JPS6111113B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to an intrabody cavity stone crushing device for crushing stones in body cavities such as the bladder, ureter, and bile duct.

Traditionally, the method of crushing stones in body cavities is (1) A method of crushing stones simply by mechanical force.

(2) A method in which ultrasonic waves are focused on the stone and the stone is broken up by vibration.

(3) A method of crushing stones by applying a vibrating hard object to them.

(4) A method that generates an electric arc to create shock waves in the fluid around the stone to fracture it.

(5) A method in which explosives are detonated near the stone to fragment it.

etc. have been proposed.

However, in the method (1) above, it is difficult to actually transmit enough force to cause fragmentation deep into the body cavity. In addition, methods (2), (3), (4), and (5) simply apply the crushing energy from outside the stone, so only a limited portion of the energy acts on the stone. However, others are absorbed into surrounding tissues. Therefore, while its ability to crush stones is weak,
A major drawback was that it caused significant damage to surrounding tissue.

The present invention has been made focusing on the above circumstances,
The objective is to provide a device for crushing stones in a body cavity that can safely and reliably crush stones and expel them from the body without damaging surrounding tissues.

Hereinafter, each embodiment of the present invention will be described based on the drawings.

1 and 2 show a first embodiment of the present invention. That is, this crushing device 1 is
It consists of a cylindrical insertion section main body 2 to be inserted into a body cavity and a proximal operation section 3, and this has the function of observing inside the body cavity like a normal endoscope. That is, the crushing device 1 is provided with an observation optical system and an illumination optical system that extend from the insertion section main body 2 to the hand operation section 3. The observation optical system is located at the tip 4 of the insertion section main body 2.
A visual field image visible through an observation window 5 provided on the front side of the camera is guided to an eyepiece 6 of a hand-side operation unit 3 so that it can be observed from the outside. The illumination optical system is configured to guide illumination light introduced through a cable 7 led out from the hand-side operating section 3 to an illumination window 8 provided on the front surface of the distal end section 4, and to irradiate it into the body cavity.

Note that the front surface of the tip portion 4 is formed into a concave shape. Further, in addition to the observation section 5 and the illumination window 8, a hot water supply port 9 and a channel port 10 are provided on this front surface, and working ends 13 and 1 of a calculus cooling means 11 and a calculus heating means 12, which will be described later, are provided.
4 are provided. Note that the hot water supply port 9 is connected to an external hot water supply device 15 through the insertion portion main body 2.
The hot water supplied from the hot water supply device 15 is spouted from the hot water supply port 9, and the calculus cooling means 1
It is designed to spray onto the working end 13 of 1.
Further, the channel port 10 communicates with the insertion port 10a of the proximal operation section 3 through the insertion section headquarters 2.

The calculus cooling means 11 is connected to a refrigerant supply pipe 1 as a refrigerant passage in a refrigerant return pipe 16 inserted into the insertion part main body 2 from the proximal operation part 3 to the distal end part 4.
7, and the tip of the refrigerant supply tube 17 is constricted to open into an expansion chamber 18 formed near the tip of the return tube 16. Further, a cooling heat transfer member 19 that forms a working end 13 and faces the expansion chamber 18 is provided. This cooling heat transfer member 19 is made of a material with good thermal conductivity, and is attached to the tip of the return pipe 16 by being fitted thereinto. The cooling heat transfer member 19 is provided so as to contact the calculus 20 within the body cavity.

Furthermore, the refrigerant supply pipe 17 is connected to a tank 21 that stores a refrigerant, such as liquefied nitrogen, so that the refrigerant is supplied, guided, and ejected into the expansion chamber 18. Then, the refrigerant is adiabatically expanded and vaporized in the expansion chamber 18,
The cooling heat transfer member 19 is cooled using the so-called Joel-Thompson effect. Note that the vaporized refrigerant is discharged to the outside through a return pipe 16. In addition, the return pipe 16 and the refrigerant supply pipe 1
Adjustment valves 22 and 23 are provided at the outer ends of the pumps 7, respectively, so that the flow rate can be adjusted.

On the other hand, the calculus heating means 12 is configured to emit a laser beam from the distal end portion 4 of the insertion section main body 2. That is, a channel 25 is formed in the insertion portion main body 2, through which a laser beam transmission member 24 made of quartz fiber or the like is inserted. It reaches the inside of the prism 26 forming the . Furthermore, the proximal end side of the laser beam transmission member 24 extends outside from the hand-held operating section 3 and is connected to a laser beam generator 27 . The calculus heating means 12 transmits the laser beam generated by the laser beam generator 27 to the laser beam transmitting member 24.
The laser beam is sent to the prism 26 at the working end 14 through the prism 26, and is emitted into the body cavity. Further, the direction of emission of this laser beam is provided so as to intersect with the direction of action of the cooling heat transfer member 19 in front of the tip portion 4 . That is, the working directions of the working ends 13 and 14 are directed inward and intersect with each other, as shown in FIG.

Next, a method of using the crushing device 1 having the above configuration will be explained.

First, the insertion section main body 2 is inserted into the body cavity 28 where the calculus 20 is located, and its distal end 4 is brought close to the calculus 20 as shown in FIG. Note that this is performed while observing the inside of the body cavity 28 using an observation optical system. Then, the working end 1 of the distal end portion 4 on the calculus cooling means 11 side
3 is pressed against the surface of the calculus 20. At this time, if the calculus 20 has a normal shape, it will be slightly away from the prism 26, which is the active end 14 on the calculus heating means 12 side.

In this state, the regulating valve 23 of the refrigerant supply pipe 17 on the proximal side is opened and the refrigerant supply pipe 17 is sent out from the tank 21. Then, the refrigerant is supplied from the tip of the refrigerant supply pipe 17 to the expansion chamber 18 at the tip portion 4.
The heat transfer member for cooling 19
to cool down. Therefore, this cooling heat transfer member 1
A part of the calculus 20 that comes into contact with the calculus 9 is cooled. Note that since the return pipe 16 is made of a heat insulating material, it does not cool any portion other than the cooling heat transfer member 19. Further, the refrigerant expanded and vaporized in the expansion chamber 18 is discharged to the outside through the return pipe 16. The amount of cooling can be controlled by appropriately adjusting the regulating valves 22 and 23.

Meanwhile, the calculus heating means 12 is also operated. That is, the laser beam generator 27 is operated to oscillate, and the laser beam is guided to the prism 26 as the working end 14 via the laser beam transmission member 24, and the laser beam is emitted from the prism 26 into the body cavity. And the stone 20 mentioned above
Heat it by applying it to other parts of the body. However, stone 20
One of the adjacent different parts is the calculus cooling means 11
The other part is cooled by the calculus heating means 12.
Since the calculus 20 is heated by heat, stress due to thermal strain is generated inside the calculus 20, and the calculus 20 can be crushed. Note that although cooling and heating are applied at the same time, crushing can be achieved in the same way even if cooling and heating are applied alternately.

In addition, the refrigerant supply pipe 1 of the calculus cooling means 11 during use
If an ice block or the like adheres to the tip of the tip 7 and obstructs the flow of the refrigerant, hot water is sprayed from the hot water supply port 9 to dissolve it. Furthermore, the melting means may be electrically heated.

3 and 4 show a second embodiment of the invention. Stone cooling means 11 of this embodiment
The expansion chamber 18 is open to the outside, and a suction pump 28 is provided at the downstream side of the regulating valve 22 in the refrigerant return pipe 16. In this case, since the refrigerant comes into direct contact with the calculus 20, cooling efficiency can be improved. In addition, the regulating valves 22, 2
By adjusting the refrigerant 3 and the suction pump 28 to appropriate conditions, the refrigerant can be discharged from the body without being unnecessarily diffused into the body cavity.

Further, the calculus heating means 12 of this embodiment heats the calculus using a high frequency current. That is, the small electrode 29 forming the working end 14 on the front surface of the tip 4
A high-frequency power source 3 is connected between the external electrodes 30, which have a large area and are brought into contact with the body surface.
1. By applying a high frequency voltage between the small electrode 29 and the external electrode 30, heat is generated between the contact area of the calculus 20 and the small electrode 29, thereby heating the calculus 20.

5 and 6 show a third embodiment of the present invention. Stone heating means 1 in this embodiment
2 uses ultrasonic waves for heating. That is, an ultrasonic vibrator 32 as an active end is attached to the front surface of the distal end portion 4, and this ultrasonic vibrator 32 is connected to an external ultrasonic power source 33 as an excitation means via a conductive wire inserted into the insertion portion main body 2. The stone is connected to the ultrasonic power source 33 and vibrates when receiving a driving voltage from the ultrasonic power source 33, thereby generating heat due to the vibration in the stone 20 that comes into contact with the stone.

Further, in this embodiment, a calculus catcher 34 is provided at the distal end portion 4. This calculus catcher 34 forms a plurality of through holes 35 provided in the insertion part main body 2,
Wires 36 are inserted through these through holes 35, respectively, and the tips of the wires 36 protruding from the tip portion 4 are tied together with a ring 37. By inserting and retracting the wires 36 in the proximal operating section 3, the stone 20 can be captured therein. Stone 20 like this
If the calculus 20 is captured and brought into contact with the working ends 13 and 14 of the calculus cooling means 11 and the calculus heating means 12, the cooling and heating effects will be enhanced.
Furthermore, mechanical pressure caused by abutment can also be used for crushing. Furthermore, the crushed stone 20, which has become smaller, can be captured and actively expelled from the body without waiting for natural expulsion even in the narrow part of the body cavity 28, which it could not pass through before being crushed.

Further, the present invention provides a calculus heating means that uses an electric current to heat a heating heat transfer member provided at the distal end of the insertion part main body 2 in a state insulated from the outside (body tissue), and brings it into contact with the calculus. But that's fine.

As explained above, the present invention creates an inflated amount inside the stone by cooling part of the stone in the body cavity and heating the other part, or by alternately cooling and heating the stone. This method generates uniform internal stress to crush the stone. Therefore, the crushing capacity is large, and the crushing can be carried out safely without applying vibrations or shock waves to the surrounding tissue as in the conventional case, and without damaging the surrounding tissue.

In particular, the liquid that has penetrated into the cracks of the calculus can be frozen and crushed by the pressure of expansion, thereby further increasing the crushing ability.

In addition, thermal effects include both cooling and heating, so if they act locally, thermal distortion will occur in the stone, but by the time the cooling and heating effects are transmitted through the stone and reach the surrounding tissues, they are Offsetting, thermal damage to surrounding tissue is extremely low.

In addition, since the cooling and heating action ends are installed at the distal end of the insertion section main body at a distance smaller than the diameter of the distal end, narrow body cavities approximately equal to the diameter of the distal end of the insertion section main body can be used. Even within the catheter, a position (of the insertion part body) can be taken so that it acts only on the stone and not on the surrounding tissues.

In particular, since the operating ends are provided so that the direction of action of cooling and heating faces inward, the degree of safety for surrounding tissues is high.

[Brief explanation of the drawing]

FIG. 1 is a side sectional view showing the first embodiment of the present invention, FIG. 2 is a front view of the tip thereof, FIG. 3 is a side sectional view showing the second embodiment of the invention, and FIG. The figure is a front view of the tip, FIG. 5 is a side sectional view of the tip showing a third embodiment of the present invention, and FIG. 6 is a perspective view of the tip. DESCRIPTION OF SYMBOLS 1... Crushing device, 2... Insertion part main body, 4... Tip part, 11... Stone cooling means, 12... Stone heating means, 13... Working end, 14... Working end, 18...
... expansion chamber, 19 ... heat transfer member for cooling, 20 ... stone, 29 ... small electrode, 32 ... ultrasonic vibrator.

Claims (1)

[Claims] 1. An insertion section body to be inserted into a body cavity, and a stone cooling means and a stone heating means each having a working end at the distal end of the insertion section main body. A device for crushing stones in body cavities. 2. The body cavity according to claim 1, wherein the calculus cooling means comprises a refrigerant passage forming an expansion chamber at the distal end of the insertion portion main body, and means for supplying a refrigerant to the refrigerant passage. Internal calculus crushing device. 3. According to claim 1 or 2, the calculus cooling means and the calculus heating means are provided with their respective working ends so that their cooling and heating directions intersect at the front of the working direction. The intrabody cavity stone crushing device described above. 4. The body cavity according to claim 2, wherein the refrigerant passage is closed to the outside at the distal end of the insertion portion main body, and a cooling heat transfer member is provided between the expansion chamber and the outer surface. Internal calculus crushing device. 5. The intrabody cavity stone crushing device according to claim 2, wherein the expansion chamber is formed to be open to the outside of the distal end of the insertion section main body. 6. Crushing of a calculus in a body cavity according to any one of claims 1 to 5, wherein the calculus heating means is configured to emit a laser beam from the distal end of the insertion section main body. Device. 7 The calculus heating means is provided with at least one of a pair of electrodes at the distal end of the insertion part main body, and
The apparatus for crushing stones in a body cavity according to any one of claims 1 to 5, further comprising a high-frequency power source that applies a high-frequency voltage between the electrodes. 8 The calculus heating means includes a heating heat transfer member made of a thermally conductive material exposed at the distal end of the insertion portion main body, and this heating heat transfer member is insulated from the outside of the insertion portion main body. 6. A device for crushing a stone in a body cavity according to any one of claims 1 to 5, characterized in that the device comprises means for heating by a current applied to the body cavity. 9. Any one of claims 1 to 5, characterized in that the calculus heating means comprises an ultrasonic vibrator provided at the distal end of the insertion section body, and excitation means for the ultrasonic vibrator. A device for crushing stones in a body cavity as described in the above.