1; FIG. 4 is a side view of a catheter in an extracorporeal lithotripter according to a second embodiment of the present invention, and FIG. 4 is a sectional view of a catheter in an extracorporeal lithotripter according to a third embodiment of the present invention. １・・・・・・・・・・・・・Human body 2・・・・・・
・・・・・・・・・ Stone 3.23.31・・・・・・
・Catheter 4.5・・・・・・Pressure sensor

Claims (1)

[Claims] Ultrasonic shock waves generated outside the body by a shock wave generator,
An extracorporeal lithotripter that concentrates treatment on affected areas such as stones in the body, which includes: a catheter inserted to the treatment site in the body cavity; a stone capture means provided at the tip of the catheter; a pressure sensor provided near the capturing means for detecting the pressure of the ultrasonic shock waves generated by the shock wave generator; and means for detecting a stone position based on a signal from the pressure sensor; An extracorporeal lithotripter comprising: control means for aligning the focal point of the ultrasonic shock waves generated by the shock wave generator with the location of the stone that has been removed.