WO2022080460A1 - 超音波処置具及び内視鏡システム - Google Patents

超音波処置具及び内視鏡システム Download PDF

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Publication number
WO2022080460A1
WO2022080460A1 PCT/JP2021/038094 JP2021038094W WO2022080460A1 WO 2022080460 A1 WO2022080460 A1 WO 2022080460A1 JP 2021038094 W JP2021038094 W JP 2021038094W WO 2022080460 A1 WO2022080460 A1 WO 2022080460A1
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WIPO (PCT)
Prior art keywords
ultrasonic
treatment tool
ultrasonic treatment
piezoelectric material
grip portion
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Ceased
Application number
PCT/JP2021/038094
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English (en)
French (fr)
Japanese (ja)
Inventor
耕平 東
孝一郎 中村
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Fujifilm Corp
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Fujifilm Corp
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Priority to JP2022557452A priority Critical patent/JPWO2022080460A1/ja
Priority to EP21880195.9A priority patent/EP4230110A4/en
Priority to CN202180070352.2A priority patent/CN116406241A/zh
Publication of WO2022080460A1 publication Critical patent/WO2022080460A1/ja
Priority to US18/299,775 priority patent/US20230240701A1/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B17/320092—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic with additional movable means for clamping or cutting tissue, e.g. with a pivoting jaw
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/22004—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves
    • A61B17/22012—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement
    • A61B17/2202—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for using mechanical vibrations, e.g. ultrasonic shock waves in direct contact with, or very close to, the obstruction or concrement the ultrasound transducer being inside patient's body at the distal end of the catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00296—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means mounted on an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/2812—Surgical forceps with a single pivotal connection
    • A61B17/282—Jaws
    • A61B2017/2825—Inserts of different material in jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B2017/2926—Details of heads or jaws
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/32—Surgical cutting instruments
    • A61B17/320068—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic
    • A61B2017/320082—Surgical cutting instruments using mechanical vibrations, e.g. ultrasonic for incising tissue

Definitions

  • the present invention relates to an ultrasonic treatment tool and an endoscopic system.
  • Patent Document 1 includes a pair of gripping portions for gripping structures such as blood vessels and an ultrasonic transducer (ultrasonic transducer), and transmits ultrasonic vibration through the gripping portions to transmit ultrasonic vibrations to the blood vessels and the like.
  • An ultrasonic treatment tool for performing treatment such as sealing and incision is described.
  • the ultrasonic vibrator is composed of various devices such as a piezoelectric material, and converts the supplied electric power into ultrasonic vibration.
  • the temperature of the gripping portion is shortened to about 60 ° C to 90 ° C, which is the denaturation temperature of proteins or the like. Need to rise in time. In order to raise the temperature of the grip in a short time, it is necessary to supply as much power as possible to each device of the ultrasonic transducer.
  • ultrasonic vibration can be efficiently transmitted and absorbed to a structure such as a blood vessel, and the temperature rise of the device can be suppressed by increasing the conversion efficiency of the supplied power into ultrasonic vibration. It is an object of the present invention to provide an ultrasonic treatment tool and an endoscopic system.
  • the ultrasonic treatment tool of the present invention includes a grip portion and an ultrasonic vibrator, and the piezoelectric material constituting the ultrasonic vibrator has a mechanical quality coefficient of 500 or more.
  • the grip portion is provided at the tip portion and grips the structure in the subject.
  • the ultrasonic vibrator is provided in the grip portion and is arranged at a position where the grip portion faces the gripped structure.
  • the direction of ultrasonic vibration by the ultrasonic vibrator and the direction of gripping by the gripping portion are parallel.
  • the ultrasonic vibrator is driven by an AC voltage signal having a frequency within 20% of the resonance frequency according to the thickness dimension of the piezoelectric material. It is preferable that the AC voltage signal for driving the ultrasonic vibrator is continuously supplied.
  • the piezoelectric material is preferably lead zirconate titanate.
  • the grip portion preferably grips a blood vessel as a structure. It is preferably an endoscopic treatment tool that is inserted into the subject through the forceps channel of the endoscope.
  • the grip portion, the ultrasonic vibrator, the tubular flexible sheath, the operation wire inserted integrally with the grip portion, and the base end portion of the flexible sheath were provided. It is preferable to have an operation unit.
  • the grip portion includes a pair of grip pieces for gripping the structure, and an ultrasonic vibrator is provided on at least one of the grip pieces.
  • the endoscope system of the present invention includes the above-mentioned ultrasonic treatment tool, a power supply device that outputs an AC voltage signal for driving an ultrasonic vibrator, and an endoscope having a forceps channel.
  • the present invention it is possible to efficiently transmit and absorb ultrasonic vibration to a structure such as a blood vessel, and to increase the conversion efficiency of the supplied power into ultrasonic vibration to suppress the temperature rise of the device. can.
  • the endoscope system 10 includes an endoscope 12, a light source device 14, a processor device 15, a display 16, a keyboard 17, and an ultrasonic treatment tool 18. And a power supply device 19 for ultrasonic waves.
  • the endoscope 12 photographs the observation target.
  • the light source device 14 emits illumination light to irradiate the observation target.
  • the processor device 15 controls the system of the endoscope system 10.
  • the display 16 is a display unit that displays an observation image or the like based on an endoscopic image.
  • the keyboard 17 is an input device for inputting settings to the processor device 15 and the like.
  • the endoscope 12 is optically connected to the light source device 14 and electrically connected to the processor device 15.
  • the endoscope 12 includes an insertion portion 12a to be inserted into the subject, an operation portion 12b provided at the base end portion of the insertion portion 12a, a curved portion 12c provided on the tip end side of the insertion portion 12a, and a tip portion 12d. have.
  • the angle knob 12e of the operation portion 12b By operating the angle knob 12e of the operation portion 12b, the curved portion 12c is curved.
  • the tip portion 12d faces in a desired direction.
  • the operation unit 12b is provided with a forceps opening 21 (see FIG. 2) in addition to the angle knob 12e.
  • the forceps opening 21 is an entrance into which the ultrasonic treatment tool 18 is inserted.
  • the ultrasonic treatment tool 18 inserted into the forceps opening 21 protrudes from the forceps outlet 22 (see FIG. 2) at the tip portion 12d.
  • An observation window and an illumination window are provided on the tip surface with the tip portion 12d, although not shown.
  • An image sensor (not shown) is placed behind the observation window, and an optical fiber cable (not shown) is placed behind the illumination window.
  • the signal line of the image sensor and the optical fiber cable are connected to the processor device 15 and the light source device 14, respectively.
  • the processor device 15 is electrically connected to the display 16 and the keyboard 17.
  • the processor device 15 performs image processing or the like on the endoscope image captured by the image sensor and displays it on the display 16.
  • a forceps channel 23 for inserting the ultrasonic treatment tool 18 is provided in the insertion portion 12a.
  • One end of the forceps channel 23 is connected to the forceps outlet 22, and the other end is connected to the forceps opening 21 provided in the operation unit 12b.
  • the forceps opening 21 is provided with a forceps plug 24.
  • the forceps channel 23 is also used as a route for sending a cleaning liquid such as water from the forceps outlet 22 and a route for sucking the contents such as body fluid such as blood and internal waste products.
  • the ultrasonic power supply device 19 supplies electric power to the ultrasonic vibrator 51 described later of the ultrasonic treatment tool 18.
  • the ultrasonic treatment tool 18 is an endoscopic treatment tool that is inserted into the subject together with the insertion portion 12a through the forceps channel 23.
  • the ultrasonic treatment tool 18 is raised as a treatment tool for an endoscope to be combined with the endoscope 12, but the actual treatment is not limited to this, and treatment with biopsy forceps, a snare, an electric knife, or the like is used.
  • the tool is also combined with the endoscope 12.
  • the ultrasonic treatment tool 18 includes a flexible sheath 31, an operation wire 32 (see FIG. 3), a grip portion 33, an ultrasonic vibrator unit 34 (see FIG. 3), and an operation portion 35.
  • the flexible sheath 31 is a tubular sheath made of a flexible material, for example, a soft resin, and is inserted into the forceps channel 23 of the endoscope 12.
  • the operation wire 32 is provided integrally with the grip portion 33 and is inserted through the flexible sheath 31.
  • the operation unit 35 includes an operation unit main body 36 and a slider 37 slidably supported by the operation unit main body 36.
  • the operation unit main body 36 is continuously provided at the base end portion of the flexible sheath 31.
  • the operation unit main body 36 is provided with a finger hook portion 36A, a cylinder portion 36B, and a connector portion 36C.
  • the columnar portion 36B extends in a direction parallel to the axial direction of the flexible sheath 31.
  • the slider 37 is engaged with the cylindrical portion 36B and slides along the cylindrical portion 36B in the axial direction of the flexible sheath 31.
  • the base end of the operation wire 32 is fixed to the slider 37. Therefore, the operation wire 32 is pushed and pulled in the flexible sheath 31 in the axial direction as the slider 37 slides.
  • the connector portion 36C is electrically connected to the ultrasonic power supply device 19 as described later.
  • the grip portion 33 is provided at the tip portion of the ultrasonic treatment tool 18, and has a pair of grip pieces 41 arranged one above the other, a link mechanism 42, and a support member 43 for supporting them. Be prepared.
  • An ultrasonic vibrator unit 34 (see FIGS. 5 and 6) is provided on the inner surface 41A of the pair of gripping pieces 41, that is, the surfaces facing each other. Then, when the grip portion 33 is closed, the inner surfaces 41A of the pair of grip pieces 41 come into contact with each other. As a result, a structure such as a blood vessel can be sandwiched between the pair of gripping pieces 41 for gripping.
  • the pair of gripping pieces 41 constituting the gripping portion 33 can be opened and closed in the vertical direction about the support shaft 41B.
  • the support shaft 41B is supported by the support member 43.
  • the grip pieces 41 are each formed in a semi-cylindrical shape so that the outer peripheral surface becomes a continuous columnar shape.
  • the link mechanism 42 includes a link plate 42A, a connecting pin 42B, and a fitting pin 42C.
  • One end of the link plate 42A is connected to a pair of gripping pieces 41 via a connecting pin 42B.
  • the position where the pair of gripping pieces 41 are connected to the link plate 42A is the base end portion of the gripping piece 41, and is the position on the base end side of the support shaft 41B.
  • the other end of the link plate 42A is connected to the connecting member 32A provided at the tip of the operation wire 32 via the fitting pin 42C.
  • the fitting pin 42C rotatably connects the link plate 42A to the connecting member 32A.
  • the connecting member 32A is formed in a cylindrical shape.
  • the connecting member 32A penetrates the through hole 43A formed in the support member 43, and a part thereof is located inside the flexible sheath 31.
  • the support member 43 is formed in a substantially cylindrical shape and is fixed to the tip of the flexible sheath 31.
  • the support member 43 has a notch 43B notched from the tip. Since the pair of grip pieces 41 and the link plate 42A move inside the notch 43B, the support member 43 does not hinder the movement of the grip pieces 41 and the link plate 42A.
  • the link mechanism 42 converts the linear motion due to the push-pull motion of the operation wire 32 into a rotary motion, and opens and closes the grip piece 41. That is, when the slider 37 is pulled toward the finger hook portion 36A, the grip piece 41 is closed and the grip portion 33 is closed, as shown in FIGS. 3A and 4. On the contrary, when the slider 37 is pushed toward the grip portion 33, the grip piece 41 is opened and the grip portion 33 is opened as shown in FIGS. 3 (B) and 5.
  • the ultrasonic vibrator unit 34 is configured by laminating an ultrasonic vibrator 51, a backing material layer 52, and an acoustic matching layer 53.
  • the ultrasonic vibrator 51 is composed of a piezoelectric material 54 (also referred to as a piezoelectric element) and electrodes 56 and 57.
  • the piezoelectric material 54 is formed in a plate shape.
  • the electrodes 56 and 57 are formed in a plate shape thinner than the piezoelectric material 54, and are laminated on both sides of the piezoelectric material 54.
  • the ultrasonic vibrator 51 is arranged in parallel with the inner surface 41A of the grip piece 41. That is, the ultrasonic vibrator 51 is arranged at a position facing the structure such as a blood vessel gripped by the grip portion 33.
  • the direction in which the ultrasonic vibrator 51 vibrates is parallel to the direction in which the piezoelectric material 54 and the electrodes 56 and 57 are laminated. Therefore, the direction of ultrasonic vibration by the ultrasonic vibrator 51 and the gripping direction Y gripped by the gripping portion 33 are parallel.
  • the piezoelectric material 54 As the piezoelectric material 54 , a material having a mechanical quality coefficient Qm of 500 or more is used.
  • the mechanical quality coefficient Qm is a coefficient representing elastic loss due to vibration, and is represented by the reciprocal of the mechanical loss coefficient. When the piezoelectric material 54 elastically vibrates, an internal loss occurs and it is converted into heat.
  • FIG. 7A shows a schematic diagram regarding the dielectric loss of the piezoelectric material 54
  • FIG. 7B shows an equivalent circuit of the piezoelectric material 54 when the dielectric loss occurs.
  • a sinusoidal AC electric field E having an angular frequency ⁇ is applied to the piezoelectric material 54
  • the electric displacement D1 vibrates in a phase advanced by ⁇ / 2 with respect to the electric field E1 in the case of no loss.
  • the electric displacement D1 is delayed by the phase difference ⁇ , and a dielectric loss (tan ⁇ in the following equation [Equation 1]) occurs by the phase difference ⁇ .
  • This dielectric loss acts as a dielectric heat generation conversion.
  • the reference numeral IL corresponds to the current supplied to the piezoelectric material 54.
  • Equation 1 There is a relationship of the following equation [Equation 1] between the equivalent capacitance Cd, the resonance resistance R1, and the angular frequency ⁇ in the equivalent circuit shown in FIG. 7B and the phase difference ⁇ .
  • the piezoelectric material 54 has an elastic loss as well as a dielectric loss.
  • a phase difference of ⁇ m is also generated in the strain with respect to the stress caused by the AC electric field.
  • the mechanical quality coefficient Qm is the equivalent capacitance C1 in the equivalent circuit of the piezoelectric material 54 when the elastic loss occurs, the resonance resistance R1, the angular frequency ⁇ s, the equivalent inductance L1, the resonance impedance Zr, the capacitance C, and the resonance frequency.
  • Equation 3 There is a relationship of the following equation [Equation 3] between fr and the anti-resonance frequency fa.
  • the mechanical quality coefficient Qm defined by the above equations [Equation 2] and [Equation 3] is used.
  • the magnitude of the mechanical quality coefficient Qm affects the sharpness of mechanical vibration at the resonance frequency.
  • the piezoelectric material 54 having a high mechanical quality coefficient Qm has a small value of the dielectric loss tan ⁇ that causes heat generation, and is less likely to cause deterioration of the polarization state.
  • the mechanical quality coefficient Qm is low, vibration causes heat generation, so that a high vibration rate cannot be obtained.
  • the mechanical quality coefficient Qm is high, the loss inside the piezoelectric material 54 is small. That is, it can be efficiently converted into ultrasonic vibration with respect to the supplied power. Therefore, in the piezoelectric material 54 having a high mechanical quality coefficient Qm, heat generation is unlikely to occur even if the piezoelectric material 54 is vibrated with a large electric power, and a high vibration speed can be obtained.
  • the piezoelectric material 54 it is preferable to use lead zirconate titanate (PZT).
  • PZT lead zirconate titanate
  • the piezoelectric material 54 is not limited to this, and any piezoelectric material having a high mechanical quality coefficient Qm may be used, and for example, hard piezoelectric ceramics other than PZT may be used.
  • the electrodes 56 and 57 are connected to the connector portion 36C of the operation portion 35 via a signal cable (not shown).
  • the signal cable is wired, for example, along the inner peripheral surface or the outer peripheral surface of the flexible sheath 31.
  • the electrodes 56 and 57 are electrically connected to the ultrasonic power supply device 19 via the signal cable and the connector portion 36C.
  • the electrodes 56 and 57 one is connected to the ground via a signal cable or the like, and the other is supplied with the power of an AC voltage signal described later from the ultrasonic power supply device 19.
  • the acoustic matching layer 53 is provided to match the acoustic impedance between the human body of the patient and the ultrasonic transducer 51.
  • the acoustic matching layer 53 is arranged outside the ultrasonic vibrator 51, and strictly speaking, as shown in FIG. 6, the acoustic matching layer 53 is on the side facing the structure gripped by the grip portion 33 with respect to the ultrasonic vibrator 51. It is piled up. That is, the acoustic matching layer 53 is provided at a position exposed from the inner surface 41A of the gripping piece 41.
  • the acoustic matching layer 53 By providing the acoustic matching layer 53, it is possible to increase the transmittance of ultrasonic waves.
  • the material of the acoustic matching layer 53 various organic materials whose acoustic impedance value is closer to that of the patient's human body can be used as compared with the piezoelectric material of the ultrasonic transducer 48.
  • Specific examples of the material of the acoustic matching layer 53 include an epoxy resin, silicon rubber, polyimide, polyethylene and the like.
  • the acoustic matching layer 53 is formed from a plurality of layers, and the material and the number of constituent layers are appropriately selected according to the required acoustic impedance value.
  • the backing material layer 52 supports the ultrasonic vibrator 51 from the back side (the side opposite to the acoustic matching layer 53).
  • the backing material is made of a rigid material such as hard rubber.
  • an air gap layer 58 that is, a gap interposed between the backing material layer 52 and the ultrasonic vibrator 51 is formed between the backing material layer 52 and the ultrasonic vibrator 51. Since the air gap layer 58 can reflect ultrasonic waves by the air inside, it has a function of reflecting ultrasonic waves emitted from the back side of the ultrasonic vibrator 51. As a result, ultrasonic vibration can be efficiently transmitted to a structure such as a blood vessel S. Not limited to this, the backing material layer 52 may be filled with a material that reflects ultrasonic waves without providing the air gap layer 58.
  • the ultrasonic power supply device 19 includes a signal transmitter 61, an amplifier 62, an impedance matching circuit 63, a current probe 64, and a control unit 65.
  • the signal transmitter 61 has a function of generating an AC voltage signal having an arbitrary frequency and waveform, and has, for example, the same configuration and function as a well-known function generator.
  • the signal transmitter 61 outputs an AC voltage signal having a frequency in a predetermined range and a sine wave waveform.
  • the frequency in the predetermined range is a frequency in which the difference from the resonance frequency of the piezoelectric material 54 is within 20%.
  • An amplifier 62 and an impedance matching circuit 63 are provided for each ultrasonic vibrator 51 in order to supply electric power to the pair of ultrasonic vibrators 51.
  • the signal transmitter 61 outputs an AC voltage signal having the same frequency and the same waveform to the amplifier 62, respectively.
  • the amplifier 62 amplifies the AC voltage signal output from the signal transmitter 61 to a voltage at a level at which the ultrasonic vibrator 51 can be driven.
  • the impedance matching circuit 63 is connected in series with the amplifier 62, and can match the input impedance of the AC voltage signal output from the amplifier 62 with the impedance of the ultrasonic vibrator 51.
  • the current probe 64 measures the current value input to the ultrasonic vibrator 51 from the impedance matching circuit 63 and inputs it to the control unit 65.
  • the control unit 65 controls the signal transmitter 61 so as to drive the ultrasonic vibrator 51 at a frequency at which the current value measured by the current probe 64 peaks.
  • control unit 65 first transmits an AC voltage signal to the signal transmitter 61 within a frequency range in which the difference from the resonance frequency according to the thickness dimension D1 of the piezoelectric material 54 described above is within 20%. Controls scanning output. Then, within the range of the frequency scanned and output, the frequency when the current value measured by the current probe 64 reaches its peak is detected, and thereafter, the ultrasonic vibrator 51 is driven at this peak frequency. ..
  • control unit 65 controls the signal transmitter 61 to continuously supply the AC voltage signal for driving the ultrasonic vibrator 51.
  • continuously supplied means that the AC voltage signal is continuously output from the signal transmitter 61 without interruption, at least while the ultrasonic vibrator 51 is being driven.
  • a doctor who is a user will explain the operation when performing treatment with the ultrasonic treatment tool 18.
  • the doctor inserts the insertion portion 12a of the endoscope 12 into the body of the patient who is the subject, observes the endoscope image taken by the image sensor, and observes, for example, the blood vessel S which is a structure in the patient's body. Find the location (see FIGS. 5 and 9) and determine where to perform the procedure.
  • the doctor inserts the flexible sheath 31 of the ultrasonic treatment tool 18 into the forceps channel 23. At this time, the doctor keeps the grip portion 33 closed by operating the operation portion 35.
  • the doctor While observing the endoscopic image captured by the image sensor of the endoscope 12, the doctor projected the ultrasonic treatment tool 18 from the forceps outlet 22 and operated the operation portion 35 to open the grip portion 33. Put it in a state. As a result, the positions of the pair of gripping pieces 41 can be aligned with the positions sandwiching the blood vessel S (state shown in FIG. 5).
  • the operation unit 35 is operated to rotate the gripping piece 41 from the open position to the closed position to grip the blood vessel S (state shown in FIG. 9). Further, the doctor operates the ultrasonic power supply device 19 to start outputting an AC voltage signal for driving the ultrasonic vibrator 51. As a result, the driving of the ultrasonic vibrator 51 starts and the ultrasonic vibration V is transmitted to the blood vessel S. At this time, in addition to the ultrasonic vibration V, heat generation such as an electrical loss that is not converted into vibration energy is also transmitted to the blood vessel S gripped by the grip portion 33.
  • the ultrasonic vibration V shown by the broken line in FIG. 9 is schematically shown and is different from the actual waveform or the like.
  • the piezoelectric material 54 constituting the ultrasonic vibrator 51 uses a material having a mechanical quality coefficient Qm of 500 or more, heat is generated in the piezoelectric material 54 even if it is vibrated with a large electric force. It is difficult and a high vibration rate can be obtained. That is, ultrasonic vibration can be efficiently transmitted and absorbed to a structure such as a blood vessel S, and the temperature of the blood vessel S can be raised to about 60 ° C to 90 ° C, which is the denaturation temperature of proteins and the like, in a short time. Can be done. This makes it possible to easily perform treatments such as sealing and incision of the blood vessel S.
  • the piezoelectric material 54 can be efficiently converted into ultrasonic vibration with respect to the supplied power, it is possible to suppress the temperature rise of the piezoelectric material 54 itself, which is a device, and the ultrasonic vibrator 51 fails. Alternatively, deterioration can be prevented.
  • the ultrasonic vibration V by the ultrasonic vibrator 51 can be more efficiently applied to a structure such as a blood vessel. Can be transmitted and absorbed. Further, since the ultrasonic vibrator 51 is driven by an AC voltage signal having a difference between the resonance frequency of the piezoelectric material 54 and the frequency within 20%, the ultrasonic vibrator 51 can be driven with even larger power. A high vibration rate can be obtained.
  • the verification results for verifying the effect of the present invention will be described.
  • the piezoelectric material 54 used for the ultrasonic vibrator 51 the piezoelectric materials of Examples 1 to 4 having a mechanical quality coefficient Qm of 500 or more applied to the present invention and the mechanical quality applied to the present invention were verified. This was done by comparing with the piezoelectric materials of Comparative Examples 1 and 2 in which the coefficient Qm was not 500 or more.
  • the types of piezoelectric materials, the mechanical quality coefficient Qm, and the ultrasonic intensity maintenance rate in Examples 1 to 4 and Comparative Examples 1 and 2 are as shown in Table 1.
  • the piezoelectric materials used in Examples 1 to 4 and Comparative Examples 1 and 2 are piezoelectric ceramics manufactured by Fuji Ceramics Corporation, which are made of different materials.
  • the ultrasonic intensity maintenance rate is a ratio between the ultrasonic intensity (proportional to the vibration velocity) in the initial state in which the ultrasonic transducer is driven and the ultrasonic intensity measured after driving for a certain period of time.
  • the ultrasonic intensity maintenance rate is high (ultrasonic intensity maintenance rate is 75% or more). .. That is, even if the ultrasonic oscillator composed of the piezoelectric materials of Examples 1 to 4 is driven, since the loss is small inside the piezoelectric material, the temperature of the device itself is unlikely to rise and deterioration is unlikely to occur. Good performance that the ultrasonic oscillator 51 can be driven with a large amount of power can be obtained.
  • the ultrasonic intensity maintenance rate is low (the ultrasonic intensity maintenance rate is 40% or less). That is, when the ultrasonic vibrator composed of the piezoelectric materials of Comparative Examples 1 and 2 is driven, the temperature of the device itself tends to rise due to a large loss inside the piezoelectric material, and deterioration or the like may occur.
  • both of the pair of gripping pieces 41 constituting the gripping portion 33 are provided with ultrasonic vibrators 51, and ultrasonic vibrations are transmitted to the structure from both of them.
  • the ultrasonic vibrator 51 may be provided only on one of the pair of gripping pieces 41 constituting the gripping portion 33.
  • the ultrasonic vibrator 51 is arranged in parallel with the inner surface 41A of one grip piece 41, and the inner surface 41A of the other grip piece 41 facing the ultrasonic vibrator 51 is an ultrasonic wave by the ultrasonic vibrator 51. It is preferably formed from a material that reflects vibration.
  • the endoscope 12 to be combined with the ultrasonic treatment tool of the present invention is not specified, but it may be any one provided with a forceps channel into which the treatment tool is inserted, for example, a bronchoscope and an upper digestion. It may be a tube endoscope or a lower gastrointestinal endoscope.

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CN202180070352.2A CN116406241A (zh) 2020-10-14 2021-10-14 超声波处置器具及内窥镜系统
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CN116406241A (zh) 2023-07-07

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