JPH1080429A - Ultrasonic medical treatment device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To enable guiding the movement of an ultrasonic vibrator part without crushing an acoustic cap by the tightening force of an anus sphinctor at the time of inserting a probe from an anus to the rectum. SOLUTION: The ultrasonic vibrator part 12 is provided inside the inserting part of the probe 1, a hard shaft 23 for transmitting movement to the ultrasonic vibrator 12 is linked to the part 12 and a hard pipe part 18 to be engaged with the acoustic cap 19 is provided in the periphery of the ultrasonic vibrator part 12. Then, a guide ring 25 is provided, which supports the hard shaft 23 while being brought into contact with the inner surface of the hard pipe part 18 with the movement of the hard shaft 23.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an intra-cavity ultrasonic treatment apparatus for performing an ultrasonic treatment by inserting a probe having an ultrasonic transducer disposed at a distal end into a body cavity.

[0002]

2. Description of the Related Art In an intracavity ultrasonic therapy apparatus of this type, a diagnostic ultrasonic vibration element and a therapeutic ultrasonic vibration element are integrally backed in an acoustic cap at a distal end of a probe inserted into a body cavity. Japanese Patent Laid-Open Publication No. Sho 6 discloses an ultrasonic treatment apparatus in a body cavity in which an ultrasonic vibration element section is provided, and the ultrasonic vibration element section is radially rotated by a motor.
It is known from JP-A-2-127050.

[0003]

In the above-mentioned prior art, the acoustic cap is easily broken by the tightening force of the anal sphincter. Further, there is no one that supports a flexible shaft that transmits motion to the ultrasonic vibration element unit. As a result, there is a possibility that the axis of the flexible shaft fluctuates with the rotational movement or the linear movement, and an accurate diagnostic ultrasonic image cannot be obtained. In addition, if the axis of the flexible shaft fluctuates, the focus of the therapeutic ultrasonic wave cannot be accurately adjusted to the treatment position.

The present invention has been made in view of the above-mentioned problems, and an object of the present invention is to prevent the acoustic cap from being crushed by the tightening force of the anal sphincter when the probe is inserted into the rectum from the anus. An object of the present invention is to provide an intra-body cavity ultrasonic treatment apparatus capable of guiding the movement of a sound wave transducer unit.

[0005]

According to the ultrasonic therapy apparatus of the present invention, an ultrasonic vibrator is provided in an insertion portion of a probe, and a rigid shaft for transmitting motion to the ultrasonic vibrator is connected to the ultrasonic vibrator. Then, an acoustic cap is provided around the ultrasonic vibrator, and a rigid pipe is provided for fitting the acoustic cap. The rigid pipe moves along with the inner surface of the rigid pipe with the movement of the rigid shaft. A guide ring member for supporting the ultrasonic vibrator is provided.

[0006]

BEST MODE FOR CARRYING OUT THE INVENTION

<First Embodiment> A first embodiment of the present invention will be described with reference to FIGS. (Construction) The ultrasonic therapy apparatus according to the present embodiment inserts a probe insertion portion into the rectum from the anus to treat prostatic hypertrophy.

[0007] This ultrasonic therapy apparatus displays a three-dimensional diagnostic ultrasonic image on a monitor, designates a treatment site on the monitor image, and irradiates a therapeutic ultrasonic wave to the affected part from a therapeutic ultrasonic transducer. Then, the affected part such as a tumor is ultrasonically cauterized. FIG. 1 is an external view showing a schematic configuration of a system of the ultrasonic therapy apparatus. The ultrasonic therapy apparatus is roughly divided into a probe 1, a probe holder 2, and a monitor 3.
And a keyboard 4 as an input operation means, a therapeutic ultrasonic signal oscillator 5, an ultrasonic signal amplifier 6, an ultrasonic observation device 7, a probe cooling system 8, and a foot switch 9.

As will be described later, the probe 1 has an ultrasonic vibrator section 12 in which a therapeutic ultrasonic vibrator 10 and a diagnostic ultrasonic vibrator 11 are bonded to each other to form a unit as an integrated unit. A drive unit 14 for radially rotating (rotating about the center axis of the insertion unit 13) and linearly moving (moving on the center axis of the insertion unit 13) the ultrasound transducer unit 12; Transmission cable 15
Consists of

The transmission cable 15 is provided with a treatment cable 15a connected to the ultrasonic signal amplifier 6 and a diagnostic cable 15b connected to the ultrasonic observation device 7.

The probe 1 is supported and fixed by a probe holder 2. The probe holder 2 can change the direction of the probe 1 and has a function of supporting and fixing the probe 1 at a selected position.

The therapeutic ultrasonic signal oscillator 5 oscillates a therapeutic ultrasonic signal. A foot switch 9 is connected to the ultrasonic signal oscillator 5. When the operator steps on the foot switch 9, a therapeutic ultrasonic signal is oscillated,
When released, oscillation of the signal is stopped.
The ultrasonic signal amplifier 6 amplifies the therapeutic ultrasonic signal oscillated by the ultrasonic signal oscillator 5 and transmits the amplified signal to the therapeutic ultrasonic transducer 10.

The ultrasonic observation device 7 is a diagnostic ultrasonic transducer 1
1 while transmitting a drive pulse, and constructing a diagnostic ultrasonic image from the echo signals obtained by the diagnostic ultrasonic transducer 11,
The ultrasonic image is displayed on the monitor 3 as shown in FIG.

The probe cooling system 8 includes the probe 1
A cooling water is supplied to the insertion portion 13 of the probe 1 to cool the insertion portion 13 of the probe 1 and to maintain the temperature of the organ contacting surface in the insertion portion 13 lower than the protein denaturation temperature of the living body. A pump and a cooling water tank (not shown) are installed in the probe cooling system 8. Then, the cooling water put in the cooling water tank is fed into the insertion portion 13 by a pump via a water feeding tube 8a, and is returned to the inside of the insertion portion 13 through a suction tube 8b. Is to be returned to.

The insertion section 13 of the probe 1 is configured as shown in FIG. The insertion portion 13 includes a distal end portion 16 and a rigid portion 17 having a smaller diameter. And the tip 16
Has a hard pipe portion 18 and a hard polyethylene cap 19 fitted on the hard pipe portion 18, and the ultrasonic vibrator portion 12 is housed in a region inside the hard pipe portion 18.

As shown in FIG. 2, the ultrasonic vibrator 1
2 has a rotor body member 12a, and the rotor treatment ultrasonic transducer 10 and the diagnostic ultrasonic transducer 11 are arranged in a back-to-back direction with respect to the rotor body member 12a to be integrated. It is configured to be attached. The therapeutic ultrasonic transducer 10 includes a circular concave-shaped therapeutic piezoelectric element 20 and a housing 21. The therapeutic signal line 22a is connected to the therapeutic piezoelectric element 20. The signal line 22a is connected to the ultrasonic signal amplifier 6 via the drive unit 14 and the treatment cable 15a. Also, the ultrasonic transducer for diagnosis 1
1 is connected to a diagnostic signal line 22b. The signal line 22b is connected to the ultrasonic observation device 7 via the drive unit 14 and the diagnostic cable 15b.

The ultrasonic vibrator section 12 is connected to the tip of the rigid shaft 23 by attaching the rotor body member 12a coaxially to the tip of the rigid shaft 23.
Then, the ultrasonic vibrator section 12 is radially rotated by the drive section 14 (the insertion section 13) through the rigid shaft 23.
(Rotation about the center axis of the insertion part)
On the center axis of the motor) is performed as described later.

As shown in FIG. 1, an opening 24 is formed in a part of a side peripheral wall portion of the hard pipe portion 18 covered with a hard polyethylene cap 19. Then, diagnostic ultrasonic waves / treatment ultrasonic waves oscillated by the ultrasonic vibrator unit 12 are irradiated from the opening 24 toward the organ. The radial angle of view of the diagnostic ultrasonic image is determined by the length of the opening 24 in the circumferential direction. The axial length of the opening 24 is determined according to the linear advance / retreat distance of the ultrasonic vibrator unit 12. The opening 24 in this embodiment is opened vertically upward when the probe 1 is placed horizontally.

The rigid pipe section 18 of the tip section 16 has the following two functions. First, when the distal end portion 16 is inserted into the rectum from the anus, there is a role of preventing the rigid polyethylene cap 19 from being crushed by the tightening force of the anal sphincter. Secondly, a guide ring 25 attached to the ultrasonic vibrator part 12 is in contact with the inner surface of the rigid pipe part 18, and the radial rotation movement of the ultrasonic vibrator part 12 about the center axis of the insertion part 13 and the insertion It has a role of guiding a linear forward / backward movement that moves on the central axis of the section 13. The guide ring 25 is provided with a plurality of holes 25a for passing cooling water.

FIG. 3 is a block circuit diagram of the ultrasonic therapy apparatus according to the present embodiment. Circuits installed in the ultrasonic observation device 7 are surrounded by alternate long and short dash lines. The therapeutic signal line 22a connected to the therapeutic ultrasonic transducer 10 and the diagnostic signal line 22b connected to the diagnostic ultrasonic transducer 11 are provided in the drive unit 14 via the inside of the rigid shaft 23. Connected to the slip ring 26. The rigid shaft 23 is connected to a DC motor 28 in the drive unit 14 via a slip ring 26 and a radial position detection unit 27.
The DC motor 28 has a linear advance / retreat mechanism 29 in the drive unit 14.
It is installed in.

The DC motor 28 is connected to a rotation control circuit 30. Further, the linear advance / retreat mechanism 29 is connected to the linear direction position detector 31 and the linear advance / retreat control circuit 32.

The radial direction position detecting section 27 and the linear direction position detecting section 31 output position signals indicating the positions of the ultrasonic transducer section 12 in the radial direction and the linear direction, and are connected to the system control circuit 33. I have.

The therapeutic ultrasonic transducer 10 passes through the therapeutic signal line 22a and the slip ring 26,
5, the ultrasonic signal amplifier 6 through the therapeutic cable 15a
Connected to. The ultrasonic signal amplifier 6 is connected to the therapeutic ultrasonic signal oscillator 5. A foot switch 9 is connected to the therapeutic ultrasonic signal oscillator 5.

The diagnostic ultrasonic transducer 11 passes through the diagnostic signal line 22b and the slip ring 26, and then passes through the diagnostic cable 15b of the transmission cable 15.
Is connected to the transmission / reception circuit 34 inside. The transmission / reception circuit 34 is connected to a memory 37 via a signal processing unit 35 and an analog / digital (A / D) converter 36. Memory 37 is 3
A digital signal processor (DSP) 38 for performing two-dimensional image processing, and further via a digital / analog converter (D / A) 39, a video signal creating unit 40
It is connected to the. The output terminal of the video signal creation unit 40 is connected to the monitor 3.

The control input terminal of the transmitting / receiving circuit 34 is connected to the system control circuit 33. The system control circuit 33 is connected to the rotation control circuit 30 and the linear advance / retreat control circuit 32,
The drive unit 14 is operated by them, and the ultrasonic vibrator unit 1 is operated.
2 to control the radial rotational movement and the linear forward / backward movement.
Then, a moving means for moving the therapeutic ultrasonic vibrator 10 and the diagnostic ultrasonic vibrator 11 in conjunction with each other is configured,
It constitutes exercise stopping means for stopping those exercises. When stopping the radial rotational movement of the ultrasonic transducer unit 12, the system control circuit 33 lowers the rotation speed of the DC motor 28 from that at the time of constructing the diagnostic ultrasonic image, and then controls the rotation control circuit 30 to rotate the DC motor 28. A stop signal is output.

(Operation) Hereinafter, the operation of the ultrasonic treatment apparatus having the above-described configuration will be described. (1) Preoperative work Insert the insertion part 13 of the probe 1 into the rectum from the anus of a patient lying on the bed in a supine position. At this time, cooling water is circulated in the insertion section 13 by the probe cooling system 8. The ultrasonic vibrator section 12 is located on the distal end side of the distal end section 16 of the insertion section 13 (the state shown in FIG. 1).

(2) Construction of Ultrasound Image for Diagnosis When the operator operates the keyboard 4 to instruct the start of construction of an ultrasound image for diagnosis, the transmission / reception circuit 34 receives a control signal from the system control circuit 33 to Outputs drive pulse. At this time, the rotation control circuit 30 causes the DC motor 28 to rotate at a high speed, and integrally and radially rotates the ultrasonic vibrator unit 12 attached to the rigid shaft 23. A drive pulse is supplied to the diagnostic ultrasonic transducer 11 via the slip ring 26 and the diagnostic signal line 22b.

Therefore, the diagnostic ultrasonic transducer 11 is driven in response to the driving pulse to oscillate ultrasonic waves. The diagnostic ultrasonic wave / therapeutic ultrasonic wave oscillated from the ultrasonic vibrator section 12 is irradiated from the opening 24 toward the organ. The ultrasonic waves radiated to the living body are reflected by surfaces of the living body having different acoustic impedances, and enter the diagnostic ultrasonic transducer 11 as reflected echoes. And the diagnostic ultrasonic transducer 1
1 outputs an echo signal representing a radial tomographic image corresponding to the reflected echo. This echo signal is transmitted to the diagnostic signal line 22b.
Is input to the transmission / reception circuit 34 via the slip ring 26. The output of the transmission / reception circuit 34 passes through a signal processing unit 35 and an analog / digital converter 36,
3 as radial tomographic image data at the forefront of
7 is supplied.

Next, the linear advance / retreat control circuit 32 operates the linear advance / retreat mechanism 29 to move the ultrasonic vibrator section 12 toward the drive section 14 (hand side) on the center axis of the insertion section 13 at a predetermined pitch. Let it. Then, as shown in FIG. 4, radial tomographic image data is acquired for each movement, and the data is transferred to the memory 37. The radial tomographic image data at different linear directions stored in the memory 37 is a DSP
38 performs three-dimensional image processing. This DS
The image data processed in P38 is displayed on the monitor 3 as a diagnostic ultrasonic image via the digital / analog converter 39 and the video signal creating unit 40.

In this embodiment, as shown in FIG. 5, the ultrasonic image displayed on the monitor 3 is not a three-dimensional stereoscopic image.
Radial tomographic image (semicircular display, the angle of view of which corresponds to the length of opening 24 in the circumferential direction) 41 and linear tomographic image 42
It is displayed every time. In the radial tomographic image 41, the index 43
Is displayed as the linear tomographic image 42. Further, the cross section at the position where the index 44 is located in the linear tomographic image 42 is displayed as the radial tomographic image 41.

(3) Positioning of Ultrasonic Transducer for Treatment The operator looks at the diagnostic ultrasonic image displayed on the monitor 3 and confirms that the affected part 45 is depicted. Affected part 4
When 5 is not drawn, the position of the probe 1 is adjusted and fixed so that the affected part 45 is drawn by adjusting the probe holder 2. After confirming the affected part 45, the operator proceeds to the operation of specifying the treatment position.

A. Positioning of treatment position in linear direction First, the operator specifies a treatment position on the linear tomographic image 42. On the linear tomographic image 42, the ultrasonic transducer for treatment 1
An index 44 indicating a linear position of 0 is displayed.
Therefore, the surgeon operates the keyboard 4 to give a command to move the index 44 to a desired treatment position. The position signal in the linear direction corresponding to the position of the index 44 is
It is transmitted to the system control circuit 33. The system control circuit 33 outputs a control signal to the linear advance / retreat control circuit 32.
The linear advance / retreat control circuit 32 operates the linear advance / retreat mechanism 29 to move the therapeutic ultrasonic transducer 10 to a linear position corresponding to the position signal.

B. Positioning of Radial Treatment Position Next, the operator designates a treatment position on the radial tomographic image 41. On the radial tomographic image 41, a treatment position indicating index 46 is displayed at the focal position of the therapeutic ultrasonic transducer 10, and the index 46 can move on the circumference of the focal position. The operator operates the keyboard 4 to move the index 46 to a desired treatment position. Then, a radial position signal corresponding to the position of the index 46 is transmitted to the system control circuit 33. Then, the operator operates the therapeutic ultrasound transducer positioning switch (not shown) on the keyboard 4.
When is pressed, the system control circuit 33 outputs a control signal to the rotation control circuit 30 to rotate the DC motor 28. At this time, the rotation control circuit 30 rotates the DC motor 28 at a lower rotation speed than when constructing the diagnostic ultrasonic image. After that, the system control circuit 33 sends the DC to the rotation control circuit 30.
A signal for stopping the rotation of the motor 28 is output.

[0033] The rotation stop signal indicates that when the power supply to the DC motor 28 is stopped and an excessive rotation due to overrun occurs, the therapeutic ultrasonic vibrator 10 is just at the designated position.
Is output at such a timing as to stop. That is, overrun control is performed.

When the rotation control circuit 30 receives the rotation stop signal, it stops supplying power to the DC motor 28. Since the DC motor 28 is not supplied with power,
Stop rotation. At this time, due to the inertia of the rotating body, the DC motor 28 slightly rotates even after the power supply is stopped,
Overrun occurs. However, the system control circuit 3
3 outputs a rotation stop signal in anticipation of this overrun, and stops when the rotation stop position of the DC motor 28, that is, the position of the therapeutic ultrasonic transducer 10 matches the designated position. Since the movement speed of the ultrasonic vibrator section 12 is reduced and then stopped by the movement stopping means, the influence of the inertia of the rotating body is small, the overrun is small, and the ultrasonic vibration is accurately stopped at the designated position.
The system control circuit 33 displays on the monitor 3 that the positioning of the therapeutic ultrasonic transducer 10 has been completed.

(4) Irradiation of therapeutic ultrasonic waves and confirmation of therapeutic effect After confirming the display of completion of positioning on the monitor 3, the operator steps on the foot switch 9 and operates the therapeutic ultrasonic signal oscillator 5.
Thus, a therapeutic ultrasonic signal is output. This signal is amplified by the ultrasonic signal amplifier 6 and transmitted to the therapeutic ultrasonic transducer 10 via the slip ring 26 and the therapeutic signal line 22a. In response to this signal, the therapeutic ultrasonic transducer 10 emits therapeutic ultrasonic waves toward the affected part 45. This irradiation is continued while the operator steps on the foot switch 9. When the operator stops stepping on the foot switch 9, irradiation of the therapeutic ultrasonic wave stops, and a radial tomographic image 41 of the treatment site is captured. The operator observes the radial tomographic image 41 after the irradiation of the therapeutic ultrasonic waves displayed on the monitor 3 and confirms whether or not the desired treatment has been performed.

If it is considered that the therapeutic effect is low, the positioning of the therapeutic ultrasonic transducer 10 and the irradiation of the therapeutic ultrasonic wave are repeated until a desired therapeutic effect is obtained. When another position is to be treated, the position to be treated is specified again, the treatment ultrasonic transducer 10 is positioned, and treatment is performed by irradiating the treatment ultrasonic wave.

In this embodiment, the ultrasonic vibrator unit 1
The DC motor 28 is used as a means for radially rotating the motor 2. However, even when a stepping motor is used, if the inertia of the radial rotation is large, an overrun may occur even in the stepping motor. The positioning control method of the acoustic transducer 10 can be applied. The means for reducing the moving speed of the ultrasonic vibrator section 12 described above may be a means for directly lowering the rotation speed of the DC motor 28 or changing the gear ratio for transmitting power from the DC motor 28 to the ultrasonic vibrator section 12. Good. As means for stopping the movement, in addition to on / off control of the power supply to the DC motor 28, a case where control for forcibly reducing the rotation in the radial direction by an electromagnetic brake or the like is also applicable.

(Effect) Since the rigid pipe portion 18 is provided inside the cap 19 at the distal end portion 16 of the probe 1, the cap 19 is prevented from being collapsed by the tightening force of the anal sphincter when the probe 1 is inserted into the rectum from the anus. I do.
Further, the guide ring 25 is in contact with the inner surface of the rigid pipe portion 18 so that the moving ultrasonic vibrator portion 12 can be centered. In addition, since the positioning of the therapeutic ultrasonic transducer is performed by setting the rotation speed of the motor to be low, overrun of the motor and its variation are reduced, and the number of repetitions of positioning of the therapeutic ultrasonic transducer is reduced. Time and physical and physical burdens on the surgeon / patient are reduced.

[Supplementary Notes] (1) An ultrasonic vibrator section provided inside the probe insertion section and having a diagnostic ultrasonic vibrator and a therapeutic ultrasonic vibrator fixed back to back, and fixed to the ultrasonic vibrator section A rigid shaft that transmits to the ultrasonic vibrator part at least one of a radial rotational movement about the central axis of the insertion portion and a linear advance / retreat movement moving on the central axis of the insertion portion, An acoustic cap provided on the insertion portion and covering at least the periphery of the ultrasonic vibrator portion, a hard pipe member provided on the insertion portion and covered with the acoustic cap, and provided in the hard pipe member, A guide ring member that supports the ultrasonic vibrator section while being in contact with the inner surface of the hard pipe member with the movement of the rigid shaft, and the ultrasonic vibrator section via the rigid shaft A rotating means for radially rotating the insertion portion about the center axis, and a rotation stopping means for stopping the rotation of the rotating means, the rotational speed of the rotating means is reduced when positioning the therapeutic ultrasonic transducer. An intracorporeal ultrasonic treatment apparatus characterized in that the rotation stopping means is operated from the beginning.

An ultrasonic therapy apparatus characterized by comprising: (2) The ultrasonic treatment apparatus according to (1), wherein the guide ring member supports a holding member of the ultrasonic transducer unit.

[0041]

As described above, according to the present invention, when the probe is inserted into the rectum from the anus, the acoustic cap is not crushed by the tightening force of the anal sphincter, and the movement of the ultrasonic vibrator is suppressed. Since the guide can be guided by the guide ring member, the motion of the ultrasonic vibrator is stabilized.

[Brief description of the drawings]

FIG. 1 is an external view of a system of an intra-body cavity ultrasonic treatment apparatus used in a first embodiment.

FIG. 2 is a longitudinal sectional view of an insertion part of a probe connected to the intracavity ultrasonic therapy apparatus used in the first embodiment.

FIG. 3 is a block circuit diagram of the intracavity ultrasonic therapy apparatus used in the first embodiment.

FIG. 4 is an explanatory diagram of a method for constructing a diagnostic ultrasonic image of the intracavity ultrasonic therapy apparatus used in the first embodiment.

FIG. 5 is a diagnostic ultrasonic image of the intracavity ultrasonic treatment apparatus used in the first embodiment.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Probe, 3 ... Monitor, 7 ... Ultrasonic observation device, 9
... Foot switch, 10 ... Ultrasonic transducer for treatment, 11 ...
Diagnostic ultrasonic transducer, 12 ultrasonic transducer section, 13 insertion section, 14 drive section, 24 opening, 28 DC motor, 27 radial position detection section, 29 linear advance / retreat mechanism, 33 System control circuit, 34 transmission / reception circuit, 3
5: signal processing unit, 37: memory, 38: digital signal processor.

Claims (1)

[Claims] 1. An ultrasonic vibrator provided in an insertion portion of a probe, a rigid shaft connected to the ultrasonic vibrator and transmitting motion to the ultrasonic vibrator, and provided in the insertion portion. An acoustic cap that covers at least the periphery of the ultrasonic vibrator part; a rigid pipe member provided on the insertion portion and covered with the acoustic cap; and a rigid pipe member provided in the rigid pipe member and configured to move the rigid shaft. And a guide ring member that supports the ultrasonic vibrator portion that moves while being in contact with the inner surface of the rigid pipe member.