JPH11299803A - Resectoscope - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a resectoscope capable of safely and efficiently obtaining medical treatment effect. SOLUTION: A resectoscope device is constituted of this resectoscope 1, a high frequency power source unit 5, an ultrasonic observation device 6 and a monitor 7 and a scope 2 and an electrode unit 8 are arranged inside the insertion part 11 of a sheath 4. A tip electrode part 80 is arranged near the tip part opening 15 of a tip part 14 and an ultrasonic vibrator 9 is disposed on the inner peripheral surface of the tip part 14. The transmission/reception surface of the ultrasonic vibrator 9 is arranged in the direction of the tip part opening 15 and appropriate treatment is performed by observing the ultrasonic observation images of a viable tissue obtained by the ultrasonic vibrator 9 and the optical images of a viable tissue surface layer obtained by the scope 2. Also, since the image of the tip electrode part 80 and the tomographic image of the viable tissue are displayed on the ultrasonic observation image, the tip electrode part 80 is easily arranged at a target part and the safe treatment is performed.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a resectoscope for performing incision, resection, transpiration and the like of body tissue by electroablation under an endoscope.

[0002]

2. Description of the Related Art In general, a resectoscope is provided in an elongated hollow sheath inserted into a body cavity from the urethra, an optical viewing tube (also referred to as a scope) as an endoscope for observation and a living tissue resection. The high frequency current is applied to the electrode disposed at the opening of the distal end of the sheath while observing the lesion surface with a scope, and the electrode is advanced and retracted by operating the operation unit. Then, a treatment is performed on the lesion.

[0003] For example, Japanese Patent Publication No. 3-24219 discloses that when a target tissue is to be resected, the target tissue is prevented from being completely cut off due to uneven hardness of the tissue. In a loop for a resectoscope, which is attached to the tip of the inserted rod-shaped electrode so as to be able to protrude and retract from the tip of the sheath, the loop is composed of at least two resection wires, and these are the same at an interval of 0.2 mm to 1.0 mm. A resectoscope loop arranged close to the direction is shown.

In Japanese Patent Application Laid-Open No. 9-262244, a high-frequency current is intensively applied to a contact portion with a living tissue to enhance the efficiency of treatment such as evaporation and coagulation of the living tissue, and to uniformly treat a wide range. In order to easily perform the operation to perform the operation, the electric unit is provided with a substantially cylindrical metal roller that is substantially in surface contact with the living tissue, and a ring that reduces the contact area with the living tissue on the outer peripheral surface of the roller. A resectoscope provided with a groove is disclosed.

[0005]

However, the loop for the resectoscope disclosed in Japanese Patent Publication No. 3-24219 or the resectoscope disclosed in Japanese Patent Application Laid-Open No. 9-262244 disclose tissue incision. The state after the treatment, such as excision and transpiration, was observed with a scope. For this reason, only the state of the surface of the treatment site can be observed, and it is difficult to determine at a glance the treatment state in the depth direction of the treatment site. Was performed based on the experience value of the elderly.
In this resectoscope treatment, if tissue is excessively scraped, complications such as bleeding and perforation may occur.To prevent this, treatment and treatment should be performed by removing living tissue little by little. Since the treatment was performed, the treatment time was prolonged, and a great burden was imposed on the operator and the patient.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a resectscope that can perform treatment and treatment safely, efficiently, and effectively.

[0007]

A resectoscope according to the present invention comprises an elongated hollow sheath inserted into a body cavity, a scope arranged in the sheath for observing the inside of the body cavity, and a scope arranged in the sheath. An ultrasonic transducer that emits ultrasonic waves from the opening at the distal end of the sheath toward the tissue in the body cavity, and an electrode unit that is disposed in the sheath and performs a treatment in the body cavity using a high-frequency ablation current.

According to this structure, the state of the surface layer of the tissue in the body cavity can be observed by the scope, and the state of the tissue in the body cavity in the depth direction can be observed by the ultrasonic transducer. Can perform the treatment. Then, a treatment result for the lesion by the electrode unit can be obtained by the scope and the ultrasonic transducer.

[0009]

Embodiments of the present invention will be specifically described below with reference to the drawings. 1 to 4 relate to an embodiment of the present invention, FIG. 1 is an explanatory diagram showing a schematic configuration of a resectoscope and a resectoscope device, FIG. 2 is an explanatory diagram showing a configuration of an electrode unit, and FIG. FIG. 4 is a view showing a configuration of a tip electrode portion of the unit, and FIG. 4 is a view for explaining the operation of the ultrasonic transducer.

As shown in FIG. 1, a resectscope device comprises a resectscope 1 having a scope 2, a working element 3, and a hollow sheath 4, and a high-frequency power supply device for supplying electricity to an electrode unit described later. 5, an ultrasonic observation device 6, and a monitor 7 connected to the ultrasonic observation device 6 for displaying an ultrasonic observation image.

The sheath 4 includes an insertion portion 11 inserted into the body cavity from the urethra, and a main body portion 12 provided at a rear end of the insertion portion 11, and a side peripheral portion of the main body portion 12. Is provided with a water supply mouthpiece 13 with a cock for supplying perfusate to the affected part. Note that a distal end portion 14 formed of a resin member or the like, which is an insulating member, is provided at the distal end of the insertion portion 11. The scope 2 and an electrode unit 8 described later are inserted through the insertion portion 11.

The scope 2 has an elongated insertion tube 21 having a built-in optical system and inserted through the insertion portion 11 and the distal end portion 14, and a hand portion 22 disposed at the base end of the insertion tube 21.
An eyepiece 23 for an operator to observe is provided at the base end of the hand 22, and illumination light for observation is provided on the side of the hand 22 for an observation site. A light guide connecting portion 24 to which a light guide (not shown) to be supplied is detachably connected is provided.

As shown in FIG. 2, the electrode unit 8 includes a metal wire 81 serving as a tip electrode portion 80 and a metal wire 8
A forked arm member 82 having a forked portion for forming a loop-shaped member 1 and a metal pipe 83 for increasing the rigidity of the metal wire 81 provided at the distal end of the forked arm member 82
And an insulating tube 86 disposed at the rear end of the metal pipe 83 to expose an end of the metal wire 81 to form an electrode connection 84. And FIG.
As shown in FIG. 7, on the surface of the metal wire 81 forming the loop-shaped tip electrode section 80, a dimple 87 for rendering the tip electrode section 80 with high brightness on an ultrasonic observation image displayed on the screen of the monitor 7 is provided. Are provided.

As shown in FIG. 1, the electrode unit 8
The distal electrode portion 80, which is disposed in the insertion portion 11 so as to be able to advance and retreat and exposes the metal wire 81, is disposed so as to be able to protrude and retract with respect to the distal portion opening 15. And
The metal wire 81 covered by the metal pipe 83
4, penetrating through the insertion portion 11 and the main body portion 12 and extending from the base end surface of the main body portion 12;

An ultrasonic vibrator 9 of a linear type or a convex type is disposed on the inner peripheral surface of the distal end portion 14 of the insertion portion 11. The transmitting / receiving surface of the ultrasonic vibrator 9 is arranged in the direction of the distal end opening 15 of the sheath 4, and the distal end electrode portion 80 moves within the scanning range of the ultrasonic vibrator 9. I have.

A signal cable (not shown) extending from the ultrasonic vibrator 9 extends through the distal end portion, the insertion portion 11 and the main body portion 12 to extend from the base end surface of the main body portion 12, and the ultrasonic observation device 6 is connected. For this reason, the echo signal emitted and received by the transmitting / receiving surface of the ultrasonic transducer 9 is transmitted to the ultrasonic observation device 6, and then is generated as an image signal, and the ultrasonic observation image is displayed on the screen of the monitor 7. It is displayed.

On the other hand, the working element 3
A sheath connecting portion 31 detachably connected to the proximal body portion 12 of the sheath 4, a guide tube 32 projecting rearward from a rear end surface of the sheath connecting portion 31, and a guide tube 32
And a substantially pipe-shaped slider 33 which is slidably held in the main body.

The electrode unit 8 is mounted on the slider 33.
A high-frequency power supply connector 35 to which a power supply cord 51 extending from the high-frequency power supply device 5 is detachably connected; An ultrasonic base 36 to which a signal cable extending from the ultrasonic vibrator 9 is connected, and a ring-shaped thumb ring 37 for hanging the operator's thumb are provided.

The slider 33 and the sheath connection portion 31
Is connected via a leaf spring 39 having one end fixed to a lever-shaped finger hook 38 integrally fixed to the sheath connection portion 31 and the other end fixed to the slider 33. While the slider 33 is constantly biased toward the eyepiece 23 by a spring 39, the slider 33 is moved forward and backward by appropriately operating a thumb ring 37 provided on the slider 33, and the electrode unit 8 The distal electrode portion 80 can be moved forward and backward to protrude and retract from the distal end opening 15 of the sheath 4.

The high-frequency power supply connector 35 and the electrode fixing portion 34 are electrically connected by a lead wire 41. The power supply cord 51 of the high-frequency power supply device 5 is connected to the high-frequency power supply connector 35 so that The electrode unit 8 is energized so that a lesion can be treated. Further, by connecting a signal cable 61 extending from the ultrasonic observation device to the ultrasonic base 36, a tomographic image of a living tissue and an image showing the tip electrode portion 80 located within the scanning range can be monitored. 7 is displayed on the screen.

A slider positioning fixing member 40 is provided at the base end of the guide tube 32, and the slider 33 is fixed by the slider positioning fixing member 40.
Is prevented from falling off from the guide tube 32. The guide tube 32 has a hollow structure inside. The elongated insertion tube 21 of the scope 2 is inserted into the inner hole, and the hand portion 22 is integrated with the slider positioning fixing member 40. Connection is fixed.

Resect scope 1 configured as described above
The operation of will be described. First, the sheath 4 of the resectoscope
Is inserted through the urethra, and while observing an optical image in the urethra through the eyepiece 23 of the scope 2 disposed on the sheath 4, the distal end opening 15 of the distal end portion 14 is arranged near the lesion.

Next, the ultrasonic observation device 6 is driven to emit ultrasonic waves from the ultrasonic transducer 9 toward the lesion as shown in FIG. Then, the tomographic image of the lesion is displayed on the screen of the monitor 7 and the tip electrode section 80 provided with the plurality of dimples 87 is drawn. Then, based on the ultrasonic observation image displayed on the screen of the monitor 7, whether the observation of the lesion in the depth direction and the arrangement position of the tip electrode section 80 of the electrode unit 8 with respect to the lesion are appropriate. After examining whether or not it is not, the surgeon resets the position of the tip electrode section 80 with respect to the lesion, and sets a high-frequency ablation current value to be supplied to the electrode unit from the depth information of the lesion.

Next, while observing the monitor 7, the surgeon appropriately operates the thumb ring 37 provided on the slider 33 to move the tip electrode portion 80 forward and backward within the scanning range. After confirming the positional relationship between 80 and the lesion, treatment is performed by turning on electricity.

After the treatment, the surface state of the lesion is observed by the scope 2 and the state in the depth direction is diagnosed by the ultrasonic observation image displayed on the monitor 7. If the treatment has been completed, the resectoscope 1 is removed from the urethra, and the procedure ends. Scope 2
As a result of the diagnosis based on the ultrasonic observation image displayed on the monitor 7, if the treatment is to be continued, the tip electrode portion 80 is again
In addition to confirming the positional relationship between the lesion and the lesion, a high-frequency ablation current value to be supplied to the electrode unit 8 is set based on the depth information of the lesion, and the next treatment is performed.

As described above, the electrode for treating the lesion in the sheath of the resectoscope, the scope for observing the surface layer state of the lesion, and the ultrasonic transducer for observing the state of the lesion in the depth direction are provided. By having provided, while being able to grasp the surface state and the state in the depth direction of the lesion, treatment can be performed,
The grasp of the state after the treatment can be easily and reliably determined from the surface state and the state in the depth direction.

In addition, since a plurality of dimples are provided on the distal electrode constituting the electrode unit for treating a lesion, the distal electrode is depicted on an ultrasonic observation image displayed on a monitor. An accurate treatment can be performed by grasping the positional relationship between the position of the lesion part and the tip electrode part based on the sound wave observation image.

With these features, it becomes possible to cause the high-frequency ablation current corresponding to the depth of the lesion to flow through the electrode unit, and to dispose the tip electrode at an appropriate position and move it within an appropriate range. Because reliable treatment can be performed smoothly, reliable treatment and treatment can be performed safely in a short time.
The burden on the operator and the patient is greatly reduced.

Instead of arranging the ultrasonic vibrator 9 on the inner peripheral surface of the distal end portion 14, the ultrasonic vibrator 91 is replaced with a bifurcated arm for forming the distal end electrode portion 80 of the electrode unit 8 as shown in FIG. It may be configured to be placed over the member 82. As a result, the tip electrode section 80 is connected to the tip opening 1.
5, an ultrasonic observation image of the body tissue can be obtained with the ultrasonic transducer 91 mounted on the forked arm member 82.

In the case of the above embodiment, although the image of the tip electrode section 80 is not displayed on the ultrasonic observation image, the ultrasonic vibrator 9
Since the arrangement position with respect to the one tip electrode unit 80 is known in advance, it is possible to recognize at which position the tip electrode unit 80 is located from the displayed ultrasonic observation image. Reference numeral 92 denotes a signal cable extending from the ultrasonic transducer 91. Other configurations, operations, and effects are the same as those of the above-described embodiment. The same members are denoted by the same reference numerals, and description thereof will be omitted. As shown in FIG. The device 10 is provided, and the microscopic vibration is transmitted to the electrode unit 8 by the vibrating device 10 to vibrate the distal electrode portion 80 so that the distal electrode portion 80 is colored in the ultrasonic observation image in the ultrasonic color Doppler mode. The same operation and effect as described above may be obtained by drawing. The tip electrode section 80
By performing the treatment in a state where is slightly vibrated, the tip electrode portion 80 smoothly moves forward and backward, and the treatment can be performed effectively.

The present invention is not limited to only the above-described embodiments, but can be variously modified without departing from the gist of the invention.

[Appendix] According to the embodiment of the present invention described in detail above, the following configuration can be obtained.

(1) An elongated hollow sheath to be inserted into a body cavity, a scope arranged in the sheath for observing the inside of the body cavity, and a sheath arranged in the sheath toward the tissue in the body cavity from the opening at the distal end of the sheath. A reject scope comprising: an ultrasonic transducer that emits an ultrasonic wave; and an electrode unit that is disposed in the sheath and performs a treatment in a body cavity using a high-frequency ablation current.

(2) The reject scope according to appendix 1, wherein the ultrasonic transducer is disposed on an inner peripheral surface of a sheath distal end portion.

(3) The reject scope according to appendix 2, wherein a tip electrode portion of the electrode unit can be arranged within a scanning range of the ultrasonic transducer.

(4) The reject scope according to appendix 2 or 3, wherein a plurality of dimples are provided at a tip electrode portion of the electrode unit.

(5) The reject scope according to appendix 1, wherein the ultrasonic vibrator is integrally arranged near a tip electrode portion of an electrode unit.

(6) The reject scope according to appendix 2 or 3, wherein a vibrating device for transmitting vibration to a tip electrode portion of the electrode unit is connectable.

[0039]

As described above, according to the present invention, it is possible to provide a resectoscope capable of performing treatment and treatment safely, efficiently and effectively.

[Brief description of the drawings]

FIG. 1 to FIG. 4 relate to an embodiment of the present invention,
FIG. 1 is an explanatory diagram showing a schematic configuration of a resectoscope and a resectscope device.

FIG. 2 is an explanatory diagram showing a configuration of an electrode unit.

FIG. 3 is a diagram showing a configuration of a tip electrode section of the electrode unit.

FIG. 4 is a diagram illustrating the operation of an ultrasonic transducer.

FIG. 5 is a view for explaining another arrangement position of the ultrasonic transducer.

FIG. 6 is an explanatory diagram showing another configuration of the resectoscope device.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Reject scope 4 ... Sheath 2 ... Scope 5 ... High frequency power supply 6 ... Ultrasonic observation device 8 ... Electrode unit 80 ... Tip electrode part

Claims (1)

[Claims] 1. An elongated hollow sheath inserted into a body cavity, a scope arranged in the sheath for observing the inside of the body cavity, and a scope arranged in the sheath from an opening at the distal end of the sheath toward the tissue in the body cavity. A resectoscope comprising: an ultrasonic transducer that emits a sound wave; and an electrode unit that is disposed in the sheath and performs a treatment in a body cavity using a high-frequency ablation current.