JPH0117695B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION TECHNICAL FIELD The present invention relates to a device for treating an affected area within a body cavity with laser light, and more particularly to a device for adjusting the pressure of gas delivered into a body cavity.

"Prior Art and its Problems" This type of laser treatment device is generally known as a laser scalpel, and when used for treatment inside a body cavity, it is transmitted through a laser power transmission fiber (hereinafter referred to as "tube") through an endoscope channel (tube). A laser fiber (called a laser fiber) is inserted into the body cavity. This laser fiber is inserted into a protective pipe in order to prevent thermal damage caused by foreign matter scattered from the affected area adhering to its tip, and further, from the gap between this protective pipe and the laser fiber, It is common to inject gas into the body cavity to prevent foreign matter from adhering to the body cavity.

For example, when using this device to treat various gastric diseases with laser irradiation, the insufflation gas fills the stomach, causing the stomach wall to stretch, rupturing tubules and causing bleeding, or causing patients to experience abnormal stomach tension. Patients may complain of pain, and furthermore, because the stomach wall stretches, minute changes in the mucous membrane cannot be accurately detected, resulting in inconveniences such as a lack of accuracy in endoscopic diagnosis and treatment of gastritis. For this reason, it is necessary to recover the gas delivered into the stomach and maintain the pressure within the stomach within a constant range. For this reason, conventionally, for example, a two-channel endoscope has been used, with one channel being used for the laser fiber and the other channel for gas suction. However, in a two-channel endoscope, the outer diameter of the tube for insertion into the body is large, which causes great pain to the patient when the tube is inserted into the body cavity. In addition, with a single-channel endoscope, it is necessary to separately insert a pipe like a gastric tube into the stomach to aspirate the insufflation gas, which causes the problem of patient pain and operator labor. It was hot.

``Purpose of the Invention'' Based on the awareness of the problems with conventional devices, the present invention aims to efficiently collect and suction the gas sent into the body cavity during laser treatment using a single-channel endoscope. The purpose is to obtain a device that can.

"Summary of the Invention" The present invention was made based on the idea that the gap between the tube body for inserting the protective pipe into the body cavity and the protective pipe is used for exhaust gas and for detecting the pressure inside the body cavity. The device is characterized in that this gap is communicated with both the suction device and the body cavity pressure detection device.

"Embodiments of the Invention" The present invention will be described below with reference to illustrated embodiments. In FIGS. 1 and 2, the laser light emitted from the power laser 11 such as a YAG laser or an Ar laser is
The light is focused through a focusing optical system 12 onto the incident end face of a laser fiber 14 fixed to the shaft portion of a mounting tube 13 . The mounting tube 13 is the mounting plate 15 of the laser scalpel main body.
The laser fiber 14 is fixed to this mounting tube 13 via a fixing jig 16.

The flexible laser fiber 14 extends from the mounting tube 13, and one end of a protection pipe 17 through which the laser fiber 14 is inserted is fixed to the attachment tube 13. The length of the tip of the laser fiber 14 is set so that it does not protrude from the protective pipe 17. There is an annular gap between the laser fiber 14 and the protective pipe 17, and an air supply nipple 18 communicating with this gap is fixed to the mounting tube 13. This air supply nipple 18 is connected to a removable air supply pipe 19.
It communicates with the air supply mechanism 20 via.

A mounting ring 21 is screwed and fixed to the end of the mounting tube 13 opposite to the condensing optical system 12, and a tube 22 into which the laser fiber 14 and the protection pipe 17 are inserted is inserted into the mounting ring 21. One end is fixed. The present invention utilizes the annular gap 23 between the tube 22 and the protective pipe 17 for exhaust gas and body cavity pressure detection.
and a pressure nipple 25 are fixed. The exhaust nipple 24 is connected to a suction mechanism 27 via a suction pipe 26, and the pressure nipple 25 is connected to a pressure sensor 29 via a connecting pipe 28.

In this device having the above configuration, in a state where the body insertion tube 31 of the endoscope 30 is inserted into the stomach 32 (body cavity), the tube 22 is inserted through the forceps channel (tube) 33, and the protective pipe 17 at the tip and the laser beam are inserted. The fiber 14 is exposed inside the stomach 32 and used. That is, in this state, the power laser 11 is driven to apply laser light to the laser fiber 14, and the affected area is treated with the laser light emitted from the tip of the laser fiber 14. At the same time, when the air supply mechanism 20 is driven to supply air supply gas to the mounting tube 13 via the air supply pipe 19 and the air supply nipple 18, this gas passes through the gap between the laser fiber 14 and the protection pipe 17. It is then delivered into the stomach 32. Therefore, the tip of the laser fiber 14 is
It is protected mechanically by the protection pipe 17 and at the same time is protected by the fluid flow caused by the air supply gas, thereby preventing the attachment of foreign matter flying from the affected area and the thermal damage caused by the attachment.

In the present invention, the insufflation gas supplied into the stomach 32 is sucked from the gap 23 between the tube 22 and the protective pipe 17 via the exhaust nipple 24, the suction pipe 26, and the suction mechanism 27. . The suction mechanism 27 is controlled by the output of the pressure sensor 29. The pressure sensor 29 is connected to the joint pipe 2
8, pressure nipple 25 and tube body 22
and the protective pipe 17 through the gap 23 between the stomach 3 and the protective pipe 17.
2, the suction mechanism 27 can be controlled according to the pressure within the stomach 32, and laser treatment can be performed in an ideal state in which the pressure within the stomach 32 is always kept within an allowable range. What is particularly important in the present invention is that the endoscope 30 does not require a special channel for evacuation of the insufflation gas, and the above evacuation and its control can be performed with just one forceps channel 33. can.

FIG. 3 shows an embodiment of a control system for performing this control. In this example, the suction mechanism 2
7 is composed of a suction bottle 35, a controller 36, an electromagnetic on-off valve 37, and a suction pump 38, and the air supply mechanism 20 is composed of an air supply pump 39 and an air filter 40. Air supply mechanism 2
0 may consist of a CO ₂ gas cylinder, for example.
The output of the pressure sensor 29 is given to a control circuit 41, and the control circuit 41 compares the output of the pressure setting circuit 42 with the output of the pressure sensor 29. Storage device 43
is a timer control device 4 that opens and closes the electromagnetic on-off valve 37.
4, which receives the output of the control circuit 41 and controls the controller 36. The controller 36 controls the amount of air sent into the suction bottle 35 when the electromagnetic on-off valve 37 is in the open state.

FIG. 4 shows an example of the body cavity pressure p controlled by the control system shown in FIG. Cyclically on (closed) off (open)
be done. In the same figure, straight line b is the pressure setting circuit 4
The pressure inside the stomach 32 set by 2, curve a is the actual pressure inside the stomach 32. Now solenoid on-off valve 37
If some factor for increasing the pressure in the stomach 32 occurs even though the valve is open, the actual pressure a in the body cavity will not increase in the interval A until the electromagnetic on-off valve 37 is opened by the timer control device 44. continue. time t1
When the electromagnetic on-off valve 37 closes at t2, it opens again.
During this time, the pressure sensor 29 detects the pressure within the stomach 32. Then, the control circuit 41 controls the pressure sensor 29
The actual pressure a is determined by comparing the pressure of the pressure setting circuit 42 and the pressure of the pressure setting circuit 42.
is larger than the set pressure b, and in the next section B, the controller 36 discharges the gas in the stomach 32 to the outside to lower the pressure in the stomach 32. The signal value (displacement amount) at time t2 is stored in the storage device 43.
is memorized. At time t3, the electromagnetic on-off valve 37 closes again and the pressure within the stomach 32 is detected by the pressure sensor 29, and the detected pressure is similarly transmitted to the control circuit 4.
1. It is input to the controller 36 via the storage device 43, and the controller 36 determines the displacement amount in the next section C so that the actual pressure a becomes the set pressure b. Thereafter, similar operations are repeated, and as a result, the actual pressure a within the stomach 32 approaches the set pressure b.

During the times t1 to t2, t3 to t4, and t5 to t6 from when the electromagnetic on-off valve 37 closes until it opens, as shown in FIG.
The reason why the actual pressure a increases is because the electromagnetic on-off valve 37 is closed, and as a result, the passage connecting the stomach 32 and the pressure sensor 29 becomes a closed loop. By making the passageway during pressure measurement into a closed loop in this way, the intrabody cavity pressure can be measured more accurately.

The above control system shows an example for controlling the device of the present invention, and the device of the present invention may be controlled by a different control system.

In the embodiment described above, the protective pipe 17 through which the laser fiber 14 is inserted is inserted into the tube 22, and the tube 22 is further inserted into the forceps channel 33 of the endoscope 30. Therefore, it is convenient to manufacture and sell the endoscope laser treatment device of the present invention and the endoscope separately as a unit. However, as is clear from consideration of the state of use, the tube 22 and the forceps channel 33 are double tubes, and the gap formed therebetween is not utilized. Therefore, the tube 22 can be omitted if a cap that can securely fix the attachment ring 21 in a sealed state is provided at the entrance of the forceps channel of the endoscope. Such an embodiment is suitable for supplying the body cavity pressure adjustment device of the present laser treatment device as an adapter for an endoscope, and has the advantage that the forceps channel 33 can be configured to be thin.

"Effects of the Invention" As described above, the body cavity pressure regulating device of the present invention supplies the gap between the laser fiber and its protective pipe into the body cavity in a laser treatment device that performs laser treatment via an endoscope. The gap between the protective pipe and the tube body that guides the protective pipe into the body cavity is used as an exhaust passage for the supplied gas and for detecting the pressure inside the body cavity. Therefore, there is no need for a dedicated exhaust channel or the use of a suction sonde, which were previously required. Therefore, the single-channel endoscope that has been widely used in the past makes it possible to perform laser treatment inside the body cavity. And a 1 channel endoscope has 2 channels.
Since the outer diameter of the tube inserted into the body is smaller than that of a channel, the pain inflicted on the patient can be reduced, and the labor required for the operator is also reduced compared to when using a gastric probe.

[Brief explanation of drawings]

Fig. 1 is a system connection diagram showing an embodiment of the body cavity pressure adjustment device of the laser treatment device of the present invention, Fig. 2 is a sectional view showing a specific structural example of the same main part, and Fig. 3 is an example of the same control system. The block diagram shown in FIG. 4 is a graph showing an example of controlling the intra-body cavity pressure by the control system shown in FIG. 11... Power laser, 12... Condensing optical system, 1
3...Mounting tube, 14...Laser fiber (fiber for laser power transmission), 17...Protection pipe, 1
8...Air supply nipple, 19...Air supply pipe, 20
... Air supply mechanism, 21 ... Mounting ring, 22 ... Tube, 23 ... Gap, 24 ... Exhaust nipple, 2
5...Pressure nipple, 26...Suction pipe, 2
7... Suction mechanism, 28... Connecting tube, 29... Pressure sensor, 30... Endoscope, 32... Stomach (body cavity),
33...forceps channel, 37...electromagnetic on-off valve,
41...control circuit, 42...pressure setting circuit.

Claims (1)

[Claims] 1. A protective pipe through which a fiber for transmitting laser power is inserted is further inserted into a tube body that reaches into a body cavity, and air is supplied into the body cavity through a gap between the protective pipe and the fiber for laser power transmission. In the laser treatment device for treating the affected area with laser light emitted from the tip of the laser power transmission fiber, the gap between the protection pipe and the tube body is communicated with both the suction device and the body cavity pressure detection device. A body cavity pressure adjustment device for a laser treatment device, characterized in that: 2. A body cavity pressure adjustment device for a laser treatment device according to claim 1, wherein the suction device has a cutoff device that shuts off suction. 3. In claim 1 or 2, the body cavity pressure detection device is a body cavity pressure adjusting device for a laser treatment device that detects the body cavity pressure when a cutoff device of the suction device is cutting off suction. 4. In any one of claims 1 to 3, the tube body is a tube of a laser treatment device that is inserted into a forceps channel of an endoscope and is a separate body from the forceps channel. Body cavity pressure adjustment device. 5. The intracorporeal pressure adjustment device of a laser treatment device according to any one of claims 1 to 3, wherein the tube body is a forceps channel of an endoscope.