JPS61272045A - Ultrasonic operation apparatus - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Application Field] The present invention uses ultrasonic vibrations of a flexible ultrasound probe to crush undesirable substances such as tumor tissue, blood clots, and calcium lumps in the body; This relates to an ultrasonic surgical device for suction and removal.

[Prior art]

Conventionally, a method for removing a thrombus involves injecting and dissolving a thrombolytic agent 5, such as streptokinase, through a catheter into the thrombus section (for example, Japanese Patent Application Laid-open No. 17306-1983).
5), a method in which the catheter is pulled out while the balloon of the balloon catheter is inflated and the thrombus is removed at the same time (for example, Japanese Patent Publication No. 16472/1982), a method in which the thrombus site is sandwiched between two inflated balloons and a thrombolytic agent is administered. Inject to soften the thrombus and withdraw the catheter, simultaneously C;
There are methods for removing thrombi (Japanese Patent Publication No. 58-501983).

However, even if a thrombolytic agent is locally injected through a catheter, there is a drawback that the thrombolytic agent flows into normal peripheral blood vessels, leading to the risk of bleeding in the peripheral blood vessels. When removing the blood clot outside the body by pulling out the catheter while it is still inflated, there is a risk of damage to the blood vessel inner wall because safety measures are not taken against the tensile stress applied to the blood vessel inner wall.A similar method for removing blood clots When using a catheter with two balloons, the two
When sandwiching a thrombus @ with two balloons e1) and (to), the balloon C33, which is closer to the tip of the catheter handle, must be inserted from a position in front of the thrombus to a position deeper than the thrombus (to). Therefore, there was a risk that the balloon υ (2) would push the thrombus in the insertion direction CI3+ and cause the thrombus to move to other parts, such as peripheral blood vessels.

In addition (21 Mechanical (: as a method of removing blood clots).

There is a method of crushing blood clots by installing a thin rod-shaped tip (a nitrile blade) and rotating the rod. There was a drawback that it was difficult to adjust the number of revolutions, etc. because there was a risk of cutting.

Recently, it has also been used as a surgical tube using ultrasound.

An ultrasonic probe was connected to an ultrasonic vibration source, and cells, carunium masses, blood clots, etc. were crushed by mechanical vibration at the ultrasonic frequency at the tip of the ultrasonic probe, and crushed through the lumen provided in the ultrasonic probe. Devices for removing cells, calcium lumps, blood clots, etc. are known. (For example, JP-A-60-51
(No. 39, Japanese Unexamined Patent Publication No. 49-21989) However,
These devices have the disadvantage that the ultrasound probe, which has a working part that vibrates mechanically at ultrasound frequencies, is not flexible and is therefore difficult to insert into curved blood vessels or into tubular structures inside the body. .

[Purpose of the invention]

The present invention is directed to the conventional thrombus removal method (2). Eliminates drawbacks such as the movement of blood clots during catheter insertion, and enables the crushing and removal of blood clots, calcium lumps, etc. within tubular tissues such as curved blood vessels, which are difficult to perform with current ultrasonic surgical equipment. As a result of intensive studies, we have found that a flexible ultrasound probe can be inserted directly into the affected area, without affecting the surrounding normal tissues, and with the mechanical vibration of the ultrasound frequency (thus reducing blood clots, blood clots, etc.). We have completed an ultrasonic surgical device that crushes and suctions out undesirable substances in the body, such as calcium lumps.

[Configuration of the Invention] That is, the present invention provides an ultrasonic vibration source that generates ultrasonic vibrations,
The ultrasonic vibration source (2: an oscillation device that supplies high-frequency electrical energy; the ultrasonic vibration source C: a horn that is connected to transmit and amplify the mechanical vibration of the ultrasonic frequency; and suction and removal of undesirable substances from the surgical site). An ultrasonic surgical device consisting of a suction device for the purpose of ultrasound probe,
a horn cover at least partially made of a flexible material, one or more lumens and one or more branch pipes communicating with the lumens and connected to the horn cover; The ultrasonic surgical device is characterized in that it has a flexible tube, an ultrasonic probe is placed in one of the lumens, and a suction device is connected to one of the branch tubes.

The present invention will be described in detail below from Drawing 1. includes a mechanical vibration generating unit of ultrasonic frequency consisting of an oscillating device (1) and a hand piece (to), a suction unit consisting of a suction device aυ and a suction bottle (121), a liquid injection unit consisting of a liquid injection device α4, and Flexible tube (8) and branch pipe (force, (9), (47
) The catheter section consists of four parts.

High-frequency electrical energy is supplied from the oscillator (1) through the cables (2) and (3).

As shown in Fig. 2, the handpiece (to) consists of two ultrasonic vibration sources (4), a horn (5), a horn cover (6), and an ultrasonic probe aη. (4), the ultrasonic vibration source (4) generates mechanical vibrations at ultrasonic frequencies and is transmitted to the horn (5).The mechanical vibrations are amplified by the horn (5) and a7).

The oscillator (1) includes a horn (5) and an ultrasonic probe (
17) Changes in mechanical load conditions (2) It has an oscillation circuit that can supply high-frequency electrical energy corresponding to Considering vibration and crushing ability, 20 to 30 KHz is suitable.

The connection between the ultrasonic vibration source (4) and the horn (5) is by a screw method, but is not limited to this method. The horn (5) is not limited to any particular material as long as it converts high-frequency electric energy such as a strain type into mechanical vibration at an ultrasonic frequency. A metal material having a fatigue strength capable of withstanding mechanical vibration C2 is suitable, and stainless steel, duralumin, titanium alloy, etc. are preferable.

Furthermore, suitable methods for connecting the horn (5) and the ultrasonic probe αD include screws, welding, and the like. Ultrasonic probe 0η
The fixing tool (43) and the flexible linear transmitting body (44) are connected (C) The fixing tool (43) and the linear transmitting body (44) are preferably connected by welding, gluing, etc. The materials of the fixture (43) and the linear transmitter (44) are not particularly limited as long as they can transmit mechanical vibrations at ultrasonic frequencies and have fatigue strength that can withstand mechanical vibrations. It is desirable that the material is made of a material that does not transmit radiation, and metal materials such as stainless steel, duralumin, titanium alloy, etc., and composite materials such as carbon fiber reinforced plastic are preferable.The horn (5) and the flexible ultrasonic probe αη Horn cover around (
6) is provided, one end of the horn cover 16) is connected with an ultrasonic vibration source (4) (2) in a suitable manner, and the other end is connected with a branch pipe (connected with adhesive and kept airtight). Although,
In particular, this connection method (not limited to two).The inside of the horn cover (6) is divided into two compartments (C) and (45) by a rubber O-ring. It is installed at the node where the amplitude of the mechanical vibration in the longitudinal direction (46) of the horn (5) is smallest, and blocks the flow of liquid. By providing the bellows part Q made of flexible material, it is possible to move the branch pipe (7) back and forth by expanding and contracting the bellows part 0 in the longitudinal direction (46).

The ultrasonic probe a7) passes through the branch tube (forced) into the inner lumen (2) of the flexible tube (8) shown in Figure 1. As shown in Figure 3(a). , ultrasonic probe α
The tip of η is so large that it does not protrude beyond the tip (161) of the flexible tube (8) when the bellows section is extended. ) is inserted into the body, the tip of the ultrasound probe a'7) is positioned within the lumen of the flexible tube (8) to prevent the tip of the ultrasound probe αη from damaging blood vessels, etc. It can be prevented.

Next, as shown in FIG.
), suction bottle α2, and tube can, (to), via Tochi.
In addition, the liquid injection device a4) is connected to the lumen of the flexible tube (8), the branch pipe (47), and the pipe (3).
7), is connected via the switching valve α9 and cheap (41). As for how to arrange the branch pipes (9) and (47), Fig. 4C shows an example in which the branch pipes (9) and (47) are fixed with a horn cover +6)C with an appropriate adhesive. The shape may be any shape that is easy for the operator to use, and is not limited to this.

As for how to use this device, first, the linear transmitter (44) installed in the branch pipe and flexible tube (8) slides, so the compartment (c) and the inner cavity ( 42) Fill (2) with body tissue (2) non-harmful liquid such as physiological saline.For example, provide a passage connecting the compartment (c!3h) on the side of the horn cover (6), and Inject liquid such as physiological saline into the compartment (c) and the inner cavity (42), and close the passage.Also, inject the suction inside of the flexible tube (8) that communicates with the suction device αυ. Fill the inner lumen of the cavity α9 and the branch pipe (9) with a liquid such as physiological saline by operating the suction device Ql) and the switching valve (13). Fill the lumen ■ with a liquid such as physiological saline.

Next, the flexible tape (8) is inserted into the body while confirming the position of the tip of the linear transmitter (44) under X-ray fluoroscopy.
Insert to the surgical site, for example, to the thrombus area. For example, as shown in FIG. 5(a), a balloon (2) is provided near the tip αe of the flexible tube (8), and a blood vessel (2) is placed inside the blood vessel (c).
) is swayed by the flow of the flexible tube (8) (2), so that the position of the tip αe is determined without affecting the blood flow. Temporarily inflate the balloon using a
to be fixed. At this point, the mutual relationship between the flexible tube (8) and the linear transmission body (44) is as shown in FIG. 3(a). Next, hold a part of the horn cover (6) on the side of the branch pipe (7) from the bellows part, and move the bellows part α1 in the direction of the arrow @(:
Contraction (secondly, as shown in Figure 3(b))
: Is the working part Qυ of the ultrasonic probe aη flexible? , -bu(
8) From the tip aυ of the blood clot (C), deflate the balloon after adjusting the position with the thrombus (C), as shown in Figure 5). The thrombus ■ is crushed by bringing the target (working part ? 21) into contact with the thrombus ■C twice, and the fragments of the crushed thrombus are shown in Figure 6 (a).
ll=Suction is carried out from the indicated suction lumen a9 using a suction device αυ and removed from the body. If the location of the thrombus is unclear, inject a contrast medium or the like through the fluid injection device a4 (therefore, the fluid injection lumen αB shown in Figure 6(a)) to determine the location of the thrombus. Perform the above operations while checking.

The material of the flexible tape (8) may be one commonly used for medical catheters such as soft vinyl chloride resin, and the material of the branch pipes (7), (9) and (47) may be is not particularly limited, but preferably one that can be bonded to the flexible tube (8). The lumen and outer periphery of the flexible Y-Ave (8) and the lumens of the branch vessels (9) and (47) are coated with an anti-blood substance, and anti-thrombotic substances include polyunthane, hydrogel, etc. ,peparinized polymer,
Urokinase polymers and the like are preferred, but are not particularly limited.

Moreover, the number of lumens of the flexible tube (8) is not particularly limited. For example, as shown in Figure 6 (A) (: lumen (2)
Even if there is only one lumen 1, the suction device (+11 and the liquid injection device fi4) (two suction devices (+11) and the liquid injection device fi4) can be used in communication with each other via the switching valve.

Ultrasonic probe 0? ) The working part 011 at the tip has an acute angle removed in order to prevent damage to the inner wall of the blood vessel, etc., and the shape of the end surface etc. is particularly limited (although not limited to, an obtuse angle or arc shape is recommended) good.

Here, as one embodiment of the device according to the present invention, the removal of a thrombus in a blood vessel (in detail) is described; Of course, it can be widely applied to crushing and removing substances that are not present.

〔Effect of the invention〕

As mentioned above, the present invention (: According to the present invention, blood clots, calcium lumps, lr.
! ! The ultrasonic probe is inserted directly into the affected area where undesirable substances such as tumors are present, and the undesirable substances are crushed by mechanical vibrations at the ultrasonic frequency without affecting the surrounding normal tissue, and the undesirable substances are immediately removed from the body. C: It can be removed, and the incision on the body surface is only slightly larger than the diameter of the flexible tube containing the ultrasound probe, making it possible to perform an extremely minimally invasive surgery in a short time, and making it easier for the patient. Because it can significantly reduce the burden on C2 after surgery,
It is suitable as an ultrasonic surgical device.

[Brief explanation of the drawing]

FIG. 1 is a diagram showing the overall configuration of an ultrasonic surgical device according to an embodiment of the present invention, and FIG. 2 is an enlarged view of the handpiece portion showing the structure inside the horn cover. Fig. 3 is an enlarged view of the bellows part, (a) shows the state in which the bellows part is extended, and (bl shows the state in which the bellows part is contracted.) Fig. 4 is an example of the shape of the handpiece. FIG. 5 is a diagram for explaining an example of the use of the device according to the present invention.
FIG. 6 is a diagram showing an example of the cross-sectional structure of a flexible tube. Further, FIG. 7 is a diagram showing a conventional method. Patent applicant: Sumitomo Bakelite Co., Ltd. Figure 1 Figure 2 Figure 3 (a) Figure 4 Figure 5 Figure 6 (a) (b) Figure 7

Claims (6)

[Claims] (1) An ultrasonic vibration source that generates ultrasonic vibrations, an oscillation device that supplies high-frequency electrical energy to the ultrasonic vibration source, and a horn that is connected to the ultrasonic vibration source and transmits and expands mechanical vibrations at the ultrasonic frequency. , and a suction device for suctioning and removing undesirable substances from the surgical site, one end of which is fixed to the tip of the horn, and the other end of which has a working part that generates mechanical vibrations at ultrasonic frequencies. an ultrasonic probe consisting of a flexible linear transmitter, a horn cover at least partially made of a flexible material, and one or more lumens communicating with the lumens; a flexible tube having two or more branch tubes connected to the horn cover, an ultrasound probe placed in one of the lumens, and a suction device connected to one of the branch tubes; An ultrasonic surgical device featuring: (2) The ultrasonic surgical device according to claim 1, characterized in that a portion of the horn cover made of a flexible material is provided with a bellows shape so that the horn cover can be expanded and contracted. (3) The ultrasonic surgical device according to claim 1 or 2, wherein all angular parts in the working part of the ultrasonic probe are obtuse angles or arcuate. (4) The ultrasonic wave according to any one of claims 1 to 3, characterized in that a liquid injection device for injecting irrigation liquid or the like is connected to a branch pipe of the flexible tube. Surgical equipment. (5) The flexible tube has a balloon near the working part of the ultrasonic probe installed in its lumen, and the balloon is inflated and deflated through one of the lumens. , an ultrasonic surgical device according to any one of claims 1 to 4. (6) According to any one of claims 1 to 5, the inner lumen and outer surface of the flexible tube in which the ultrasound probe is installed are coated with an antithrombotic substance. Ultrasonic surgical equipment.