JPS6252575B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to a high frequency electric scalpel device that uses high frequencies to remove polyps and the like.

Conventionally, in order to remove polyps endoscopically using a high-frequency electrocautery device, the neck of the polyp is tied up with a monopolar loop electrode, and an external electrode is electrically connected to the loop electrode to the patient's body surface. A high-frequency current was passed between the bones to cauterize and remove them. However, in this case, for example, if the neck of the polyp is too thick, the blood vessels in the neck may not be cauterized sufficiently, and if the set output of the high-frequency power source is too large or the binding force of the loop electrode is too strong, the polyp may instantly There was a risk that the patient's neck would be severed, and there was a risk that the blood vessels in the neck could not be cauterized sufficiently, leading to bleeding.

The present invention has been made based on the above-mentioned circumstances, and its object is to provide a high-frequency electric scalpel device that can safely excise a portion to be excised, such as the neck of a polyp, after sufficiently cauterizing it.

That is, the present invention uses the internal electrode as a bipolar electrode to sufficiently cauterize the part to be excised at the start of ablation, and after a predetermined period of time, switches the internal electrode to a monopolar electrode to cut the part to be excised. This allows for safe resection without causing bleeding.

Hereinafter, this invention will be described in a first embodiment shown in FIGS. 1 to 4.
This will be explained with reference to an example. In the figure, reference numeral 1 denotes a sheath made of an electrically insulating material, and the sheath 1 can be inserted into a body cavity through a forceps channel of an endoscope (not shown). A pair of internal electrodes 2 and 3, which are electrically insulated from each other, are inserted into the sheath 1 so as to be movable in the axial direction. Tips 2 of these internal electrodes 2 and 3
As shown in Fig. 2, when protruding from the tip of the sheath 1, a and 3a are bent in the direction of mutual expansion, and when drawn into the sheath 1, they pinch the neck _A1 of the polyp A. It is now possible to do so. In addition, the electrode tip 2
3a and 3a are arranged so that they are staggered so that they are not located in the same plane, as shown in FIG.

Further, 4 is an external electrode that is electrically connected to the patient's body surface, and this external electrode 4 and the internal electrodes 2 and 3 are connected to the patient's body surface.
In addition, a high frequency is provided by a high frequency power supply device 5, which will be described below.

6 is a power supply section of this high frequency power supply device 5,
This high frequency power supply section 6 is provided with a high frequency generation circuit 7, an output circuit 8, and a step-up transformer 9. The secondary output terminal 10a of this step-up transformer 9,
10b, the internal electrodes 2 and 3 and the external electrode 4
A first changeover switch 11 and a second changeover switch 12 are provided between the two.

That is, the normally open fixed contact 11a of the first changeover switch 11 is connected to one internal electrode 2 and the output terminal 10a, the normally closed fixed contact 11b is connected to the other output terminal 10b, and the movable contact 11c is connected to the other output terminal 10b. It is connected to the internal electrode 3.

In addition, the normally open fixed contact 1 of the second changeover switch 12
2a is connected to the output terminal 10b, and the movable contact 12c is connected to the external electrode 4. These movable contacts 11c and 12c are operated in conjunction with each other by a relay 13.

14 is a relay drive circuit, 15 is a delay circuit connected to this relay drive circuit 14, and this delay circuit 15 is provided with a timer 15a that can arbitrarily set the switching time of the changeover switches 11 and 12. There is. This delay circuit 15 and the high frequency generation circuit 7 are connected to an operation switch 16. As this operation switch 16, for example, a foot switch that can be turned on and off with the foot is adopted. In addition, these delay circuit 15, relay drive circuit 14, relay 13, changeover switch 11, 12
The switching means 17 is constituted by the following.

In the high-frequency electric scalpel device configured as described above, when the operation switch 16 is turned on, the high-frequency signal oscillated by the high-frequency generation circuit 7 is amplified by the output circuit 8, further boosted by the step-up transformer 9, and then sent to the output terminals 10a, 10b. is output to. At this time, the changeover switches 11 and 12 are in the state shown in FIG. 1, and in order to introduce high frequency waves to the internal electrodes 2 and 3, a high frequency wave is applied between the electrode tips 2a and 3a. That is, these electrodes 2 and 3 function as bipolar electrodes to bind and energize the neck A ₁ of the polyp A, so that a sufficient high-frequency current can flow to the internal tissue of the neck A ₁ to cauterize it. That is, at the start of ablation, bipolar ablation is performed first.

In addition, in this state, the tips 2 of the internal electrodes 2 and 3
By drawing a and 3a into the sheath 1, the binding force can be increased. In this case, the electrode tip 2
Since the electrodes 2a and 3a are staggered and not located on the same plane, even if these electrode tips 2a and 3a are strongly squeezed and crossed, the tips 2a and 3a will not come into contact with each other. , can prevent short circuits. However, in this way, the electrode tip 2
When a and 3a are close to each other, high-frequency current begins to discharge between the electrode tips 2a and 3a.
High frequency current may no longer flow inside the tissue of the polyp neck _A1 . If this state continues for a long time, the tissues near the neck _A1 may also become necrotic due to heat generated by the high-frequency current.

Therefore, as described below, the bipolar ablation is automatically switched to the monopolar ablation. That is, when the operation switch 16 is turned on and ablation is started as described above, the delay circuit 15 also starts operating at the same time, and when the predetermined time _t1 set by the timer 15a has elapsed, the operation of the relay drive circuit 14 causes the delay circuit 15 to start operating. The relay 13 is driven, and the movable contacts 11c and 12c of the changeover switches 11 and 12 are switched to the normally open fixed contacts 11a and 12a, respectively. Therefore, the internal electrodes 2 and 3 have the same potential, and a high frequency wave is applied between the internal electrodes 2 and 3 and the external electrode 4. In other words, in this state, the internal electrodes 2 and 3 function as monopolar electrodes like conventional loop electrodes, and by pulling these internal electrodes 2 and 3 into the sheath 1 and sufficiently tightening and energizing them, the polyp neck A is ₁ can be safely amputated without bleeding.

Note that FIG. 5 shows a second embodiment of the present invention, and since the basic configuration is the same as that of the first embodiment, common parts are given the same reference numerals and explanations are omitted, and differences are omitted. This will be discussed below. That is, in this second embodiment, the output signal of the delay circuit 15 can be input to the output circuit 8 via the wiring 18. As shown in FIG. 6, this output circuit 8 outputs a high frequency signal at a lower output during bipolar ablation before t ₁ hour has elapsed from the start of ablation than during monopolar ablation after t ₁ hour has elapsed. is configured to do so. Therefore, according to the second embodiment, it is possible to prevent instantaneous severing of the polyp neck due to excessive output during bipolar cauterization, and safer resection is possible.

Further, in the present invention, the high frequency power supply section may be configured so that the overall output can be adjusted while maintaining the output ratio between bipolar ablation and monopolar ablation at a constant value. In this case, it is possible to optimally adjust the output according to the size of the polyp, etc., and safe resection is possible by lowering the high-frequency output during bipolar ablation, as in the second embodiment.

As explained above, the present invention includes a pair of internal electrodes that can be used as bipolar electrodes, an external electrode that is electrically connected to the patient's body surface, and a high frequency applied between the internal electrodes at the start of ablation to perform bipolar ablation. The device is provided with a switching means that applies high frequency to the internal electrodes and the external electrodes by switching after a predetermined period of time has elapsed. Therefore, according to this invention, the internal tissue of the part to be resected can be sufficiently cauterized by bipolar cauterization and then cut by monopolar cautery, so that the blood vessels within the part to be resected are also sufficiently cauterized, causing bleeding. It has the great effect of being able to be safely removed without causing any damage.

[Brief explanation of the drawing]

1 to 4 show a first embodiment of the present invention, FIG. 1 is a schematic diagram of the entire high-frequency electric scalpel device, FIG. 2 is a cross-sectional view of the sheath tip showing the internal electrode, and FIG. The figure is a front view of the internal electrode in Fig. 2 seen from the tip side, Fig. 4 is a time chart showing the operation of the high frequency power supply device, and Fig. 5 is a high frequency electric scalpel device showing a second embodiment of the present invention. FIG. 6 is a time chart showing changes in output in the same high frequency electric scalpel device. DESCRIPTION OF SYMBOLS 1... Sheath, 2, 3... Internal electrode, 4... External electrode, 6... High frequency power supply part, 11, 12... Changeover switch, 15a... Timer, 17... Switching means, A ₁ ... Polyp neck (part to be excised).

Claims (1)

[Scope of Claims] 1. A sheath inserted into a body cavity, a pair of internal electrodes that are electrically insulated from each other and protrude from the distal end of the sheath and sandwich the part to be resected, and electrically connected to the patient's body surface. and a high frequency power supply unit that generates a high frequency voltage, and when starting ablation, a high frequency from the high frequency power supply unit is applied between the pair of internal electrodes to perform bipolar ablation, and after a predetermined time elapses, a switching operation is performed. A high-frequency electric scalpel device comprising a switching means for performing monopolar cauterization by applying high frequency between the internal electrode and the external electrode. 2. The switching means comprises a timer that can arbitrarily set a switching time for switching from bipolar ablation to monopolar ablation, and a changeover switch operated by the timer. A high-frequency electric scalpel device according to scope 1. 3. The high-frequency electric scalpel device according to claim 1 or 2, wherein the high-frequency power supply unit outputs high-frequency waves at a lower output during bipolar ablation than during monopolar ablation. 4. The high-frequency electric scalpel device according to claim 3, wherein the high-frequency power source section is capable of adjusting the output while maintaining a constant output ratio between bipolar cauterization and monopolar cauterization.