JPS6321504B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention relates to a high-frequency electric scalpel device suitable for removing polyps.

Generally, when polyps are removed using high-frequency waves, a loop electrode is used as an internal electrode that is introduced endoscopically into a human body cavity.The neck of the polyp is tied up with this loop electrode, and then the loop electrode is connected to the skin of the human body. A high-frequency current was passed between the polyp and an external electrode applied to the polyp to remove the polyp.
In this case, the high-frequency current flows from the loop electrode through the neck of the polyp to the external electrode, but if the neck of the polyp is too thick, the blood vessels in the neck cannot be sufficiently cauterized, and the output setting of the high-frequency power supply may be too high. If the tightening force on the neck by the loop electrode was too strong, the neck would be instantly severed without sufficiently cauterizing the blood vessels in the neck, and there was a great danger of causing major bleeding.

This invention was made based on the above circumstances, and its purpose is to sufficiently cauterize the internal tissue of the neck of a polyp before cutting it by using bipolar internal and external electrodes. In this way, it is an object of the present invention to provide a high frequency electric scalpel device which eliminates the risk of bleeding due to cutting.

An embodiment of the present invention will be described below with reference to the drawings. 1 to 8 show a first embodiment of the present invention, in which numeral 1 represents a high frequency output device. This high frequency output device 1 is provided with a high frequency generation circuit 3 to which a foot switch 2 is connected, and an output circuit 4 is connected to this high frequency generation circuit 3. This output circuit 4 is connected to a primary winding 6 of an output transformer 5, and this secondary winding 7 is connected to a first internal terminal 8 and a second internal terminal 9. The high frequency output device 1 has first to third connection terminals 10, 1.
1 and 12 are provided, and these connection terminals 10 and 1
A changeover switch 13 is provided between the terminals 1 and 12 and the internal terminals 8 and 9. That is, the changeover switch 13 has a first changeover part 14 and a second changeover part 15. The normally open contact 14a of the first switching section 14 is connected to the first internal terminal 8.
The normally closed contact 14b is connected to the second internal terminal 9.
Furthermore, this common contact 14c is connected to the second connection terminal 1
Connected to 1. In addition, the second switching unit 1
The normally open contact 15a of No. 6 is connected to the second internal terminal 9, and the normally closed contact 15b is open. moreover,
This common contact 15c is connected to the third connection terminal 12.

The first connection terminal 10 and the second connection terminal 11
In this case, a bipolar internal electrode 16 is connected to this first
The electrode 17 and the second electrode 18 are connected to each other. The internal electrode 16 is inserted endoscopically into the body cavity, and the first and second electrodes 17 and 18 are inserted into a sheath 19 made of an insulating material, as shown in FIG. The first through hole 20 and the second
They are respectively inserted into the through holes 21 of 2 so as to be freely movable forward and backward. The distal ends of the first and second electrodes 17 and 18 are bent into a hook shape, and are pre-arranged so that when the distal ends are protruded from the sheath 19, they are bent away from each other as shown in FIG. It has a habit. Furthermore, when the first and second electrodes 17 and 18 are drawn into the sheath 19, their positions are shifted so that their tips do not come into contact with each other, as shown in FIG. Therefore, when the neck 23 of the polyp 22 is clamped between the first and second electrodes 17 and 18 as shown in FIG. 6, the tips of these electrodes 17 and 18 will be electrically short-circuited. There are no more.

Further, the output circuit 4 is connected to an output setting circuit 25 that sets the voltage value output from the output circuit 4 to the primary winding 6 using a dial (not shown). A reference voltage generation circuit 26 is connected to this output setting circuit ₂₅ and generates a reference voltage V ₁ based on the set value here.
is input to one input terminal of the comparator 27. Furthermore, a current detection circuit 28 is provided between the first internal terminal 8 and the first output terminal 10 to detect the current flowing there. This current detection circuit 28 is connected to a level conversion circuit 30 via a voltage conversion circuit 29.
The circuit voltage V ₂ output from 0 is the comparator 27
is input to the other input terminal of the .
A relay drive circuit 31 is connected to the output terminal of this comparator 27.
is connected, and a drive signal is output from the relay drive circuit 31 according to a comparison value between the reference voltage V ₁ and the circuit voltage V ₂ . This drive signal is input to a relay 32 connected to a relay drive circuit 31, and when this relay 32 is operated, the first switching section 14 and the second switching section 15 of the changeover switch 13 are switched.

Furthermore, an external electrode 33 that is applied to the patient's skin is connected to the third connection terminal 12.

Next, the operation of the above configuration will be explained. First, the internal electrode 16 is inserted into the patient's body cavity through an endoscope, and the first electrode 17 and second electrode 18
After pinching the neck 23 of the polyp 22, the changeover switch 13 is set to the state shown in FIG. 1, that is, the first state, and the foot switch 2 is turned on.
Then, the high frequency generation circuit 3 generates a high frequency signal, this signal is amplified by the output circuit 4, inputted to the primary winding 6 of the output transformer 5, and boosted by the secondary winding 7, so that the first internal A high frequency output based on the value set by the output setting circuit 25 is generated between the terminal 8 and the second internal terminal 9. Then, the high frequency current flows from the first internal terminal 8 to the first connecting terminal 10.
reaches the first electrode 17 of the internal electrode 16 via
This leads to the second electrode 18 through the neck 23 of the polyp 22, and from this second electrode 18 to the common contact 14c and the normally closed contact 14 of the switching part 14 of the switching switch 13 via the second connection terminal 11.
b to the second internal terminal 9. Therefore, since the high-frequency current passes through the inside of the neck 23 of the polyp 22 held between the first electrode 17 and the second electrode 18, the internal tissues and blood vessels are sufficiently cauterized.

In such a first state, when a high frequency output is generated between the first internal terminal 8 and the second internal terminal 9, the reference voltage generation circuit 26 outputs a voltage according to the setting value in the output setting circuit 25. A reference voltage V ₁ is output, and this reference voltage V ₁ is input to the comparator 27 . On the other hand, in the high-frequency energization in the first state, since the tissue of the neck 23 of the polyp 22 contains a large amount of water at this initial stage, the impedance of this tissue is low, and therefore the current flowing through the neck 23 is large. When the neck 23 is heated by the high-frequency current, water evaporates from this tissue.
The impedance increases rapidly and the current flowing through it decreases rapidly. Further, the voltage between the first and second internal terminals 8 and 9 of the secondary winding 7 at this time is small at the beginning when a large amount of high-frequency current flows, as shown in FIG. 7, and when the impedance of the tissue becomes high. It increases when the high frequency current decreases.

Therefore, at the initial stage of high-frequency energization, the current detected by the current detection circuit 28 is large and the voltage conversion circuit 29 outputs a large voltage, so this output voltage is converted by the level conversion circuit 30 and outputted as described above. The circuit voltage V ₂ according to the voltage is the comparator 2
7 is input. The comparator 27 compares the reference voltage V ₁ and the circuit voltage V ₂ , and when the tissue impedance of the neck 23 is small, level conversion is performed to output the circuit voltage V ₂ so that V ₂ >V ₁ . Since the circuit 30 is regulated, there is no output from the comparator 27, so the relay 32 is not activated and the first state continues.

When such a first state continues for a predetermined period of time, water evaporates from the tissue as described above, so the tissue impedance rapidly increases and the current flowing there sharply decreases. Then, current detection circuit 2
8 decreases, and the value of the circuit voltage V ₂ output from the level conversion circuit 23 becomes smaller.
In the comparator 27, V ₂ <V ₁ . Therefore,
Since the comparator 27 outputs a signal to the relay drive circuit 31 and the relay 32 is turned on, the changeover switch 13 is switched. Changeover switch 13
When switched, the common contact 14c of the first switching section 14 connects to the normally open contact 14a, and
The common contact 15c of the second switching section 15 is connected to the normally open contact 15a. Then, in this second state, the high-frequency current flows from the first internal terminal 8 to the first and second electrodes 17 and 18 via the first and second connection terminals 10 and 11, and from there flows into the polyp 2.
external electrode 3 through the neck 23 of 2 and the patient's body.
3. This external electrode 33 is connected to the third connection terminal and the common contact 15 of the second switching section 15.
c and to the second internal terminal 9 via the normally open contact 15a. Therefore, the neck 23 of the polyp 22
After the internal tissues and blood vessels have been sufficiently cauterized in the first state, the system automatically switches to the second state according to the change in tissue impedance.
Since the entire neck 23 will be cauterized in this state, the first and second electrodes 17 of the internal electrode 16,
By drawing the polyp 18 into the sheath 19 and continuing to apply electricity, the polyp 22 can be cut from the neck 23 without causing bleeding.

The operation of each part when switching from the first state to the second state described above will be further explained with reference to FIG. 8. Turn foot switch 2 from t ₁ to _{t 3} as shown in Figure 8a.
When the tissue impedance in the first state is low between t ₁ and _{t 2} , the circuit voltage V ₂ output from the level conversion circuit 30 is output from the reference voltage circuit 26 as shown in FIG. 8b. Therefore, the relay 32 is connected to the _eighth reference voltage V1.
It is in the OFF state as shown in Figure c. Cervical region 23
is heated and tissue impedance increases rapidly at t ₂ , V ₂ < V ₁ and the relay 32 is turned on.
The polyp 22 can be cut by transitioning from the state to the second state.

FIG. 9 shows a second embodiment of the invention. In this embodiment, a change in the impedance of the tissue of the neck 23 is detected by a change in voltage.
That is, a voltage detection circuit 34 is connected in parallel to the secondary winding 7 of the output transformer 5, and this voltage detection circuit 34 is directly connected to the level conversion circuit 30, and the other parts are the same as in the first embodiment. It has the same configuration as .

According to such a configuration, the voltage detected by the voltage detection circuit 34 also changes in response to a change in the tissue impedance of the neck 23, so that this voltage change causes the high frequency energization to be switched to the first level as in the first embodiment. can be switched from the state to the second state.

As described above, the present invention is capable of ablating an affected area using high frequency waves using the first bipolar internal electrode.
It is possible to switch between a first state in which electricity is applied between the second electrode and a second state in which electricity is applied between the internal electrode and the external electrode, and this switching is detected by detecting the impedance of the affected area. I decided to do this by changing this impedance. Therefore, in the first state, the internal tissues and blood vessels in the neck of the polyp held between the first and second internal electrodes are sufficiently cauterized, and in the second state, the neck is completely cauterized. Moreover, since the switching from the first state to the second state is automatically performed by detecting the change in impedance, that is, when the neck of the polyp has been sufficiently cauterized, it is possible to remove the polyp. This can be done safely without causing bleeding.

[Brief explanation of the drawing]

1 to 8 show a first embodiment of the present invention, FIG. 1 is a schematic configuration diagram of the entire device, FIG. 2 is a sectional view of the internal electrode, and FIG. 2
FIG. 4 is a plan view of the state in which the first and second electrodes are retracted;
Fig. 5 is a side view taken along the line shown in Fig. 4, Fig. 6 is a side view of the neck of the polyp being held between the first and second internal electrodes, and Fig. 7 is a side view of the state in which the neck of the polyp is held between the first and second internal electrodes. An explanatory diagram explaining the state of the current, FIG. 8 is an explanatory diagram explaining the state of each part when switching from the first state to the second state, and FIG. 9 shows a second embodiment of the present invention. It is a schematic block diagram of the whole apparatus. DESCRIPTION OF SYMBOLS 1... High frequency output device, 13... Changeover switch, 16... Internal electrode, 17... First electrode,
18...Second electrode, 25...Output setting circuit, 2
7... Comparator, 28... Current detection circuit, 32...
Relay, 33...external electrode, 34...voltage detection circuit.

Claims (1)

[Claims] 1. In a high-frequency electric scalpel device that cuts a diseased area by passing a high-frequency current through it, the high-frequency electric scalpel device has one end of a high-frequency output terminal connected to a first electrode of a bipolar internal electrode, and the other end connected to a first electrode of a bipolar internal electrode. 2
and a second state in which one end of the high frequency output terminal is connected to the first and second electrodes of the internal electrode and the other end is connected to the external electrode; A high-frequency electric scalpel device comprising a detection circuit that detects impedance of an affected area and switches the switching means from a first state to a second state based on a change in impedance.