JP2001037775A - Treatment device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a treatment device capable of using microwaves as treatment energy, recognizing the geometric enlargement of a treatment area in the axial direction of an energy supplying tool and controlling the output of the microwaves. SOLUTION: The microwaves for treatment of a microwave oscillation part 2 are impressed to a microwave piercing applicator 5 and radiated from a microwave antenna part 6 on the tip side to the side of a viable tissue 7 to which it is pierced. At this time, along the axial direction of the microwave piercing applicator 5, by first electrodes 8A and 8B and second electrodes 9A and 9B respectively arranged in a pair inside a cauterization range to be cauterized near the microwave antenna part 6 and on the outer side, the impedance of the viable tissue is measured by high frequency signals from an HF oscillation part 14. With the impedance between the second electrodes 9A and 9B as a reference, the geometric enlargement of the treatment area to the axial direction of the microwave piercing applicator 5 is recognized from an impedance measured value between the other electrodes and the output of the microwaves is controlled.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a treatment apparatus for applying treatment energy to living tissue for treatment.

[0002]

2. Description of the Related Art As treatment for malignant or benign tumors, heating or coagulation ablation therapy using various energies such as radio frequency, radio wave, argon beam, microwave and laser has been performed.

[0003] Microwaves, which are particularly excellent in the ability of energy to penetrate deep into tissues, have been widely used, for example, for coagulation treatment of hepatocellular carcinoma.

However, this method cannot be performed under direct observation because it is performed in a deep part of a living body, and it is still general to output microwaves according to a table of microwave output values and output time prepared in advance. However, it is difficult to optimally consider the difference in blood flow effect depending on the case or site.

In recent years, a technique has been proposed in which coagulation is performed while observing degeneration of a treatment site tissue in real time by using an ultrasonic diagnostic apparatus together during the operation. However, the procedure becomes complicated, there is a possibility that intracellular bubbling is likely to occur during microwave radiation, which may obstruct the visual field of ultrasonic observation, and the difference in judgment by the operator in determining the coagulation range from the ultrasonic image is The problem is that there is room for intervention.

On the other hand, as disclosed in Japanese Patent Application Laid-Open No. Hei 9-117456, there is an idea to estimate the degree of coagulation by observing the level of a traveling wave and a reflected wave of a microwave radiated from a microwave electrode to a tissue during a treatment. Proposed.

[0007]

However, the criterion is different depending on the type of the microwave electrode, and the level of the reflected wave determined from the biological characteristics near the microwave electrode is used as the criterion. The problem is that it is not easy to grasp the progress of the geometric dimensions clearly.

(Object of the Invention) The present invention uses a microwave having excellent coagulation depth as energy for treatment, and uses a microwave for an energy supply device (applicator) to geometrically expand a treatment area such as coagulation. It is a first object of the present invention to provide a treatment apparatus capable of controlling the output of microwaves by grasping in the axial direction.

Further, the present invention grasps the geometric expansion of the treatment area in the axial direction of the energy supply device (applicator) and controls the microwave output, thereby improving the safety, reliability and simplicity of the treatment. It is also an object to provide an improved treatment device.

[0010] Further, even when energy other than microwaves is used for treatment, the present invention controls the output of microwaves by grasping in the axial direction of an energy supply tool (applicator), thereby improving the safety of treatment. It is also an object to provide a treatment device that improves certainty and simplicity.

[0011]

In order to achieve the above object, a treatment apparatus according to the present invention has a needle shape which is inserted into a living tissue by puncture and applies treatment energy to a living body at a distal end side. An applicator having a treatment section, a measurement electrode provided at a distance from the treatment section in the axial direction of the applicator, and energy supply means for supplying microwave energy to the treatment section for treatment energy for treatment Measuring signal generating means for supplying a high-frequency signal for measurement at a frequency different from the frequency of the therapeutic energy to the measuring electrode; and measuring impedance from an output of the measuring signal generating means supplied to the measuring electrode. By providing an impedance measuring means and a control means for controlling the output of the energy supply means based on the measurement result of the impedance measuring means, By irradiating the treatment energy with a favorable microwave, the treatment area such as coagulation of the living tissue is expanded from the vicinity of the treatment portion to the outside thereof. By grasping the geometric spread of the treatment area in the axial direction, the output of the treatment energy by microwaves can be controlled.

In addition, an applicator having a treatment section for applying energy for treatment to a living body at a distal end portion punctured and inserted into the living tissue, and at least a front side of the treatment section of the applicator are provided. A measurement electrode, an energy supply unit that supplies energy for treatment to the treatment unit, a frequency generation unit that supplies a signal of a measurement frequency to the measurement electrode, and a frequency generation unit that is supplied to the measurement electrode. By providing an impedance measuring means for measuring the impedance from the output, and a control means for controlling the output of the energy supplying means based on the measurement result of the impedance measuring means, the living tissue can be irradiated from the vicinity of the treatment section by irradiation of therapeutic energy. The treatment area such as coagulation is expanded to the outside, and at that time, the biological tissue between the measurement electrodes is Measurement of impedance, to grasp the geometrical spread of the treatment area in the axial direction of the applicator, and to allow the output control of the therapeutic energy.

[0013]

Embodiments of the present invention will be described below with reference to the drawings. (First Embodiment) FIGS. 1 to 8 relate to a first embodiment of the present invention, FIG. 1 shows a configuration of a treatment apparatus according to the first embodiment, and FIG. Shows the configuration of
FIG. 3 shows the configuration of the distal end side of the microwave applicator,
FIG. 4 shows a state in which a microwave applicator is punctured into a living tissue to perform a coagulation treatment, FIG. 5 shows a state in which the microwave applicator is punctured deeper than in FIG. 4 to perform a coagulation treatment, and FIG. FIG. 7 shows a connection relationship between a measurement electrode provided on an applicator and a monitor unit, FIG. 7 shows a microwave output during a coagulation treatment and a timing relationship of a monitor operation, and FIG. 8 shows a relationship between a microwave output amount and a cauterization level. Is shown.

A treatment apparatus 1 having a coagulation range recognition function according to a first embodiment of the present invention shown in FIG. 1 is a microwave oscillating unit for generating energy for treatment, more specifically, microwave energy. The microwave having a frequency of, for example, 2450 MHz oscillated by the microwave oscillating unit 2 is transmitted by the microwave transmission cable 3 and applied to the base end of the microwave puncturing applicator 5 to generate a needle-shaped microwave. It is transmitted to the distal end side by the puncture applicator 5 and irradiated from a microwave radiating antenna section 6 serving as a treatment section on the distal end side to a treatment target site such as a diseased part of a living tissue 7 into which the microwave radiating antenna section 6 is punctured. Is done.

In order to be able to monitor the state of cauterization by the microwave, the microwave puncturing applicator 5
Is provided with a pair of first electrodes 8A and 8B (separated in the axial direction of the applicator 5) and a pair of second electrodes 9A and 9B from the microwave radiating antenna unit 6 serving as a treatment unit. It is.

More specifically, as shown in FIG. 3, with respect to the center of the microwave radiating antenna section 6 which radiates the microwave, a (needle-shaped applicator) at a far point side (tip side) along the center axis direction. And a pair of first electrodes 8 at symmetrical outer peripheral positions facing each other on the near point side (front side).
A and 8B, and a pair of second electrodes 9A and 9B arranged to face the first electrodes 8A and 8B, for example, at positions closer to the near point than the near point 8B.

The first electrodes 8A and 8B are electrodes for measuring the impedance of the living tissue 7 cauterized by the microwave radiated from the microwave radiating antenna unit 6, and are provided inside the cauterization area 10 to be cauterized or Set near the boundary.

On the other hand, the second electrodes 9A and 9B are separated from the microwave radiating antenna section 6 in the axial direction (cauterizing area 10) so as to be set in the living tissue 7 outside the cauterizing area 10. These electrodes are arranged further apart than the first electrodes 8A and 8B, and are used to measure the reference impedance of the portion of the living tissue 7 that is not cauterized.

Then, as shown in FIG.
A and 8B are connected to the cautery range monitor unit 11, and one electrode 8A and one (9A) of the second electrodes 9A and 9B are connected to the cautery level monitor unit 12, and the second electrodes 9A and 9B.
B is connected to the ablation reference monitor 13.

As shown in FIG. 1, the ablation range monitor 11, the ablation level monitor 12, and the ablation reference monitor 13 are, for example, 350 kHz or 500 kHz.
Is connected to a high-frequency oscillation unit (abbreviated as HF oscillation unit) 14 for generating a high-frequency signal for measurement.

That is, the HF oscillator 14 is connected to each monitor 1
Each is connected to two electrodes via 1, 12, and 13, and measures the impedance of the living tissue 7 between the electrodes,
Obtain information on the cautery range, cautery level, and cautery standard.

The HF oscillating unit 14 is connected to a control unit 15, and the oscillating operation is controlled by the control unit 15.
Signals from the cautery range monitor 11 and the cautery reference monitor 13 are input to the cautery range comparator 16. The signals of the cautery level monitor 12 and the cautery reference monitor 13 are
It is input to the cautery level comparison unit 17.

The signals from the cauterizing range comparing section 16 and the cauterizing level comparing section 17 are input to the coagulation range recognizing section 18, which transmits the result to the control section 15. Set values such as the cautery level are also transmitted from the input unit 19 to the control unit 15.

The result is transmitted from the control unit 15 to the microwave output control unit 20 in accordance with the input signal, and the microwave output control unit 20 controls the output of the microwave oscillation unit 2 and simultaneously notifies the notification unit 21 of the output. Sent and announces cautery information by voice or display.

An ablation range monitor 11, an ablation level monitor 12, and an ablation reference monitor 1 for measuring impedance.
3 has the same configuration, and for example, FIG. 2 shows the configuration of the ablation range monitor 11 as a representative example.

The high-frequency signal from the HF oscillating unit 14 passes through the current measuring unit 23 of the ablation range monitoring unit 11, and the first electrode pair 8
A and 8B, and the high-frequency current flowing at that time is measured.

The cauterizing range monitor 11 is provided with a voltage measuring unit 24 for measuring a voltage between the first pair of electrodes 8A and 8B. The high frequency current measured by the current measuring unit 23 and the voltage measuring unit 24 are measured. The high-frequency voltage measured at 24 is input to an impedance calculator 25 for calculating impedance,
The impedance is calculated by the impedance calculation unit 25, and the calculation result is transmitted to the ablation range comparison unit 16.

In FIG. 3, the first electrodes 8A and 8B are arranged at positions on the outer peripheral surfaces that are 180 ° opposite to each other with respect to the center axis. However, the present invention is not limited to this. They may be arranged in the same direction. Further, the current measuring unit 23 may use a current probe other than a normal ammeter. Next, the operation of the present embodiment will be described.

The microwave puncturing applicator 5 is provided with a microwave radiating antenna 6 shown in FIG. 3 near the tip, and as shown in FIG.
Microwaves are radiated at the center, and a treatment for coagulating the living tissue 7 by increasing the temperature of the surrounding living tissue 7 (with the microwave radiating antenna unit 6 set in the living tissue 7 by puncturing) can be performed.

FIGS. 4 and 5 show the state. As shown in FIG. 4, when the microwave radiating antenna 6 is inserted into the living tissue 7 and solidified, the vicinity of the surface is most strongly coagulated, so that the coagulation can be confirmed as seen in a cross section.

On the other hand, in the case of deep penetration as shown in FIG.
The state of the solidification is hidden and cannot be confirmed from the surface. The present embodiment is devised so that coagulation can be monitored even in such a case. As shown in FIG. 6, the first electrodes 8A and 8B connected to the cautery range monitor 11
Is set in the cauterization range 10, and the coagulation range can be monitored from the vicinity of the microwave radiating antenna unit 6 after the cauterization starts.

The second electrodes 9A and 9B connected to the cautery reference monitor 13 are outside the cautery range 10, and the reference impedance of the non-cauterized tissue is measured. By comparing the impedance value of the cauterization range monitoring unit 11 with the reference impedance value obtained by the cauterization reference monitoring unit 13, the cauterization range can be detected with high accuracy. This comparison is performed by the ablation range comparison unit 16.

Further, the cautery level monitor section 12 is connected to one electrode 8A of the first electrode to be paired and one electrode 9A of the second electrode to be paired. That is, cauterization range 1
By measuring the impedance between the electrode within 0 and the electrode outside the cauterization range 10, the degree of cauterization can be known.
The level of the ablation can be detected by comparing the value with the value of the ablation reference monitor 13. This comparison is performed by the ablation level comparison unit 17.

Although the ablation level monitor 12 has been described as a combination connected to the first electrode 8A and the second electrode 9A, in addition to this combination, the first electrode 8A and the second electrode 9B, or the first electrode 8B and Second electrode 9A or first electrode 8B
And the second electrode 9B.

The ablation range detection result by the ablation range comparison unit 16 and the ablation level detection result by the ablation level comparison unit 17 are used by the coagulation range recognition unit 18 to determine both the extent of coagulation and the depth, that is, the extent of ablation. Both degrees of cauterization can be recognized.

By setting the cautery range and the level of the cautery level from the input unit 19, the cauterization state can be notified by the notification unit 21 by voice or display image. Further, according to the result, the microwave output control unit 20 can be controlled to automatically reduce or stop the microwave output.

A specific example of controlling the microwave output according to the degree of cauterization will be described with reference to the time charts of FIGS. FIG. 7 shows the timing of the microwave output and the monitor operation. As shown in FIG. 7A, when the microwave is output, for example, for 15 seconds (ON in the figure), the output is stopped for a short period, and during the stop period (Low level in the figure), as shown in FIG. 7B. The HF output of the HF oscillating unit 14 is turned ON (high level in the figure), and FIG. 7 (C) and FIG. 7 (D)
The impedance of the cautery reference monitor 13 and the cautery level monitor 12 is measured to confirm the coagulation level.

When the measurement is completed, the microwave is again applied for 15 minutes.
Secondly, the impedance is measured in the same manner.
Hereinafter, the process is repeated until the value set by the input unit 19 is reached. Although not shown in FIG. 7, the ablation range monitor 11
The same applies to. The microwave output time can be variably set by the input unit 19.

FIG. 8 shows the relationship between the microwave output amount and the ablation level value (impedance value). As shown in FIG. 8A, the initial microwave output amount is, for example, 50 W,
The output was varied according to the ablation level shown in FIG.

The ablation level was set at 1 to 5 stages, and was reduced to 50 W, 40 W, and 30 W according to the stage, so that the expected ablation level could be automatically performed. The step of the microwave output amount and the step of the ablation level can be variably set by the input unit 19. Further, the cauterization level step may be set by an impedance value.

This embodiment has the following effects. Since the treatment is performed while checking the coagulation range, a safe and reliable cautery treatment can be performed.

That is, a treatment area such as coagulation of a living tissue is expanded from the vicinity of the treatment portion to the outside thereof by irradiating therapeutic energy with a microwave having a good coagulation penetration property. By measuring the impedance of the tissue, grasping the geometric spread of the treatment area in the axial direction of the applicator, and controlling the output of therapeutic energy using microwaves, treatment can be performed while confirming the coagulation range. A safe and reliable cautery treatment can be performed.

(Second Embodiment) Next, FIGS.
A treatment apparatus according to a second embodiment of the present invention will be described with reference to FIG. FIG. 9 shows the configuration of the treatment apparatus in a usage example, and FIG. 10 shows the configuration of an applicator.

The therapeutic device 31 shown in FIG. 9 generates microwave therapeutic energy and generates a microwave high-frequency energy for measurement.
A connector 33 provided on a panel of the main body 32;
Each has an extension cable for microwave transmission (extension cable for first frequency) 35 and an applicator 37 connected via an extension cable for high-frequency transmission (extension cable for second frequency).

The applicator 37 has a pointed needle (or a cylinder) for emitting a microwave to perform a medical treatment.
The electrode 5 for the second frequency is provided on the applicator body 38 having the shape.
3 and 54 are provided on the outer peripheral surface of the applicator body 38. Then, the coaxial connector 41 at the base end (rear end) of the applicator main body 38 is connected to the microwave transmission extension cable 35, and the terminals 43 a and 43 b of the connector 42 at the base end (rear end) of the covering lead 55 are provided. ) Is connected to the extension cable 36 for high-frequency transmission.

As shown in FIG. 10, the applicator body 38 of the applicator 37 has a cylindrical shape with a sharp tip, and is disposed outside a central conductor 44 made of copper or steel wire so as to cover the periphery thereof. Hollow dielectric 45
A metal cylindrical tube 46 made of copper, stainless steel, or the like disposed outside the dielectric 45 so as to cover the same; a cylindrical spacer 47 made of the same fluororesin as the dielectric 45; A tip conductor 48 made of copper or stainless steel, a bonding material 49 such as solder for electrically connecting the tip conductor 48 to the center conductor 44, and a fitting means 50 provided on the tip conductor 48.
And a tip pin 51, which is installed by fitting to the fitting means 50 and is made of resin, and covers at least the tip conductor 48 and the metal cylindrical tube 46, and is made of fluorocarbon resin or the like.
2 and a coaxial connector 41 installed at the rear end of the applicator body 38.

The outer peripheral surface of the applicator body 38 is covered with a coating 52 near the tip of the applicator body 38.
Second frequency electrodes 53 and 54 made of, for example, a ring-shaped conductive member provided on the second frequency electrodes 53 and 54 are provided. The second frequency electrodes 53 and 54 are independently electrically connected to the second frequency electrodes 53 and 54, respectively. Insulated lead wire 55 and lead wire 5
5, a connector 42 is provided at the rear end, and terminals 43a and 43b are provided on the connector 42.

Next, the operation of the present embodiment will be described. FIG.
As shown in (1), the applicator 37 is percutaneously punctured so as to reach a site to be treated, such as hepatocellular carcinoma, which has developed in the living body 56, for example, the liver 57, which is a substantial organ. At this time, trocars, ultrasonic observation equipment, X-ray observation equipment, MRI
An observation device may be used in combination.

The applicator 37 is connected to the main body 32 in advance by a first frequency extension cable 35 and a second frequency extension cable 36 via connectors 33 and 34 provided on the panel of the main body 32, respectively. .

With the applicator 37 punctured, the second
Frequency, for example, a weak high frequency of several watts of 350 kHz or less is supplied from the main body 32 by the operation of the operator, and is supplied to the living body 56 through the second frequency electrodes 53 and 54 provided on the applicator 37. You. The bioimpedance in the second frequency band is measured from the supplied high-frequency voltage and current.

The measured bioimpedance value is stored in a memory or the like in the main body 32, and a first frequency for treatment, for example, a microwave of 2450 MHz is applied from the main body 32 to the applicator 37 by the operator's switch operation. Is supplied to the living body, and microwaves are injected into the living body from a first frequency electrode (microwave antenna in the present embodiment) which is configured substantially at the center of the spacer 47, and heating is started.

In the process of heating the living body 56, the detection of the biological impedance at the second frequency is continuously performed, and the change in the impedance value is sequentially observed. When the amount of microwave energy input increases with the passage of time, a phase change occurs sequentially in the living tissue in the order of heating → protein denaturation → drying (→ carbonization), and the coagulated region 58 is geometrically expanded.

Since there is a correlation between the phase change and the change in bioimpedance due to the second frequency, if an absolute threshold value or a relative change amount is set in advance in bioimpedance,
A desired phase change of the living body 56 can be detected.
Therefore, if the output of the first frequency is stopped when a desired phase change is obtained, a constant tissue coagulation can be obtained.
In particular, the second frequency electrode 5 is disposed in the axial direction of the applicator 37.
Because of the provision of 3 and 54, the region of the coagulation treatment in the axial direction of the applicator 37 can be grasped.

The second frequency electrodes 53 and 54 may be arranged at substantially equal positions in the axial direction of the applicator 37 from the center of the first frequency electrode as shown in FIG. 9 or FIG. , May be arranged in an uneven positional relationship. Further, both of the second frequency electrodes may be arranged on the distal end side of the applicator beyond the first frequency electrode, or may be arranged on the proximal end side.

When the bioimpedance value is infinite, that is, when no high-frequency current is applied between the second frequency electrodes, it is determined that the applicator 37 is insufficiently inserted into the tissue. Then, unnecessary radiation of the first frequency can be prevented.

The energy for the treatment is not limited to the microwaves described above, but may be high-frequency waves, radio waves, laser light, ultrasonic waves, or the like. In addition to 57, it can be applied to the brain, tongue, prostate and the like.

This embodiment has the following effects. According to this embodiment, the expansion of the geometrical coagulation region in the axial direction of the applicator, particularly in the treatment site in the parenchymal organ, is not affected by indeterminate factors such as the blood flow effect of the living body and the operator's rule of thumb. Since the coagulation state can always be observed, the therapeutic effect, safety, and operability of the treatment can be improved.

Further, since the bioimpedance can be detected in the high frequency band, components which are more expensive than in the case of microwaves are not required, so that the apparatus can be constructed at low cost.

(Third Embodiment) Next, a third embodiment of the present invention will be described with reference to FIGS.
The applicator 61 shown in FIG. 11 has a configuration in which a substantially hemispherical tip member 52a is integrally provided at the tip of the coating 52 in the applicator 37 shown in FIG.

More specifically, the applicator 61 includes a central conductor 44 made of a single or stranded wire of copper or steel, a hollow dielectric 45 disposed on the outer periphery of the central conductor 44, and a copper or steel An outer shield 46 made of a braided wire, a cylindrical spacer 47 made of fluorine resin equivalent to the dielectric 45, and a tip conductor 4 electrically connected to the center conductor 44 and made of copper or stainless steel.
8, a bonding material 49 such as solder for electrically connecting the tip conductor 48 to the center conductor 44, a coating 52 covering at least the tip conductor 48 and the outer shield 46 and made of a fluororesin, A distal end member 52a provided at the distal end of the coating 52 so as to cover the
A coaxial connector (not shown) installed at the rear end of the second applicator; second frequency electrodes 53 and 54 made of, for example, a cylindrically-shaped conductive member installed on the coating 52 near the tip of the applicator 61; Second frequency electrodes 53 and 54
Lead wires 55 electrically connected to the
And a connector and a terminal (not shown) installed at the rear end of the lead wire 55.

Next, the operation of the present embodiment will be described. Second
Since the applicator 61 of the present embodiment is configured as a whole flexibly as compared with the applicator 37 of the embodiment,
For example, as shown in FIG. 12, it is possible to use together with flexible endoscopes 66 and 67.

When used in conjunction with an endoscope 66 inserted orally, a coagulation treatment of a treatment site 69 (for example, esophageal varices or Barrett's esophagus) generated in the esophagus 68 can be performed by the applicator 61.

By operating the applicator 61 from the endoscope 67 inserted through the stomach 71 to the duodenal papilla 72, a treated part 74 (such as bile duct stenosis) generated in the bile duct 73 via the duodenal papilla 72. Coagulation treatment can be performed. The basic mechanism of action is equivalent to that of the above-described second embodiment, and it is possible to perform optimal coagulation treatment.

Further, if necessary, the absolute threshold value or the relative change amount of the bioelectrical impedance may be individually set for each part. In addition, the applicable range of the applicator of the present embodiment is not limited to the description of FIG. 12, and the oral cavity, ear cavity, nasal cavity, stomach, small intestine, large intestine, colon, rectum, urethra,
Obviously, it can be applied to luminal organs such as the ureter, uterus, and vagina.

This embodiment has the following effects. According to the present embodiment, the geometrical coagulation region in the axial direction of the applicator, particularly in the treatment site generated in the luminal organ, is not affected by indefinite factors such as the blood flow effect of the living body and the operator's rule of thumb. Since the enlargement and coagulation state can always be observed, the treatment effect, safety, and operability of treatment can be improved.

(Fourth Embodiment) Next, a fourth embodiment of the present invention will be described with reference to FIG. The applicator 81 in the present embodiment is different from the applicator 37 shown in FIG. 10 in that third third frequency electrodes 82 and 83 for measurement and the third frequency electrodes 82 and 8 are further provided.
3, and a connector 85 (and terminals 86a and 86b on the connector 85) connected to the rear end of the lead wire 84 is provided.

More specifically, the applicator 81 shown in FIG. 13 includes a central conductor 44 made of copper or steel wire or the like.
And a hollow cylindrical dielectric 45 arranged to cover the center conductor 44, a metal cylindrical tube 46 made of copper or stainless steel, and a cylindrical spacer made of fluororesin equivalent to the dielectric 45. 47, a tip conductor 48 electrically connected to the center conductor 44 and made of copper, stainless steel, or the like; a bonding material 49 such as solder for electrically connecting the tip conductor 48 to the center conductor 44; Fitting means 50, a tip pin 51 fitted and fitted with the fitting means 50 and made of resin, and at least a tip conductor 4.
8, a coating 52 made of a fluororesin or the like covering the metal cylindrical tube 46, a coaxial connector 41 installed at the rear end of the applicator 81, and a coaxial connector 41 installed on the coating 52 near the tip of the applicator 81. The second frequency electrodes 53 and 54, the third frequency electrodes 82 and 83, and the second frequency electrodes 53 and 5 which are formed of a cylindrical conductive member.
4 are electrically connected independently to each other.
A connector 42 installed at the rear end of the lead wire 55;
Terminals 43a and 43b installed on the connector 42;
A coated lead wire 84 electrically connected to the third frequency electrodes 82 and 83 independently of each other, a connector 85 installed at the rear end of the lead wire 84, and terminals 86a and 86b installed on the connector 85; It is composed of

Next, the operation of the present embodiment will be described. First
As the coagulation range in the living tissue is advanced by the energy of the frequency, the second frequency electrode and the third frequency electrode are sequentially taken into the region.

When a high frequency of, for example, 350 kHz is used as the second frequency and a high frequency of, for example, 500 kHz is used as the third frequency, the bioimpedance can be measured independently between the electrodes.

The arrangement of the second and third frequency electrodes is shown in FIG.
The electrodes are not limited to those shown in FIG. 3, and each electrode may be arbitrarily arranged on either the distal end side or the proximal end side of the spacer 47 which is a coagulation center.

This embodiment has the following effects. According to the present embodiment, since the geometric expansion of the coagulation region can be detected more reliably, it is possible to further improve the therapeutic effect and safety.

(Fifth Embodiment) Next, FIGS.
A fifth embodiment of the present invention will be described with reference to FIG. FIG.
The treatment apparatus 91 shown in FIG. 4 includes a microwave oscillator 92 that generates a microwave for treatment, an impedance measuring device 93 that generates a high frequency for measurement, and measures impedance.
A microwave cable 94 and a signal cable 95 are connected to the microwave oscillator 92 and the impedance measuring device 93, respectively.
14 shows a microwave applicator 98 to which a microwave connector 96 and a measurement electrode connector 97 are connected, and FIG. 14 shows, for example, a state in which coagulation treatment of the liver 99 is performed. Has been punctured.

By connecting the microwave connector 96 of the microwave applicator 98 to the microwave oscillator 92 via the microwave cable 94, the microwave for medical treatment is transmitted from the microwave oscillator 92, and the microwave applicator 98 is connected to the microwave oscillator 92. Irradiation is performed from the tip portion of the reference numeral 98.

By connecting the measuring electrode connector 97 of the microwave applicator 98 to the impedance measuring device 93 via the signal cable 95, a high frequency signal having a frequency greatly different from the frequency of the microwave is output from the impedance measuring device 93. Also output during microwave output,
The impedance can be measured even during microwave output.

FIG. 15 shows the entire microwave applicator 98. The microwave applicator 98 has a coaxial structure, and the inner conductor is a microwave antenna unit 101a.
Meanwhile, the external conductor is electrically connected to the microwave antenna unit 101b.

Microwave antenna units 101a and 101b
Microwaves are irradiated around the space between
3 spreads. The surface of the microwave applicator 101 has six measurement electrodes 102a to 102a along its axial direction.
02f are arranged in a ring shape in order from the front end side, are insulated from each other, and are connected to the signal connector 97.

In this embodiment, the measuring electrode 102a
Is electrically connected to the microwave antenna unit 101a. The measurement electrodes 102b to 102f are connected to the microwave antenna unit 101.
b are arranged at equal intervals (for example, 5 mm) on the rear end side.

Next, the operation of the present embodiment will be described. The impedance of the various measurement electrode pairs is measured during microwave therapy. As the coagulation of the tissue progresses, the impedance increases. By observing the change in the impedance, the extent of the coagulation range can be known.

A pair of measuring electrodes 102a-102b, 102
a-102c, 102a-102d, 102a-102
e, the impedance of 102a-102f is measured, and information on the extent of expansion of the solidified region 103 is obtained by observing the transition. Also, a pair of measurement electrodes 102b-102
c, 102c-102d, 102d-102e, 102
By observing the impedance of e-102f, information on the extent of the coagulation region 103 can be obtained with higher sensitivity.

When the impedance of the pair of measurement electrodes 102a-102b becomes an open value, it can be seen that the microwave antenna portions 101a and 101b have fallen out of the tissue. Although the rigid microwave applicator 98 for puncturing is shown here, a flexible microwave applicator may be used.

This embodiment has the following effects. The coagulation therapy is performed by the applicator 98, and the extent of the treatment range can be known in detail, particularly the extent of the applicator 98 in the axial direction. Further, since the measuring electrode 102a at the tip is connected to the internal conductor of the applicator 98, no extra electric wire is required for the antenna unit, and there is no influence on the microwave radiation characteristics. This makes it possible to maintain the same treatment capacity as before.

(Sixth Embodiment) Next, a sixth embodiment of the present invention will be described with reference to FIG. Microwave applicator 9 according to the sixth embodiment shown in FIG.
The difference from the microwave applicator 98 in the fifth embodiment 8 'shown in FIG. 15 is that there is no measurement electrode connected to the microwave antenna section 101a on the distal end side of the microwave applicator 98. The measuring electrodes are 102b to 102f only on the rear end side of the microwave antenna unit 101b.
There are five.

Next, the operation of the present embodiment will be described. Fifth
As in the first embodiment, the impedance of various measurement electrode pairs is measured during the execution of the microwave therapy. Since the impedance increases as the coagulation of the tissue progresses, the extent of the coagulation region 103 can be known by observing the change in the impedance.

A pair of measuring electrodes 102b-102c, 102
c-102d, 102d-102e, 102e-102
By measuring the impedance of f and observing its transition, information on the extent of the solidification region 103 can be obtained. Although a rigid puncture microwave applicator 98 'is shown here, a flexible microwave applicator may be used.

This embodiment has the following effects. Fifth
In the same manner as in the embodiment, the coagulation treatment is performed by the applicator 98 ', and the extent of the treatment range can be known. In addition, since all of the measurement electrodes are insulated from the microwave antenna unit, it is possible to reduce the necessity of providing a necessary filter on the impedance measuring instrument side.

(Seventh Embodiment) Next, a sixth embodiment of the present invention will be described with reference to FIG. Microwave applicator 106 in the present embodiment separates microwave applicator 98 ′ in FIG. 16 into microwave applicator section 107 and hollow puncture catheter section 108 through which microwave applicator section 107 can pass. The configuration is as follows.

As shown in FIG. 17, the microwave applicator 107 in the present embodiment has a coaxial structure, and the inner conductor is connected to the microwave antenna 101a and the outer conductor is connected to the microwave antenna 101b. I have.
Microwaves are transmitted from the microwave connector 96, and the microwaves are irradiated mainly between the microwave antenna units 101a and 101b.

On the other hand, the microwave applicator section 10
7 is inserted into the cylindrical puncture catheter section 108, and five measurement electrodes 102b to 102f
Are arranged at regular intervals (for example, 5 mm) from the front end side, are insulated from each other, and are connected to the signal connector 97. The microwave applicator 107 can be inserted into the puncture catheter 108, and the inserted state is shown in FIG.
become that way.

Next, the operation of the present embodiment will be described. After puncturing the puncture catheter section 108 into the treatment section, the microwave applicator section 107 is inserted and punctured. The impedance of the various measurement electrode pairs is measured during microwave therapy. As the coagulation of the tissue progresses, the impedance increases. By observing the change in the impedance, the extent of the coagulation range can be known.

As in the sixth embodiment shown in FIG. 16, measurement electrode pairs 102b-102c, 102e-102d,
By measuring the impedances of 2d-102e and 102e-102f and observing the transition, information on the extent of the coagulation range can be obtained.

This embodiment has the following effects. Coagulation therapy is performed as in the other embodiments, and the extent of the treatment range can be known. Further, since the measurement electrode is arranged on the puncture catheter section, the structure of the microwave applicator does not become complicated.

(Eighth Embodiment) Next, FIGS.
An eighth embodiment of the present invention will be described with reference to FIG. FIG.
8 is an insertion portion 13 of the probe 130 according to the present embodiment.
1 shows the tip side.

An ultrasonic wave transmitting / receiving means 132 is provided at the tip of the insertion section 131, and an optical observation means 133 and an opening 135 of a channel 134 provided in the insertion section 131 are provided on the front side. Further, a surface electrode 136 is provided on the surface of the insertion portion in front thereof. Channel 134
The needle-shaped electrode 137 is inserted through the opening 135 and is disposed so as to be able to protrude and retract from the opening 135.

An ultrasonic field of view 138 as an observation field observed by the ultrasonic wave transmitting / receiving means 132 and the optical observation means 1
The directions of the optical field of view 139 observed by 33 substantially coincide with each other, and the opening angle of the opening 135 is adjusted so that the needle-shaped electrode 137 is punctured into the tissue in the direction of the visual field. As shown in FIG. 19, the needle-like electrode 137 is formed of an electrode 141 having a sharp tip and an insulating member 142 covering the periphery of the electrode 141. Optical observation means 1
Reference numeral 33 denotes an objective lens system 143 at the tip and an image guide 144 having a tip face disposed at the image forming position.

Next, the operation of the present embodiment will be described. The insertion section 131 of the probe 130 is inserted into a living body cavity, for example, into the esophagus 145 as shown in FIG. Upon reaching the desired position, the needle electrode 137 is advanced while puncturing the desired position while observing the inside of the tissue with ultrasonic waves by the ultrasonic wave transmitting / receiving means 132.

In this state, a high-frequency current is applied between the electrode 141 of the needle electrode 137 and the surface electrode 136,
Coagulate surrounding tissue. Simultaneously, the impedance between the two electrodes is measured, and when the impedance value reaches a preset impedance value, the application of the high-frequency current is stopped.

This embodiment has the following effects. The needle-like electrode can be punctured into the tissue while observing the desired inner surface of the lumen by the optical observation means 133 and observing the inside of the tissue at the desired part by the ultrasonic wave transmitting / receiving means 132. The electrode can be punctured and placed.

Further, since the ultrasonic observation of the puncture portion is possible even during the coagulation, the positional deviation of the needle electrode can be known, so that the desired portion can be surely coagulated. Furthermore, since the tissue degeneration state of a desired site, that is, the degree of coagulation, can be detected by impedance measurement, insufficient or excessive coagulation can be prevented, and constant coagulation can always be performed.

The application of the probe 130 is not limited to the esophagus 145 of the above example, but is applied to all cavities of a living body, for example, through the urethra 146 as shown in FIG. 147 lower prostate 148
Or via the rectum 149 as shown in FIG. 22, ie, transrectally to the prostate 148 or rectum 149,
As shown in FIG. 23, it may be applied to the bronchus 151 via the esophagus 145, that is, orally.

The solidification means may be a high-frequency solidification means using a monopolar electrode according to the present embodiment.
4. As shown in FIG. 25, a bipolar, microwave, or laser may be used.

The bipolar electrode 161 shown in FIG. 24 has an inner electrode 162, an insulating coating 163 covering the inner electrode 162, an outer electrode 164 disposed outside the insulating coating 163, and a tip of the outer electrode 164. And an outer coating 165 provided so as to cover the portion. Note that the external electrode 164 may also serve as a function of a denatured state detection electrode.

The laser treatment tool 171 shown in FIG. 25 comprises a laser fiber 172, an external electrode 173 provided on the outer periphery of the laser fiber 172, and an external coating 174.

[Supplementary Notes] An applicator having a treatment section for applying energy for treatment to a living body at a distal end side in a needle shape that is punctured and inserted into a living tissue, and provided separately from the treatment section in the axial direction of the applicator. A measuring electrode, an energy supply unit for supplying the treatment unit with treatment energy for treatment by microwave, and a measurement for supplying a high-frequency signal for measurement of a frequency different from the frequency of the treatment energy to the measurement electrode. Signal generation means, impedance measurement means for measuring impedance from the output of the measurement signal generation means supplied to the measurement electrode, and control means for controlling the output of the energy supply means based on the measurement result of the impedance measurement means. , A treatment device comprising:

2. An applicator provided with a treatment unit that applies energy for treatment to a living body at a distal end portion that is punctured and inserted into a living tissue, a measurement electrode provided at least on the near side of the treatment unit of the applicator, and Energy supply means for supplying energy for treatment to the treatment section, frequency generation means for supplying a signal of a frequency for measurement to the measurement electrode, and impedance measurement from the output of the frequency generation means supplied to the measurement electrode And a control unit for controlling an output of the energy supply unit based on a measurement result of the impedance measurement unit.

3. First to supply energy for treatment
A frequency generator, a second frequency generator for supplying energy for measurement, and an applicator including a first frequency electrode for supplying energy for treatment to a living body;
An electrode for a second frequency installed on the applicator;
A treatment apparatus comprising: means for measuring impedance between frequency electrodes; and means for controlling output of a first frequency in accordance with a result of impedance measurement.

4. The treatment device according to claim 3, wherein
The frequency electrode is composed of a plurality of electrode pairs. 5. The treatment device according to claim 4, wherein the first device for the second frequency is provided.
An electrode pair, a second electrode pair for a second frequency, a second frequency generating means for selectively operating between the electrodes, a means for measuring an impedance between the first electrodes, and an impedance between the second electrodes. , A means for measuring the impedance between the first and second electrodes, and a means for controlling the output of the first frequency in accordance with the three measurement results. 6. The treatment device according to claim 5, wherein the first device for the second frequency is provided.
An electrode pair is disposed within a range to be ablated by the first frequency;
The second pair of electrodes for the second frequency is disposed outside the range to be ablated by the first frequency, and the means for measuring the impedance between the first electrodes constitutes a cautery level monitor, and measures the impedance between the second electrodes. The means comprises a non-cautery level monitor and the means for measuring the impedance between the first and second electrodes comprises a cautery range monitor.

7. The treatment device according to any one of supplementary notes 3 to 6, wherein a third frequency generator that supplies energy for measurement, a third frequency electrode installed on the applicator, and a third frequency electrode And means for controlling the output of the first frequency in accordance with the impedance measurement result. 8. The treatment device according to any one of supplementary notes 3 to 7, wherein the first frequency is a frequency of 1 GHz or more, and the second frequency is a frequency of 1 GHz or less.

9. The first frequency is 2450 ± 100MH
9. The treatment apparatus according to any one of appendices 3 to 8, wherein z is the first frequency electrode is a microwave antenna. 10. Appendix 3 in which the second frequency is 350 ± 35 KHz
10. The treatment device according to any one of claims 9 to 9. 11. Appendix 3 where the second frequency is 500 ± 50 KHz
10. The treatment device according to any one of claims 9 to 9. 12. 8. The treatment device according to claim 7, wherein the second frequency is 350 ± 50 KHz, and the third frequency is 500 ± 50 KHz.

13. An applicator used in combination with the treatment apparatus according to Supplementary notes 3 to 12, wherein the first frequency electrode for output and the second or third frequency electrode for measurement are coaxially arranged.

14. Appendix 1 having a plurality of measurement electrode pairs
4. The applicator according to 3. 15. 15. The applicator according to any one of supplementary notes 13 and 14, wherein an outer surface of the therapeutic first frequency electrode is insulated. 16. 15. The applicator according to any of supplementary notes 13 to 14, wherein the treatment first frequency electrode and one of the measurement electrodes are electrically connected.

17. 16. The applicator according to any one of appendices 13 to 15, wherein all of the measurement electrodes are insulated from the first frequency electrode for treatment. 18. A catheter used in combination with the treatment apparatus according to Supplementary Notes 3 to 12, wherein a measurement electrode is disposed on an outer surface of a hollow catheter body, and an applicator having a first frequency electrode for treatment is detachably attached to the inside thereof. Built-in freely.

19. An optical observation unit and an ultrasonic observation unit whose viewing directions are substantially the same, a needle-like electrode capable of puncturing a living tissue in the field of view, and an electrode having a sufficiently large area as compared with the needle-like electrode, are provided. A probe which can be inserted into a body cavity of a living body, and which has means for detecting biological information of a tissue around the needle electrode by the two electrodes.

20. The probe according to Supplementary Note 19, wherein the needle-shaped electrode is provided with energy emission means,
9 to measure the impedance at least at the time of energy release, and control the energy released from the energy release means based on the measurement result. 21. 21. The treatment apparatus according to Supplementary Note 20, wherein the energy emitting means is constituted by a monopolar electrode, a bipolar electrode, or a laser probe.

[0114]

As described above, according to the present invention, there is provided an applicator having a treatment section for applying energy for treatment to a living body at a distal end side in the form of a needle which is punctured and inserted into a living tissue, A measuring electrode provided at a distance from the treatment section in the axial direction of the applicator; an energy supply unit for supplying a treatment energy for treatment to the treatment section by microwave; Measuring signal generating means for supplying a high-frequency signal for measuring a frequency different from the frequency of energy, impedance measuring means for measuring impedance from an output of the measuring signal generating means supplied to the measuring electrode, and the impedance measuring means And control means for controlling the output of the energy supply means based on the measurement results of the above. The treatment area such as coagulation of the living tissue is expanded from the vicinity of the treatment section to the outside by irradiation of the lugi, and the impedance of the living tissue between the measurement electrodes is measured by a high-frequency signal. By grasping the geometric spread, it is possible to control the output of the treatment energy by microwaves.

Further, an applicator provided with a treatment section for applying energy for treatment to a living body at a distal end portion which is punctured and inserted into a living tissue, and provided at least in front of the treatment section of the applicator. A measurement electrode, an energy supply unit that supplies energy for treatment to the treatment unit, a frequency generation unit that supplies a signal of a measurement frequency to the measurement electrode, and a frequency generation unit that is supplied to the measurement electrode. Since there are provided impedance measuring means for measuring impedance from the output and control means for controlling the output of the energy supply means based on the measurement result of the impedance measuring means, the living tissue can be irradiated from the vicinity of the treatment section by irradiation of therapeutic energy. The treatment area such as coagulation is expanded to the outside, and the impedance of the biological tissue between the measurement electrodes is measured by the measurement signal. The scan measurements, to grasp the geometrical spread of the treatment area in the axial direction of the applicator, allows the output control of the therapeutic energy.

[Brief description of the drawings]

FIG. 1 is a block diagram showing a configuration of a treatment apparatus according to a first embodiment of the present invention.

FIG. 2 is a block diagram showing a configuration of an ablation range monitoring unit.

FIG. 3 is a side view showing the configuration on the distal end side of the microwave applicator.

FIG. 4 is a diagram showing a state in which a microwave applicator punctures a living tissue to perform a coagulation treatment.

FIG. 5 is a diagram showing a state in which a coagulation treatment is performed by puncturing deeper than in FIG. 4;

FIG. 6 is an explanatory diagram showing a connection relationship between a measurement electrode provided in a microwave applicator and a monitor unit.

FIG. 7 is an explanatory diagram showing a timing relationship between a microwave output and a monitoring operation during a coagulation treatment.

FIG. 8 is a diagram showing a relationship between a microwave output amount and an ablation level.

FIG. 9 is a perspective view showing a configuration of a treatment apparatus according to a second embodiment of the present invention.

FIG. 10 is a diagram showing an internal configuration of an applicator.

FIG. 11 is a diagram showing an internal configuration of an applicator according to a third embodiment of the present invention.

FIG. 12 is an explanatory diagram of performing a treatment procedure by being inserted into a channel of an endoscope.

FIG. 13 is a diagram illustrating an internal configuration of an applicator according to a fourth embodiment of the present invention.

FIG. 14 is a perspective view showing a configuration of a treatment apparatus according to a fifth embodiment of the present invention.

FIG. 15 is a perspective view showing a configuration of a microwave applicator.

FIG. 16 is a perspective view showing a configuration of a microwave applicator according to a sixth embodiment of the present invention.

FIG. 17 is a perspective view showing a configuration of a microwave applicator according to a seventh embodiment of the present invention.

FIG. 18 is a cross-sectional view illustrating a configuration of a distal end side of a probe according to an eighth embodiment of the present invention.

FIG. 19 is a cross-sectional view showing a configuration of a needle electrode.

FIG. 20 is a diagram showing a state in which treatment is performed by being inserted into the esophagus.

FIG. 21 is a view showing a state in which a treatment is performed by being inserted into the urethra.

FIG. 22 is a view showing a state in which treatment is performed by transrectal insertion.

FIG. 23 is a diagram showing a state in which a bronchus is treated by being inserted orally.

FIG. 24 is a cross-sectional view showing a configuration of a bipolar electrode that performs a coagulation treatment in a modified example.

FIG. 25 is a sectional view showing the configuration of a laser treatment tool according to another modification.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 ... Treatment apparatus 2 ... Microwave oscillation part 3 ... Microwave transmission cable 5 ... Microwave puncture applicator 6 ... Microwave antenna part 7 ... Biological tissue 8A, 8B ... 1st electrode 9A, 9B ... 2nd electrode 10 ... Ablation range 11 ... Ablation range monitor section 12 ... Ablation level monitor section 13 ... Ablation reference monitor section 14 ... HF oscillation section 15 ... Control section 16 ... Ablation range comparison section 17 ... Ablation level comparison section 18 ... Coagulation range recognition section 19 ... Input unit 20 ... Microwave output control unit 21 ... Notification unit 23 ... Current measurement unit 24 ... Voltage measurement unit 25 ... Impedance calculation unit

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[Procedure amendment]

[Submission date] August 12, 1999 (1999.8.1)
2)

[Procedure amendment 1]

[Document name to be amended] Statement

[Correction target item name]

[Correction method] Change

[Correction contents]

20. The probe according to Supplementary Note 19, wherein the needle-shaped electrode is provided with energy emission means,
By being used in combination with construction according to any one of 1 to 12, measuring the impedance at least energy release, the measurement results by what energy emitted from the energy emitting means is controlled. 21. 21. The treatment apparatus according to Supplementary Note 20, wherein the energy emitting means is constituted by a monopolar electrode, a bipolar electrode, or a laser probe.

[Procedure amendment 2]

[Document name to be amended] Drawing

[Correction target item name] FIG.

[Correction method] Change

[Correction contents]

FIG. 13

 ──────────────────────────────────────────────────続 き Continuing on the front page (72) Inventor Satoshi Mizukawa 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Norihiko Haruyama 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. F term (reference) 4C026 AA03 AA04 FF39 GG03 GG06 HH02 HH13 4C060 KK04 KK06 KK07 KK10 KK13 KK20 KK23 4C082 MA02 MC01 ME02 ME05 ME06 RA02 RA06 RE40 RJ03 RJ06 RL02 RL13

Claims (2)

[Claims] 1. An applicator having a needle-shaped puncture-inserted inside a living tissue and having a treatment section on the distal end side for applying energy for treatment to a living body; A measuring electrode provided at a distance, energy supplying means for supplying a treatment energy for treatment to the treatment section by microwaves, and a high frequency for measurement of a frequency different from the frequency of the treatment energy to the measurement electrode A signal generation unit for measurement that supplies a signal; an impedance measurement unit that measures impedance from an output of the signal generation unit for measurement supplied to the measurement electrode; and an output of the energy supply unit based on a measurement result of the impedance measurement unit. A treatment device comprising: control means for controlling; 2. An applicator provided with a treatment section for applying energy for treatment to a living body at a distal end portion punctured and inserted into a living tissue, and provided at least on the near side of the treatment section of the applicator. A measurement electrode, an energy supply unit that supplies energy for treatment to the treatment unit, a frequency generation unit that supplies a signal of a measurement frequency to the measurement electrode, and a frequency generation unit that is supplied to the measurement electrode. A treatment apparatus comprising: impedance measuring means for measuring impedance from an output; and control means for controlling an output of the energy supply means based on a measurement result of the impedance measuring means.