JPH0414580B2 - - Google Patents

Description

[Detailed Description of the Invention] [Industrial Application Field] The present invention is an ultrasonic surgery for crushing stones existing in body cavities such as kidneys, ureters, and urethra using ultrasonic vibrations and removing them from the body cavities. It is related to the device.

[Prior Art] Conventionally, methods for removing stones in body cavities such as the kidney, ureter, and urethra include methods of removing stones through open surgery, and percutaneous removal of stones using a basket catheter or loop catheter through a nephrostomy. Methods such as inserting the stone into the renal pelvis and grasping and removing the stone are used. However, in the case of open surgery, recovery after surgery takes a very long time. Furthermore, when using a basket catheter or loop catheter, it is difficult to remove stones larger than the size of the renal fistula, for example, about 8 mm, and stones that are embedded in the calyx, such as coral stones, have the disadvantage that they cannot be grasped. Ta.

Recently, various new methods for crushing stones have been proposed. For example, Tokukai Akira
56-23943). However, this method has the risk of damaging the biological tissue on the surface of the body cavity by heating the stone.

Additionally, as a type of non-invasive lithotripsy, a shock wave is generated by an electric discharge or an explosive explosion, and the convergence is focused through a lens or the like to focus on the stone located within the body cavity rather than the body surface, and the stone is fragmented. A method (for example, Japanese Patent Application Laid-open No. 88146/1983) has also been disclosed. but,
Coral stones and giant stones are difficult to crush;
In addition, when calculus sand with a diameter of 4 mm or less is crushed by shock waves and is naturally excreted, it may become clogged at the narrowed part of the ureter or the ureteral orifice, causing hydronephrosis, pain, kidney damage, etc. It has the disadvantage that it is difficult to crush lower ureteral stones and to apply it to children because it requires a sufficient distance from the bone crest.

Furthermore, as a method of crushing a calculus, a method of crushing a calculus by using mechanical vibrations at an ultrasonic frequency or converting the mechanical vibrations into impact force using an impactor attached to the tip (for example, Japanese Patent Application Laid-Open No. 49 -21989 Publication). However, there are relatively soft stones such as phosphate stones, and hard stones such as urate stones and oxalate stones. It can only be crushed. Also,
If the surface of the stone was smooth, there was a risk that the stone would be dislodged even if the ultrasonic vibrating tip of the probe came into contact with it. Furthermore, when converting mechanical vibrations into impact force to crush a stone, the crushing performance improves, but it is necessary to drive the probe and ultrasonic vibration source at an efficient frequency to which the mass load of the impacting body is applied. Furthermore, even if a dynamic impedance feedback oscillator with excellent load tracking characteristics is used to deal with the high load of crushing a stone, it is difficult to continuously convert mechanical vibrations at ultrasonic frequencies into impact force. difficult. Moreover, the stress applied to the probe also increased, and there was a risk that the probe would be damaged.

[Purpose of the Invention] The present invention aims to solve the above-mentioned problems of the conventional stone removal method. By using the method of suction removal outside the body cavity through the cavity, there is no limit to the size of stones that can be crushed and removed, and it can also crush and remove stones such as coral-shaped stones embedded in the renal calyx, unfixed stones, hard stones with smooth surfaces, etc. The present invention aims to provide an ultrasonic surgical device that is capable of continuously crushing all kinds of stones, has no risk of damage to the probe during surgery, and has excellent operability.

[Structure of the Invention] That is, the present invention provides a feedback oscillator, a bolt-tight Languevin type vibrator having a through hole parallel to the vibration direction, a metal horn having a through hole, a tubular probe joined to the tip of the horn, and a suction device, the tip of the tubular probe in contact with the calculus, in which the bolted lunge-type vibrator, the metal horn, and the through holes of the tubular probe communicate with each other and are connected to the suction device;
This ultrasonic surgical device is made of a metal having a smaller specific gravity than the tubular probe, and is joined with an annular tool having a smaller inner diameter than the tubular probe.

Hereinafter, the present invention will be explained in detail with reference to the drawings.

FIG. 1 is a diagram showing the configuration of an ultrasonic surgical device according to an embodiment of the present invention. A high frequency current is sent from the feedback oscillator 1 through the cable 2 to the bolted Languevin type transducer 3 (hereinafter referred to as BLT),
BLT3 generates mechanical vibrations at ultrasonic frequencies. Ultrasonic frequency is 20~40KHz, preferably 23~
30KHz, BLT3 consists of an electrostrictive element with a through hole parallel to the vibration direction, and its maximum diameter is usually 10 to 30 mmφ, but is not particularly limited.
From the viewpoint of operability or crushing performance, the diameter is preferably 15 to 25 mm.

Mechanical vibrations at ultrasonic frequencies generated by the BLT 3 are amplified by a horn 4 connected to the tip of the BLT 3 in an appropriate manner, for example, with a screw, and further transmitted to a tubular probe 5 joined to the tip of the horn 4. The material of the horn 4 and the tubular probe 5 is preferably titanium alloy or stainless steel, which have high fatigue strength, but is not particularly limited. Further, the method of joining the horn 4 and the tubular probe 5 is not particularly limited, but if the horn 4 and the tubular probe 5 are made of the same metal, arc gas welding in argon gas or electron beam welding in a vacuum may be used. It is preferable to join them, and if they are dissimilar metals, it is preferable to connect them with screws. The amplitude at the working part 11 of the tip part 6 of the tubular probe 5 is:
Preferably, the thickness is 40 μm or more. In addition, the working part 11
The positioning method for bringing the stone into contact with the stone is not particularly limited, but a method using an endoscope is preferable. Stone fragments crushed in the working part 11 are sucked into the suction device 8 from the tube 7 through holes (through holes) inside the tubular probe 5, the horn 4, and the BLT 3, and are discharged therefrom.

FIG. 2 is a diagram showing an embodiment of the tip portion 6 of the tubular probe 5. As shown in FIG. A plurality of slits 9 are provided at the tip 6.
is provided, and the diameter of the opening 10 is equal to that of the tubular probe 5.
is smaller than the diameter of the through-hole. Moreover, since the thickness of the working part 11 is thinner than the wall thickness of the tubular probe 5, the vibration energy in the working part 11 increases in inverse proportion to the area of the working part 11, improving the crushing ability. The number and width of the slits 9 are not particularly limited. FIG. 3 is a diagram showing the state of stone fragmentation using the tubular probe 5 having the tip structure shown in FIG. 2. The tubular probe 5 is vibrating in the direction of arrow 14, but due to the effect of the slit 9, the working part 11 is vibrating not only in the direction of arrow 14 but also in the direction of arrow 13, which is a complex vibration. Therefore, it is possible to prevent a phenomenon in which the calculus 12 is thrown away simply by the working part 11 coming into contact with the calculus 12, which has been a problem in the past.

FIG. 4 shows an embodiment in which the opening diameter of the tip 6 of the tubular probe 5 is smaller than the diameter of the through hole of the tubular probe. In the example of FIG. They are joined in an appropriate manner. Preferred joining methods include arc gas welding in argon gas and electron beam welding in vacuum. Further, it is preferable to use a titanium alloy as the material of the annular tool 16, and by using an alloy having a specific gravity lighter than that of the material of the tubular probe 5, the working part 11 of the annular tool 16 is lower than the vibration speed of the tubular probe 5. The vibration speed becomes higher, which has the advantage of improving crushing performance. FIG. 5 is a diagram showing the state of stone fragmentation using the tubular probe 5 having the tip structure shown in FIG. It has the effect of preventing clogging caused by stone fragments to be removed.

FIG. 6 shows another embodiment of the tip 6 of the tubular probe 5, which has a holder 19 fixed to the tip 6 in a suitable manner. As the material of the holder 19, it is preferable to use resins such as fluorine-based, polyimide-based, polyamide-based, polycarbonate-based, polyester-based, etc., which have excellent heat resistance, or titanium alloys, stainless steel, etc., which have excellent corrosion resistance. The shape thereof is not particularly limited as long as it can hold the stone as shown in FIG. 7, such as a linear shape or a plate shape. FIG. 7 is a diagram showing a state in which a stone is crushed by the tubular probe 5 having the holder 19 shown in FIG. ing. The vibration direction of the tubular probe 5 is indicated by arrow 2.
1, but due to the function of the holder 19,
It is possible to prevent the phenomenon in which the working part 11 blows away the calculus 12, which was a problem in the prior art.

FIG. 8 is a diagram showing the cross-sectional shape of the tubular probe 5, in which a plurality of grooves 20 are provided on the inner surface of the tubular probe 5 in parallel to the vibration direction. This reduces the contact area between the tubular probe 5 and the stone fragments passing through the inner cavity 17 of the tubular probe 5, thereby providing the effect of preventing clogging due to stone fragments.

[Effects of the Invention] According to the present invention, the vibration speed at the most advanced working part of the ultrasonic surgical device that comes into contact with the stone and has a crushing action is increased, and the crushing performance is improved. Compared to conventional devices, the stone can be continuously and reliably crushed and removed regardless of the size, nature, or site of occurrence of the stone, and it does not require excessive use of the probe during surgery. Since no force is applied, there is no risk of damage, and it is suitable as an ultrasonic surgical device for crushing and removing stones in body cavities.

[Brief explanation of drawings]

FIG. 1 is a diagram showing the configuration of an ultrasonic surgical device according to an embodiment of the present invention. 2, 4 and 6 are views showing examples of the shape of the tip of the tubular probe of the present invention, and FIGS. 3, 5 and 7 are views shown in FIGS. 2 and 4, respectively. 7 is a diagram showing a state in which a stone is being crushed using the tubular probe shown in FIG. 6. FIG. Moreover, FIG. 8 is a diagram showing an example of the cross-sectional shape of the tubular probe of the present invention.

Claims (1)

[Scope of Claims] 1. A feedback oscillator, a bolt-tight Languevin type vibrator having a through hole parallel to the vibration direction, a metal horn having a through hole, a tubular probe joined to the tip of the horn, and a suction device. The ultrasound system consists of a bolted lunge-type vibrator, a metal horn, and a tubular probe whose through holes communicate with each other and are connected to a suction device to crush stones in the body cavity and remove them from the body cavity. An ultrasonic surgical device characterized in that an annular tool made of a metal having a lower specific gravity than the tubular probe and having a smaller inner diameter than the tubular probe is joined to the tip of the tubular probe that contacts the calculus. 2. The ultrasonic surgical device according to claim 1, characterized in that a plurality of grooves parallel to the ultrasonic vibration direction are provided on the inner surface of the metal annular tool. 3. The ultrasonic wave according to claim 1 or 2, characterized in that a plurality of flexible linear or plate-shaped holders are attached to the tip of the tubular probe that comes into contact with the calculus. Surgical equipment.