本申请是申请人奥林巴斯医疗株式会社于2009年08月11日提出的PCT申请PCT/JP2009/064193于2012年04月10日进入国家阶段的申请号为200980161891.6、发明名称为“治疗用处理器具、治疗用处理装置及治疗处理方法”的发明申请的分案申请。This application is the PCT application PCT/JP2009/064193 filed by the applicant Olympus Medical Co., Ltd. on August 11, 2009, and entered the national phase on April 10, 2012. The application number is 200980161891.6, and the invention name is "Therapeutic A divisional application of the invention application of "treatment instrument, treatment device for treatment and treatment treatment method".
技术领域technical field
本发明涉及一种用于对生物体组织进行治疗/处理的治疗用处理器具、治疗用处理装置及治疗处理方法。The present invention relates to a therapeutic treatment instrument, a therapeutic treatment device, and a therapeutic treatment method for treating/treating living tissue.
背景技术Background technique
一般公知有生物体组织通过(1)使作为接合对象的生物体组织彼此相接触、(2)使对象组织的蛋白质改性、(3)去除存在于对象组织之间的水分而能够相接合。这是利用了用于构成蛋白质的氨基酸的极性基团的极性的结合，即利用了所谓的氢结合的接合。例如在美国专利第6626901号说明书中存在这种记载。It is generally known that living tissues can be joined together by (1) bringing living tissues to be joined together into contact, (2) modifying proteins of the target tissues, and (3) removing water present between the target tissues. This is bonding utilizing the polarity of the polar group of the amino acid constituting the protein, that is, bonding utilizing so-called hydrogen bonding. There is such a description in, for example, US Patent No. 6,626,901.
另外，使蛋白质改性是指改变作为蛋白质的特征之一的立体构造，即，为了形成上述立体构造而使具有一定的规则性来相结合的极性基团彼此的结合离解。利用使极性基团彼此的结合离解而成为自由的极性基团能够促进其与存在于相邻的蛋白质中的极性基团之间的新的结合，能够引起蛋白质彼此的结合、即生物体组织彼此的接合。In addition, modifying a protein refers to changing the three-dimensional structure that is one of the characteristics of proteins, that is, dissociating the bonds between polar groups that are bonded with a certain regularity in order to form the above-mentioned three-dimensional structure. By dissociating the bonds between polar groups and becoming free, the polar groups can promote new bonds with polar groups existing in adjacent proteins, and can cause protein bonds, that is, biological The bonding of body tissues to each other.
为了引起该现象，在医疗用处理器具中，利用高频、热量、超声波、激光等各种能量。通过利用这些能量，谋求提高接合对象组织的温度，同时进行蛋白质的改性与存在于对象组织之间的水分(H2O)的去除。由此，实现组织的接合。当前作为血管密封装置而实际应用的能量装置也利用了本现象。In order to cause this phenomenon, various energies such as high frequency, heat, ultrasonic waves, and laser light are used in medical treatment instruments. By utilizing these energies, it is intended to increase the temperature of the target tissue to be bonded, and to simultaneously modify the protein and remove moisture (H2 O) present between the target tissue. Thereby, joining of tissues is achieved. Energy devices currently in practical use as blood vessel sealing devices also take advantage of this phenomenon.
在此，说明由去除水分(H2O)带来的效果。一般公知水分子H2O具有较强的极性。都知道因该较强的极性而容易与具有极性的极性基团相结合。该结合在水分子H2O彼此的分子之间也成立，由此，会引起水分子H2O特有的现象。例如相对于氦的蒸发热量为0.0845kJ/mol，水分子H2O的蒸发热量为40.8kJ/mol(9.74666kcal/mol)，表示出较高的值。众所周知，这种较高的值因在水分子H2O之间进行氢结合而成。如上所述，水分子H2O由于该较强的极性而容易与具有极性基团的分子相结合。即，也容易与具有极性基团的蛋白质相结合。这在存在水分子H2O的情况下难以进行组织的接合。Here, the effect of removing moisture (H2 O) will be described. It is generally known that the water molecule H2 O has strong polarity. It is known that it is easy to combine with a polar group having polarity due to the strong polarity. This bonding is also established between water molecules H2 O, thereby causing a phenomenon unique to water molecules H2 O. For example, the heat of evaporation of the water molecule H2 O is 40.8 kJ/mol (9.74666 kcal/mol) with respect to the heat of evaporation of helium which is 0.0845 kJ/mol, showing relatively high values. This higher value is known to result from hydrogen bonding between water moleculesH2O . As described above, the water molecule H2 O is easily combined with molecules having polar groups due to this strong polarity. That is, it also easily binds to proteins having polar groups. This makes bonding of tissues difficult in the presence of water moleculesH2O .
在当前的治疗装置中，组织接合需要能量的理由无非是为了去除该水分子H2O。在组织接合中，去除存在于所接合的组织之间的水分子H2O可以说是为了达到稳定且牢固的接合的条件。In current therapeutic devices, the reason why energy is required for tissue engagement is simply to remove this water molecule H2 O. In tissue joining, the removal of water molecule H2 O present between joined tissues can be said to be a condition for achieving stable and firm joining.
另一方面，在生物体中存在有许多水分是不言自明的事实。虽然存在于各个组织内的水分也消失，但是在组织外、脏器外也存在各种消化液、润滑液或在处理时添加的生理盐水等许多水分。On the other hand, it is a self-evident fact that there is a lot of water in living organisms. Although the water present in each tissue also disappears, there is also a lot of water such as various digestive juices, lubricating fluids, and physiological saline added at the time of treatment outside the tissues and organs.
存在于这些组织的内侧及外侧的水分无疑也存在于完成了接合的生物体组织彼此的接合部的组织周边。存在于接合部的周边的水分子H2O如上所述那样具有较强的极性，容易与存在于周围的极性基团相结合。该情况即使是与其他的极性基团完成了一次结合的极性基团也不例外。使已经完成的结合离解且使水分子H2O自身结合于此。因此，蛋白质彼此的结合离解，若以微观观察，则生物体组织彼此的接合强度随着时间的推移而降低。The moisture existing inside and outside these tissues is undoubtedly also present in the tissue periphery of the junction of the joined living tissue. The water molecule H2 O existing around the joining portion has strong polarity as described above, and easily bonds with the polar groups existing around it. This is the case even for a polar group that has once bonded with another polar group. The already completed binding is dissociated and the water molecule H2 O binds itself there. Therefore, the binding and dissociation of proteins, and when viewed microscopically, the bonding strength between living tissues decreases with time.
发明内容Contents of the invention
本发明的目的在于提供一种能够防止水分进入生物体组织彼此的接合部、长时间维持生物体组织彼此紧密接触的状态、即能够良好地维持接合部的强度的治疗用处理器具、治疗用处理装置及治疗处理方法。The object of the present invention is to provide a therapeutic treatment tool and a therapeutic treatment tool that can prevent moisture from entering the junction between living tissues and maintain the state of close contact between living tissues for a long time, that is, can maintain the strength of the junction well. Devices and therapeutic treatments.
本发明提供一种治疗用处理器具，其用于对生物体组织之间进行接合处理，其特征在于，该治疗用处理器具包括：至少一对保持构件，其用于保持处理对象的生物体组织；能量输出部，其设置在上述一对保持构件的至少一者上，并且与能量源相连接，并用于向利用上述一对保持构件保持的生物体组织供给能量来接合生物体组织之间而形成接合部；以及接合维持辅助部，为了对维持生物体组织之间的接合状态进行辅助，该接合维持辅助部能够在上述处理对象的生物体组织上涂布用于防止水分渗入的物质。The present invention provides a treatment instrument for treatment, which is used for joint treatment between biological tissues, and is characterized in that the treatment instrument for treatment includes: at least one pair of holding members, which are used to hold the biological tissue of the treatment object an energy output unit, which is arranged on at least one of the above-mentioned pair of holding members, and is connected to an energy source, and is used to supply energy to the living tissue held by the above-mentioned pair of holding members to join between the living tissues forming a junction; and a junction maintenance auxiliary part which can apply a substance for preventing penetration of water on the living tissue to be treated in order to assist in maintaining the junction state between the living tissues.
附图说明Description of drawings
图1是表示第1实施方式的治疗用处理系统的概略图。Fig. 1 is a schematic diagram showing a therapeutic treatment system according to a first embodiment.
图2是表示第1实施方式的治疗用处理系统的概略框图。Fig. 2 is a schematic block diagram showing a therapeutic treatment system according to the first embodiment.
图3A是表示第1实施方式的治疗用处理系统的双极型的能量处理器具的闭合的处理部及柄线的概略纵剖视图。3A is a schematic vertical cross-sectional view showing a closed treatment portion and a shank of the bipolar energy treatment instrument of the treatment treatment system according to the first embodiment.
图3B是表示第1实施方式的治疗用处理系统的能量处理器具的张开的处理部及柄线的概略纵剖视图。3B is a schematic vertical cross-sectional view showing an expanded treatment portion and a shank of the energy treatment instrument of the treatment treatment system according to the first embodiment.
图4A表示第1实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是从图4B及图4C的箭头4A方向看到的概略俯视图。4A shows a first holding member of the treatment part of the energy treatment device of the treatment treatment system according to the first embodiment, and is a schematic plan view seen from the direction of arrow 4A in FIGS. 4B and 4C .
图4B表示第1实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图4A中及图4C中的4B－4B线的概略纵剖视图。4B shows a first holding member of the treatment part of the energy treatment device of the treatment treatment system for treatment according to the first embodiment, and is a schematic vertical cross-sectional view taken along line 4B-4B in FIGS. 4A and 4C .
图4C表示第1实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图4A中及图4B中的4C－4C线的概略横截面图。Fig. 4C shows the first holding member of the treatment part of the energy treatment device of the treatment treatment system according to the first embodiment, and is a schematic cross-sectional view taken along line 4C-4C in Figs. 4A and 4B.
图5A是表示在利用第1实施方式的治疗用处理系统的能量处理器具的处理部保持生物体组织的状态下、在对该保持的生物体组织施加了高频能量的情况下所示的时间与阻抗之间的关系的概略图表。FIG. 5A is a diagram showing time when high-frequency energy is applied to the held living tissue in a state where the treatment unit of the energy treatment device of the therapeutic treatment system according to the first embodiment holds the living tissue. Schematic diagram of the relationship between impedance and impedance.
图5B是表示刚使用第1实施方式的治疗用处理系统的能量处理器具进行了处理之后的生物体组织的状态的概略立体图。5B is a schematic perspective view showing a state of a living tissue immediately after being treated with the energy treatment device of the therapeutic treatment system according to the first embodiment.
图6是表示在使用第1实施方式的治疗用处理系统接合生物体组织、并对已接合的生物体组织的外周进行涂敷时、利用能量源、脚踏开关及流体源完成的治疗用处理系统的控制状态的流程图。Fig. 6 shows the therapeutic treatment completed by using the energy source, foot switch, and fluid source when using the therapeutic treatment system according to the first embodiment to join living tissue and apply coating to the periphery of the joined living tissue. Flow chart of the control state of the system.
图7是表示在利用第1实施方式的变形例的治疗用处理系统的能量处理器具的处理部保持生物体组织的状态下、在对该保持的生物体组织施加了高频能量的情况下所示的时间与相位差之间的关系的概略图表。FIG. 7 is a diagram showing a state in which a living tissue is held by the treatment unit of the energy treatment device of the therapeutic treatment system according to a modified example of the first embodiment, and high-frequency energy is applied to the held living tissue. A schematic diagram of the relationship between time and phase difference shown.
图8表示第1实施方式的变形例的治疗用处理系统，是在将相位差的变化用作高频能量的供给/供给停止的阈值而进行处理的情况下的概略框图。Fig. 8 is a schematic block diagram showing a medical treatment system according to a modified example of the first embodiment in which a change in phase difference is used as a threshold value for supply/stop of high-frequency energy.
图9是表示使用第1实施方式的变形例的治疗用处理系统的单极型的能量处理器具对生物体组织进行处理的状态的概略示意图。9 is a schematic diagram showing a state in which a living tissue is treated using a monopolar energy treatment instrument of a therapeutic treatment system according to a modified example of the first embodiment.
图10是表示第1实施方式的变形例的治疗用处理系统的概略图。Fig. 10 is a schematic diagram showing a therapeutic treatment system according to a modified example of the first embodiment.
图11A表示第2实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是从图11B及图11C的箭头11A方向看到的概略俯视图。11A shows the first holding member of the treatment part of the energy treatment device of the treatment treatment system for treatment according to the second embodiment, and is a schematic plan view seen from the direction of arrow 11A in FIGS. 11B and 11C .
图11B表示第2实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图11A中及图11C中的11B－11B线的概略纵剖视图。11B shows the first holding member of the treatment part of the energy treatment device of the treatment treatment system for treatment according to the second embodiment, and is a schematic vertical cross-sectional view taken along line 11B-11B in FIGS. 11A and 11C .
图11C表示第2实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图11A中及图11B中的11C－11C线的概略横截面图。11C shows the first holding member of the treatment part of the energy treatment device of the treatment treatment system for treatment according to the second embodiment, and is a schematic cross-sectional view taken along line 11C-11C in FIGS. 11A and 11B .
图12是表示第3实施方式的治疗用处理系统的概略图。Fig. 12 is a schematic diagram showing a therapeutic treatment system according to a third embodiment.
图13是表示第3实施方式的治疗用处理系统的概略框图。Fig. 13 is a schematic block diagram showing a therapeutic treatment system according to a third embodiment.
图14A表示第3实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是从图14B及图14C的箭头14A方向看到的概略俯视图。Fig. 14A shows the first holding member of the treatment part of the energy treatment instrument of the treatment treatment system for treatment according to the third embodiment, and is a schematic plan view seen from the direction of arrow 14A in Figs. 14B and 14C.
图14B表示第3实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图14A中及图14C中的14B－14B线的概略纵剖视图。14B shows the first holding member of the treatment part of the energy treatment device of the treatment treatment system for treatment according to the third embodiment, and is a schematic vertical cross-sectional view taken along line 14B-14B in FIGS. 14A and 14C .
图14C表示第3实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图14A中及图14B中的14C－14C线的概略横截面图。14C shows the first holding member of the treatment part of the energy treatment device of the treatment treatment system for treatment according to the third embodiment, and is a schematic cross-sectional view taken along line 14C-14C in FIGS. 14A and 14B .
图15A是表示第3实施方式的治疗用处理系统的双极型的能量处理器具的闭合的处理部及柄线的概略纵剖视图。15A is a schematic vertical cross-sectional view showing a closed treatment portion and a shank of a bipolar energy treatment instrument of a therapeutic treatment system according to a third embodiment.
图15B是表示第3实施方式的治疗用处理系统的能量处理器具的张开的处理部及柄线的概略纵剖视图。15B is a schematic vertical cross-sectional view showing an expanded treatment portion and a shank of the energy treatment instrument of the therapeutic treatment system according to the third embodiment.
图16是表示在使用第3实施方式的治疗用处理系统接合生物体组织、并对已接合的生物体组织的外周进行涂敷时、利用能量源、脚踏开关及流体源完成的治疗用处理系统的控制状态的流程图。Fig. 16 shows the therapeutic treatment completed by using the energy source, the foot switch and the fluid source when the living tissue is joined using the therapeutic treatment system according to the third embodiment and the outer periphery of the joined living tissue is coated. Flow chart of the control state of the system.
图17是表示刚使用第3实施方式的治疗用处理系统的能量处理器具进行了处理之后的生物体组织的状态的概略立体图。17 is a schematic perspective view showing a state of a living tissue immediately after being treated with the energy treatment device of the therapeutic treatment system according to the third embodiment.
图18A表示第4实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是从图18B及图18C的箭头18A方向看到的概略俯视图。Fig. 18A shows the first holding member of the treatment part of the energy treatment device of the medical treatment system according to the fourth embodiment, and is a schematic plan view seen from the direction of arrow 18A in Figs. 18B and 18C.
图18B表示第4实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图18A中及图18C中的18B－18B线的概略纵剖视图。Fig. 18B shows the first holding member of the treatment part of the energy treatment device of the treatment treatment system for treatment according to the fourth embodiment, and is a schematic longitudinal sectional view taken along line 18B-18B in Figs. 18A and 18C.
图18C表示第4实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图18A中及图18B中的18C－18C线的概略横截面图。Fig. 18C shows the first holding member of the treatment part of the energy treatment device of the medical treatment system according to the fourth embodiment, and is a schematic cross-sectional view taken along line 18C-18C in Figs. 18A and 18B.
图18D是表示配设在第4实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件的高频电极上的突起的概略立体图。18D is a schematic perspective view showing protrusions arranged on the high-frequency electrode of the first holding member of the treatment portion of the energy treatment device of the treatment system for treatment according to the fourth embodiment.
图19A表示第4实施方式的治疗用处理系统的能量处理器具的处理部的第2保持构件，是从图19B及图19C的箭头19A方向看到的概略俯视图。Fig. 19A shows the second holding member of the treatment part of the energy treatment device of the medical treatment system according to the fourth embodiment, and is a schematic plan view seen from the direction of arrow 19A in Figs. 19B and 19C.
图19B表示第4实施方式的治疗用处理系统的能量处理器具的处理部的第2保持构件，是沿着图19A中及图19C中的19B－19B线的概略纵剖视图。Fig. 19B shows the second holding member of the treatment part of the energy treatment device of the treatment treatment system for treatment according to the fourth embodiment, and is a schematic longitudinal sectional view taken along line 19B-19B in Figs. 19A and 19C.
图19C表示第4实施方式的治疗用处理系统的能量处理器具的处理部的第2保持构件，是沿着图19A中及图19B中的19C－19C线的概略横截面图。Fig. 19C shows the second holding member of the treatment part of the energy treatment device of the treatment treatment system for treatment according to the fourth embodiment, and is a schematic cross-sectional view taken along line 19C-19C in Figs. 19A and 19B.
图20是表示刚使用第4实施方式的治疗用处理系统的能量处理器具进行了处理之后的生物体组织的状态的概略立体图。20 is a schematic perspective view showing a state of a living tissue immediately after being treated with the energy treatment device of the therapeutic treatment system according to the fourth embodiment.
图21A表示第5实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是从图21B的箭头21A方向看到的概略俯视图。Fig. 21A shows a first holding member of the treatment part of the energy treatment device of the therapeutic treatment system according to the fifth embodiment, and is a schematic plan view seen from the direction of arrow 21A in Fig. 21B.
图21B表示第5实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图21A中的21B－21B线的概略横截面图。Fig. 21B shows the first holding member of the treatment part of the energy treatment instrument of the treatment treatment system for treatment according to the fifth embodiment, and is a schematic cross-sectional view taken along line 21B-21B in Fig. 21A.
图22A是表示配设在第5实施方式的治疗用处理系统的能量处理器具上的刀具的包含刃部的顶端部的概略立体图。22A is a schematic perspective view showing a tip portion including a blade portion of a knife disposed on an energy treatment instrument of a medical treatment system according to a fifth embodiment.
图22B是表示配设在第5实施方式的治疗用处理系统的能量处理器具上的刀具的概略横截面图。Fig. 22B is a schematic cross-sectional view showing a blade disposed on an energy treatment device of a medical treatment system according to a fifth embodiment.
图22C是表示一边利用第5实施方式的治疗用处理系统的能量处理器具的处理部保持生物体组织一边进行接合处理、并利用刀具切割该生物体组织的状态的概略横截面图。22C is a schematic cross-sectional view showing a state in which the living tissue is being joined while being held by the treatment unit of the energy treatment instrument of the therapeutic treatment system according to the fifth embodiment, and the living tissue is cut with a knife.
图22D是表示刚使用第5实施方式的治疗用处理系统的能量处理器具进行了处理之后的生物体组织的状态的概略立体图。22D is a schematic perspective view showing a state of a living tissue immediately after being treated with the energy treatment device of the therapeutic treatment system according to the fifth embodiment.
图23是表示在使用第5实施方式的治疗用处理系统对生物体组织进行处理时、利用能量源、脚踏开关及流体源完成的治疗用处理系统的控制状态的流程图。23 is a flow chart showing the control state of the therapeutic treatment system by using the energy source, foot switch and fluid source when the living tissue is treated using the therapeutic treatment system according to the fifth embodiment.
图24A是表示配设在第6实施方式的治疗用处理系统的能量处理器具上的刀具的包含刃部的顶端部的概略立体图。24A is a schematic perspective view showing a tip portion including a blade portion of a knife disposed on an energy treatment instrument of a medical treatment system according to a sixth embodiment.
图24B是表示配设在第6实施方式的治疗用处理系统的能量处理器具上的刀具的概略横截面图。Fig. 24B is a schematic cross-sectional view showing a blade disposed on an energy treatment instrument of a medical treatment system according to a sixth embodiment.
图24C是表示一边利用第6实施方式的治疗用处理系统的能量处理器具的处理部保持生物体组织一边进行接合处理、并利用刀具切割了生物体组织的状态的概略横截面图。24C is a schematic cross-sectional view showing a state in which the living tissue is cut while being held by the treatment unit of the energy treatment instrument of the therapeutic treatment system according to the sixth embodiment while the living tissue is being joined, and the living tissue is cut with a knife.
图24D是表示刚使用第6实施方式的治疗用处理系统的能量处理器具进行了处理之后的生物体组织的状态的概略立体图。24D is a schematic perspective view showing a state of a living tissue immediately after being treated with the energy treatment device of the therapeutic treatment system according to the sixth embodiment.
图25是表示第7实施方式的治疗用处理系统的概略图。Fig. 25 is a schematic diagram showing a therapeutic treatment system according to a seventh embodiment.
图26A表示第7实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是从图26B中的箭头26A方向看到的概略俯视图。Fig. 26A shows the first holding member of the treatment part of the energy treatment instrument of the treatment treatment system for treatment according to the seventh embodiment, and is a schematic plan view seen from the direction of arrow 26A in Fig. 26B.
图26B表示第7实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图26A中的26B－26B线的概略横截面图。Fig. 26B shows the first holding member of the treatment part of the energy treatment instrument of the treatment treatment system for treatment according to the seventh embodiment, and is a schematic cross-sectional view taken along line 26B-26B in Fig. 26A.
图27A是表示分别在第7实施方式的治疗用处理系统的能量处理器具的处理部的第1及第2保持构件的主体上配设有覆盖构件的状态的概略立体图。27A is a schematic perspective view showing a state in which covering members are disposed on the main bodies of the first and second holding members of the treatment part of the energy treatment device of the treatment system for treatment according to the seventh embodiment.
图27B是表示配设在第7实施方式的治疗用处理系统的能量处理器具的处理部的第1及第2保持构件的主体上的覆盖构件的概略立体图。27B is a schematic perspective view showing covering members disposed on the main bodies of the first and second holding members of the treatment portion of the energy treatment device of the treatment system for treatment according to the seventh embodiment.
图28A是表示配设在第7实施方式的治疗用处理系统的能量处理器具的处理部的第1及第2保持构件的主体上的片状的覆盖构件的概略图。28A is a schematic diagram showing a sheet-shaped covering member disposed on the main bodies of the first and second holding members of the treatment portion of the energy treatment device of the treatment system for treatment according to the seventh embodiment.
图28B是表示配设在第7实施方式的治疗用处理系统的能量处理器具的处理部的第1及第2保持构件的主体上的多孔质状的覆盖构件的概略立体图。28B is a schematic perspective view showing a porous covering member arranged on the main bodies of the first and second holding members of the treatment portion of the energy treatment device of the treatment system for treatment according to the seventh embodiment.
图28C是表示配设在第7实施方式的治疗用处理系统的能量处理器具的处理部的第1及第2保持构件的主体上的网状的覆盖构件的概略立体图。28C is a schematic perspective view showing a net-like covering member disposed on the main bodies of the first and second holding members of the treatment portion of the energy treatment device of the treatment system for treatment according to the seventh embodiment.
图29是表示在使用第7实施方式的治疗用处理系统对生物体组织进行处理时、利用能量源、脚踏开关及流体源完成的治疗用处理系统的控制状态的流程图。29 is a flow chart showing the control state of the therapeutic treatment system by using the energy source, the foot switch and the fluid source when the living tissue is treated using the therapeutic treatment system according to the seventh embodiment.
图30是表示在使用第7实施方式的治疗用处理系统的能量处理器具进行处理时、在生物体组织的表面上配设有覆盖构件的状态的概略立体图。30 is a schematic perspective view showing a state in which a covering member is arranged on the surface of a living tissue during treatment using the energy treatment instrument of the treatment system for treatment according to the seventh embodiment.
图31A表示第8实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是从图31B的箭头31A方向看到的概略俯视图。Fig. 31A shows the first holding member of the treatment part of the energy treatment instrument of the therapeutic treatment system according to the eighth embodiment, and is a schematic plan view seen from the direction of arrow 31A in Fig. 31B.
图31B表示第8实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图31A中的31B－31B线的概略横截面图。Fig. 31B shows the first holding member of the treatment part of the energy treatment instrument of the treatment treatment system for treatment according to the eighth embodiment, and is a schematic cross-sectional view taken along line 31B-31B in Fig. 31A.
图32是表示在使用第8实施方式的治疗用处理系统对生物体组织进行处理时、利用能量源、脚踏开关及流体源完成的治疗用处理系统的控制状态的流程图。Fig. 32 is a flow chart showing the control state of the therapeutic treatment system by using the energy source, the foot switch and the fluid source when the living tissue is treated using the therapeutic treatment system according to the eighth embodiment.
图33是表示在使用第8实施方式的治疗用处理系统的能量处理器具进行处理时、在生物体组织的表面上配设有覆盖构件的状态的概略立体图。Fig. 33 is a schematic perspective view showing a state in which a covering member is arranged on the surface of a living tissue during treatment using the energy treatment instrument of the therapeutic treatment system according to the eighth embodiment.
图34是表示在使用第8实施方式的治疗用处理系统对生物体组织进行处理时、利用能量源、脚踏开关及流体源完成的治疗用处理系统的控制状态的流程图。34 is a flow chart showing the control state of the therapeutic treatment system using the energy source, foot switch and fluid source when the living tissue is treated using the therapeutic treatment system according to the eighth embodiment.
图35是表示在使用第8实施方式的治疗用处理系统对生物体组织进行处理时、利用能量源、脚踏开关及流体源完成的治疗用处理系统的控制状态的流程图。35 is a flow chart showing the control state of the therapeutic treatment system using the energy source, foot switch and fluid source when the living tissue is treated using the therapeutic treatment system according to the eighth embodiment.
图36A是表示在利用第9实施方式的治疗用处理系统对生物体组织进行接合处理时、配设在生物体组织之间的网状的覆盖构件的概略立体图。36A is a schematic perspective view showing a mesh-like covering member disposed between living tissues when the living tissues are joined together by the medical treatment system according to the ninth embodiment.
图36B是表示在利用第9实施方式的治疗用处理系统对生物体组织进行接合处理时、配设在生物体组织之间的多孔质状的覆盖构件的概略立体图。Fig. 36B is a schematic perspective view showing a porous covering member disposed between living tissues when the living tissues are joined together by the medical treatment system according to the ninth embodiment.
图36C是表示在利用第9实施方式的治疗用处理系统进行处理时、以在接合对象的生物体组织之间夹着覆盖构件的状态一边利用能量处理器具的处理部保持接合对象的生物体组织一边进行接合处理的状态的概略横截面图。36C is a diagram showing that the biological tissue to be joined is held by the treatment part of the energy treatment instrument while the covering member is sandwiched between the biological tissues to be joined when the treatment system for treatment according to the ninth embodiment is used; A schematic cross-sectional view of a state where bonding is being performed.
图37A是表示第10实施方式的治疗用处理系统的概略图。Fig. 37A is a schematic diagram showing a therapeutic treatment system according to a tenth embodiment.
图37B是表示第10实施方式的治疗用处理系统的能量处理器具的手柄的概略局部纵剖视图。37B is a schematic partial longitudinal sectional view showing the handle of the energy treatment device of the medical treatment system according to the tenth embodiment.
图38是表示第10实施方式的治疗用处理系统的概略框图。Fig. 38 is a schematic block diagram showing a medical treatment system according to a tenth embodiment.
图39A是表示第10实施方式的治疗用处理系统的双极型的能量处理器具的闭合的处理部及柄线的概略纵剖视图。39A is a schematic longitudinal sectional view showing a closed treatment portion and a shank of a bipolar energy treatment instrument of a treatment system for treatment according to a tenth embodiment.
图39B是表示第10实施方式的治疗用处理系统的能量处理器具的张开的处理部及柄线的概略纵剖视图。39B is a schematic vertical cross-sectional view showing the expanded treatment portion and the shank of the energy treatment instrument of the treatment system for treatment according to the tenth embodiment.
图40A是表示第10实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件的概略俯视图。40A is a schematic plan view showing the first holding member of the treatment portion of the energy treatment instrument of the medical treatment system according to the tenth embodiment.
图40B是表示利用第10实施方式的治疗用处理系统的能量处理器具的处理部保持生物体组织的状态的、沿着图39A所示的40B－40B线的概略横截面图。40B is a schematic cross-sectional view taken along line 40B-40B shown in FIG. 39A , showing a state in which the treatment part of the energy treatment device of the treatment treatment system for treatment according to the tenth embodiment holds a living body.
图41是表示第10实施方式的治疗用处理系统的能量处理器具的手柄的变形例的概略局部纵剖视图。Fig. 41 is a schematic partial longitudinal sectional view showing a modified example of the handle of the energy treatment device of the medical treatment system according to the tenth embodiment.
图42A表示第11实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是从图42B及图42C的箭头42A方向看到的概略俯视图。Fig. 42A shows the first holding member of the treatment part of the energy treatment device of the medical treatment system according to the eleventh embodiment, and is a schematic plan view seen from the direction of arrow 42A in Figs. 42B and 42C.
图42B表示第11实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图42A中及图42C中的42B－42B线的概略纵剖视图。Fig. 42B shows the first holding member of the treatment part of the energy treatment device of the medical treatment system according to the eleventh embodiment, and is a schematic longitudinal sectional view taken along line 42B-42B in Figs. 42A and 42C.
图42C表示第11实施方式的治疗用处理系统的能量处理器具的处理部的第1保持构件，是沿着图42A中及图42B中的42C－42C线的概略横截面图。Fig. 42C shows the first holding member of the treatment part of the energy treatment device of the therapeutic treatment system according to the eleventh embodiment, and is a schematic cross-sectional view taken along line 42C-42C in Figs. 42A and 42B.
图43是表示第12实施方式的治疗用处理系统的概略图。Fig. 43 is a schematic diagram showing a therapeutic treatment system according to a twelfth embodiment.
图44A是表示第12实施方式的治疗用处理系统的双极型的能量处理器具的处理部的、分离了主体侧保持构件和离开侧保持构件的状态的概略主视图。44A is a schematic front view showing a state in which the main body side holding member and the separation side holding member are separated, showing the treatment portion of the bipolar energy treatment instrument of the treatment treatment system for treatment according to the twelfth embodiment.
图44B表示第12实施方式的治疗用处理系统的能量处理器具的处理部的、分离了主体侧保持构件和离开侧保持构件的状态，是沿着图44A中的44B－44B线的概略纵剖视图。Fig. 44B shows a state in which the treatment part of the energy treatment device of the therapeutic treatment system according to the twelfth embodiment is separated from the main body side holding member and the separation side holding member, and is a schematic longitudinal sectional view along line 44B-44B in Fig. 44A .
图45表示第12实施方式的治疗用处理系统的能量处理器具的处理部的主体侧保持构件，是从图44A中的箭头45方向看到的概略俯视图。Fig. 45 shows a main body side holding member of the treatment part of the energy treatment device of the therapeutic treatment system according to the twelfth embodiment, and is a schematic plan view seen from the direction of arrow 45 in Fig. 44A.
图46A是表示第12实施方式的治疗用处理系统的双极型的能量处理器具的处理部的、闭合了主体侧保持构件和离开侧保持构件的状态的概略主视图。46A is a schematic front view showing a state in which the main body side holding member and the separation side holding member are closed of the treatment part of the bipolar energy treatment instrument of the treatment treatment system for treatment according to the twelfth embodiment.
图46B是表示第12实施方式的治疗用处理系统的双极型的能量处理器具的处理部的、张开了主体侧保持构件和离开侧保持构件的状态的概略纵剖视图。46B is a schematic longitudinal sectional view showing a state in which the main body side holding member and the separation side holding member are opened, showing the treatment portion of the bipolar energy treatment instrument of the medical treatment system according to the twelfth embodiment.
图47A是表示第13实施方式的治疗用处理系统的双极型的能量处理器具的处理部的、分离了主体侧保持构件和离开侧保持构件的状态的概略主视图。47A is a schematic front view showing a state in which the main body side holding member and the separation side holding member are separated, showing the treatment portion of the bipolar energy treatment instrument of the treatment treatment system according to the thirteenth embodiment.
图47B表示第13实施方式的治疗用处理系统的能量处理器具的处理部的、分离了主体侧保持构件和离开侧保持构件的状态，是沿着图47A中的47B－47B线的概略纵剖视图。Fig. 47B shows a state in which the treatment part of the energy treatment device of the therapeutic treatment system according to the thirteenth embodiment is separated from the main body side holding member and the separation side holding member, and is a schematic longitudinal sectional view along line 47B-47B in Fig. 47A .
具体实施方式Detailed ways
以下，参照附图说明用于实施本发明的最佳方式。Hereinafter, the best mode for carrying out the present invention will be described with reference to the drawings.
(第1实施方式)(first embodiment)
使用图1～图6说明第1实施方式。The first embodiment will be described using FIGS. 1 to 6 .
在此，作为能量处理器具(治疗用处理器具)，例如以用于穿过腹壁来进行处理的、线型的外科用处理器具12为例进行说明。Here, as an energy treatment instrument (treatment treatment instrument), for example, a linear surgical treatment instrument 12 for performing treatment through the abdominal wall will be described as an example.
如图1及图2所示，治疗用处理系统10具有能量处理器具12、能量源(控制部)14、脚踏开关(也可以是手动开关)16(参照图2)及流体源18。As shown in FIGS. 1 and 2 , the therapeutic treatment system 10 includes an energy treatment device 12 , an energy source (control unit) 14 , a foot switch (or a manual switch) 16 (see FIG. 2 ), and a fluid source 18 .
如图1所示，能量处理器具12具有手柄22、柄线24及能够开闭的处理部(保持部)26。手柄22借助线缆28与能量源14相连接。如图2所示，在能量源14上连接有脚踏开关16。As shown in FIG. 1 , the energy treatment tool 12 has a handle 22 , a handle 24 , and an openable and closable treatment portion (holding portion) 26 . The handle 22 is connected to the energy source 14 by means of a cable 28 . As shown in FIG. 2 , a foot switch 16 is connected to the energy source 14 .
脚踏开关16具有未图示的踏板。手术者通过操作(按压/解除按压)脚踏开关16的踏板，切换从能量源14向外科用处理器具12供给能量(在该实施方式中为高频能量)的ON/OFF、进而是否使后述的流体(接合辅助剂)流入这一连串的动作。在踏板处于被按压状态时，根据适当设定的状态(控制了能量输出量、能量输出时刻等的状态)输出高频能量。若解除踏板的按压，则强制停止高频能量的输出。另外，在踏板处于被按压状态时，流入预定流量的流体，若解除按压，则流体的流入停止。The foot switch 16 has an unillustrated pedal. The operator operates (presses/releases) the pedal of the foot switch 16 to switch ON/OFF of supplying energy (in this embodiment, high-frequency energy) from the energy source 14 to the surgical treatment tool 12, and whether to turn the back The above-mentioned fluid (junction aid) flows into this series of actions. When the pedal is in the depressed state, high-frequency energy is output according to an appropriately set state (a state in which the amount of energy output, the timing of energy output, and the like are controlled). When the pedal is released, the output of high-frequency energy is forcibly stopped. Also, when the pedal is pressed, a predetermined flow rate of fluid flows in, and when the pedal is released, the inflow of fluid stops.
如图1所示，手柄22形成为手术者易于握持的形状，例如形成为大致L字状。在手柄22的一端配设有柄线24。从与该柄线24同轴的手柄22的基端延伸有上述线缆28。在线缆28内贯穿有后述的高频电极92、94的通电线28a、28b。As shown in FIG. 1 , the handle 22 is formed in a shape that the operator can easily hold, for example, in a substantially L-shape. A handle wire 24 is arranged at one end of the handle 22 . The aforementioned cable 28 extends from the proximal end of the handle 22 coaxial with the handle 24 . Conduction wires 28 a , 28 b of high-frequency electrodes 92 , 94 described later penetrate through the cable 28 .
另一方面，手柄22的另一端侧是向远离柄线24的轴向的方向延伸并供手术者把持的把持部。手柄22以排列设置在其另一端侧的方式具有处理部开闭把手32。该处理部开闭把手32在手柄22的大致中央部分与手柄22的后述的护套44(参照图3A及图3B)的基端相连结。若使该处理部开闭把手32靠近及离开手柄22的另一端，则护套44沿其轴向移动。On the other hand, the other end side of the handle 22 is a grasping portion that extends in the axial direction away from the handle wire 24 and is grasped by the operator. The handle 22 has a treatment part opening and closing handle 32 arranged in a row on the other end side. The treatment part opening and closing handle 32 is connected to the base end of a sheath 44 (see FIGS. 3A and 3B ) described later of the handle 22 at a substantially central portion of the handle 22 . When the opening and closing handle 32 of the treatment part is moved closer to and separated from the other end of the handle 22, the sheath 44 moves along its axial direction.
如图3A及图3B所示，柄线24具有筒体42和以能够滑动的方式配设在该筒体42的外侧的护套44。筒体42的基端部固定于手柄22(参照图1)。护套44能够沿着筒体42的轴向滑动。As shown in FIGS. 3A and 3B , the handle 24 has a cylindrical body 42 and a sheath 44 slidably arranged outside the cylindrical body 42 . The base end portion of the cylindrical body 42 is fixed to the handle 22 (see FIG. 1 ). The sheath 44 is slidable in the axial direction of the barrel 42 .
在筒体42的外侧沿其轴向形成有凹部46。在该凹部46上配设有与后述的高频电极(能量输出部)92相连接的电极用通电线28a。在筒体42的内部贯穿有与后述的高频电极(能量输出部)94相连接的电极用通电线28b。A concave portion 46 is formed on the outer side of the cylindrical body 42 in the axial direction thereof. Electrode current wires 28 a connected to a high-frequency electrode (energy output unit) 92 to be described later are disposed on the concave portion 46 . An electrode current conducting wire 28 b connected to a high-frequency electrode (energy output unit) 94 to be described later penetrates through the inside of the cylindrical body 42 .
如图1所示，处理部26配设在柄线24的顶端。如图3A及图3B所示，处理部26具有一对保持构件52、54、即第1保持构件(第1钳口)52及第2保持构件(第2钳口)54。As shown in FIG. 1 , the treatment part 26 is arranged at the tip of the handle wire 24 . As shown in FIGS. 3A and 3B , the treatment unit 26 has a pair of holding members 52 and 54 , that is, a first holding member (first jaw) 52 and a second holding member (second jaw) 54 .
优选的是图3A及图3B所示的第1及第2保持构件52、54自身分别整体上具有绝缘性。如图4A～图4C所示，第1保持构件52一体地具有第1保持构件主体(以下，主要称作主体)62和设置于该主体62的基端部的基部64。主体62是通过与第2保持构件54的后述的主体72协作来保持图5B所示的生物体组织L1、L2的部分，具有保持面(边缘部)62a。基部64是与柄线24的顶端相连结的部分。第1保持构件52的主体62及基部64配设在同一轴上。而且，在主体62与基部64之间形成有台阶66。It is preferable that the first and second holding members 52 and 54 themselves shown in FIGS. 3A and 3B have insulating properties as a whole. As shown in FIGS. 4A to 4C , the first holding member 52 integrally has a first holding member main body (hereinafter, mainly referred to as a main body) 62 and a base portion 64 provided at a base end portion of the main body 62 . The main body 62 is a portion that holds the living tissues L1 and L2 shown in FIG. 5B in cooperation with a main body 72 described later of the second holding member 54 , and has a holding surface (edge portion) 62 a. The base portion 64 is a portion connected to the tip of the handle wire 24 . The main body 62 and the base 64 of the first holding member 52 are arranged on the same axis. Also, a step 66 is formed between the main body 62 and the base 64 .
第2保持构件54虽未像图4A～图4C所示的第1保持构件52那样详细图示，但是一体地具有第2保持构件主体(以下，主要称作主体)72和设置于该主体72的基端部的基部74。主体72是通过与第1保持构件52的主体62协作来保持生物体组织L1、L2的部分，具有保持面(边缘部)72a。基部74是与柄线24的顶端相连结的部分。第2保持构件54的主体72及基部74配设在同一轴上。而且，在主体72与基部74之间形成有台阶76。Although the second holding member 54 is not shown in detail as the first holding member 52 shown in FIGS. The base portion 74 of the base end portion. The main body 72 is a portion that holds the living tissues L1, L2 in cooperation with the main body 62 of the first holding member 52, and has a holding surface (edge portion) 72a. The base portion 74 is a portion connected to the tip of the handle wire 24 . The main body 72 and the base 74 of the second holding member 54 are arranged on the same axis. Also, a step 76 is formed between the main body 72 and the base 74 .
另外，在该实施方式及后述的实施方式中，第1保持构件52的主体62与第2保持构件54的主体72具有相同的形状。另外，关于第1保持构件52的基部64与第2保持构件54的基部74，第2保持构件54的基部74如后述那样形成为枢接在柄线24的筒体42上这一点与第1保持构件52的基部64不同，其他构造皆相同，因此适当地省略说明。In addition, in this embodiment and the embodiments described later, the main body 62 of the first holding member 52 and the main body 72 of the second holding member 54 have the same shape. In addition, regarding the base portion 64 of the first holding member 52 and the base portion 74 of the second holding member 54, the point that the base portion 74 of the second holding member 54 is formed to be pivotally connected to the cylindrical body 42 of the handle 24 as described later is different from that of the second holding member 54. 1. The base portion 64 of the holding member 52 is different, and other structures are the same, so descriptions are appropriately omitted.
如图4C所示，第1保持构件52的主体62的外表面形成为平滑的曲面状。虽未图示，但是第1保持构件52的基部64的外表面也形成为平滑的曲面状。在第2保持构件54相对于第1保持构件52闭合的状态下，处理部26的横截面与主体62、72及基部64、74的横截面一起形成为大致圆形或大致椭圆状。在第2保持构件54相对于第1保持构件52闭合的状态下，第1及第2保持构件52、54的主体62、72的保持面(边缘部)62a、72a相互相对而抵接。另外，在该状态下，第1及第2保持构件52、54的主体62、72的基端部的外径形成为大于基部64、74的外径。而且，在主体62、72与基部64、74之间分别形成有上述台阶66、76。As shown in FIG. 4C , the outer surface of the main body 62 of the first holding member 52 is formed in a smooth curved shape. Although not shown, the outer surface of the base portion 64 of the first holding member 52 is also formed in a smooth curved shape. When the second holding member 54 is closed with respect to the first holding member 52 , the cross section of the treatment part 26 together with the cross sections of the main bodies 62 , 72 and the bases 64 , 74 is formed into a substantially circular or substantially elliptical shape. When the second holding member 54 is closed with respect to the first holding member 52 , the holding surfaces (edges) 62 a , 72 a of the main bodies 62 , 72 of the first and second holding members 52 , 54 face and abut against each other. In addition, in this state, the outer diameter of the base end portion of the main body 62 , 72 of the first and second holding members 52 , 54 is formed larger than the outer diameter of the base portion 64 , 74 . Furthermore, the aforementioned steps 66 , 76 are formed between the main bodies 62 , 72 and the bases 64 , 74 , respectively.
第1保持构件52的基部64固定于柄线24的筒体42的顶端部。另一方面，第2保持构件54的基部74利用支承销82以能够转动的方式支承在柄线24的筒体42的顶端部，该支承销82沿与柄线24的轴向正交的方向配设。第2保持构件54通过绕支承销82的轴线转动而能够相对于第1保持构件52开闭。该第2保持构件54例如被板簧等弹性构件84偏置，以相对于第1保持构件52张开。The base portion 64 of the first holding member 52 is fixed to the distal end portion of the cylindrical body 42 of the handle 24 . On the other hand, the base portion 74 of the second holding member 54 is rotatably supported on the top end portion of the cylindrical body 42 of the handle 24 by a support pin 82 extending in a direction perpendicular to the axial direction of the handle 24 . Equipped. The second holding member 54 can be opened and closed relative to the first holding member 52 by turning around the axis of the support pin 82 . The second holding member 54 is biased by an elastic member 84 such as a leaf spring so as to open relative to the first holding member 52 .
在此，在相对于第1保持构件52闭合了第2保持构件54的状态下，第1及第2保持构件52、54对合它们的基部64、74而成的大致圆形或大致椭圆状的外周面形成为与筒体42的顶端部的外周面大致相同或者直径稍微大于筒体42的顶端部的外周面的直径。因此，通过使护套44相对于筒体42滑动，能够利用护套44的顶端覆盖第1保持构件52及第2保持构件54的基部64、74。Here, in a state where the second holding member 54 is closed with respect to the first holding member 52, the first and second holding members 52, 54 have a substantially circular or substantially elliptical shape formed by abutting their bases 64, 74. The outer peripheral surface of the cylindrical body 42 is formed to be substantially the same as or slightly larger in diameter than the outer peripheral surface of the distal end portion of the cylindrical body 42 . Therefore, by sliding the sheath 44 relative to the cylindrical body 42 , the base portions 64 , 74 of the first holding member 52 and the second holding member 54 can be covered by the tip of the sheath 44 .
在该状态下，如图3A所示，第2保持构件54克服弹性构件84的偏置力而相对于第1保持构件52闭合。另一方面，若使护套44从利用护套44的顶端覆盖第1及第2保持构件52、54的基部64、74的状态向筒体42的基端侧滑动，则如图3B所示，第2保持构件54在弹性构件84的偏置力的作用下相对于第1保持构件52张开。In this state, as shown in FIG. 3A , the second holding member 54 is closed relative to the first holding member 52 against the biasing force of the elastic member 84 . On the other hand, when the sheath 44 is slid toward the base end side of the cylindrical body 42 from the state where the top end of the sheath 44 covers the bases 64, 74 of the first and second holding members 52, 54, as shown in FIG. 3B , , the second holding member 54 is opened relative to the first holding member 52 by the biasing force of the elastic member 84 .
如图4A～图4C所示，在第1及第2保持构件52、54的主体62、72上形成有优选为平行的、两列凹槽状的流路(通道)62b、72b。即，主体62、72的流路62b、72b向外侧开口。流路62b、72b的顶端闭塞。As shown in FIGS. 4A to 4C , the main bodies 62 , 72 of the first and second holding members 52 , 54 are formed with preferably parallel groove-shaped channels (passages) 62 b , 72 b in two rows. That is, the flow paths 62b, 72b of the main bodies 62, 72 open outward. The ends of the flow paths 62b and 72b are closed.
在基部64、74上分别形成有优选为平行的、两列管路64a、74a。即，基部64、74的管路64a、74a除了两端部以外相对于外侧闭合。主体62、64的流路62b、72b与基部64、74的管路64a、74a相连续而成。在基部64、74的管路64a、74a的基端连接有贯穿于柄线24的内部的、具有挠性的软管18a的顶端。软管18a的基端穿过手柄22向能量处理器具12的外部延伸而与流体源18相连接。因此，能够使储存在流体源18中的液体等后述的流体穿过软管18a而引导到第1及第2保持构件52、54的基部64、74的管路64a、74a、主体62、72的流路62b、72b。另外，优选的是，软管18a使用在能量处理器具12的外侧透明或半透明的挠性管。通过使用这种透明或半透明的管，能够目视确认液体流动的情况。Formed on the bases 64, 74 are two preferably parallel rows of conduits 64a, 74a, respectively. That is, the ducts 64a, 74a of the bases 64, 74 are closed with respect to the outside except for both ends. The flow passages 62b, 72b of the main bodies 62, 64 and the pipe passages 64a, 74a of the base parts 64, 74 are formed continuously. The distal end of a flexible hose 18 a that passes through the inside of the handle 24 is connected to the base ends of the pipe lines 64 a , 74 a of the base portions 64 , 74 . The base end of the hose 18 a extends through the handle 22 to the exterior of the energy treatment device 12 to connect with the fluid source 18 . Therefore, the fluid stored in the fluid source 18, such as the liquid described later, can be guided to the pipes 64a, 74a of the bases 64, 74 of the first and second holding members 52, 54, the main body 62, 72 flow paths 62b, 72b. In addition, it is preferable to use a transparent or translucent flexible tube on the outside of the energy processing device 12 as the hose 18a. By using such a transparent or translucent tube, the flow of the liquid can be visually confirmed.
另外，在从流体源18向处理部26引导液体的情况下，优选的是软管18a在靠近第1及第2保持构件52、54的基部64、74的位置分支成两个或四个。In addition, when guiding the liquid from the fluid source 18 to the treatment unit 26 , it is preferable that the hose 18 a is branched into two or four at positions close to the bases 64 , 74 of the first and second holding members 52 , 54 .
另外，根据从流体源18向处理部26引导的液体的粘性，也可以在穿过软管18a向第1及第2保持构件52、54供给液体时使用空力压力等对供给进行辅助。In addition, depending on the viscosity of the liquid guided from the fluid source 18 to the treatment unit 26, when the liquid is supplied to the first and second holding members 52, 54 through the hose 18a, the supply may be assisted by using pneumatic pressure or the like.
而且，在第1及第2保持构件52、54的主体62、72的保持面(边缘部)62a、72a的内侧配设有平板状的高频电极(接合构件)92、94作为输出构件、能量释放部。这些高频电极92、94借助连接器96a、96b与通电线28a、28b的顶端进行电连接。而且，这些通电线28a、28b与能量源14的后述的高频能量输出部104相连接。因此，通过向保持在高频电极92、94之间的生物体组织L1、L2通电而使生物体组织L1、L2产生焦耳热，来使生物体组织L1、L2自身被加热而改性。Further, plate-shaped high-frequency electrodes (bonding members) 92 and 94 are arranged inside the holding surfaces (edges) 62a and 72a of the main bodies 62 and 72 of the first and second holding members 52 and 54 as output members, Energy Release Department. These high-frequency electrodes 92, 94 are electrically connected to the tips of the conducting wires 28a, 28b via connectors 96a, 96b. And these power supply lines 28a, 28b are connected to the high-frequency energy output part 104 mentioned later of the energy source 14. As shown in FIG. Therefore, by energizing the living tissues L1 and L2 held between the high-frequency electrodes 92 and 94 to generate Joule heat in the living tissues L1 and L2, the living tissues L1 and L2 themselves are heated and modified.
这些高频电极92、94是对主体62、72各自的两列槽状的流路62b、72b加盖的构件，这些流路62b、72b分别形成为管路。在高频电极92、94上，沿着各个流路62b、72b形成有多个开口(接合维持辅助部)92a、94a。因此。能够使来自上述流体源18的流体从高频电极92、94的开口92a、94a渗出。另外，优选的是开口92a、94a例如配置成等间隔，或者配置成调整开口直径等而使从各个开口92a、94a渗出相同量的液体。These high-frequency electrodes 92, 94 cover the respective two rows of groove-shaped flow paths 62b, 72b of the main bodies 62, 72, and these flow paths 62b, 72b are respectively formed as pipe paths. On the high-frequency electrodes 92, 94, a plurality of openings (joint maintenance auxiliary portions) 92a, 94a are formed along the respective flow paths 62b, 72b. therefore. The fluid from the above-mentioned fluid source 18 can be made to seep out from the openings 92a, 94a of the high-frequency electrodes 92, 94 . In addition, it is preferable that the openings 92a and 94a are arranged, for example, at equal intervals, or arranged so that the same amount of liquid seeps out from the respective openings 92a and 94a by adjusting the opening diameter or the like.
这些高频电极92、94除了用于利用高频能量对生物体组织L1、L2进行处理以外，还能够用作测量生物体组织L1、L2之间的阻抗Z(参照图5A)、相位θ(参照图7)的传感器。高频电极92、94例如能够通过通电线28a、28b与能量源14的后述的检测部106进行发送、接收信号。在此，说明利用检测部106测量阻抗Z的情况。These high-frequency electrodes 92, 94 can be used to measure the impedance Z (refer to FIG. 5A ), phase θ ( See Figure 7) for the sensor. The high-frequency electrodes 92 and 94 can transmit and receive signals to and from a detection unit 106 described later of the energy source 14 , for example, via the energizing wires 28 a and 28 b . Here, a case where the impedance Z is measured by the detection unit 106 will be described.
如图2所示，能量源14具有第1控制部(能量控制部)102、高频能量输出部(第1高频能量输出部)104、检测部106、显示部108及扬声器110。在第1控制部102上连接有高频能量输出部104、检测部106、显示部108及扬声器110，利用第1控制部102控制高频能量输出部104、检测部106、显示部108及扬声器110。As shown in FIG. 2 , the energy source 14 has a first control unit (energy control unit) 102 , a high-frequency energy output unit (first high-frequency energy output unit) 104 , a detection unit 106 , a display unit 108 and a speaker 110 . The high-frequency energy output unit 104, the detection unit 106, the display unit 108 and the loudspeaker 110 are connected to the first control unit 102, and the high-frequency energy output unit 104, the detection unit 106, the display unit 108 and the loudspeaker are controlled by the first control unit 102 110.
高频能量输出部104产生能量，经由通电线28a、28b向高频电极92、94供给能量。另外，高频能量输出部104也作为向在第7实施方式中说明的加热器222、232(参照图26A及图26B)供给能量的能量输出部发挥作用。The high-frequency energy output unit 104 generates energy, and supplies energy to the high-frequency electrodes 92 and 94 via the electric wires 28a and 28b. In addition, the high-frequency energy output unit 104 also functions as an energy output unit that supplies energy to the heaters 222 and 232 (see FIGS. 26A and 26B ) described in the seventh embodiment.
检测部106通过通电线28a、28b检测利用保持生物体组织L1、L2的高频电极92、94所获得的测量结果而计算出阻抗Z。显示部108是一边通过显示来确认阻抗Z的阈值Z1的设定等一边进行各种设定的部分。扬声器110具有声源(未图示)，用于通知处理结束、在产生问题时等发出声音。通知处理结束的声音与通知产生了问题的声音之间音色不同。另外，扬声器110在处理过程中也能够像第1阶段的处理已结束的声音、第2阶段的处理已结束的声音那样对处理进行划分而发出声音。The detection unit 106 detects the measurement results obtained by the high-frequency electrodes 92 and 94 holding the living tissues L1 and L2 through the energizing wires 28a and 28b to calculate the impedance Z. The display unit 108 is a unit for performing various settings while confirming the setting of the threshold value Z1 of the impedance Z through the display. The speaker 110 has a sound source (not shown) and is used for notifying the end of the process and emitting a sound when a problem occurs. There is a difference in tone between the sound notifying the end of processing and the sound notifying that a problem has occurred. In addition, the speaker 110 can also emit a sound by dividing the processing into a sound that the first-stage processing is completed and a sound that the second-stage processing is completed during the processing.
在能量源14的第1控制部102上连接有脚踏开关16，并且连接有流体源18的后述的第2控制部(流量控制部)132。因此，若操作脚踏开关16，则能量源14会工作，并且流体源18会工作。The foot switch 16 is connected to the first control unit 102 of the energy source 14 , and a second control unit (flow control unit) 132 , which will be described later, of the fluid source 18 is also connected. Thus, if the foot switch 16 is operated, the energy source 14 will be activated and the fluid source 18 will be activated.
若将脚踏开关16切换为ON(按压未图示的踏板)，则进行能量处理器具12的处理，若切换为OFF(解除踏板的按压)，则处理停止。显示部108作为利用第1控制部102控制高频能量输出部104的输出量(输出量自身、或者进行何种处理(是以接合生物体组织L1、L2彼此为目的的处理还是以密封生物体组织的开口为目的的处理等))、能量的输出时刻时的设定部件(控制器)发挥功能。当然显示部108具有用于显示所设定的内容的显示功能。When the foot switch 16 is switched ON (depresses a pedal not shown), the processing of the energy processing device 12 is performed, and when switched OFF (the pedal is released), the processing stops. The display unit 108 is used to control the output of the high-frequency energy output unit 104 by the first control unit 102 (the output itself, or what kind of treatment to perform (whether it is the treatment for the purpose of joining the living tissue L1, L2 or sealing the living body) Tissue opening for the purpose of processing, etc.), energy output time setting means (controller) function. Of course, the display unit 108 has a display function for displaying the set content.
检测部106通过用于输出高频能量的第1及第2高频电极92、94能够检测出(计算出)第1及第2高频电极92、94之间的生物体组织L1、L2的阻抗Z。即，检测部106与第1及第2高频电极92、94具有用于测量第1及第2高频电极92、94之间的生物体组织L1、L2的阻抗Z的传感器功能。The detection unit 106 can detect (calculate) the energy of the living tissues L1 and L2 between the first and second high-frequency electrodes 92 and 94 through the first and second high-frequency electrodes 92 and 94 for outputting high-frequency energy. Impedance Z. That is, the detection unit 106 and the first and second high-frequency electrodes 92 and 94 have a sensor function for measuring the impedance Z of the living tissues L1 and L2 between the first and second high-frequency electrodes 92 and 94 .
流体源18具有流体存储部122和流量调整部124。流量调整部124具有第2控制部(流量控制部)132和流量调整机构134。The fluid source 18 has a fluid storage part 122 and a flow rate adjustment part 124 . The flow adjustment unit 124 has a second control unit (flow control unit) 132 and a flow adjustment mechanism 134 .
图1所示的流体存储部122由存储流体的例如透明的袋等形成。在该流体存储部122上以能够装卸的方式连接有软管18a的基端。流量调整部124的第2控制部132与能量源14的第1控制部102相连接。因此，第2控制部132与能量源14连动地进行工作。流量调整机构134例如由弹簧夹等形成，以调整通过软管18a流向能量处理器具12的流体的流量。即，第2控制部132通过使流量调整机构134工作，来控制从流体存储部122经由软管18a向第1及第2保持构件52、54供给的液体等流体的流量。The fluid storage unit 122 shown in FIG. 1 is formed of, for example, a transparent bag or the like for storing fluid. The proximal end of the hose 18 a is detachably connected to the fluid storage unit 122 . The second control unit 132 of the flow rate adjustment unit 124 is connected to the first control unit 102 of the energy source 14 . Therefore, the second control unit 132 operates in conjunction with the energy source 14 . The flow adjustment mechanism 134 is formed by, for example, a spring clip or the like to adjust the flow of fluid flowing to the energy treatment tool 12 through the hose 18a. That is, the second control unit 132 controls the flow rate of fluid such as liquid supplied from the fluid storage unit 122 to the first and second holding members 52 , 54 through the hose 18 a by operating the flow rate adjustment mechanism 134 .
在流体存储部122中能够存储例如粘接剂等、用于在对利用高频能量处理了的生物体组织LT的外表面Sc进行涂布时防止水分渗入生物体组织LT的物质(接合辅助剂)。优选的是，用于防止水分渗入生物体组织LT的物质是若涂布在生物体组织上则渗入生物体组织的生物体吸收性材料。存储在流体存储部122中的物质不仅是液体，例如也可以是凝胶状的物质。即，存储在流体存储部122中的物质只要是能够通过软管18a流动的流体即可。用于防止水分渗入生物体组织LT的物质含有化合物。该化合物是利用物理作用、化学作用或者这两种作用来覆盖或接合生物体组织LT的物质。优选的是，化合物是蛋白质、糖质、聚合物、固化剂中的至少一种。优选的是，蛋白质是纤维蛋白、白蛋白、胶原蛋白、明胶中的至少一种。优选的是，糖质是淀粉、透明质酸、壳聚糖中的至少一种。优选的是，聚合物是聚乙二醇、聚乙醇酸、聚乳酸、聚己内酰胺。优选的是，固化剂是丙烯酸酯衍生物、醛衍生物、琥珀酰亚胺衍生物、异氰酸盐衍生物。即，用于防止水分渗入生物体组织的物质(接合辅助剂)例如能够列举出有机类粘接剂、无机类粘接剂、粘接用生物体材料、交联剂、单体类·聚合物类的树脂材料等。另外，在使用粘接剂的情况下，能够使用两种液体混合型的粘接剂等各种粘接剂。The fluidstorage part 122 can store, for example, an adhesive, etc., for preventing moisture from penetrating into the living tissue LT when the outer surface Sc of the living tissueLT treated with high-frequency energy is applied (joint). adjuvant). Preferably, the substance for preventing moisture from penetrating into the living tissueLT is a bioabsorbable material that penetrates into the living tissue when coated on the living tissue. The substance stored in the fluid storage unit 122 is not limited to a liquid, but may be a gel-like substance, for example. That is, the substance stored in the fluid storage unit 122 may be any fluid that can flow through the hose 18a. Substances used to prevent moisture from penetrating into living tissue LT contain compounds. The compound is a substance that covers or joins living tissueLT by physical action, chemical action, or both actions. Preferably, the compound is at least one of protein, carbohydrate, polymer, and curing agent. Preferably, the protein is at least one of fibrin, albumin, collagen, gelatin. Preferably, the carbohydrate is at least one of starch, hyaluronic acid and chitosan. Preferably, the polymer is polyethylene glycol, polyglycolic acid, polylactic acid, polycaprolactam. Preferably, the curing agent is an acrylate derivative, an aldehyde derivative, a succinimide derivative, an isocyanate derivative. That is, substances (adhesion aids) for preventing moisture from penetrating into living tissues include, for example, organic adhesives, inorganic adhesives, biological materials for adhesion, cross-linking agents, monomers, and polymers. class of resin materials, etc. In addition, in the case of using an adhesive, various adhesives such as a two-liquid mixed type adhesive can be used.
而且，在存储在流体存储部122中的例如粘接剂等液体、凝胶状的物质中，也可以含有抗生剂、生长促进剂等。Furthermore, liquid or gel-like substances such as adhesives stored in the fluid storage unit 122 may contain antibiotics, growth promoters, and the like.
另外，在表1中表示与在以下说明的接合生物体组织L1、L2彼此的实验中所使用的8种接合辅助构件的主要成分对应的接合辅助构件的种类。当然，接合辅助构件的主要成分、种类并不限定于表1所示的内容。In addition, Table 1 shows the types of joining assisting members corresponding to the main components of the eight types of joining assisting members used in the experiment of joining the living tissues L1 and L2 described below. Of course, the main components and types of joining auxiliary members are not limited to those shown in Table 1.
(表1)(Table 1)
表1 在接合生物体组织的实验中所使用的接合辅助构件的主要成分与种类Table 1 Main components and types of coaptation auxiliary components used in the experiment of coaptation with biological tissues
当在流体存储部122中存储有液体物质的情况下，能够通过与流体存储部122相连接的软管18a向能量处理器具12的第1及第2保持构件52、54的基部64、74的管路64a、74a及主体62、72的流路62b、72b引导液体物质。当在流体存储部122中存储有凝胶状的物质的情况下，通过对流体存储部122施加例如空气压力等压力，能够通过与流体存储部122相连接的软管18a向能量处理器具12的第1保持构件52的基部64的管路64a、主体62的流路62b引导凝胶状的物质。When a liquid substance is stored in the fluid storage part 122, it can be connected to the base parts 64, 74 of the first and second holding members 52, 54 of the energy treatment device 12 through the hose 18a connected to the fluid storage part 122. The conduits 64a, 74a and the flow paths 62b, 72b of the bodies 62, 72 conduct liquid substances. When a gel-like substance is stored in the fluid storage part 122, by applying pressure such as air pressure to the fluid storage part 122, the fluid storage part 122 can be connected to the energy treatment device 12 through the hose 18a. The tube 64 a of the base 64 of the first holding member 52 and the flow channel 62 b of the main body 62 guide the gel-like substance.
在图5A中表示在从高频能量输出部104向高频电极92、94供给期望的能量并对生物体组织L1、L2进行高频处理时的高频电极92、94之间的生物体组织L1、L2的、能量供给时间t与生物体组织L1、L2间的阻抗Z之间的关系。另外，在图6中表示利用高频能量输出部104进行的能量处理器具12的控制流程的一个例子。5A shows the living tissue between the high-frequency electrodes 92 and 94 when desired energy is supplied from the high-frequency energy output unit 104 to the high-frequency electrodes 92 and 94 to perform high-frequency treatment on the living tissues L1 and L2. The relationship between L1, L2, the energy supply time t and the impedance Z between the living tissue L1, L2. In addition, an example of the control flow of the energy treatment tool 12 by the high-frequency energy output part 104 is shown in FIG. 6 .
接着，说明该实施方式的治疗用处理系统10的作用。Next, the operation of the therapeutic treatment system 10 of this embodiment will be described.
在利用高频能量下的处理来接合生物体组织L1、L2彼此之后，向流体源18的流体存储部122内预先放入用于对接合两个生物体组织L1、L2而成的生物体组织LT的外周进行涂敷的流体。在此，说明流体为生物体组织LT用的粘接剂的情况。该粘接剂例如为若接触到空气等则干燥的粘接剂，特别优选的是具有速干性的粘接剂。另外，与流体存储部122相连接的软管18a在流量调整机构134的作用下关闭，通常粘接剂不从流体存储部122朝向能量处理器具12流动。After the living tissues L1 and L2 are joined together by treatment under high-frequency energy, the living tissues for joining the two living tissues L1 and L2 are placed in the fluid storage part 122 of the fluid source 18 in advance. The periphery of theLT is coated with fluid. Here, a case where the fluid is an adhesive for the living tissueLT will be described. The adhesive is, for example, an adhesive that dries when exposed to air or the like, and is particularly preferably a quick-drying adhesive. In addition, the hose 18 a connected to the fluid storage part 122 is closed by the flow adjustment mechanism 134 , and normally the adhesive does not flow from the fluid storage part 122 to the energy treatment device 12 .
手术者预先操作能量源14的显示部108，设定治疗用处理系统10的输出条件(步骤S11)。利用显示部108确认来自高频能量输出部104的输出(设定电力Pset[W])、由检测部106检测出的阻抗Z的阈值Z1[Ω]、能量最大供给时间t1[sec]等。在将来自高频能量输出部104的输出、由检测部106检测出的阻抗Z的阈值Z1设定为不同的值的情况下如此进行设定，利用显示部108进行确认。另外，设定从流体存储部122通过软管18a流到能量处理器具12的流量V1。进而，设定预先打开软管18a的最长时间t－max。即，在打开软管18a之后即使未达到流量V1，在经过了时间t－max之后，也自动地关闭软管18a。The operator operates the display unit 108 of the energy source 14 in advance to set the output conditions of the treatment system 10 (step S11 ). The output from the high-frequency energy output unit 104 (set power Pset [W]), the threshold value Z1 [Ω] of the impedance Z detected by the detection unit 106 , the maximum energy supply time t1 [sec], etc. are confirmed on the display unit 108 . When the output from the high-frequency energy output unit 104 and the threshold value Z1 of the impedance Z detected by the detection unit 106 are set to different values, it is set in this way and confirmed by the display unit 108 . In addition, the flow rate V1 flowing from the fluid storage part 122 to the energy treatment device 12 through the hose 18a is set. Furthermore, the maximum time t-max in which the hose 18a is opened in advance is set. That is, even if the flow rate V1 has not been reached after opening the hose 18a, the hose 18a is automatically closed after the elapse of time t-max.
如图3A所示，在相对于第1保持构件52闭合了第2保持构件54的状态下，例如穿过腹壁向腹腔内插入外科用处理器具12的处理部26及柄线24。使外科用处理器具12的处理部26与处理对象(保持对象)的生物体组织L1、L2相对。As shown in FIG. 3A , with the second holding member 54 closed relative to the first holding member 52 , the treatment portion 26 and the handle 24 of the surgical treatment instrument 12 are inserted into the abdominal cavity, for example, through the abdominal wall. The treatment unit 26 of the surgical treatment instrument 12 is made to face the living tissues L1 and L2 of the treatment target (holding target).
为了利用第1保持构件52及第2保持构件54保持处理对象的生物体组织L1、L2，操作手柄22的处理部开闭把手32。利用该操作，使护套44相对于筒体42向柄线24的基端部侧移动。在弹性构件84的偏置力的作用下，不能够将基部64、74之间维持为筒状，第2保持构件54相对于第1保持构件52张开。In order to hold the living tissues L1 , L2 to be treated by the first holding member 52 and the second holding member 54 , the treatment portion of the handle 22 is operated to open and close the handle 32 . With this operation, the sheath 44 is moved toward the base end side of the handle wire 24 relative to the cylindrical body 42 . Due to the biasing force of the elastic member 84 , the space between the base portions 64 , 74 cannot be maintained in a cylindrical shape, and the second holding member 54 is opened relative to the first holding member 52 .
将接合对象(处理对象)的生物体组织L1、L2配置在第1及第2保持构件52、54的高频电极92、94之间。在该状态下，操作手柄22的处理部开闭把手32。此时，使护套44相对于筒体42向柄线24的顶端部侧移动。克服弹性构件84的偏置力而利用护套44使基部64、74之间闭合而成为筒状。因此，一体形成在基部64上的第1保持构件52的主体62与一体形成在基部74上的第2保持构件54的主体72闭合。即，第2保持构件54相对于第1保持构件52闭合。这样，将接合对象的生物体组织L1、L2保持在第1保持构件52与第2保持构件54之间。The living tissues L1 and L2 to be joined (processed) are arranged between the high-frequency electrodes 92 and 94 of the first and second holding members 52 and 54 . In this state, the treatment part of the handle 22 is operated to open and close the handle 32 . At this time, the sheath 44 is moved toward the distal end side of the handle wire 24 relative to the cylindrical body 42 . Against the biasing force of the elastic member 84, the sheath 44 closes between the base parts 64 and 74 to form a cylindrical shape. Therefore, the main body 62 of the first holding member 52 integrally formed on the base portion 64 and the main body 72 of the second holding member 54 integrally formed on the base portion 74 are closed. That is, the second holding member 54 is closed with respect to the first holding member 52 . In this way, the living tissues L1 and L2 to be joined are held between the first holding member 52 and the second holding member 54 .
此时，处理对象的生物体组织L1与第1保持构件52的高频电极92相接触，处理对象的生物体组织L2与第1保持构件54的高频电极94相接触。在第1保持构件52的主体62的保持面(边缘部)62a与第2保持构件54的主体72的保持面(边缘部)72b相对的接触面的两者上，紧密接触有接合对象的生物体组织L1、L2的周边组织。另外，生物体组织L1的接触面C1与生物体组织L2的接触面C2以相互给对方施加压力的方式相接触。At this time, the living tissue L1 to be treated is in contact with the high-frequency electrode 92 of the first holding member 52 , and the living tissue L2 to be treated is in contact with the high-frequency electrode 94 of the first holding member 54 . On both of the contact surfaces of the holding surface (edge portion) 62a of the main body 62 of the first holding member 52 and the holding surface (edge portion) 72b of the main body 72 of the second holding member 54, the organism to be bonded is in close contact. Peripheral tissues of body tissues L1 and L2. In addition, the contact surface C1 of the living tissue L1 and the contact surface C2 of the living tissue L2 are in contact so as to apply pressure to each other.
如此，在将生物体组织L1、L2保持在第1保持构件52与第2保持构件54之间的状态下，操作脚踏开关16的踏板。从脚踏开关16向第1控制部102输入信号，能量源14的第1控制部102判断是否在操作者的操作下脚踏开关16的踏板被按压而切换成了ON(S12)。In this way, the pedal of the foot switch 16 is operated while the living tissues L1 and L2 are held between the first holding member 52 and the second holding member 54 . A signal is input from the foot switch 16 to the first control unit 102, and the first control unit 102 of the energy source 14 determines whether or not the pedal of the foot switch 16 is pressed and turned ON by the operator's operation (S12).
在第1控制部102判断为脚踏开关16的踏板被按压而切换成了ON时，从第1控制部102向高频能量输出部104输入信号。高频能量输出部104产生能量，通过通电线28a、28b向高频电极92、94之间的生物体组织L1、L2供给能量(S13)。此时，高频能量输出部104向第1保持构件52的高频电极92与第2保持构件54的高频电极94之间供给利用显示部108预先设定的设定电力Pset[W]、例如20[W]～80[W]左右的电力。When the first control unit 102 determines that the pedal of the foot switch 16 is pressed and switched ON, a signal is input from the first control unit 102 to the high-frequency energy output unit 104 . The high-frequency energy output unit 104 generates energy, and supplies energy to the living tissues L1, L2 between the high-frequency electrodes 92, 94 through the energizing wires 28a, 28b (S13). At this time, the high-frequency energy output unit 104 supplies the set electric power Pset [W], which is preset by the display unit 108 , between the high-frequency electrode 92 of the first holding member 52 and the high-frequency electrode 94 of the second holding member 54 . For example, about 20 [W] to 80 [W] of electric power.
因此，高频能量输出部104向第1保持构件52的高频电极92与第2保持构件54的高频电极94之间的接合对象的生物体组织L1、L2通入高频电流。即，对保持在高频电极92、94之间的生物体组织L1、L2施加高频能量。因此，在保持在高频电极92、94之间的生物体组织L1、L2内产生焦耳热，生物体组织L1、L2自身被加热。在焦耳热的作用下，破坏保持在高频电极92、94之间的生物体组织L1、L2内的细胞膜而放出细胞膜内物质，使其与以胶原为首的细胞外成分均匀化。由于在高频电极92、94之间的生物体组织L1、L2内流动有高频电流，因此如此均匀化的组织L1、L2被进一步作用焦耳热，进行例如生物体组织L1、L2的接触面C1、C2彼此、组织的层间彼此的接合。因而，若向高频电极92、94之间的生物体组织L1、L2通入高频电流，则生物体组织L1、L2自身发热而脱水，同时生物体组织L1、L2的内部改性(生物体组织L1、L2烧灼)，接触面C1、C2彼此紧密接触而成为接合部C。这样，两个生物体组织L1、L2彼此相接合，形成具有接合部C的生物体组织LT。Therefore, the high-frequency energy output unit 104 supplies high-frequency current to the living tissues L1 and L2 to be bonded between the high-frequency electrode 92 of the first holding member 52 and the high-frequency electrode 94 of the second holding member 54 . That is, high-frequency energy is applied to the living tissues L1 and L2 held between the high-frequency electrodes 92 and 94 . Therefore, Joule heat is generated in the living tissues L1 , L2 held between the high-frequency electrodes 92 , 94 , and the living tissues L1 , L2 themselves are heated. Under the action of Joule heat, the cell membranes in the living tissues L1 and L2 held between the high-frequency electrodes 92 and 94 are destroyed to release the substances in the cell membranes and make them homogeneous with extracellular components including collagen. Since a high-frequency current flows in the biological tissues L1, L2 between the high-frequency electrodes 92, 94, Joule heat is further applied to the homogenized tissues L1, L2 in this way, and for example, the contact surface of the biological tissues L1, L2 The bonding between C1 and C2 and between the layers of the tissue. Therefore, when a high-frequency current is applied to the living tissues L1, L2 between the high-frequency electrodes 92, 94, the living tissues L1, L2 will generate heat and dehydrate themselves, and at the same time, the internal modification of the living tissues L1, L2 (biological The body tissues L1 and L2 are cauterized), and the contact surfaces C1 and C2 are in close contact with each other to form a junction C. In this way, the two living tissues L1 and L2 are joined to each other to form the living tissue LT having the joined portion C.
另外，随着生物体组织L1、L2的改性，从生物体组织L1、L2放出流体(例如液体(血液)和/或气体(水蒸气))。此时，第1及第2保持构件52、54的主体62、72的保持面62a、72a对生物体组织L1、L2的紧密接触度高于高频电极92、94对生物体组织L1、L2的紧密接触度。因此，保持面62a、72a作为用于抑制来自生物体组织L1、L2的流体向第1保持构件52及第2保持构件54的外侧逃离的势垒部(堤坝)发挥功能。即，能够防止接合处理对象的生物体组织L1、L2以外的生物体组织产生热传播。In addition, as the living tissues L1 and L2 are modified, fluid (for example, liquid (blood) and/or gas (steam)) is released from the living tissues L1 and L2. At this time, the degree of close contact between the holding surfaces 62a, 72a of the main bodies 62, 72 of the first and second holding members 52, 54 to the living tissues L1, L2 is higher than that of the high-frequency electrodes 92, 94 to the living tissues L1, L2. close contact. Therefore, the holding surfaces 62 a , 72 a function as barriers (dams) for preventing the fluid from the living tissues L1 , L2 from escaping to the outside of the first holding member 52 and the second holding member 54 . That is, it is possible to prevent heat propagation from living tissues other than the living tissues L1 and L2 to be joined.
此时，由于第1及第2保持构件52、54的高频电极92、94具有传感器功能，因此通过通电线28a、28b向检测部106传递所保持的生物体组织L1、L2之间的信息(阻抗Z)。如图5A所示，开始处理(开始向生物体组织L1、L2之间供给高频能量)时的阻抗Z的初始值Z0例如为50[Ω]～60[Ω]左右。而且，随着高频电流流入生物体组织L1、L2而烧灼生物体组织L1、L2，阻抗Z在暂时下降至Zmin(例如10[Ω]左右)之后逐渐上升。At this time, since the high-frequency electrodes 92, 94 of the first and second holding members 52, 54 have a sensor function, information on the held living tissues L1, L2 is transmitted to the detection unit 106 through the energizing wires 28a, 28b. (impedance Z). As shown in FIG. 5A , the initial value Z0 of the impedance Z when the treatment is started (the supply of high-frequency energy between the living tissues L1 and L2 is started) is, for example, about 50 [Ω] to 60 [Ω]. Then, as the high-frequency current flows into the living tissues L1 and L2 to burn the living tissues L1 and L2, the impedance Z temporarily drops to Zmin (for example, about 10 [Ω]) and then gradually rises.
第1控制部102控制检测部106以便以等时间间隔(例如数毫秒)计算出高频电极92、94之间的生物体组织L1、L2的信息。第1控制部102判断根据来自检测部106的信号计算出的高频能量输出时的阻抗Z是否成为预先在显示部108中设定(S11)的阈值Z1(如图5A所示，在此为约1000[Ω])以上(S14)。另外，当然能够适当地设定阻抗Z的阈值Z1。The first control unit 102 controls the detection unit 106 so as to calculate information on the living tissues L1 and L2 between the high-frequency electrodes 92 and 94 at equal time intervals (for example, several milliseconds). The first control unit 102 judges whether the impedance Z when the high-frequency energy output calculated from the signal from the detection unit 106 has reached the threshold value Z1 (as shown in FIG. About 1000 [Ω]) or more (S14). In addition, of course, the threshold value Z1 of the impedance Z can be appropriately set.
优选的是，阈值Z1例如大于初始值Z0，位于阻抗Z的值的上升率减缓的位置(参照图5A)。在判断为阻抗Z达到阈值Z1或者大于阈值Z1的情况下，从第1控制部102向高频能量输出部104传输信号。然后，使从高频能量输出部104向第1及第2保持构件52、54的高频电极92、94的输出停止(S151)。Preferably, the threshold value Z1 is greater than the initial value Z0, for example, and is located at a position where the rate of increase in the value of the impedance Z is slow (see FIG. 5A ). When it is determined that the impedance Z has reached the threshold Z1 or is greater than the threshold Z1, a signal is transmitted from the first control unit 102 to the high-frequency energy output unit 104 . Then, the output from the high-frequency energy output unit 104 to the high-frequency electrodes 92 and 94 of the first and second holding members 52 and 54 is stopped (S151).
另一方面，只要阻抗Z未达到阈值Z1，就继续输出能量。在判断为生物体组织L1、L2之间的阻抗Z小于阈值Z1的情况下，继续对保持在第1及第2保持构件52、54的高频电极92、94之间的生物体组织L1、L2施加用于进行处理的高频能量。然后，在生物体组织L1、L2之间的阻抗Z达到阈值Z1、或者开始从高频能量输出部104供给能量而经过了预定的时间t后，使来自高频能量输出部104的能量输出停止。此时，生物体组织LT在接合部C处相接合。On the other hand, energy output continues as long as the impedance Z does not reach the threshold Z1. When it is determined that the impedance Z between the living tissues L1, L2 is smaller than the threshold value Z1, the living tissues L1, L2 held between the high-frequency electrodes 92, 94 of the first and second holding members 52, 54 are continuously tested. L2 applies high frequency energy for treatment. Then, when the impedance Z between the living tissues L1 and L2 reaches the threshold value Z1, or after a predetermined time t has elapsed since the energy supply from the high-frequency energy output unit 104 has started, the energy output from the high-frequency energy output unit 104 is stopped. . At this time, the living tissueLT is joined at the joining portion C. As shown in FIG.
然后，持续按压脚踏开关16的踏板。另外，生物体组织LT也维持被保持构件52、54保持的状态。Then, keep pressing the pedal of the foot switch 16. In addition, the living tissueLT is also maintained in a state held by the holding members 52 and 54 .
在利用第1控制部102停止从高频能量输出部104向高频电极92、94的能量供给(S151)的同时，从第1控制部102向第2控制部132传输信号。第2控制部132使流量调整机构134工作，打开软管18a(S152)。因此，从流体存储部122通过软管18a向能量处理器具12供给粘接剂。即，利用软管18a从流体存储部122通过手柄22及柄线24的内部向第1及第2保持构件52、54的基部64、74的管路64a、74a及主体62、72的流路62b、72b供给粘接剂。因此，粘接剂从沿着主体62、72的流路62b、72b形成的高频电极92、94的开口92a、94a渗出。A signal is transmitted from the first control unit 102 to the second control unit 132 while the energy supply from the high-frequency energy output unit 104 to the high-frequency electrodes 92 and 94 is stopped by the first control unit 102 (S151). The second control unit 132 operates the flow rate adjustment mechanism 134 to open the hose 18a (S152). Therefore, the adhesive is supplied from the fluid storage unit 122 to the energy treatment tool 12 through the hose 18a. That is, the fluid storage part 122 passes through the inside of the handle 22 and the handle 24 to the tubes 64a, 74a of the bases 64, 74 of the first and second holding members 52, 54 and the flow paths of the main bodies 62, 72 using the hose 18a. 62b, 72b supply adhesive. Therefore, the adhesive seeps out from the openings 92a, 94a of the high-frequency electrodes 92, 94 formed along the flow paths 62b, 72b of the main bodies 62, 72 .
从高频电极92、94的开口92a、94a渗出的粘接剂以对所接合的生物体组织的外周面进行涂布的方式扩散涂布。即，在高频电极92、94与生物体组织相接触的整个面上涂布粘接剂。然后，粘接剂例如若接触空气则随着时间的推移而逐渐固化。优选的是此处的粘接剂具有速干性，在固化了时具有防水性。因此，因粘接剂固化而接合了的生物体组织LT的外表面Sc被涂敷。因此，能够防止液体从所接合的生物体组织LT的外表面Sc进入接合部C(接触面C1、C2之间)。The adhesive exuded from the openings 92a, 94a of the high-frequency electrodes 92, 94 is diffusely applied so as to coat the outer peripheral surface of the living tissue to be bonded. That is, an adhesive is applied to the entire surfaces of the high-frequency electrodes 92 and 94 in contact with living tissue. Then, the adhesive gradually solidifies with time, for example, when exposed to air. It is preferable that the adhesive here is quick-drying and waterproof when cured. Therefore, the outer surface Sc of the living tissueLT bonded by curing of the adhesive is coated. Therefore, it is possible to prevent liquid from entering the joint portion C (between the contact surfaces C1 and C2 ) from the outer surface Sc of the joined living tissueLT .
另外，粘接剂的性质当然因其种类而不同，但在该实施方式中，在接合生物体组织L1、L2之后涂布粘接剂是因为，生物体组织用的粘接剂是在生物体组织L1、L2尽可能干燥的状态下进行涂布的情况下发挥有效的粘接作用。即，若在未充分去除水分的状态下涂布粘接剂，则即使供给能量，水分也难以从生物体组织L1、L2中去除，但是通过在接合生物体组织L1、L2之后涂布粘接剂，能够防止这种状态。另外，若在未充分去除水分的状态下涂布粘接剂，则有时会在粘接剂中混合有水分，但是通过在接合生物体组织L1、L2之后涂布粘接剂，能够防止这种状态。In addition, although the properties of the adhesive differ depending on the type, of course, in this embodiment, the adhesive is applied after the living tissues L1 and L2 are joined because the adhesive for the living tissue is formed in the living body. When the tissues L1 and L2 are applied in a dry state as much as possible, an effective adhesive action is exhibited. That is, if the adhesive is applied in a state where moisture is not sufficiently removed, moisture is difficult to remove from the living tissues L1 and L2 even if energy is supplied, but by applying the adhesive after joining the living tissues L1 and L2 Agents can prevent this state. In addition, if the adhesive is applied in a state in which moisture is not sufficiently removed, moisture may be mixed in the adhesive, but this can be prevented by applying the adhesive after joining the living tissues L1 and L2. state.
在从流体存储部122经由软管18a通过了预定流量的粘接剂(S16)时、或者在打开软管18a预定时间之后，第2控制部132再次使流量调整机构134工作而关闭软管18a(S17)。When a predetermined flow rate of adhesive has passed through the hose 18a from the fluid storage unit 122 (S16), or after opening the hose 18a for a predetermined time, the second control unit 132 operates the flow rate adjustment mechanism 134 again to close the hose 18a. (S17).
在关闭软管18a后经过了预定的时间(例如数秒)之后，从扬声器110发出蜂鸣等声音来通知处理(生物体组织彼此的接合处理及防止水分进入已接合的接触面C1、C2的处理)已结束(S18)。然后，医生等在根据来自扬声器110的声音、显示部108的显示确认处理已结束之后，使脚离开脚踏开关16的踏板而解除对踏板的按压。After a predetermined time (for example, several seconds) has elapsed after closing the hose 18a, a sound such as a buzzer is emitted from the speaker 110 to notify the process (the process of joining living tissues and the process of preventing moisture from entering the joined contact surfaces C1, C2). ) has ended (S18). Then, the doctor or the like confirms the completion of the processing by the sound from the speaker 110 and the display on the display unit 108 , and releases the pedal from the pedal of the foot switch 16 by removing the foot from the pedal.
另外，处理是在按压脚踏开关16的踏板的状态下从图6所示的“开始”进行至“结束”，若在从“开始”到“结束”的期间解除踏板的按压，则第1控制部102在解除该踏板的按压的时刻强制停止处理。即，在中途停止供给高频能量、或中途停止供给粘接剂的情况下，在从扬声器110发出蜂鸣等声音之前使脚离开脚踏开关16的踏板，解除对踏板的按压。若解除踏板的按压，则第1控制部102使在从高频能量输出部104输出能量时从高频能量输出部104向电极92、94的输出停止。另外，第2控制部132在软管18a处于打开状态时使流量调整机构134工作而关闭软管18a，从而停止供给流体。In addition, the process proceeds from "start" to "end" shown in FIG. The control unit 102 forcibly stops the processing when the pedal is released from depression. That is, when the supply of high-frequency energy or the supply of adhesive is stopped midway, the foot is released from the pedal of the foot switch 16 before the speaker 110 emits a sound such as a buzzer, and the pedal is released from pressing. When the pressing of the pedal is released, the first control unit 102 stops the output from the high-frequency energy output unit 104 to the electrodes 92 and 94 when outputting energy from the high-frequency energy output unit 104 . In addition, the second control unit 132 operates the flow rate adjustment mechanism 134 to close the hose 18a when the hose 18a is in the open state, thereby stopping the supply of fluid.
医生在确认了来自扬声器110的蜂鸣音之后操作处理部开闭把手32，松开生物体组织LT。此时，如图5B所示，生物体组织彼此的接触面C1、C2相接合而形成接合部C。另外，在生物体组织LT上，具有生物体吸收性的粘接剂一边从生物体组织LT的外表面Sc朝向接合部C渗入一边固化，因此生物体组织LT成为被粘接剂涂敷了的状态。另外，由于粘接剂具有生物体吸收性，因此有时从开口92a、94a渗出的粘接剂也会涂布于图5B所示的生物体组织L1、L2的侧面。After confirming the buzzer sound from the speaker 110, the doctor operates the opening and closing handle 32 of the treatment part to loosen the living tissueLT . At this time, as shown in FIG. 5B , the contact surfaces C1 and C2 of the living tissues are joined to form a joined portion C. As shown in FIG. In addition, since the bioabsorbable adhesive hardens on the living tissueLT while penetrating from the outer surface Sc of the living tissueLT toward the junction C, the living tissueLT becomes coated with the adhesive. The state of applying. In addition, since the adhesive has bioabsorbability, the adhesive leaking from the openings 92a and 94a may be applied to the side surfaces of the living tissues L1 and L2 shown in FIG. 5B.
如上所述，根据该实施方式，能够获得以下效果。As described above, according to this embodiment, the following effects can be obtained.
通过一边测量生物体组织L1、L2的阻抗Z一边进行生物体组织L1、L2的接合处理，能够更可靠地进行生物体组织L1、L2彼此的接触面C1、C2的紧密接触。另外，在进行了生物体组织L1、L2彼此的接合处理之后，通过利用粘接剂等对已进行接合处理的生物体组织LT的外周进行涂敷，能够防止水分进入已进行接合处理的生物体组织LT的接合部C。因此，能够长时间维持生物体组织L1、L2的接触面C1、C2紧密接触的状态(生物体组织LT接合的状态)。By performing the joining process of the living tissues L1 and L2 while measuring the impedance Z of the living tissues L1 and L2 , it is possible to more reliably bring the contact surfaces C1 and C2 of the living tissues L1 and L2 into close contact. In addition, after the bonding treatment of the living tissues L1 and L2 is performed, by applying an adhesive or the like to the outer periphery of the living tissue LT which has undergone the bonding treatment, it is possible to prevent moisture from entering the living tissue L T which has undergone the bonding treatment. Junction C of body tissueLT . Therefore, the state in which the contact surfaces C1 and C2 of the living tissues L1 and L2 are in close contact (the state in which the living tissues LT are joined) can be maintained for a long period of time.
另外，在生物体组织L1、L2彼此接合之后，在使用两液体混合型的粘接剂作为对已接合的生物体组织LT的外周进行涂敷的流体物质的情况下，只要在流体源18中排列设置两种液体即可。在该情况下，两个软管18a以排列设置的状态从流体源18向能量处理器具12延伸，液体通过手柄22及柄线24分别独立地供给至处理部26的第1及第2保持构件52、54的主体62、72的流路62b、72b。而且，只要设为两种液体在从高频电极92、94的开口92a、94a渗出时进行混合即可。这样，能够防止粘接剂在软管18a的内部、第1及第2保持构件52、54的内部固化。另外，在使用两液体混合型的粘接剂的情况下，也优选的是在一个软管18a上形成有两条流路(未图示)。In addition, after the living tissues L1 and L2 are bonded to each other, in the case of using a two-liquid mixing type adhesive as the fluid substance to coat the outer periphery of the bonded living tissue LT , only the fluid source 18 Arrange the two liquids in the middle. In this case, the two hoses 18a extend from the fluid source 18 to the energy treatment tool 12 in a state of being arranged side by side, and the liquid is independently supplied to the first and second holding members of the treatment part 26 through the handle 22 and the handle wire 24. The flow paths 62b, 72b of the main bodies 62, 72 of 52, 54. Moreover, what is necessary is just to mix when two types of liquids seep out from the opening 92a, 94a of the high-frequency electrode 92,94. In this way, it is possible to prevent the adhesive from curing inside the hose 18a and inside the first and second holding members 52, 54. Also, when using a two-liquid mixing type adhesive, it is preferable to form two flow paths (not shown) in one hose 18a.
在上述实施方式中，说明了使用利用检测部106检测出的阻抗Z(参照图5A)作为生物体信息的例子，但是也优选的是使用相位的变化量(相位差Δθ)(参照图7)作为生物体信息。在使用相位差Δθ的情况下，如图8所示，检测部106具有电压检测部142、电流检测部144及相位检测部146。相位检测部146与第1控制部102相连接，电压检测部142及电流检测部144连接于能量处理器具12(高频电极92、94)，并且连接于相位检测部146。关于这一点，并不限于第1实施方式，后述的实施方式也是相同的。In the above-mentioned embodiment, an example of using the impedance Z (see FIG. 5A ) detected by the detection unit 106 as biological information is described, but it is also preferable to use the amount of change in phase (phase difference Δθ) (see FIG. 7 ). as biological information. When using the phase difference Δθ, the detection unit 106 includes a voltage detection unit 142 , a current detection unit 144 , and a phase detection unit 146 as shown in FIG. 8 . The phase detection unit 146 is connected to the first control unit 102 , and the voltage detection unit 142 and the current detection unit 144 are connected to the energy processing device 12 (high-frequency electrodes 92 and 94 ) and also connected to the phase detection unit 146 . This point is not limited to the first embodiment, and the same applies to embodiments described later.
在使高频能量输出部104产生高频电压的情况下，基于高频能量输出部104的高频电压的、具有预定的频率及峰值的高频电流借助电流检测部144输出到外科用处理器具12。电压检测部142检测出通过了高频能量输出部104的高频电压的峰值，将检测出的峰值作为输出电压值信息对相位检测部146进行输出。电流检测部144检测出根据通过了高频能量输出部104的高频电压而产生的高频电流的峰值，将检测出的峰值作为输出电流值信息对相位检测部146进行输出。When the high-frequency energy output unit 104 is made to generate a high-frequency voltage, a high-frequency current having a predetermined frequency and a peak value based on the high-frequency voltage of the high-frequency energy output unit 104 is output to the surgical treatment instrument via the current detection unit 144. 12. The voltage detection unit 142 detects the peak value of the high-frequency voltage passed through the high-frequency energy output unit 104 , and outputs the detected peak value to the phase detection unit 146 as output voltage value information. The current detection unit 144 detects the peak value of the high-frequency current generated by the high-frequency voltage passing through the high-frequency energy output unit 104 , and outputs the detected peak value to the phase detection unit 146 as output current value information.
相位检测部146根据从电压检测部142输出的输出电压值信息检测出通过高频能量输出部104输出的高频电压的相位，之后，将检测出的相位作为输出电压相位信息而与输出电压值信息一起输出到第1控制部102。另外，相位检测部146在根据从电流检测部144输出的输出电流值信息检测出通过了高频能量输出部104的高频电流的相位之后，将检测出的相位作为输出电流相位信息而与输出电流值信息一起输出到第1控制部102。The phase detection unit 146 detects the phase of the high-frequency voltage output by the high-frequency energy output unit 104 based on the output voltage value information output from the voltage detection unit 142, and then compares the detected phase with the output voltage value as output voltage phase information. The information is output to the first control unit 102 together. In addition, after the phase detecting unit 146 detects the phase of the high-frequency current passing through the high-frequency energy output unit 104 based on the output current value information output from the current detecting unit 144, the detected phase is compared with the output current phase information as the output current phase information. The current value information is output to the first control unit 102 together.
第1控制部102根据从相位检测部146输出的输出电压值信息、输出电压相位信息、输出电流值信息及输出电流相位信息计算出通过高频能量输出部104输出的高频电压及高频电流的相位差Δθ。The first control unit 102 calculates the high-frequency voltage and high-frequency current output by the high-frequency energy output unit 104 based on the output voltage value information, output voltage phase information, output current value information, and output current phase information output from the phase detection unit 146. The phase difference Δθ.
第1控制部102根据对应于脚踏开关16的踏板的操作而输出的指示信号和计算出的相位差Δθ，对高频能量输出部104进行将高频电流及高频电压的输出状态改变为ON状态或OFF状态的控制。The first control unit 102 changes the output state of the high-frequency current and the high-frequency voltage to the high-frequency energy output unit 104 according to the instruction signal output corresponding to the operation of the pedal of the foot switch 16 and the calculated phase difference Δθ. ON state or OFF state control.
如图7所示，通过高频能量输出部104输出的高频电流及高频电压的相位差Δθ在对生物体组织LT进行处理的初始阶段为0°或大致0°。另外，在显示部108中预先将相位差Δθ的值设定为90°或接近90°的值。As shown in FIG. 7 , the phase difference Δθ between the high-frequency current and the high-frequency voltage output by the high-frequency energy output unit 104 is 0° or approximately 0° at the initial stage of processing the living tissueLT . In addition, the value of the phase difference Δθ is set in advance in the display unit 108 to be 90° or a value close to 90°.
继续按压脚踏开关16的踏板，随着保持在第1及第2保持构件52、54的高频电极92、94之间的生物体组织L1、L2的处理的进行，生物体组织L1、L2脱水，生物体组织L1、L2被烧灼、凝固。随着如此进行处理，通过高频能量输出部104输出的高频电压及高频电流的相位差Δθ例如以适当的时间t1为界从0°或大致0°的状态进行增加。Continue to press the pedal of the foot switch 16, along with the progress of the treatment of the living tissue L1, L2 held between the high-frequency electrodes 92, 94 of the first and second holding members 52, 54, the living tissue L1, L2 Dehydration, biological tissues L1 and L2 are burned and coagulated. With such processing, the phase difference Δθ of the high-frequency voltage and high-frequency current output by the high-frequency energy output unit 104 increases from a state of 0° or approximately 0°, for example, with an appropriate time t1 as a boundary.
之后，若通过进一步继续按压脚踏开关16的踏板，进行期望部位的处理，则例如在时间t1以后，由第1控制部102计算出的相位差Δθ的值成为图7所示的90°附近的恒定值。Afterwards, if the pedal of the foot switch 16 is further pressed to perform processing on a desired part, for example, after time t1, the value of the phase difference Δθ calculated by the first control unit 102 becomes approximately 90° as shown in FIG. 7 . constant value.
另外，在该变形例中，第1控制部102并不限于在检测出相位差Δθ成为90°附近的恒定值时进行上述控制，例如也可以在检测出相位差Δθ以大于45°并且为90°以下的预定的值成为恒定时进行上述控制。In addition, in this modified example, the first control unit 102 is not limited to performing the above-mentioned control when the phase difference Δθ is detected to be a constant value near 90°. The above control is performed when the predetermined value below ° is constant.
另外，也可以组合阻抗Z的变化与相位θ的变化这两者来对向生物体组织L1、L2投入的能量进行切换。即，也优选的是，在显示部108中适宜地设定、使用阻抗Z的变化与相位θ的变化中的、达到阈值较早的一者或较晚的一者等。In addition, the energy injected into the living tissues L1 and L2 may be switched by combining both the change of the impedance Z and the change of the phase θ. That is, it is also preferable to appropriately set and use in the display unit 108 , which one of the change in the impedance Z and the change in the phase θ reaches the threshold earlier or later.
另外，在后述的第7实施方式(参照图26A及图26B)中说明，也能够利用取代高频电极92、94而使用了加热器222、223的热能进行处理。在该情况下，可以一边测量与加热器222、232相接触的生物体组织的温度一边进行处理。In addition, as described in the seventh embodiment (see FIG. 26A and FIG. 26B ) described later, it is also possible to perform treatment using heat energy using heaters 222 and 223 instead of high-frequency electrodes 92 and 94 . In this case, the treatment may be performed while measuring the temperature of the living tissue in contact with the heaters 222 and 232 .
另外，在该实施方式中，说明了使用双极型的能量处理器具12的情况，但是也可以使用单极型的处理器具(参照图9)。In addition, in this embodiment, the case of using the bipolar energy treatment instrument 12 was described, but a monopolar energy treatment instrument may also be used (see FIG. 9 ).
在该情况下，如图9所示，在被处理的患者P上安装极板150。该极板150借助通电线150a与能量源14相连接。而且，配设在第1保持构件52上的高频电极92与配设在第2保持构件54上的高频电极94处于利用通电线28a、28b进行电连接的同电位的状态。在该情况下，由于与高频电极92、94相接触的生物体组织L1、L2的面积分别充分地小于极板150与生物体相接触的面积，因此电流密度增高，但极板150中的电流密度降低。因此，被第1及第2保持构件52、54保持的生物体组织L1、L2在焦耳热的作用下被加热，相反，与极板150相接触的生物体组织的加热小到可以忽略的程度。因而，只有由第1及第2保持构件52、54把持的部分中的、与同电位的高频电极92、94相接触的生物体组织L1、L2被加热而改性。In this case, as shown in FIG. 9 , the pad 150 is attached to the patient P to be treated. The pole plate 150 is connected to the energy source 14 by means of a power supply line 150a. Further, the high-frequency electrode 92 arranged on the first holding member 52 and the high-frequency electrode 94 arranged on the second holding member 54 are in a state of being electrically connected by the electric wires 28 a and 28 b at the same potential. In this case, since the areas of the biological tissues L1 and L2 in contact with the high-frequency electrodes 92 and 94 are sufficiently smaller than the area of the living body in contact with the electrode plate 150, the current density increases, but the area of the electrode plate 150 The current density is reduced. Therefore, the living tissues L1 and L2 held by the first and second holding members 52 and 54 are heated under the action of Joule heat, while the heating of the living tissues in contact with the electrode plate 150 is negligibly small. . Therefore, only the living tissues L1 , L2 in the portions gripped by the first and second holding members 52 , 54 that are in contact with the high-frequency electrodes 92 , 94 at the same potential are heated and modified.
另外，在该实施方式中，说明了使用高频能量对生物体组织L1、L2进行处理的情况，但是例如也可以使用微波等能量。在该情况下，能够将高频电极92、94用作微波电极。In addition, in this embodiment, the case where the living tissues L1 and L2 are treated using high-frequency energy has been described, but energy such as microwaves may also be used, for example. In this case, the high-frequency electrodes 92 and 94 can be used as microwave electrodes.
另外，在该实施方式中，以用于穿过腹壁对腹腔内(体内)的生物体组织L1、L2进行处理的线型的能量处理器具12(参照图1)为例进行了说明，但是例如如图10所示，也能够使用穿过腹壁向体外取出处理对象组织来进行处理的打开用的线型的能量处理器具(治疗用处理器具)12a。In addition, in this embodiment, the linear energy treatment instrument 12 (see FIG. 1 ) for treating the living tissues L1 and L2 in the abdominal cavity (in vivo) through the abdominal wall has been described as an example. However, for example As shown in FIG. 10 , it is also possible to use an opening linear energy treatment instrument (treatment treatment instrument) 12a that passes through the abdominal wall to take out the tissue to be treated and treats it outside the body.
该能量处理器具12a具有手柄22和处理部(保持部)26。即，与用于穿过腹壁进行处理的能量处理器具12(参照图1)不同，去除了柄线24。另一方面，在手柄22内配设有具有与柄线24相同的作用的构件。因此，能够与上述图1所示的能量处理器具12相同地使用图10所示的能量处理器具12a。This energy treatment instrument 12 a has a handle 22 and a treatment part (holding part) 26 . That is, unlike the energy treatment appliance 12 (see FIG. 1 ) for treatment through the abdominal wall, the handle wire 24 is eliminated. On the other hand, a member having the same function as the handle 24 is arranged inside the handle 22 . Therefore, the energy treatment tool 12a shown in FIG. 10 can be used similarly to the energy treatment tool 12 shown in FIG. 1 mentioned above.
另外，也可以不使用流体存储部122而直接利用像注射器那样的注入器向生物体组织供给粘接剂。另外，作为粘接剂的供给方法，流体调整部124也可以使用旋转泵等控制向生物体组织供给的粘接剂的流量。虽未特别说明，但是在以下说明的实施方式中，也允许直接利用像注射器那样的注入器向生物体组织供给粘接剂等。In addition, the adhesive may be directly supplied to the living tissue using an injector such as a syringe without using the fluid storage unit 122 . In addition, as a supply method of the adhesive, the fluid adjustment unit 124 may use a rotary pump or the like to control the flow rate of the adhesive to be supplied to the living tissue. Although not particularly described, in the embodiments described below, it is also possible to directly supply an adhesive or the like to living tissue using an injector such as a syringe.
(第2实施方式)(second embodiment)
接着，使用图11A～图11C说明第2实施方式。该实施方式是第1实施方式的变形例，对与在第1实施方式中使用的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略该构件的说明。Next, a second embodiment will be described using FIGS. 11A to 11C . This embodiment is a modified example of the first embodiment, and the same members as those used in the first embodiment or members having the same functions are given the same reference numerals, and descriptions of these members are omitted.
在图11A～图11C所示的第1保持构件52的主体62中，取代流路(凹部)62b(参照图4A～图4C)而配设有具有绝缘性的流体导管162。去除了第1实施方式中所说明的高频电极92、94的开口92a、94a。In the main body 62 of the first holding member 52 shown in FIGS. 11A to 11C , an insulating fluid conduit 162 is disposed instead of the flow path (recess) 62b (see FIGS. 4A to 4C ). The openings 92a, 94a of the high-frequency electrodes 92, 94 described in the first embodiment are removed.
流体导管162沿着主体62的外周的边缘部以环状配设在靠近高频电极92表面的位置。如图11C所示，流体导管162的横截面例如形成为大致圆形、矩形等。优选的是，流体导管162具有适度的弹性力，以在利用第1及第2保持构件52、54保持生物体组织L1、L2时与生物体组织L1的外表面紧密接触。流体导管162与第1保持构件52的基部64的管路64a相连接。另外，在流体导管162的内侧配设有高频电极92。The fluid conduit 162 is disposed in a ring shape along the outer peripheral edge of the main body 62 at a position close to the surface of the high-frequency electrode 92 . As shown in FIG. 11C , the cross section of the fluid conduit 162 is formed in, for example, a substantially circular shape, a rectangular shape, or the like. Preferably, the fluid conduit 162 has an appropriate elastic force so as to be in close contact with the outer surface of the living tissue L1 when the living tissues L1 and L2 are held by the first and second holding members 52 and 54 . The fluid conduit 162 is connected to the conduit 64 a of the base 64 of the first holding member 52 . In addition, a high-frequency electrode 92 is disposed inside the fluid conduit 162 .
在流体导管162上隔开适当的间隔形成有多个开口(接合维持辅助部)162a。如图11B及图11C所示，这些开口162a朝向高频电极92的表面，并且朝向高频电极92的中心轴线。因此，能够使从流体导管162的开口162a排出的流体沿着高频电极92的表面朝向高频电极92的中心轴线流动。A plurality of openings (joint maintenance auxiliary parts) 162 a are formed at appropriate intervals in the fluid conduit 162 . As shown in FIGS. 11B and 11C , these openings 162 a face the surface of the high-frequency electrode 92 and face the central axis of the high-frequency electrode 92 . Therefore, the fluid discharged from the opening 162 a of the fluid conduit 162 can be caused to flow toward the central axis of the high-frequency electrode 92 along the surface of the high-frequency electrode 92 .
另外，如图11A所示，由于流体导管162的开口162a位于靠近高频电极92表面的位置，因此流体导管162的一部分从高频电极92的表面突出。因此，流体导管162在使用高频电极92处理了生物体组织L1、L2时起到防止从生物体组织L1、L2产生的蒸气等流体向外部漏出的势垒部的作用。In addition, as shown in FIG. 11A , since the opening 162 a of the fluid conduit 162 is located close to the surface of the high-frequency electrode 92 , a part of the fluid conduit 162 protrudes from the surface of the high-frequency electrode 92 . Therefore, the fluid conduit 162 functions as a barrier preventing fluid such as vapor generated from the living tissues L1 and L2 from leaking outside when the living tissues L1 and L2 are treated using the high-frequency electrode 92 .
另外，虽未图示，但是在第2保持构件54的主体72的边缘部上也配设有与第1保持构件52对称且具有开口(接合维持辅助部)164a的流体导管164。因此，流体导管164在使用高频电极94处理了生物体组织L1、L2时起到防止从生物体组织L1、L2产生的蒸气等流体向外部漏出的势垒部的作用。另外，流体导管164与第2保持构件54的基部74的管路74a相连接。In addition, although not shown, a fluid conduit 164 symmetrical to the first holding member 52 and having an opening (joint maintenance auxiliary portion) 164a is also arranged on the edge portion of the main body 72 of the second holding member 54 . Therefore, the fluid conduit 164 functions as a barrier preventing fluid such as vapor generated from the living tissues L1 and L2 from leaking outside when the living tissues L1 and L2 are treated using the high-frequency electrode 94 . In addition, the fluid conduit 164 is connected to the pipe line 74 a of the base portion 74 of the second holding member 54 .
另外，虽未图示，但是优选的是，流体导管162形成为双腔管，一个(内侧)是具有开口162a的管路，另一个(外侧)成为供作为制冷剂的气体、液体通过的管路。在该情况下，通过使制冷剂在另一个管路(外侧的管路)中循环，能够对与流体导管162相接触的部分的生物体组织L1、L2进行冷却。因此，能够防止热量通过生物体组织L1、L2向第1及第2保持构件52、54的保持面62a、72a的外侧导热，从而能够更可靠地防止对处理对象的生物体组织L1、L2的外侧的生物体组织L1、L2带来热量的影响。In addition, although not shown in the figure, it is preferable that the fluid conduit 162 is formed as a double-lumen tube, one (inner side) is a tube having an opening 162a, and the other (outer side) is a tube through which gas or liquid as a refrigerant passes. road. In this case, by circulating the refrigerant through the other pipe (the outer pipe), it is possible to cool the living tissues L1 and L2 in the parts that are in contact with the fluid conduit 162 . Therefore, heat can be prevented from being conducted to the outside of the holding surfaces 62a, 72a of the first and second holding members 52, 54 through the living tissues L1, L2, thereby more reliably preventing damage to the living tissues L1, L2 to be treated. The outer living tissues L1 and L2 are affected by heat.
治疗用处理系统10的其他构造、作用与第1实施方式中所说明的情况相同，因此省略说明。The other structures and functions of the treatment system 10 for treatment are the same as those described in the first embodiment, and thus description thereof will be omitted.
(第3实施方式)(third embodiment)
接着，使用图12～图16说明第3实施方式。该实施方式是第1及第2实施方式的变形例，对与在第1及第2实施方式中使用的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略该构件的说明。Next, a third embodiment will be described using FIGS. 12 to 16 . This embodiment is a modified example of the first and second embodiments, and the same members as those used in the first and second embodiments or members having the same functions are given the same reference numerals, and the descriptions of the members are omitted. illustrate.
如图12所示，能量处理器具12b的手柄22以与处理部开闭把手32排列设置的状态具有用于使后述的刀具(处理用辅助器具)180移动的刀具驱动把手34。As shown in FIG. 12 , the handle 22 of the energy treatment tool 12 b has a knife driving handle 34 for moving a knife (treatment auxiliary tool) 180 described later in a state aligned with a treatment part opening and closing handle 32 .
如图13所示，在能量源14上，除了第1实施方式中所说明的检测部(在此称为第1检测部)106以外，在第1控制部102上连接有第2检测部107。第2检测部107与配设在刀具180的后述的长槽184的卡定部184a、184b、184c上的传感器185相连接。As shown in FIG. 13, on the energy source 14, in addition to the detection unit (herein referred to as the first detection unit) 106 described in the first embodiment, a second detection unit 107 is connected to the first control unit 102. . The second detection unit 107 is connected to a sensor 185 disposed on locking portions 184 a , 184 b , and 184 c of a long groove 184 of the cutter 180 , which will be described later.
第1及第2保持构件52、54的主体62、72及基部64、74的外形除了形成有后述的刀具引导槽172、174以外，形成为与第2实施方式的第1及第2保持构件52、54相同。The outer shapes of the main bodies 62, 72 and the bases 64, 74 of the first and second holding members 52, 54 are similar to those of the first and second holding members of the second embodiment, except that tool guide grooves 172, 174 described later are formed. Members 52, 54 are identical.
如图14A～图15B所示，在第1保持构件52的主体62及基部64中的、靠近第2保持构件54的一侧形成有笔直的刀具引导槽172。同样，在第2保持构件54的主体72及基部74中的、靠近第1保持构件52的一侧形成有笔直的刀具引导槽174。在这些刀具引导槽172、174内以能够进出的方式配设有后述的一个刀具180。As shown in FIGS. 14A to 15B , a straight cutter guide groove 172 is formed on the side closer to the second holding member 54 in the main body 62 and the base 64 of the first holding member 52 . Similarly, a straight cutter guide groove 174 is formed on the side closer to the first holding member 52 of the main body 72 and the base portion 74 of the second holding member 54 . One cutter 180 , which will be described later, is disposed in these cutter guide grooves 172 , 174 so as to be able to move in and out.
如图14A所示，配设在第1及第2保持构件52、54的主体62、72上的高频电极92、94例如形成为大致U字状，在第1及第2保持构件52、54的主体62、72的基端部具有两个端部。即，各个高频电极92、94连续地形成。而且，在高频电极92、94上，形成有与第1及第2保持构件52、54一起引导刀具180的刀具引导槽(为方便起见，标注附图标记172、174)。As shown in FIG. 14A, the high-frequency electrodes 92, 94 arranged on the main bodies 62, 72 of the first and second holding members 52, 54 are formed in, for example, substantially U-shaped, and the first and second holding members 52, 54 The base end portion of the main body 62, 72 of 54 has two ends. That is, the respective high-frequency electrodes 92 and 94 are formed continuously. Further, the high frequency electrodes 92 , 94 are formed with cutter guide grooves (reference numerals 172 , 174 for convenience) that guide the cutter 180 together with the first and second holding members 52 , 54 .
另外，第1及第2保持构件52、54的刀具引导槽172、174形成为相互相对的状态，并沿着柄线24的轴向而形成。而且，利用与第1及第2保持构件52、54相互作用的两个刀具引导槽172、174能够引导一个刀具180。In addition, the cutter guide grooves 172 , 174 of the first and second holding members 52 , 54 are formed so as to face each other, and are formed along the axial direction of the shank 24 . Furthermore, one cutter 180 can be guided by the two cutter guide grooves 172 , 174 interacting with the first and second holding members 52 , 54 .
第1保持构件52的刀具引导槽172形成在第1保持构件52的主体62及基部64的中心轴线上，第2保持构件54的刀具引导槽174形成在第2保持构件54的主体72及基部74的中心轴线上。The tool guide groove 172 of the first holding member 52 is formed on the central axis of the main body 62 and the base portion 64 of the first holding member 52 , and the tool guide groove 174 of the second holding member 54 is formed on the main body 72 and the base portion of the second holding member 54 . 74 on the central axis.
在柄线24的筒体42的内部，以沿着其轴向能够移动的方式配设有驱动杆182。在驱动杆182的基端配设有刀具驱动把手34。在驱动杆182的顶端配设有薄板状的刀具(处理用辅助器具)180。因此，若操作刀具驱动把手34，则刀具180借助驱动杆182而沿柄线24的轴向移动。Inside the cylindrical body 42 of the handle 24, a drive rod 182 is disposed so as to be movable in the axial direction thereof. A knife driving handle 34 is disposed at the base end of the driving rod 182 . A thin plate-shaped cutter (processing auxiliary tool) 180 is arranged at the tip of the drive rod 182 . Therefore, when the knife drive handle 34 is operated, the knife 180 moves in the axial direction of the handle line 24 via the drive rod 182 .
刀具180在其顶端形成有刃180a，在基端固定有驱动杆182的顶端。在该刀具180的顶端与基端之间形成有长槽184。在该长槽184上，在柄线24的筒体42上固定有沿与柄线24的轴向正交的方向延伸的移动限制销42a。因此，刀具180的长槽184沿着移动限制销42a移动。这样，刀具180笔直地移动。此时，刀具180配设在第1及第2保持构件52、54的刀具引导槽(流路、流体放出槽)172、174内。The cutter 180 has a blade 180a formed at its tip, and a tip of a drive rod 182 is fixed at its base. A long groove 184 is formed between the tip end and the base end of the cutter 180 . In this long groove 184 , a movement restricting pin 42 a extending in a direction perpendicular to the axial direction of the handle 24 is fixed to the cylindrical body 42 of the handle 24 . Therefore, the long slot 184 of the cutter 180 moves along the movement restricting pin 42a. In this way, the cutter 180 moves straight. At this time, the cutter 180 is disposed in the cutter guide grooves (flow paths, fluid discharge grooves) 172 , 174 of the first and second holding members 52 , 54 .
另外，在刀具180的长槽184的一端、另一端、以及一端与另一端之间的例如3个位置形成有用于卡定移动限制销42a、并控制刀具180的移动的卡定部184a、184b、184c。在刀具180的长槽184内配设有传感器185，该传感器185能够识别移动限制销42a的位置，并且能够识别移动限制销42a的移动方向。传感器185采用使用了光的传感器、接触型传感器等各种传感器。因此，当移动限制销42a位于长槽184的一端(顶端)的卡定部184a时，能够识别刀具180的刃180a容纳于柄线24的内部，当移动限制销42a位于另一端(后端)184b时，能够识别刀具180的刃180a穿过柄线24的顶端配设于刀具引导槽172、174的情况。因而，第2检测部107利用传感器185能够识别刀具180的刃180a相对于柄线24及处理部26的位置，从而能够容易地判断是否位于利用刀具180的刃180a切割生物体组织的位置。In addition, locking portions 184a, 184b for locking the movement limiting pin 42a and controlling the movement of the knife 180 are formed at one end, the other end, and at three positions between the one end and the other end of the long groove 184 of the knife 180. , 184c. A sensor 185 capable of recognizing the position of the movement limiting pin 42 a and the moving direction of the movement regulating pin 42 a is arranged in the long groove 184 of the cutter 180 . As the sensor 185, various sensors such as a sensor using light and a contact sensor are used. Therefore, when the movement limiting pin 42a is located at the locking portion 184a at one end (top end) of the long groove 184, it can be recognized that the blade 180a of the knife 180 is accommodated inside the handle line 24, and when the movement limiting pin 42a is located at the other end (rear end). 184b, it can be recognized that the edge 180a of the knife 180 passes through the tip of the handle 24 and is arranged in the knife guide grooves 172, 174. Therefore, the second detection unit 107 can recognize the position of the blade 180a of the knife 180 relative to the shank 24 and the treatment portion 26 using the sensor 185, and can easily determine whether it is at a position where the blade 180a of the knife 180 cuts the living tissue.
在图15A及图15B所示的能量处理器具12的柄线24的筒体42及护套44上，分别形成有供后述的蒸气(气体)、液体(组织液)等流体放出的流体放出口186、188。这些流体放出口186、188形成在柄线24的基端侧。On the barrel 42 and the sheath 44 of the handle 24 of the energy treatment device 12 shown in FIGS. 15A and 15B , there are respectively formed fluid outlets for releasing fluids such as steam (gas) and liquid (interstitial fluid) described later. 186, 188. These fluid discharge ports 186 , 188 are formed on the base end side of the handle wire 24 .
在此，虽未图示，但是也优选的是，在护套44的流体放出口188的外周面上设有连接管头。此时，后述的流体通过刀具引导槽172、174、柄线24的筒体42的流体放出口186、柄线24的护套44的流体放出口188、以及连接管头而排出。在该情况下，通过对连接管头内进行抽吸，能够从流体放出口186、188容易地排出从生物体组织L1、L2放出的蒸气、液体等流体。Here, although not shown, it is also preferable to provide a connection nipple on the outer peripheral surface of the fluid discharge port 188 of the sheath 44 . At this time, the fluid described later is discharged through the cutter guide grooves 172, 174, the fluid discharge port 186 of the cylinder body 42 of the handle 24, the fluid discharge port 188 of the sheath 44 of the handle 24, and the connecting pipe head. In this case, fluids such as vapor and liquid released from the living tissues L1 and L2 can be easily discharged from the fluid discharge ports 186 and 188 by suctioning the inside of the connecting tube.
另外，优选的是，流体放出口186、188设置在柄线24上，但也优选的是流体放出口186、188设置在手柄22上。In addition, it is preferred that the fluid discharge ports 186 , 188 are provided on the handle 24 , but it is also preferred that the fluid discharge ports 186 , 188 are provided on the handle 22 .
如图14A～图14C所示，在第1及第2保持构件52、54的主体62、72上配设有第1流体导管162、164(在第2实施方式中，简述为流体导管162、164)，但这已在第2实施方式中进行了说明，因此省略此处的说明。As shown in FIGS. 14A to 14C , first fluid conduits 162 , 164 (in the second embodiment, simply referred to as fluid conduits 162 ) are arranged on the main bodies 62 , 72 of the first and second holding members 52 , 54 . , 164), but this has already been described in the second embodiment, so the description here is omitted.
如图14B所示，在刀具引导槽172、174的边缘部配设有具有绝缘性的第2流体导管192、194。该第2流体导管192例如与第1保持构件52的基部64的管路64a相连接。同样，另一个第2流体导管194例如与第2保持构件54的基部74的管路74a相连接。As shown in FIG. 14B , insulating second fluid conduits 192 , 194 are disposed at edge portions of the cutter guide grooves 172 , 174 . The second fluid conduit 192 is connected to, for example, the pipe line 64 a of the base portion 64 of the first holding member 52 . Likewise, another second fluid conduit 194 is connected to, for example, the pipe line 74 a of the base 74 of the second holding member 54 .
在第2流体导管192、194上分别隔开适当的间隔形成有多个开口(接合维持辅助部)192a、194a。流体导管192、194的开口192a、194a的方向朝向隔着刀具180相对的相同的第2流体导管192、194。In the second fluid conduits 192 and 194, a plurality of openings (joint maintenance auxiliary parts) 192a and 194a are formed at appropriate intervals, respectively. The openings 192 a , 194 a of the fluid conduits 192 , 194 are directed toward the same second fluid conduits 192 , 194 facing each other across the cutter 180 .
另外，第2流体导管192、194既可以各为一对，也可以是各一个流体导管192、194弯曲为大致U字状。In addition, each of the second fluid conduits 192 and 194 may be a pair, or each of the fluid conduits 192 and 194 may be bent in a substantially U-shape.
接着，使用图16说明该实施方式的治疗用处理系统10的作用。Next, the operation of the therapeutic treatment system 10 of this embodiment will be described using FIG. 16 .
如第1实施方式所说明那样，向流体源18的流体存储部122内放入在接合了生物体组织L1、L2之后用于对该接合了的生物体组织LT进行涂敷的流体(接合辅助剂)。与流体存储部122相连接的软管18a在流量调整机构134的作用下关闭，粘接剂不会朝向能量处理器具12流动。As described in the first embodiment, the fluid for coating the joined living tissues LT after joining the living tissues L1 and L2 is put into the fluid storage part 122 of the fluid source 18 (joint). adjuvant). The hose 18 a connected to the fluid storage part 122 is closed under the action of the flow adjustment mechanism 134 , and the adhesive will not flow toward the energy treatment device 12 .
手术者预先操作能量源14的显示部108，设定治疗用处理系统10的输出条件(S31)。利用显示部108确认来自高频能量输出部104的输出(设定电力Pset[W])、由检测部106检测出的阻抗Z的阈值Z1[Ω]、能量供给时间t1[sec]等。在将来自高频能量输出部104的输出、由检测部106检测出的阻抗Z的阈值Z1设定为不同值的情况下如此进行设定，利用显示部108进行确认。另外，设定从流体存储部122通过软管18a流到能量处理器具12的流量V1。The operator operates the display unit 108 of the energy source 14 in advance to set the output conditions of the therapeutic treatment system 10 (S31). The output from the high-frequency energy output unit 104 (set power Pset [W]), the threshold value Z1 [Ω] of the impedance Z detected by the detection unit 106 , the energy supply time t1 [sec], etc. are confirmed on the display unit 108 . When the output from the high-frequency energy output unit 104 and the threshold value Z1 of the impedance Z detected by the detection unit 106 are set to different values, it is set in this way and confirmed by the display unit 108 . In addition, the flow rate V1 flowing from the fluid storage part 122 to the energy treatment device 12 through the hose 18a is set.
如图15A所示，在相对于第1保持构件52闭合了第2保持构件54的状态下，例如穿过腹壁向腹腔内插入外科用处理器具12的处理部26及柄线24。为了利用第1及第2保持构件52、54保持处理对象的生物体组织L1、L2，操作手柄22的处理部开闭把手32，将接合对象的生物体组织L1、L2保持在第1及第2保持构件52、54之间。As shown in FIG. 15A , with the second holding member 54 closed relative to the first holding member 52 , the treatment portion 26 and the handle 24 of the surgical treatment instrument 12 are inserted into the abdominal cavity, for example, through the abdominal wall. In order to hold the living tissues L1 and L2 of the treatment target by the first and second holding members 52 and 54, the treatment part opening and closing handle 32 of the handle 22 is operated to hold the living tissues L1 and L2 of the joining target in the first and second holding members 52 and 54. 2 Between the retaining members 52,54.
在将生物体组织L1、L2保持在第1保持构件52及第2保持构件54之间的状态下，操作脚踏开关16的踏板，从脚踏开关16向第1控制部102输入信号，能量源14的第1控制部102判断是否在操作者的操作下脚踏开关16的踏板被按压而切换成了ON(S32)。In the state where the living tissues L1 and L2 are held between the first holding member 52 and the second holding member 54, the pedal of the foot switch 16 is operated, and a signal is input from the foot switch 16 to the first control part 102, and energy The first control unit 102 of the source 14 judges whether or not the pedal of the foot switch 16 is pressed and switched ON by the operator's operation (S32).
在第1控制部102判断为脚踏开关16的踏板被按压而切换成了ON时，从第1控制部102向高频能量输出部104输入信号。高频能量输出部104通过通电线28a、28b向高频电极92、94之间的生物体组织L1、L2供给能量(S33)。然后，向高频电极92、94之间的生物体组织L1、L2通入高频电流。因此，生物体组织L1、L2自身发热而脱水，同时生物体组织L1、L2的内部改性(生物体组织L1、L2烧灼)，生物体组织L1、L2彼此的接触面C1、C2成为接合部C。另外，判断阻抗Z是否达到预定的阈值Z1(S34)，若达到阈值Z1则停止供给高频能量(S35)。When the first control unit 102 determines that the pedal of the foot switch 16 is pressed and switched ON, a signal is input from the first control unit 102 to the high-frequency energy output unit 104 . The high-frequency energy output unit 104 supplies energy to the living tissues L1, L2 between the high-frequency electrodes 92, 94 through the energizing wires 28a, 28b (S33). Then, a high-frequency current is supplied to the living tissues L1 and L2 between the high-frequency electrodes 92 and 94 . Therefore, the living tissues L1 and L2 self-heat and dehydrate, and at the same time, the living tissues L1 and L2 are internally modified (the living tissues L1 and L2 are cauterized), and the contact surfaces C1 and C2 of the living tissues L1 and L2 become junctions. c. In addition, it is judged whether or not the impedance Z has reached a predetermined threshold Z1 (S34), and if the impedance Z has reached the threshold Z1, the supply of high-frequency energy is stopped (S35).
然后，从扬声器110发出用于通知使用了高频能量的生物体组织L1、L2的接合处理结束的蜂鸣音(第1次蜂鸣音)(S36)。Then, a buzzer sound (1st buzzer sound) is emitted from the speaker 110 to notify that the joining process of the living tissues L1 and L2 using the high-frequency energy is completed (S36).
接着，医生在确认了第1次蜂鸣音之后，操作图12所示的刀具驱动把手34。即，使刀具180从图15A及图15B所示的状态沿着刀具引导槽172、174前进。随着该刀具180的前进，在高频电极92、94的作用下改性而接合的部位被切断。此时，传感器185例如检测出卡定部184a、184b、184c相对于移动限制销42a的相对位置，传输到第2检测部107。第2检测部107对刀具180相对于柄线24及处理部26的位置及移动方向进行识别(S37)。Next, the doctor operates the knife driving handle 34 shown in FIG. 12 after confirming the first beep sound. That is, the cutter 180 is advanced from the state shown in FIGS. 15A and 15B along the cutter guide grooves 172 and 174 . As the cutter 180 advances, the parts reformed and bonded by the high-frequency electrodes 92 and 94 are cut. At this time, the sensor 185 detects, for example, the relative positions of the locking portions 184 a , 184 b , and 184 c with respect to the movement restricting pin 42 a and transmits them to the second detection portion 107 . The second detection unit 107 recognizes the position and moving direction of the cutter 180 relative to the handle 24 and the treatment unit 26 (S37).
当识别到由第2检测部107检测出的刀具180的移动方向向切割生物体组织LT的方向移动时，第1控制部102向第2控制部132传送信号，使流量调整机构134工作而打开软管18a(S38)。When it is recognized that the moving direction of the knife 180 detected by the second detection unit 107 is moving in the direction of cutting the living tissueLT , the first control unit 102 sends a signal to the second control unit 132 to make the flow rate adjustment mechanism 134 work and The hose 18a is opened (S38).
因此，粘接剂穿过软管18a而从第1及第2保持构件52、54的流体导管162、164的开口162a、164a渗出粘接剂，并且从流体导管192、194的开口192a、194a渗出粘接剂。然后，从流体导管162、164的开口162a、164a渗出的粘接剂涂布在与高频电极92、94相接触的部分(所接合的生物体组织LT的外周面Sc)，并且从流体导管192、194的开口192a、194a渗出的粘接剂涂布在刀具180的侧面。因此，在切割生物体组织LT时，刀具180的侧面与生物体组织LT的切割面S相接触，从而使粘接剂涂布在由刀具180切割的生物体组织LT的切割面S上。Therefore, the adhesive seeps out from the openings 162a, 164a of the fluid conduits 162, 164 of the first and second holding members 52, 54 through the hose 18a, and also leaks from the openings 192a, 192a, 194a of the fluid conduits 192, 194. 194a oozes adhesive. Then, the adhesive seeping out from the openings 162a, 164a of the fluid conduits 162, 164 is applied to the portion in contact with the high-frequency electrodes 92, 94 (the outer peripheral surface Sc of the living tissueLT to be bonded), and Adhesive exuded from the openings 192 a , 194 a of the fluid conduits 192 , 194 coats the sides of the cutter 180 . Therefore, when the living tissueLT is cut, the side surface of the cutter 180 is in contact with the cutting surface S of the living tissueLT , so that the adhesive is applied to the cutting surface S of the living tissueLT cut by the cutter 180. superior.
判断是否在软管18a中通过了预定流量的粘接剂(S39)，当通过了预定流量的粘接剂时，使流量调整机构134工作而关闭软管18a(S310)。It is judged whether a predetermined flow rate of adhesive has passed through the hose 18a (S39), and when the predetermined flow rate of adhesive has passed, the flow rate adjustment mechanism 134 is operated to close the hose 18a (S310).
然后，从扬声器110发出用于通知粘接剂的涂布已结束的蜂鸣音(第2次蜂鸣音)(S311)。Then, a buzzer sound (second buzzer sound) notifying that application of the adhesive has been completed is emitted from the speaker 110 (S311).
医生在确认了来自扬声器110的第2次蜂鸣音之后，解除对脚踏开关16的踏板的按压，并且操作手柄22的处理部开闭把手32，松开生物体组织LT。此时，如图17所示，生物体组织L1、L2在接合部C处相接合，并且在切割面S处被切割。然后，对接合部C的表面Sc及切割面S涂布粘接剂来进行涂敷。After confirming the second buzzer sound from the speaker 110, the doctor releases the pedal of the foot switch 16, and operates the opening and closing handle 32 of the treatment part of the handle 22 to release the living tissueLT . At this time, as shown in FIG. 17 , the living tissues L1 and L2 are joined at the joining portion C and cut at the cutting plane S. As shown in FIG. Then, the adhesive is applied to the surface Sc and the cut surface S of the joint portion C by applying it.
如上所述，根据该实施方式，能够获得以下效果。As described above, according to this embodiment, the following effects can be obtained.
在处理时能够使从生物体组织L1、L2产生的血液等流体进入刀具引导槽172、174内。而且，能够从形成在柄线24的筒体42及护套44上的流体放出口186、188向能量处理器具12b的外部引导进入到刀具引导槽172、174内的流体。因此，能够极力防止水分残留在生物体组织L1、L2的接合部C的接合面上，从而能够更快地进行生物体组织L1、L2的接合处理。因而，能够更有效地进行接合生物体组织L1、L2、对接合部C进行涂敷的一连串的处理。Fluids such as blood generated from the living tissues L1 and L2 can be allowed to enter the cutter guide grooves 172 and 174 during treatment. Furthermore, the fluid entering the cutter guide grooves 172 and 174 can be guided to the outside of the energy treatment device 12 b from the fluid discharge ports 186 and 188 formed on the cylinder body 42 and the sheath 44 of the handle 24 . Therefore, it is possible to prevent moisture from remaining on the joint surface of the joint part C of the living tissues L1 and L2 as much as possible, and the joint treatment of the living tissues L1 and L2 can be performed more quickly. Therefore, a series of processes of joining the living tissues L1 and L2 and coating the joined portion C can be performed more efficiently.
另外，由于不仅能够利用粘接剂对接合对象的生物体组织LT的外周面进行涂敷，也能够对生物体组织LT的切割面S涂布粘接剂而对接合面进行涂敷，因此，能够防止水分进入生物体组织LT的接合部C。In addition, since the adhesive can be applied not only to the outer peripheral surface of the living tissueLT to be bonded, but also to the cut surface S of the living tissueLT to apply the adhesive to the bonded surface, Therefore, it is possible to prevent moisture from entering the junction C of the living tissueLT .
另外，如上所述，也可以在刀具180移动时打开软管18a而使粘接剂流入，但是也可以在筒体42的移动限制销42a从刀具180的长槽184的一端184a穿过中间部184c达到另一端184b之后打开软管18a。在该情况下，由刀具180的刃180a进行生物体组织LT的切割已经完毕(已经形成了切割面S)。而且，在筒体42的移动限制销42a从刀具180的长槽184的另一端184b穿过中间部184c达到一端184a的期间，流入粘接剂。这样，在刀具180的刃180a从第1及第2保持构件52、54的刀具引导槽172、174被引入柄线24内时，由生物体组织LT的切割面S彼此形成空间。若粘接剂从开口192a、194a渗出，则粘接剂进入切割面S之间。另外，由于能够利用传感器185检测出筒体42的移动限制销42a在刀具180的长槽184的一端184a与另一端184b之间移动的情况，因此能够容易地掌握接合对象的生物体组织LT与刀具180之间的位置关系。因此，也能够适当地设定利用流量调整机构134关闭软管18a的时刻。In addition, as mentioned above, when the cutter 180 moves, the hose 18a may be opened to allow the adhesive to flow in, but the movement restricting pin 42a of the cylindrical body 42 may pass through the middle part from the end 184a of the long groove 184 of the cutter 180 The hose 18a is opened after 184c reaches the other end 184b. In this case, the cutting of the living tissueLT by the blade 180a of the cutter 180 has been completed (the cutting surface S has been formed). And, while the movement restricting pin 42a of the cylindrical body 42 passes from the other end 184b of the long groove 184 of the cutter 180 through the middle portion 184c to the one end 184a, the adhesive flows in. Thus, when the blade 180a of the knife 180 is drawn into the handle 24 from the knife guide grooves 172, 174 of the first and second holding members 52, 54, a space is formed between the cut surfaces S of the living tissueLT . When the adhesive seeps out from the openings 192a and 194a, the adhesive enters between the cut surfaces S. As shown in FIG. In addition, since the sensor 185 can detect that the movement restricting pin 42a of the cylindrical body 42 moves between the one end 184a and the other end 184b of the elongated groove 184 of the knife 180, it is possible to easily grasp the living tissue LT of the joining target. The positional relationship with the tool 180. Therefore, the timing at which the hose 18a is closed by the flow rate adjustment mechanism 134 can also be appropriately set.
另外，在该实施方式中，说明采用蜂鸣音作为从扬声器110发出的声音，但是也可以利用语音通知处理的内容、利用语音通知处理的顺序等。另外，优选的是第1次蜂鸣音与第2次蜂鸣音大不相同，能够容易地识别分别是哪个处理结束。In addition, in this embodiment, a buzzer sound is used as the sound emitted from the speaker 110 , but the content of the processing, the order of the processing, and the like may be notified by a voice. In addition, it is preferable that the beep sound of the first time and the beep sound of the second time are very different, and it is possible to easily recognize which process is completed.
另外，在该实施方式中，说明了通过操作刀具驱动把手34来手动使刀具180工作的情况，但是也优选的是在结束利用高频能量对生物体组织L1、L2彼此的接合处理之后，不操作刀具驱动把手34而是自动地使刀具180工作来切割生物体组织LT。即，也可以自动地进行从用于接合生物体组织L1、L2彼此的使用了高频能量的处理开始、一直到用于对已接合的生物体组织LT进行涂敷的处理结束为止的一连串处理。In addition, in this embodiment, the case where the knife 180 is operated manually by operating the knife driving handle 34 has been described, but it is also preferable not to press the knife 180 after the joining process of the living tissues L1 and L2 using high-frequency energy is completed. Operating the knife driving handle 34 instead automatically operates the knife 180 to cut the living tissue LT . That is, a series of processes from the treatment using high-frequency energy for joining the living tissues L1 and L2 to the end of the treatment for coating the joined living tissues LT may be automatically performed. deal with.
(第4实施方式)(fourth embodiment)
接着，使用图18A～图20说明第4实施方式。该实施方式是第1实施方式的变形例，对与第1实施方式中所说明的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略详细的说明。Next, a fourth embodiment will be described using FIGS. 18A to 20 . This embodiment is a modified example of the first embodiment, and the same members as those described in the first embodiment or members having the same functions are denoted by the same reference numerals, and detailed description thereof will be omitted.
如图17A～图17C所示，如第1实施方式中所说明那样，在第1保持构件52的主体62上形成有凹部62b。在第1保持构件52的主体62上配设有第1高频电极92。在第1高频电极92中的、第1保持构件52的主体62的凹部62b上，朝向第2保持构件54形成有多个突起(接合维持辅助部)202。突起202形成为适当的长度，以在生物体组织L1、L2上形成图20所示的孔P。突起202未必需要贯穿生物体组织L1、L2，优选的是突起202的顶端(相对于第1高频电极92的远端部)位于比生物体组织L1、L2的接触面C 1、C2靠近第2高频电极94的位置。As shown in FIGS. 17A to 17C , as described in the first embodiment, the main body 62 of the first holding member 52 is formed with a recessed portion 62 b. A first high-frequency electrode 92 is arranged on the main body 62 of the first holding member 52 . In the first high-frequency electrode 92 , a plurality of protrusions (joint maintenance auxiliary portions) 202 are formed toward the second holding member 54 on the recessed portion 62 b of the main body 62 of the first holding member 52 . The protrusion 202 is formed with an appropriate length so that the hole P shown in FIG. 20 is formed in the living tissue L1, L2. The protrusion 202 does not necessarily need to penetrate the biological tissues L1, L2, and it is preferable that the top end of the protrusion 202 (relative to the distal end portion of the first high-frequency electrode 92) is located closer to the first contact surface C1, C2 than the biological tissues L1, L2. 2 The position of the high-frequency electrode 94.
如图18D所示，在各个突起202上形成有一个或多个开口204。另外，优选的是开口204为多个。突起202与凹部62b相连通，能够通过流路62b渗出粘接剂等流体(接合辅助剂)。As shown in FIG. 18D , one or more openings 204 are formed on each protrusion 202 . In addition, it is preferable that there are a plurality of openings 204 . The protrusion 202 communicates with the recessed portion 62b, and fluid (bonding aid) such as an adhesive can seep out through the flow path 62b.
如图19A～图19C所示，在第2保持构件54的主体72及高频电极94上形成有凹部(接合维持辅助部)206。各凹部206形成为容纳从配设在第1保持构件52上的高频电极92突出的突起202。As shown in FIGS. 19A to 19C , recessed portions (bonding maintenance auxiliary portions) 206 are formed on the main body 72 of the second holding member 54 and the high-frequency electrode 94 . Each recess 206 is formed to accommodate the protrusion 202 protruding from the high-frequency electrode 92 arranged on the first holding member 52 .
高频电极92、94的表面位于比第1及第2保持构件52、54的主体62、74的边缘部62a、72a低的位置。另外，第1高频电极92的突起202的长度形成为不会与第2保持构件54的凹部206相接触的高度。因此，形成为即使在将第1高频电极92的突起202配设于第2高频电极94的凹部206的状态下，第1高频电极92与第2高频电极94也不会相接触。The surfaces of the high-frequency electrodes 92 , 94 are positioned lower than the edge portions 62 a , 72 a of the main bodies 62 , 74 of the first and second holding members 52 , 54 . In addition, the length of the protrusion 202 of the first high-frequency electrode 92 is formed to a height that does not come into contact with the concave portion 206 of the second holding member 54 . Therefore, even when the protrusion 202 of the first high-frequency electrode 92 is disposed in the concave portion 206 of the second high-frequency electrode 94, the first high-frequency electrode 92 and the second high-frequency electrode 94 are not in contact with each other. .
接着，使用图6说明该实施方式的治疗用处理系统10的作用。Next, the operation of the therapeutic treatment system 10 of this embodiment will be described using FIG. 6 .
以与第1实施方式相同的方式保持接合对象的生物体组织L1、L2。此时，由于在配设于第1保持构件52的高频电极92上配设有突起202，因此，突起202贯穿生物体组织L1、L2而形成孔P，并且容纳于配设在第2保持构件54及高频电极94上的凹部206内。The living tissues L1 and L2 to be joined are held in the same manner as in the first embodiment. At this time, since the protrusion 202 is disposed on the high-frequency electrode 92 disposed on the first holding member 52, the protrusion 202 penetrates the living tissues L1, L2 to form a hole P, and is accommodated in the second holding member disposed on the second holding member 52. Inside the concave portion 206 on the component 54 and the high frequency electrode 94 .
在该状态下，利用从配设在第1及第2保持构件52、54上的高频电极92、94输出的高频能量来接合两个生物体组织L1、L2。此时，设置在配设于第1保持构件52的高频电极92上的突起202维持着贯穿了生物体组织L1、L2的状态(配设在孔P内的状态)。In this state, the two living tissues L1, L2 are joined by high-frequency energy output from the high-frequency electrodes 92, 94 arranged on the first and second holding members 52, 54. At this time, the protrusion 202 provided on the high-frequency electrode 92 arranged on the first holding member 52 maintains the state of penetrating the living tissues L1 and L2 (the state of being arranged in the hole P).
此时，由于突起202配设在生物体组织L1、L2的内部，向突起202与第2高频电极94之间的生物体组织通电，因此能够高效地进行生物体组织L1、L2的使用了高频能量的处理。At this time, since the protrusion 202 is arranged inside the living tissue L1, L2, and the living tissue between the protrusion 202 and the second high-frequency electrode 94 is energized, the living tissue L1, L2 can be efficiently used. Processing of high frequency energy.
在阻抗Z达到阈值Z1之后，打开流量调整机构134而从流体存储部122通过软管18a流入粘接剂。此时，由于在第1保持构件52的基部64上设有管路64a，在主体62上设有凹部62b，因此粘接剂从突起202的开口204渗出。此时，由于突起202贯穿已接合的生物体组织LT而配设在孔P内，因此从开口204渗出的粘接剂的一部分涂布在生物体组织LT彼此的接合部C上。粘接剂的一部分从接合部C的接合面直接渗入。由于粘接剂除了粘接作用以外还具有涂敷作用，因此能够防止水分进入接合部C，并且能够维持接合状态。After the impedance Z reaches the threshold value Z1, the flow rate adjustment mechanism 134 is opened, and the adhesive flows in from the fluid storage part 122 through the hose 18a. At this time, since the duct 64 a is provided on the base 64 of the first holding member 52 and the recess 62 b is provided on the main body 62 , the adhesive leaks out from the opening 204 of the protrusion 202 . At this time, since the protrusion 202 penetrates through the joined living tissuesLT and is disposed in the hole P, a part of the adhesive seeping out from the opening 204 is applied to the joining portion C between the living tissuesLT . A part of the adhesive directly infiltrates from the joint surface of the joint C. Since the adhesive has a coating function in addition to the bonding function, it is possible to prevent moisture from entering the joint portion C, and to maintain the joint state.
当高频能量对生物体组织L1、L2彼此的接合、以及粘接剂对于接合部C的涂布这一连串的处理结束时，从扬声器110发出蜂鸣等声音来通知医生。When the series of processes of bonding the living tissues L1 and L2 with the high-frequency energy and applying the adhesive to the joint C are completed, the speaker 110 emits a sound such as a buzzer to notify the doctor.
如以上说明那样，根据该实施方式，能够获得以下效果。As described above, according to this embodiment, the following effects can be obtained.
由于不仅能够使高频电极92、94之间的生物体组织L1、L2产生焦耳热，而且能够使贯穿生物体组织L1、L2的突起202与高频电极94之间的生物体组织L1、L2产生焦耳热，因此即使是在生物体组织L1、L2的厚度较厚的情况(高频能量难以渗入生物体组织L1、L2的情况)下，也能够易于使能量渗入生物体组织L1、L2。Since Joule heat can be generated not only in the living tissues L1, L2 between the high-frequency electrodes 92, 94, but also in the living tissues L1, L2 between the protrusions 202 penetrating through the living tissues L1, L2 Since Joule heat is generated, energy can be easily penetrated into the living tissues L1 and L2 even when the living tissues L1 and L2 are thick (when it is difficult for high-frequency energy to penetrate the living tissues L1 and L2).
由于利用设置在高频电极92上的突起202，能够直接向接合对象的生物体组织L1、L2的接合部C等已接合的生物体组织LT的内部供给、渗入粘接剂等流体，因此能够更可靠地进行接合部C的接合，并且能够使粘接剂的涂敷作用作用到包含接合面在内的接合部C附近。Since the protrusion 202 provided on the high-frequency electrode 92 can directly supply and infiltrate a fluid such as an adhesive into the jointed living tissueLT such as the joining portion C of the living tissues L1 and L2 to be joined, The bonding of the bonding portion C can be performed more reliably, and the application action of the adhesive can be applied to the vicinity of the bonding portion C including the bonding surface.
另外，在该实施方式中，说明了在利用第1及第2保持构件52、54保持了生物体组织时利用第1保持构件52的突起202在生物体组织L1、L2上形成孔P的情况。另外，突起202在利用第1及第2保持构件52、54保持了生物体组织L1、L2时未必必须形成孔P。即，在利用第1及第2保持构件52、54保持了生物体组织L1、L2时，也可以使第1保持构件52的突起202向第2保持构件54的凹部206按压生物体组织L2。即使在该情况下，随着向第1及第2高频电极92、94之间的生物体组织L1、L2供给高频能量，也在生物体组织L1、L2上形成孔P，即，突起202配设到孔P内。In addition, in this embodiment, when the living tissue is held by the first and second holding members 52, 54, the case where the hole P is formed in the living tissue L1, L2 by the protrusion 202 of the first holding member 52 is described. . In addition, the protrusion 202 does not necessarily have to form the hole P when the living tissues L1 and L2 are held by the first and second holding members 52 and 54 . That is, when the living tissues L1 and L2 are held by the first and second holding members 52 and 54 , the protrusion 202 of the first holding member 52 may press the living tissue L2 against the recess 206 of the second holding member 54 . Even in this case, as high-frequency energy is supplied to the living tissues L1 and L2 between the first and second high-frequency electrodes 92 and 94, holes P, that is, protrusions are formed in the living tissues L1 and L2. 202 is fitted into the hole P.
另外，第1保持构件52的高频电极92的突起202也可以由具有绝缘性的硬质树脂材料等另外构件形成。在该情况下，允许突起202与第2保持构件54的高频电极94相接触。In addition, the protrusion 202 of the high-frequency electrode 92 of the first holding member 52 may be formed of another member such as an insulating hard resin material. In this case, the protrusion 202 is allowed to come into contact with the high-frequency electrode 94 of the second holding member 54 .
(第5实施方式)(fifth embodiment)
接着，使用图21A～图23说明第5实施方式。该实施方式是第3实施方式的变形例，对与第3实施方式中所说明的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略详细的说明。Next, a fifth embodiment will be described using FIGS. 21A to 23 . This embodiment is a modified example of the third embodiment, and the same members as those described in the third embodiment or members having the same functions are denoted by the same reference numerals, and detailed description thereof will be omitted.
如图21A及图21B所示，在该实施方式中，从第1及第2保持构件52、54的主体62、72上去除了凹部62b、72b(参照图4A～图4C)、管路64a、74a(参照图4A～图4C)。As shown in FIGS. 21A and 21B , in this embodiment, the recesses 62b, 72b (refer to FIGS. 4A to 4C ), the conduits 64a, 74a (see FIGS. 4A to 4C ).
图22A所示的刀具180在顶端具有刃180a。在刀具180的内部沿着刀具180的长度方向例如在图22B中的上下处形成有管路212、214。形成在刀具180的内部的管路212、214穿过驱动杆182的内部与软管18a相连接。如图22A及图22B所示，在刀具180的侧面沿着刀具180的长度方向隔开适当的间隔形成有多个开口(接合维持辅助部)212a、214a。这些开口212a、214a与管路212、214相连通。因此，能够通过管路212、214从开口212a、214a排出粘接剂等、用于防止水分渗入生物体组织LT的物质(接合辅助剂)。The cutter 180 shown in FIG. 22A has an edge 180a at the tip. Pipelines 212 , 214 are formed inside the cutter 180 along the length direction of the cutter 180 , for example, at upper and lower positions in FIG. 22B . Pipelines 212 , 214 formed inside the cutter 180 pass through the inside of the drive rod 182 and are connected to the hose 18 a. As shown in FIGS. 22A and 22B , a plurality of openings (bonding maintenance auxiliary portions) 212 a and 214 a are formed at appropriate intervals along the longitudinal direction of the blade 180 on the side surface of the blade 180 . These openings 212a, 214a communicate with the conduits 212, 214. Therefore, substances (bonding aids) for preventing moisture from penetrating into the living tissueLT , such as adhesives, can be discharged from the openings 212a and 214a through the pipes 212 and 214 .
另外，在该实施方式中，说明了刀具180在一连串处理的中途的适当情况下自动工作的情况。In addition, in this embodiment, the case where the cutter 180 operates automatically in an appropriate case in the middle of a series of processing was demonstrated.
接着，使用图23说明该实施方式的治疗用处理系统10的作用。Next, the operation of the therapeutic treatment system 10 of this embodiment will be described with reference to FIG. 23 .
如第1实施方式中所说明那样，利用从高频电极92、94发出的高频能量来接合生物体组织L1、L2的接触面C1、C2彼此(S51～S56)。As described in the first embodiment, the contact surfaces C1 and C2 of the living tissues L1 and L2 are joined together by the high-frequency energy emitted from the high-frequency electrodes 92 and 94 (S51 to S56).
然后，为了切割已接合的生物体组织LT而使刀具180工作(S57)。与刀具180的工作连动地打开软管18a(S58)。因此，在切割已接合的生物体组织LT时，粘接剂从刀具180的开口212a渗出，涂布于切割面S。即，随着生物体组织LT的切割的进行，涂布从刀具180的开口212a渗出的粘接剂。Then, the cutter 180 is operated to cut the joined living tissueLT (S57). The hose 18a is opened in conjunction with the operation of the cutter 180 (S58). Therefore, when the joined living tissueLT is cut, the adhesive seeps out from the opening 212a of the knife 180 and is applied to the cut surface S. FIG. That is, as the cutting of the living tissueLT proceeds, the adhesive seeping out from the opening 212a of the cutter 180 is applied.
此时，如图22B所示，由于在刀具180的上下形成有开口212a，因此在假设为各个生物体组织L1、L2的厚度相同的情况下，在从接合部C的接合面偏移的位置涂布粘接剂。由于所涂布的粘接剂在第1及第2保持构件52、54的朝向下向适当的方向流动，因此粘接剂涂布在被刀具180切割的整个切割面S上。At this time, as shown in FIG. 22B , since openings 212 a are formed above and below the cutter 180 , assuming that the thicknesses of the living tissues L1 and L2 are the same, at positions shifted from the joint surfaces of the joint C, Apply adhesive. Since the applied adhesive flows in an appropriate direction downward toward the first and second holding members 52 , 54 , the adhesive is applied over the entire cut surface S cut by the cutter 180 .
另外，在生物体组织LT中的、与高频电极92、94相接触的表面上也流动而涂布有粘接剂。因此，粘接剂涂布在生物体组织LT的整个外表面上。In addition, the adhesive agent flows and is applied to the surface of the living tissueLT that is in contact with the high-frequency electrodes 92 and 94 . Therefore, the adhesive is coated on the entire outer surface of the living tissueLT .
在预定流量的粘接剂流入软管18a内的情况下，关闭软管18a(S510)，并且使刀具18返回到原来的位置。然后，在利用配设在刀具180上的传感器185识别出刀具180返回到原来的位置的情况下(S511)，从扬声器110发出用于通知一连串处理已结束的蜂鸣音(S512)。When a predetermined flow rate of adhesive flows into the hose 18a, the hose 18a is closed (S510), and the cutter 18 is returned to the original position. Then, when the sensor 185 disposed on the knife 180 recognizes that the knife 180 has returned to its original position (S511), a buzzer sound is emitted from the speaker 110 notifying that a series of processes have been completed (S512).
(第6实施方式)(sixth embodiment)
接着，使用图24A～图24D说明第6实施方式。该实施方式是第5实施方式的变形例，对与第5实施方式中所说明的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略详细的说明。Next, a sixth embodiment will be described using FIGS. 24A to 24D . This embodiment is a modified example of the fifth embodiment, and the same members as those described in the fifth embodiment or members having the same functions are assigned the same reference numerals, and detailed descriptions thereof are omitted.
如图24B所示，在刀具180的内部，沿着刀具180的长度方向形成有一个管路216。形成在刀具180的内部的管路216穿过驱动杆182的内部与软管18a相连接。在刀具180的侧面的宽度方向的中央形成有多个开口(接合维持辅助部)216a。因此，在切割生物体组织LT的同时将粘接剂涂布在接合部C的接合面附近。因而，粘接剂(接合辅助剂)渗入接合部C的接合面而固化。另外，在该情况下，如图24D所示，越靠近切割面S，渗入的粘接剂越多，且随着远离切割面S，粘接剂的渗入量变少。As shown in FIG. 24B , inside the cutter 180 , a pipe 216 is formed along the length direction of the cutter 180 . A pipe line 216 formed inside the cutter 180 passes through the inside of the drive rod 182 and is connected to the hose 18a. A plurality of openings (bonding maintenance assisting portions) 216 a are formed at the center in the width direction of the side surface of the cutter 180 . Therefore, the adhesive is applied to the vicinity of the joint surface of the joint C at the same time as the living tissueLT is cut. Therefore, the adhesive (bonding auxiliary agent) penetrates into the bonding surface of the bonding portion C and hardens. In addition, in this case, as shown in FIG. 24D , the closer to the cut surface S, the more the adhesive penetrates, and the farther away from the cut surface S, the less the adhesive penetrates.
(第7实施方式)(seventh embodiment)
接着，使用图25～图30说明第7实施方式。该实施方式是第1及第5实施方式的变形例，对与第1及第5实施方式中所说明的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略详细的说明。Next, a seventh embodiment will be described using FIGS. 25 to 30 . This embodiment is a modified example of the first and fifth embodiments, and the same members as those described in the first and fifth embodiments or members having the same functions are denoted by the same reference numerals, and detailed description thereof will be omitted. .
如图25所示，该实施方式的治疗用处理系统10具有能量处理器具12和能量源14。在此，说明从治疗用处理系统10上去除了流体源18的情况。As shown in FIG. 25 , the therapeutic treatment system 10 of this embodiment has an energy treatment device 12 and an energy source 14 . Here, a case where the fluid source 18 is removed from the therapeutic treatment system 10 will be described.
如图26A及图26B所示，在第1保持构件52的主体62上配设有平板状的加热器(能量输出部)222。该加热器222被主体62的保持面62a包围。另外，虽未图示，但是在第2保持构件54的主体72上配设有平板状的加热器(能量输出部)232。该加热器232被主体72的保持面72a包围。As shown in FIGS. 26A and 26B , a flat heater (energy output unit) 222 is disposed on the main body 62 of the first holding member 52 . The heater 222 is surrounded by the holding surface 62 a of the main body 62 . In addition, although not shown, a flat heater (energy output unit) 232 is arranged on the main body 72 of the second holding member 54 . The heater 232 is surrounded by the holding surface 72 a of the main body 72 .
如图27A所示，在第1保持构件52的主体62的外周，配设有横截面预先形成为C字状的覆盖构件(片状构件)224(参照图27B)。As shown in FIG. 27A , on the outer periphery of the main body 62 of the first holding member 52 , a covering member (sheet-like member) 224 (see FIG. 27B ) that is preliminarily formed into a C-shaped cross section is arranged.
如图28A～图28C所示，覆盖构件224中的与加热器222相接触的部分分别使用无孔片状、网状、多孔质状等各种材料。覆盖构件224含有第1实施方式中所说明的接合辅助剂的成分，并以若被加热到适当的温度则被加热了的部分熔融而接合辅助剂的成分在生物体组织的表面扩散渗入、或者若被冷却则在生物体组织的表面扩散渗入的状态固化。在固化时，如第1实施方式中所说明那样，起到防止水分从生物体组织的外侧渗入后述的接合面等的作用。As shown in FIGS. 28A to 28C , various materials such as a non-porous sheet shape, a mesh shape, and a porous shape are used for the portion of the covering member 224 that is in contact with the heater 222 . The covering member 224 contains the components of the bonding auxiliary agent described in the first embodiment, and when heated to an appropriate temperature, the heated part melts, and the components of the bonding auxiliary agent diffuse and infiltrate on the surface of the living tissue, or When cooled, it solidifies in a state where it diffuses and permeates the surface of living tissue. At the time of curing, as described in the first embodiment, it functions to prevent moisture from penetrating from the outside of the living tissue into the joint surface described later and the like.
另外，优选的是该覆盖构件224在加热前(例如无孔片状、网状、多孔质状等状态)能够至少沿圆周方向(与第1保持构件52的主体62的长度方向正交的宽度方向)伸缩。而且，在覆盖构件224配设在第1保持构件52的主体62上时，能够使其与第1保持构件52的主体62的保持面62a、及主体62中离开第2保持构件54的外表面紧密接触。In addition, it is preferable that the covering member 224 can at least extend along the circumferential direction (the width perpendicular to the longitudinal direction of the main body 62 of the first holding member 52 ) before heating (for example, non-porous sheet shape, mesh shape, porous shape, etc.) direction) stretches. Moreover, when the covering member 224 is arranged on the main body 62 of the first holding member 52, it can be separated from the holding surface 62a of the main body 62 of the first holding member 52 and the outer surface of the second holding member 54 in the main body 62. Close contact.
覆盖构件(接合维持辅助剂)224、234由于在利用第1及第2保持构件52、54的主体62、72保持了生物体组织L1、L2时配设在生物体组织L1、L2与加热器222、232之间，因此被生物体组织L1、L2朝向加热器222、232按压。因此，在利用第1及第2保持构件52、54保持了生物体组织L1、L2时，覆盖构件224、234与加热器222、232相接触。The covering members (junction maintenance aids) 224, 234 are arranged between the living tissues L1, L2 and the heater when the living tissues L1, L2 are held by the main bodies 62, 72 of the first and second holding members 52, 54. 222 , 232 , thus being pressed toward the heaters 222 , 232 by the living tissues L1 , L2 . Therefore, when the living tissues L1 , L2 are held by the first and second holding members 52 , 54 , the covering members 224 , 234 come into contact with the heaters 222 , 232 .
配设在第1保持构件52上的覆盖构件224的端部彼此既可以处于在第1保持构件52的主体62中的、离开第2保持构件54的主体72的位置相对的状态，也可以处于一部分重叠的状态。在第2保持构件54上也配设加热器232及覆盖构件234。在该情况下，优选的是与第1保持构件52相同地配设加热器232及覆盖构件234。The ends of the covering member 224 disposed on the first holding member 52 may be in a state facing each other at a position apart from the main body 72 of the second holding member 54 in the main body 62 of the first holding member 52, or may be in a state of being separated from each other. A partially overlapping state. A heater 232 and a cover member 234 are also disposed on the second holding member 54 . In this case, it is preferable to arrange the heater 232 and the covering member 234 similarly to the first holding member 52 .
接着，使用图29说明该实施方式的治疗用处理系统10的作用。Next, the operation of the therapeutic treatment system 10 of this embodiment will be described with reference to FIG. 29 .
首先，操作显示部108，进行各种设定。例如设定加热器222、232的最高温度、从高频能量输出部104向加热器222、232输出能量的时间、生物体组织的处理结束的温度(在此为生物体组织L1、L2的表面温度)的阈值T1等(S71)。First, the display unit 108 is operated to perform various settings. For example, the maximum temperature of the heaters 222, 232, the time for outputting energy from the high-frequency energy output unit 104 to the heaters 222, 232, the temperature at which the treatment of the living tissue ends (here, the surface of the living tissue L1, L2) are set. temperature) threshold T1, etc. (S71).
然后，在覆盖构件224、234分别卷绕在第1及第2保持构件52、54的主体62、72上的状态下，利用第1及第2保持构件52、54的主体62、72保持生物体组织L1、L2。即，配设在第1保持构件52上的覆盖构件224与生物体组织L1中的、与接触于生物体组织L2的接触面C1相反一侧的表面相接触。另外，配设在第2保持构件54上的覆盖构件234与生物体组织L2中的、与接触于生物体组织L1的接触面C2相反一侧的表面相接触。Then, in the state where the covering members 224, 234 are respectively wound on the main bodies 62, 72 of the first and second holding members 52, 54, the living things are held by the main bodies 62, 72 of the first and second holding members 52, 54. Body tissues L1, L2. That is, the covering member 224 disposed on the first holding member 52 is in contact with the surface of the living tissue L1 that is opposite to the contact surface C1 that contacts the living tissue L2 . In addition, the covering member 234 disposed on the second holding member 54 is in contact with the surface of the living tissue L2 that is opposite to the contact surface C2 that contacts the living tissue L1 .
在该状态下，若按压脚踏开关16的踏板(S72)，则从高频能量输出部104向加热器222、232传递能量(S73)，加热器222、232的温度逐渐上升(电能转换为热能)。然后，在加热器222、232的热能的作用下，覆盖构件224、234中的、与加热器222、232相接触的部分熔融，在生物体组织L1、L2的外表面涂布用于防止水分渗入生物体组织LT的物质。另外，在加热器222、232的温度上升的同时，加热器222、232的热量作用到生物体组织L1、L2而对生物体组织L1、L2施加热量。然后，在进行阻抗Z的测量、生物体组织L1、L2的表面温度T的测量、或者经过预定时间t1之后(S74)，停止从高频能量输出部104向加热器222、232供给能量(S75)。之后，从扬声器110发出用于通知一连串的处理结束的蜂鸣音(S76)。In this state, if the pedal (S72) of the foot switch 16 is pressed, energy is transferred from the high-frequency energy output part 104 to the heaters 222, 232 (S73), and the temperature of the heaters 222, 232 gradually rises (electric energy is converted to thermal energy). Then, under the action of the heat energy of the heaters 222, 232, the parts of the covering members 224, 234 that are in contact with the heaters 222, 232 are melted, and the outer surfaces of the living tissues L1, L2 are coated with moisture-proof Substances that penetrate into living tissue LT. In addition, as the temperature of the heaters 222 and 232 rises, the heat of the heaters 222 and 232 acts on the living tissues L1 and L2 to apply heat to the living tissues L1 and L2. Then, after the measurement of the impedance Z, the measurement of the surface temperature T of the living tissue L1, L2, or the elapse of the predetermined time t1 (S74), the energy supply from the high-frequency energy output part 104 to the heaters 222, 232 is stopped (S75 ). Thereafter, a buzzer sound is emitted from the speaker 110 to notify that a series of processing is completed (S76).
用于防止水分渗入生物体组织LT的物质是例如因能量供给的停止而被冷却，从而逐渐固化。而且，用于防止水分渗入生物体组织LT的物质维持对已接合的生物体组织LT进行了涂敷的状态。The substance for preventing moisture from penetrating into the living tissueLT is gradually solidified by being cooled by stopping the energy supply, for example. Furthermore, the substance for preventing moisture from penetrating into the living tissueLT maintains the state of being applied to the joined living tissueLT .
另外，优选的是覆盖构件224、234中的、未与加热器222、232相接触的部分维持配设在第1及第2保持构件52、54的主体62、72上的状态。即，配设在第1保持构件52上的覆盖构件224从主体62的保持面62a离开第2保持构件54的一侧维持着配设于主体62的外周面的状态。另外，配设在第2保持构件54上的覆盖构件234从主体72的保持面72a离开第1保持构件52的一侧维持着配设于主体72的外周面的状态。In addition, it is preferable that the parts of the covering members 224 , 234 not in contact with the heaters 222 , 232 maintain a state of being arranged on the main bodies 62 , 72 of the first and second holding members 52 , 54 . That is, the cover member 224 arranged on the first holding member 52 maintains the state of being arranged on the outer peripheral surface of the main body 62 on the side away from the second holding member 54 from the holding surface 62 a of the main body 62 . In addition, the cover member 234 arranged on the second holding member 54 maintains a state of being arranged on the outer peripheral surface of the main body 72 on the side away from the first holding member 52 from the holding surface 72 a of the main body 72 .
另外，在使用图28B所示的多孔质状的覆盖构件224、234、图28C所示的网状的覆盖构件224、234的情况下，在处理中也可以不使用加热器222、232而使用高频电极92、94。在使用图28B所示的多孔质状的覆盖构件224、234的情况下，高频电极92、94的一部分与生物体组织L1、L2相接触。另外，在使用图28C所示的网状的覆盖构件224、234的情况下，高频电极92、94的一部分与生物体组织L1、L2相接触。因而，在使用这些多孔质状、网状的覆盖构件224、234的情况下，能够使用高频电极92、94或加热器222、232中的任意一种。In addition, in the case of using the porous covering members 224, 234 shown in FIG. 28B and the mesh-like covering members 224, 234 shown in FIG. High-frequency electrodes 92,94. When the porous covering members 224 and 234 shown in FIG. 28B are used, a part of the high-frequency electrodes 92 and 94 is in contact with the living tissues L1 and L2. In addition, in the case of using the mesh-shaped covering members 224 and 234 shown in FIG. 28C , a part of the high-frequency electrodes 92 and 94 is in contact with the living tissues L1 and L2 . Therefore, when using these porous or mesh covering members 224, 234, either of the high-frequency electrodes 92, 94 and the heaters 222, 232 can be used.
另一方面，在使用图28A所示的无孔片状的覆盖构件224、234的情况下，由于高频电极92、94不会与生物体组织L1、L2相接触，因此该情况优选的是使用加热器222、232。另外，只要在无孔片状的覆盖构件224、234的一部分上设置孔，使高频电极92、94能够直接与生物体组织L1、L2相接触，也能够如下所说明那样利用高频能量进行处理。另外，只要采用通电材料形成覆盖构件224、234，也可以如下所说明那样利用高频能量进行处理。On the other hand, in the case of using the non-porous sheet-like covering members 224, 234 shown in FIG. 28A, since the high-frequency electrodes 92, 94 do not contact the living tissues L1, L2, it is preferable Heaters 222, 232 are used. In addition, as long as a hole is provided in a part of the non-porous sheet-shaped covering member 224, 234 so that the high-frequency electrodes 92, 94 can directly contact the living tissue L1, L2, it can also be performed using high-frequency energy as described below. deal with. In addition, as long as the covering members 224 and 234 are formed of an electrically conductive material, they can also be treated with high-frequency energy as described below.
接着，说明在取代加热器222、232而使用高频电极92、94对生物体组织L1、L2进行处理的情况下的治疗用处理系统10的作用。在此，使用图28B所示的多孔质状的覆盖构件224、234、图28C所示的网状的覆盖构件224、234。Next, the operation of the treatment system 10 for treatment when the living tissues L1 and L2 are treated using the high-frequency electrodes 92 and 94 instead of the heaters 222 and 232 will be described. Here, porous covering members 224 and 234 shown in FIG. 28B and mesh covering members 224 and 234 shown in FIG. 28C are used.
如图27A所示，利用覆盖构件224、234卷绕在第1及第2保持构件52、54的主体62、72上的状态下的主体62、72来保持生物体组织L1、L2。此时，虽然覆盖构件224、234与生物体组织L1、L2的外表面相接触，但是由于在覆盖构件224、234上具有孔，因此高频电极92、94的一部分也与生物体组织L1、L2的外表面相接触。在如此保持了生物体组织L1、L2的状态下，从高频电极92、94向生物体组织L1、L2供给高频能量。As shown in FIG. 27A , the living tissues L1 , L2 are held by the main bodies 62 , 72 with the covering members 224 , 234 wound around the main bodies 62 , 72 of the first and second holding members 52 , 54 . At this time, although the covering members 224, 234 are in contact with the outer surfaces of the living tissues L1, L2, since the covering members 224, 234 have holes, part of the high-frequency electrodes 92, 94 also contact the living tissues L1, L2. contact with the outer surface. With the living tissues L1 and L2 held in this way, high-frequency energy is supplied from the high-frequency electrodes 92 and 94 to the living tissues L1 and L2 .
随着从高频电极92、94向生物体组织L1、L2供给能量而生物体组织L1、L2自身发热，覆盖构件224、234中的、与生物体组织L1、L2相接触的部分熔融。然后，熔融的覆盖构件224、234在利用第1及第2保持构件52、54的主体62、72保持的生物体组织L1、L2的整个外周面上扩展。即，成为与粘接剂等流体涂布于生物体组织L1、L2的外周面的情况相同的状态。而且，若阻抗Z达到预定的阈值Z1而停止向高频电极92、94供给能量，则生物体组织LT的温度降低，并且用于防止水分渗入生物体组织LT的物质固化。As energy is supplied from the high-frequency electrodes 92 and 94 to the living tissues L1 and L2 , the living tissues L1 and L2 generate heat by themselves, and portions of the covering members 224 and 234 that are in contact with the living tissues L1 and L2 melt. Then, the molten covering members 224 , 234 spread over the entire outer peripheral surfaces of the living tissues L1 , L2 held by the main bodies 62 , 72 of the first and second holding members 52 , 54 . That is, it is in the same state as when a fluid such as an adhesive is applied to the outer peripheral surfaces of the living tissues L1 and L2. Then, when the impedance Z reaches the predetermined threshold value Z1 and the energy supply to the high frequency electrodes 92 and 94 is stopped, the temperature of the living tissueLT is lowered, and the substance for preventing moisture from penetrating into the living tissueLT is solidified.
此时，粘接剂等流体起到防止水分渗入已接合的生物体组织LT的作用。因此，能够长时间维持生物体组织L1、L2彼此相接合的状态。At this time, the fluid such as the adhesive plays a role of preventing moisture from penetrating into the bonded living tissueLT . Therefore, the joined state of the living tissues L1 and L2 can be maintained for a long period of time.
另外，在图30中表示覆盖构件224、234覆盖于生物体组织L1、L2的外侧的示意图。在这种状态下，若使用热能、高频能量对生物体组织L1、L2进行处理，则已接合的生物体组织LT的外侧成为被用于防止水分渗入生物体组织LT的物质覆盖的状态。In addition, FIG. 30 shows a schematic view in which the covering members 224, 234 cover the outside of the living tissues L1, L2. In this state, if the living tissues L1 and L2 are treated with thermal energy or high-frequency energy, the outside of the joined living tissuesLT becomes covered with a substance for preventing moisture from penetrating into the living tissuesLT . state.
(第8实施方式)(eighth embodiment)
接着，使用图31A～图35说明第8实施方式。该实施方式是第7实施方式的变形例，对与第7实施方式中所说明的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略详细的说明。Next, an eighth embodiment will be described using FIGS. 31A to 35 . This embodiment is a modified example of the seventh embodiment, and the same members as those described in the seventh embodiment or members having the same functions are assigned the same reference numerals, and detailed description thereof will be omitted.
如图31A及图31B所示，在第1及第2保持构件52、54上形成有刀具引导槽172、174。另外，刀具引导槽172、174能够供具有长槽184的刀具180(参照图15A及图15B)出入。As shown in FIGS. 31A and 31B , cutter guide grooves 172 and 174 are formed in the first and second holding members 52 and 54 . In addition, the cutter guide grooves 172 and 174 allow a cutter 180 (see FIGS. 15A and 15B ) having a long groove 184 to enter and exit.
在配设在第1保持构件52的主体62上的高频电极92的背面，配设有多个加热器(能量输出部)242。同样，虽未图示，但在配设在第2保持构件54的主体72上的高频电极94的背面，配设有多个加热器(能量输出部)252。在此，加热器242、252能够利用高频能量输出部104进行控制。即，高频能量输出部104能够向高频电极92、94供给能量，并且能够向加热器242、252供给能量。另外，既可以设为能够选择性地向高频电极92、94、加热器242、252这两者供给能量，也可以设为能够同时向该两者供给能量。A plurality of heaters (energy output units) 242 are arranged on the back surface of the high-frequency electrode 92 arranged on the main body 62 of the first holding member 52 . Similarly, although not shown, a plurality of heaters (energy output units) 252 are arranged on the back surface of the high-frequency electrode 94 arranged on the main body 72 of the second holding member 54 . Here, the heaters 242 and 252 can be controlled by the high-frequency energy output unit 104 . That is, the high-frequency energy output unit 104 can supply energy to the high-frequency electrodes 92 and 94 and can supply energy to the heaters 242 and 252 . In addition, energy may be selectively supplied to both the high-frequency electrodes 92 and 94 and the heaters 242 and 252 , or energy may be supplied to both of them simultaneously.
而且，由于高频电极92、94分别由具有良好导热性的材料形成，因此，若从高频能量输出部104向加热器242、252供给能量而使加热器242、252发热，则从加热器242、252向高频电极92、94导热。传递到高频电极92、94的热量例如以同心状从加热器242、252扩散。Moreover, since the high-frequency electrodes 92 and 94 are formed of materials having good thermal conductivity, respectively, if energy is supplied from the high-frequency energy output unit 104 to the heaters 242 and 252 to cause the heaters 242 and 252 to generate heat, the heat from the heaters will 242 , 252 conduct heat to high-frequency electrodes 92 , 94 . The heat transmitted to the high-frequency electrodes 92 and 94 diffuses concentrically from the heaters 242 and 252 , for example.
接着，使用图32说明该实施方式的治疗用处理系统10的作用。在此，使用含有接合辅助剂的、无孔片状的覆盖构件224、234。Next, the operation of the therapeutic treatment system 10 of this embodiment will be described with reference to FIG. 32 . Here, non-porous sheet-like covering members 224 and 234 containing a bonding auxiliary agent are used.
另外，适当地设定从高频能量输出部104对加热器242、252输出的输出量及输出时间(S181)。在此，说明将对加热器242、252输出的输出时间设为10秒的情况。In addition, the output amount and output time from the high-frequency energy output unit 104 to the heaters 242 and 252 are appropriately set (S181). Here, a case where the output time to the heaters 242 and 252 is set to 10 seconds will be described.
若按压脚踏开关16的踏板(S182)，则从高频能量输出部104向加热器242、252供给能量，使加热器242、252发热(S183)。判断从供给能量开始是否经过了10秒(S184)。在从高频能量输出部104向加热器242、252输出了10秒之后，停止对加热器242、252供给能量(S185)。然后，从扬声器110发出蜂鸣音，通知停止对加热器242、252供给热能，并且通知使刀具180工作(S186)。When the pedal of the foot switch 16 is pressed (S182), energy is supplied from the high-frequency energy output unit 104 to the heaters 242, 252, and the heaters 242, 252 generate heat (S183). It is judged whether or not 10 seconds have elapsed since the energy was supplied (S184). After 10 seconds of output from the high-frequency energy output unit 104 to the heaters 242 and 252, energy supply to the heaters 242 and 252 is stopped (S185). Then, a buzzer sound is emitted from the speaker 110 to notify that the heating energy supply to the heaters 242 and 252 is stopped and that the cutter 180 is operated (S186).
在此，通过自加热器242、252向高频电极92、94导热，使无孔片状的覆盖构件224、234的与高频电极92、94相接触的部分熔融。Here, heat conduction from the heaters 242 and 252 to the high-frequency electrodes 92 and 94 melts portions of the non-porous sheet-shaped covering members 224 and 234 that are in contact with the high-frequency electrodes 92 and 94 .
之后，使刀具180向刀具引导槽前进，切割生物体组织L1、L2(S187)。即，形成生物体组织L1、L2的切割面S。然后，使刀具180返回到原来的位置(S188)。Thereafter, the knife 180 is advanced toward the knife guide groove to cut the living tissues L1 and L2 (S187). That is, the cut surface S of the living tissue L1, L2 is formed. Then, the cutter 180 is returned to the original position (S188).
然后，从高频能量输出部104向高频电极92、94供给能量(S189)。在此，当判断为阻抗Z达到阈值Z1时(S1810)，停止从高频能量输出部104向高频电极92、94的输出(S1811)。Then, energy is supplied from the high-frequency energy output unit 104 to the high-frequency electrodes 92 and 94 (S189). Here, when it is determined that the impedance Z has reached the threshold value Z1 (S1810), the output from the high-frequency energy output unit 104 to the high-frequency electrodes 92 and 94 is stopped (S1811).
从扬声器110发出蜂鸣音，通知高频能量的供给已停止(S1812)。因此，医生等能够识别一连串的处理已结束。A buzzer sound is emitted from the speaker 110 to notify that the supply of high-frequency energy has stopped (S1812). Therefore, a doctor or the like can recognize that a series of treatments has been completed.
在该实施方式中，说明了组合加热器242、252作用下的热能与高频电极92、94作用下的高频能量这两者来进行一连串处理的情况，但是也能够仅使用热能来进行一连串的处理。In this embodiment, the case where a series of treatments are performed in combination of thermal energy by the heaters 242, 252 and high-frequency energy by the high-frequency electrodes 92, 94 is described, but it is also possible to perform a series of treatments using only thermal energy. processing.
接着，使用图34说明使用含有接合辅助剂的多孔质状或网状的覆盖构件224、234时的治疗用处理系统10的作用(第1作用)。Next, the action (first action) of the therapeutic treatment system 10 when using the porous or mesh-like covering members 224 and 234 containing the joining auxiliary agent will be described with reference to FIG. 34 .
操作显示部108，设定高频能量的输出量等(S281)。然后，利用分别配设有覆盖构件224、234的第1及第2保持构件52、54的主体62、72来保持生物体组织L1、L2。在该状态下按压脚踏开关16的踏板(S282)。The display unit 108 is operated to set the output amount of high-frequency energy and the like (S281). Then, the living tissues L1, L2 are held by the main bodies 62, 72 of the first and second holding members 52, 54 provided with the covering members 224, 234, respectively. In this state, the pedal of the foot switch 16 is pressed (S282).
从高频能量输出部104向高频电极92、94传递能量，向高频电极92、94之间的生物体组织L1、L2通入高频电流(S283)。当通入高频电流时，阻抗Z从初始值Z0下降，之后再次上升(参照图5A)。在此，将最下点的阻抗设为Zmin，将在最下点的阻抗Zmin之后测量的下一测量的阻抗设为Zmin+1，此时，最下点的阻抗Zmin的下一测量的阻抗Zmin+1大于阻抗Zmin，并且，在阻抗Zmin+1小于初始值Z0的情况下，能够判断出最下点的阻抗Zmin(S284)。如此，当判断为阻抗Z从最下点的阻抗Zmin再次转为上升时，停止供给来自高频能量输出部104的能量(S285)。此时，从扬声器110发出蜂鸣音，通知停止向生物体组织L1、L2供给高频能量，并且识别使刀具180动作的情况(S286)。Energy is transmitted from the high-frequency energy output unit 104 to the high-frequency electrodes 92, 94, and a high-frequency current is passed to the living tissues L1, L2 between the high-frequency electrodes 92, 94 (S283). When a high-frequency current is applied, the impedance Z drops from an initial value Z0 and then rises again (see FIG. 5A ). Here, the impedance at the lowest point is set to Zmin, and the next measured impedance measured after the impedance Zmin at the lowest point is set to Zmin+1. At this time, the next measured impedance of the impedance Zmin at the lowest point Zmin+1 is greater than the impedance Zmin, and if the impedance Zmin+1 is smaller than the initial value Z0, the impedance Zmin of the lowest point can be determined (S284). In this way, when it is determined that the impedance Z has turned to rise again from the impedance Zmin at the lowest point, the supply of energy from the high-frequency energy output unit 104 is stopped (S285). At this time, a buzzer sound is emitted from the speaker 110 to notify that the supply of high-frequency energy to the living tissues L1 and L2 is stopped, and it is recognized that the blade 180 is operated (S286).
刀具180在沿着第1及第2保持构件52、54的刀具引导槽172、174自动且缓慢前进而切割生物体组织L1、L2之后(S287)，返回到原来的位置(S288)。此时，在被控制了速度、位置等的状态下，刀具180从柄线24的移动限制销42a位于刀具180的长槽184的顶端侧的卡定部184a的状态移动，从而移动到长槽184的基端侧的卡定部184b，之后，刀具180再次移动，从而配设到长槽184的顶端侧的卡定部184a(原来的位置)上。The cutter 180 automatically and slowly advances along the cutter guide grooves 172, 174 of the first and second holding members 52, 54 to cut the living tissues L1, L2 (S287), and then returns to the original position (S288). At this time, in the state where the speed, position, etc. are controlled, the cutter 180 moves from the state where the movement restricting pin 42a of the handle 24 is located at the engaging portion 184a on the front end side of the long groove 184 of the cutter 180, thereby moving to the long groove. 184 on the base end side of the locking portion 184 , and then the cutter 180 is moved again to be arranged on the locking portion 184 a on the distal end side of the elongated groove 184 (original position).
之后，从高频能量输出部104向加热器242、252供给能量，加热器242、252发热(S289)。从高频能量输出部104向加热器242、252开始供给能量，当经过了10秒时(S2810)，停止供给能量(S2811)。After that, energy is supplied from the high-frequency energy output unit 104 to the heaters 242 and 252, and the heaters 242 and 252 generate heat (S289). Energy supply from the high-frequency energy output unit 104 to the heaters 242 and 252 is started, and when 10 seconds have elapsed (S2810), the energy supply is stopped (S2811).
加热器242、252向高频电极92、94导热，从这些高频电极92、94直接向生物体组织施加热量，因此在使生物体组织(蛋白质)一体地改性的同时对作为蛋白质彼此结合的阻碍因素的水分进行去除。The heaters 242, 252 conduct heat to the high-frequency electrodes 92, 94, and directly apply heat to the living tissue from these high-frequency electrodes 92, 94, thereby integrally modifying the living tissue (protein) and binding to each other as proteins. The hindering factor of moisture is removed.
然后，从扬声器110发出蜂鸣音，通知一连串的处理已结束(S2812)。Then, a buzzer sound is emitted from the speaker 110 to notify that a series of processes have been completed (S2812).
另外，覆盖构件224、234既可以通过利用高频能量使生物体组织L1、L2发热而熔融，也可以通过利用加热器242、252直接加热覆盖构件224、234而使其熔融。In addition, the covering members 224 , 234 may be melted by heating the living tissues L1 , L2 with high-frequency energy, or may be melted by directly heating the covering members 224 , 234 with the heaters 242 , 252 .
接着，使用图35说明使用了多孔质状或网状的覆盖构件224、234时的治疗用处理系统10的作用(第2作用)。Next, the action (second action) of the therapeutic treatment system 10 when the porous or mesh-like covering members 224 and 234 are used will be described with reference to FIG. 35 .
在此，与图34所示的第1作用不同，说明不使用加热器242、252、而利用高频电极92、94的高频能量处理来进行一连串处理的情况。Here, unlike the first operation shown in FIG. 34 , a case where a series of treatments are performed by high-frequency energy treatment by high-frequency electrodes 92 and 94 without using heaters 242 and 252 will be described.
与第1作用相同，利用刀具180切割生物体组织L1、L2、直至形成切割面S这一过程是相同的(S381－S388)。在使刀具180返回到原来的位置之后，利用高频电极92、94进行使用了高频能量的处理(S389)。然后，在阈值Z1与阻抗Z相同、或阻抗Z大于阈值Z1的情况下(S3810)，停止供给来自高频能量输出部104的能量(S3811)。然后，通过从扬声器110发出蜂鸣音来通知一连串的处理已结束(S3812)。Similar to the first action, the process of cutting the living tissues L1 and L2 with the cutter 180 until the cutting plane S is formed is the same (S381-S388). After the cutter 180 is returned to the original position, a process using high-frequency energy is performed by the high-frequency electrodes 92 and 94 (S389). Then, when the threshold Z1 is equal to the impedance Z, or the impedance Z is greater than the threshold Z1 (S3810), the supply of energy from the high-frequency energy output unit 104 is stopped (S3811). Then, a buzzer sound is emitted from the speaker 110 to notify that a series of processes have been completed (S3812).
如以上说明那样，根据该实施方式能够获得以下效果。As described above, according to this embodiment, the following effects can be obtained.
由于能够适当地组合利用高频能量进行的生物体组织的处理和利用热能进行的生物体组织的处理，因此能够对生物体组织进行最佳的处理。Since the treatment of living tissue by high-frequency energy and the treatment of living tissue by thermal energy can be appropriately combined, optimal treatment of living tissue can be performed.
(第9实施方式)(ninth embodiment)
接着，使用图36A～图36C说明第9实施方式。该实施方式是第7及第8实施方式的变形例，对与第7及第8实施方式中所说明的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略详细的说明。Next, a ninth embodiment will be described using FIGS. 36A to 36C . This embodiment is a modified example of the seventh and eighth embodiments, and the same members as those described in the seventh and eighth embodiments or members having the same functions are given the same reference numerals, and detailed descriptions are omitted. .
在该实施方式中，说明以在生物体组织L1、L2的接触面C1、C2之间夹入了含有接合辅助剂的网状(参照图36A)或多孔质状(参照图36B)的接合辅助构件(接合维持辅助部)262的状态利用热能、高频能量形成牢固的接合部C的情况。In this embodiment, a mesh-shaped (refer to FIG. 36A ) or porous (refer to FIG. 36B ) bonding aid is explained between the contact surfaces C1 and C2 of the living tissues L1 and L2 . The state of the member (joint maintenance auxiliary part) 262 is formed by thermal energy or high-frequency energy to form a strong joint part C.
接合辅助构件262优选的是使用与第7实施方式中所说明的覆盖构件224、234相同的原材料，在该情况下，起到与覆盖构件224、234相同的作用。It is preferable to use the same material as the covering members 224 and 234 described in the seventh embodiment for the joining auxiliary member 262 , and in this case, it functions the same as the covering members 224 and 234 .
在生物体组织L1、L2之间配置接合辅助构件262。在此，利用能量处理器具12的第1及第2保持构件52、54保持生物体组织L1、L2。此时，接合辅助构件262由于配设在生物体组织L1、L2之间，因此通过利用第1及第2保持构件52、54保持生物体组织L1、L2而将接合辅助构件262保持在生物体组织L1、L2之间。The joint assisting member 262 is disposed between the living tissues L1, L2. Here, the living tissues L1 and L2 are held by the first and second holding members 52 and 54 of the energy treatment device 12 . At this time, since the joining auxiliary member 262 is arranged between the living tissues L1 and L2, the joining supporting member 262 is held in the living body by holding the living tissues L1 and L2 by the first and second holding members 52 and 54. Tissue between L1 and L2.
在此，由于接合辅助构件262形成为网状(参照图36A)、多孔质状(参照图36B)，因此生物体组织L1、L2的接触面C1、C2的一部分相互接触。因此，若向高频电极92、94之间通入高频电流，则生物体组织L1、L2被通电而生物体组织L1、L2发热。接合辅助构件262因生物体组织L1、L2的发热而熔融，成为与在整个接触面C1、C2上涂布有用于防止水分渗入生物体组织LT的物质相同的情况。而且，用于防止水分渗入生物体组织LT的物质从接触面C1、C2朝向与高频电极92、94相接触的外表面Sc渗入。因此，用于防止水分渗入生物体组织LT的物质不仅渗入生物体组织L1、L2彼此的接合面，还渗入接合面周围的组织。因而，能够在生物体组织L1、L2中的、不仅接触面C1、C2上、而且在更广的范围内形成生物体组织L1、L2彼此的接合部C。即，此处所说的接合部C不仅包括接合面，还包括其周围的组织。Here, since the joining auxiliary member 262 is formed in a mesh shape (see FIG. 36A ) or a porous shape (see FIG. 36B ), parts of the contact surfaces C1 , C2 of the living tissues L1 , L2 are in contact with each other. Therefore, when a high-frequency current is passed between the high-frequency electrodes 92, 94, the living tissues L1, L2 are energized, and the living tissues L1, L2 generate heat. The joint assisting member 262 melts due to heat generated by the living tissues L1, L2, and is coated with a substance for preventing moisture from penetrating into the living tissues LT over the entire contact surfaces C1, C2. Furthermore, the substance for preventing the infiltration of moisture into the living tissueLT infiltrates from the contact surfaces C1 , C2 toward the outer surface Sc in contact with the high-frequency electrodes 92 , 94 . Therefore, the substance for preventing the infiltration of moisture into the living tissue LT penetrates not only into the joint surfaces of the living tissues L1 and L2 but also into the tissues around the joint surfaces. Therefore, the joint portion C between the living tissues L1 and L2 can be formed not only on the contact surfaces C1 and C2 but also over a wider range of the living tissues L1 and L2 . That is, the joint portion C referred to here includes not only the joint surface but also its surrounding tissues.
在该状态下，向生物体组织L1、L2通入高频电流直至阻抗Z达到阈值Z1。在阻抗Z达到了阈值Z1之后，停止供给能量。此时，生物体组织L1、L2的接合部C的接合面通过生物体组织L1、L2的高频能量下的处理而使胶原彼此接合，并且利用用于防止水分渗入生物体组织LT的物质相接合。In this state, a high-frequency current is passed through the living tissues L1 and L2 until the impedance Z reaches the threshold value Z1. After the impedance Z reaches the threshold value Z1, the supply of energy is stopped. At this time, the joint surface of the junction part C of the living tissues L1 and L2 is treated with high-frequency energy of the living tissues L1 and L2 to join the collagens together, and a substance for preventing moisture from penetrating into the living tissues LT is used. join together.
如以上说明那样，根据该实施方式，能够获得以下效果。As described above, according to this embodiment, the following effects can be obtained.
通过在生物体组织L1、L2之间配置接合辅助构件262而接合生物体组织L1、L2彼此，除了在使用高频能量时获得的生物体组织L1、L2的接合力以外，还能够利用粘接剂这样的物质来接合接触面C1、C2彼此，因此能够获得较大的接合力。另外，由于粘接剂这样的物质是用于防止水分渗入生物体组织LT的物质，因此能够防止水分渗入生物体组织L1、L2的接合面，因此能够长时间维持较大的接合力。By arranging the joining auxiliary member 262 between the living tissues L1 and L2 to join the living tissues L1 and L2, in addition to the joining force of the living tissues L1 and L2 obtained when high-frequency energy is used, it is also possible to utilize adhesive Since the contact surfaces C1 and C2 are bonded to each other using a substance such as an agent, a large bonding force can be obtained. In addition, since substances such as adhesives are used to prevent moisture from penetrating into the living tissue LT , it is possible to prevent moisture from penetrating into the bonding surface of the living tissues L1 and L2, thereby maintaining a high bonding force for a long time.
(第10实施方式)(tenth embodiment)
接着，使用图37～图41说明第10实施方式。该实施方式是第1～第9实施方式的变形例，对与第1～第9实施方式中所说明的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略详细的说明。Next, a tenth embodiment will be described using FIGS. 37 to 41 . This embodiment is a modified example of the first to ninth embodiments, and the same members as those described in the first to ninth embodiments or members having the same functions are denoted by the same reference numerals, and detailed description thereof will be omitted. .
如图39A及图39B所示，第1保持构件52的基部64以相对于筒体42能够转动的方式被支承销83枢接。该支承销83配设为与第1实施方式中所说明的支承销82平行。与第2保持构件54的基部74的弹性构件84相同，第1保持构件52的基部64被板簧等弹性构件85偏置。另外，在该实施方式中，如图37A及图39B所示，能量处理器具12c的处理部26优选的是第1保持构件52及第2保持构件54这两者相对于柄线24的中心轴线对称张开。As shown in FIGS. 39A and 39B , the base portion 64 of the first holding member 52 is pivotally connected to the support pin 83 so as to be rotatable with respect to the cylindrical body 42 . The support pin 83 is disposed parallel to the support pin 82 described in the first embodiment. Like the elastic member 84 of the base portion 74 of the second holding member 54 , the base portion 64 of the first holding member 52 is biased by an elastic member 85 such as a leaf spring. In addition, in this embodiment, as shown in FIG. 37A and FIG. 39B , it is preferable that the treatment portion 26 of the energy treatment tool 12c is positioned so that both the first holding member 52 and the second holding member 54 are relative to the central axis of the handle 24. Open symmetrically.
如图37A、图38、图39A及图38B所示，在该实施方式中，作为处理用辅助器具，取代刀具180(参照图15A及图15B)而配设有管状构件(接合维持辅助部)272。如图39A及图39B所示，管状构件272的基端与软管18a相连接。As shown in Fig. 37A, Fig. 38, Fig. 39A and Fig. 38B, in this embodiment, a tubular member (joint maintenance auxiliary part) is arranged instead of the knife 180 (see Fig. 15A and Fig. 15B ) as a treatment auxiliary tool. 272. As shown in FIGS. 39A and 39B , the proximal end of the tubular member 272 is connected to the hose 18 a.
如图39B所示，在该管状构件272的顶端部侧形成有多个侧孔272a。该管状构件272利用配设在手柄22上的管状构件移动用把手36的操作能够在从柄线24的内部到处理部26的内部之间进退，能够检测管状构件272相对于处理部26、柄线24的位置。As shown in FIG. 39B , a plurality of side holes 272 a are formed on the tip side of the tubular member 272 . The tubular member 272 can move forward and backward from the inside of the handle 24 to the inside of the treatment part 26 by operating the handle 36 for moving the tubular member provided on the handle 22, and it is possible to detect the relative position of the tubular member 272 to the treatment part 26, the handle, and the handle. The location of line 24.
如图40A及图40B所示，在第1保持构件52的主体62上形成有凹部(管状构件引导槽)62c，该凹部62c形成有用于使管状构件272进退的空间。优选的是，该凹部62c的宽度形成为稍微大于管状构件272的外径。在凹部62c内也配设有高频电极92a。配设在凹部62c内的高频电极92a与配设在主体62的保持面62a的内侧的高频电极92为同电位。As shown in FIGS. 40A and 40B , the main body 62 of the first holding member 52 has a recessed portion (tubular member guide groove) 62c forming a space for moving the tubular member 272 forward and backward. It is preferable that the width of the concave portion 62 c is formed slightly larger than the outer diameter of the tubular member 272 . The high-frequency electrode 92a is also arranged in the concave portion 62c. The high-frequency electrode 92 a arranged in the concave portion 62 c has the same potential as the high-frequency electrode 92 arranged inside the holding surface 62 a of the main body 62 .
另外，如图40B所示，在第2保持构件54的主体72上也形成有凹部72c，在凹部72c内配设有与高频电极94同电位的高频电极94a。Further, as shown in FIG. 40B , a recess 72 c is also formed in the main body 72 of the second holding member 54 , and a high-frequency electrode 94 a having the same potential as the high-frequency electrode 94 is disposed in the recess 72 c.
接着，说明该实施方式的治疗用处理系统10的作用。Next, the operation of the therapeutic treatment system 10 of this embodiment will be described.
如图40B所示，将能量处理器具12c的管状构件272配置在接合对象的生物体组织L1、L2彼此之间。然后，利用第1及第2保持构件52、54的主体62、72保持生物体组织L1、L2，并且利用生物体组织L1、L2夹住管状构件272。此时，将第7实施方式中所说明的、含有接合辅助剂的网状、多孔质状的覆盖构件224、234(参照图28B及图28C)配设在接合对象的生物体组织L1、L2的外侧。As shown in FIG. 40B , the tubular member 272 of the energy processing device 12c is arranged between the living tissues L1 and L2 of the joining target. Then, the body tissues L1, L2 are held by the bodies 62, 72 of the first and second holding members 52, 54, and the tubular member 272 is sandwiched by the body tissues L1, L2. At this time, the mesh-shaped and porous covering members 224 and 234 (see FIG. 28B and FIG. 28C ) containing the bonding auxiliary agent described in the seventh embodiment are placed on the living tissues L1 and L2 of the bonding target. outside.
在该状态下，从流体存储部122通过软管18a向管状构件272导入粘接剂等用于防止水分渗入生物体组织LT的物质(接合辅助剂)。因此，从管状构件272的侧孔272a向生物体组织L1、L2涂布用于防止水分渗入生物体组织LT的物质。在该状态下，操作管状构件移动用把手36，从第1及第2保持构件52、54的主体62、72之间抽出管状构件272。因此，生物体组织L1、L2的接触面C1、C2彼此隔着用于防止水分渗入生物体组织LT的物质相接触。In this state, a substance (junction aid) for preventing moisture from penetrating into the living tissueLT , such as an adhesive, is introduced from the fluid storage unit 122 through the hose 18a into the tubular member 272 . Therefore, a substance for preventing moisture from penetrating into the living tissues LT is applied to the living tissues L1 and L2 from the side hole 272 a of the tubular member 272 . In this state, the tubular member moving handle 36 is operated, and the tubular member 272 is pulled out from between the main bodies 62 , 72 of the first and second holding members 52 , 54 . Therefore, the contact surfaces C1, C2 of the living tissues L1, L2 are in contact with each other via a substance for preventing moisture from penetrating into the living tissues LT .
然后，从高频能量输出部104向高频电极92、94供给能量。因此，接合面上的用于防止水分渗入生物体组织LT的物质被加热，并且接合面彼此相接合。另外，网状、多孔质状的覆盖构件224、234在来自生物体组织L1、L2的热量的作用下熔融而对接合对象的生物体组织L1、L2的外侧进行涂敷。Then, energy is supplied from the high-frequency energy output unit 104 to the high-frequency electrodes 92 and 94 . Therefore, the substance for preventing moisture from penetrating into the living tissueLT on the joint surfaces is heated, and the joint surfaces are joined to each other. In addition, the mesh-shaped and porous covering members 224 and 234 are melted by heat from the living tissues L1 and L2 to coat the outer sides of the living tissues L1 and L2 to be joined.
若随着向高频电极92、94供给能量、或者能量的供给停止，则用于防止水分渗入生物体组织LT的物质固化。此时，配设在生物体组织L1、L2彼此的接合面上的、用于防止水分渗入生物体组织LT的物质从生物体组织L1、L2彼此的接触面C1、C2朝向高频电极92、92a、94、94a渗入。因此，用于防止水分渗入生物体组织LT的物质发挥作用，以维持生物体组织L1、L2彼此接合的状态(粘接状态)。When the energy is supplied to the high-frequency electrodes 92 and 94 or the energy supply is stopped, the substance for preventing moisture from penetrating into the living tissueLT solidifies. At this time, the substance for preventing moisture from penetrating into the living tissue LT arranged on the joint surfaces of the living tissues L1 and L2 is directed toward the high-frequency electrode 92 from the contact surfaces C1 and C2 of the living tissues L1 and L2. , 92a, 94, 94a infiltrated. Therefore, the substance for preventing moisture from penetrating into the living tissue LT functions to maintain the state in which the living tissues L1 , L2 are bonded to each other (adhesive state).
如以上说明那样，根据该实施方式，能够获得以下效果。As described above, according to this embodiment, the following effects can be obtained.
能够在生物体组织L1、L2之间直接涂布用于防止水分渗入生物体组织LT的物质。即，能够在生物体组织L1、L2的接触面C1、C2彼此之间可靠地涂布用于防止水分渗入生物体组织LT的物质。因而，在使用高频能量等接合生物体组织L1、L2彼此时，由于在接触面C1、C2之间配设有用于防止水分渗入生物体组织LT的物质，因此即使作用有解除生物体组织L1、L2彼此的接合的方向的力，也能够防止水分向生物体组织L1、L2彼此的接合面进入，从而能够长时间维持接合状态。A substance for preventing moisture from penetrating into the living tissue LT can be directly applied between the living tissues L1 and L2 . That is, a substance for preventing moisture from penetrating into the living tissue LT can be reliably applied between the contact surfaces C1 , C2 of the living tissues L1 , L2 . Therefore, when the living tissues L1 and L2 are joined together using high-frequency energy or the like, since a substance for preventing moisture from penetrating into the living tissuesLT is arranged between the contact surfaces C1 and C2, even if it acts to release the living tissues The force in the joining direction of L1, L2 can also prevent moisture from entering the joining surface of living tissues L1, L2, and maintain the joined state for a long time.
另外，在该实施方式中，说明了使用覆盖构件224、234的情况，但是未必必须使用覆盖构件224、234。In addition, in this embodiment, the case where the covering members 224 and 234 are used has been described, but the covering members 224 and 234 are not necessarily required to be used.
另外，在该实施方式中，说明了取代刀具180而使用管状构件272的情况，但是也可以在管状构件272的基端配设超声波振子276(参照图41)。即，管状构件272作为对生物体组织L1、L2输出超声波能量的能量输出部发挥功能。在该情况下，能够通过使用了管状构件272的超声波处理以使胶原露出在生物体组织L1、L2的接触面C1、C2的方式进行了预处理，之后，利用用于防止水分渗入生物体组织LT的物质粘接生物体组织L1、L2。In addition, in this embodiment, the case where the tubular member 272 is used instead of the cutter 180 has been described, but the ultrasonic vibrator 276 may be arranged at the proximal end of the tubular member 272 (see FIG. 41 ). That is, the tubular member 272 functions as an energy output unit that outputs ultrasonic energy to the living tissues L1 and L2. In this case, pretreatment can be performed by ultrasonic treatment using the tubular member 272 so that the collagen is exposed on the contact surfaces C1 and C2 of the living tissues L1 and L2, and then, the ultrasonic treatment for preventing moisture from penetrating into the living tissues can be performed. The substance ofLT adheres to living tissue L1, L2.
(第11实施方式)(the eleventh embodiment)
接着，使用图42A～图42C说明第11实施方式。该实施方式是第1～第10实施方式的变形例。在上述实施方式中，说明了使用高频能量、由加热器242、252的发热带来的热能、超声波能量等进行处理的情况，但是在该实施方式中，说明使用由激光带来的热能进行处理的情况下的第1保持构件52。Next, an eleventh embodiment will be described using FIGS. 42A to 42C . This embodiment is a modified example of the first to tenth embodiments. In the above-mentioned embodiment, the case of using high-frequency energy, thermal energy due to heat generated by the heaters 242 and 252, ultrasonic energy, etc. for treatment has been described. The first holding member 52 in case of handling.
如图42A～图42C所示，在第1保持构件52上取代高频电极92而配设有导热板(能量输出部)282。在该导热板282上形成有凹槽282a。在该导热板282的凹槽282a内配设有扩散器(diffuser)284作为输出构件、能量输出部。在该扩散器284的内部贯穿有光纤(能量输出部)286。因此，若激光入射到光纤286，则激光从扩散器284向外侧扩散。该激光下的能量照射到导热板282而转换为热能。因此，能够像第8实施方式中所述的、从加热器242导热的高频电极92(参照图31A及图31B)那样使用导热板282。As shown in FIGS. 42A to 42C , a heat conduction plate (energy output unit) 282 is arranged on the first holding member 52 instead of the high-frequency electrode 92 . A groove 282 a is formed on the heat conducting plate 282 . A diffuser (diffuser) 284 is disposed in the groove 282 a of the heat conduction plate 282 as an output member or an energy output unit. An optical fiber (energy output unit) 286 penetrates inside the diffuser 284 . Therefore, when the laser light enters the optical fiber 286 , the laser light diffuses outward from the diffuser 284 . The energy of the laser light is irradiated on the thermally conductive plate 282 to be converted into thermal energy. Therefore, the heat transfer plate 282 can be used like the high-frequency electrode 92 (see FIGS. 31A and 31B ) that conducts heat from the heater 242 described in the eighth embodiment.
由于在图42A～图42C所示的流体导管162上具有开口162a(参照图11A～图11C)，因此能够将用于防止水分渗入生物体组织LT的物质涂布在生物体组织LT的外周面上。Since the fluid conduit 162 shown in FIGS. 42A to 42C has an opening 162a (refer to FIGS. 11A to 11C), a substance for preventing moisture from penetrating into the living tissueLT can be applied to the living tissueLT . on the peripheral surface.
另外，也能够取代流体导管162而形成第1保持构件52的主体62的边缘部(保持面)62a，使用第7实施方式中所说明的覆盖构件224(参照图27A)来进行处理。即，即使使用激光下的能量也能够与上述实施方式相同地进行处理。In addition, instead of the fluid conduit 162, the edge portion (holding surface) 62a of the main body 62 of the first holding member 52 can be formed, and the covering member 224 (see FIG. 27A ) described in the seventh embodiment can be used for processing. That is, even if energy under laser light is used, the same processing as in the above-mentioned embodiment can be performed.
另外，通过使用导热板282来作为例如高频电极92，能够进行组合了热能与高频能量的适当的处理、仅使用了热能的处理、仅使用了高频能量的处理等各种处理。Also, by using the heat conduction plate 282 as the high-frequency electrode 92, for example, various treatments such as appropriate treatment combining thermal energy and high-frequency energy, treatment using only thermal energy, and treatment using only high-frequency energy can be performed.
(第12实施方式)(12th embodiment)
接着，使用图43～图46B说明第12实施方式。该实施方式是第1～第11实施方式的变形例。在此，作为能量处理器具，以例如穿过腹壁或者用于在腹壁外进行处理的、圆弧式的双极型能量处理器具(治疗用处理器具)12d为例进行说明。Next, a twelfth embodiment will be described using FIGS. 43 to 46B. This embodiment is a modified example of the first to eleventh embodiments. Here, as an energy treatment instrument, for example, an arcuate bipolar energy treatment instrument (treatment treatment instrument) 12d for passing through the abdominal wall or performing treatment outside the abdominal wall will be described as an example.
如图43所示，能量处理器具12d具有手柄322、柄线324及能够开闭的处理部(保持部)326。在手柄322上借助线缆28连接有能量源14，并借助软管18a连接有流体源18。As shown in FIG. 43 , the energy treatment tool 12 d has a handle 322 , a handle 324 , and an openable and closable treatment portion (holding portion) 326 . The energy source 14 is connected to the handle 322 by means of a cable 28 and the fluid source 18 is connected by means of a hose 18a.
在手柄322上配设有处理部开闭旋钮332和刀具驱动杆334。处理部开闭旋钮332能够相对于手柄322旋转。若使该处理部开闭旋钮332相对于手柄322例如向右旋转，则处理部326的后述的离开侧保持构件354离开主体侧保持构件352(参照图46B)，若向左旋转，则离开侧保持构件354靠近主体侧保持构件352(参照图46A)。The handle 322 is provided with a treatment part opening and closing knob 332 and a cutter driving lever 334 . The treatment part opening and closing knob 332 is rotatable relative to the handle 322 . If the treatment part opening and closing knob 332 is rotated clockwise with respect to the handle 322, for example, the later-described separation side holding member 354 of the treatment part 326 is separated from the main body side holding member 352 (refer to FIG. The side holding member 354 is close to the main body side holding member 352 (refer to FIG. 46A ).
柄线324形成为圆筒状。考虑到向生物体组织的插入性，该柄线324适度弯曲。当然也优选的是笔直地形成柄线324。The handle wire 324 is formed in a cylindrical shape. The handle 324 is moderately curved in consideration of insertion into living tissue. Of course, it is also preferable to form the handle line 324 straight.
在柄线324的顶端配设有处理部326。如图44A及图44B所示，处理部326具有形成于柄线324的顶端的主体侧保持构件(第1保持构件)352和相对于该主体侧保持构件352能够装卸的离开侧保持构件(第2保持构件)354。A treatment part 326 is arranged at the tip of the handle wire 324 . As shown in FIGS. 44A and 44B , the treatment part 326 has a main body side holding member (first holding member) 352 formed at the tip of the handle 324 and a separation side holding member (first holding member) detachable from the main body side holding member 352. 2 holding member) 354.
主体侧保持构件352具有圆筒体362、框架364、通电用管366、刀具368、刀具用推动件370和第1及第2流体导管372、374。这些圆筒体362及框架364具有绝缘性。圆筒体362与柄线324的顶端相连结。框架364以固定状态配设在圆筒体362上。The main body side holding member 352 has a cylindrical body 362 , a frame 364 , a tube for conducting electricity 366 , a cutter 368 , a pusher 370 for a cutter, and first and second fluid conduits 372 and 374 . These cylindrical body 362 and frame 364 have insulation. The cylindrical body 362 is connected to the top end of the handle wire 324 . The frame 364 is arranged on the cylindrical body 362 in a fixed state.
框架364的中心轴开口。在该框架364的开口的中心轴上，以能够沿着框架364的中心轴在预定的范围内移动的方式配设有通电用管366。若使手柄322的处理部开闭旋钮332旋转，则如图46A及图46B所示，该通电用管366例如能够在滚珠丝杠(未图示)的作用下在预定的范围内移动。在该通电用管366上形成有向径向内侧突出的突起366a，以供后述的通电用柄线382的连接器部382a能够配合脱离。The central axis of the frame 364 is open. On the central axis of the opening of the frame 364 , a tube 366 for conducting electricity is disposed so as to be movable within a predetermined range along the central axis of the frame 364 . When the treatment part opening and closing knob 332 of the handle 322 is rotated, as shown in FIGS. 46A and 46B , the energization tube 366 can move within a predetermined range by, for example, a ball screw (not shown). A projection 366 a protruding radially inward is formed on the current-conducting tube 366 so that a connector portion 382 a of a current-conducting handle 382 described later can be engaged and detached.
在通电用管366的内侧，配设有供流体向离开侧保持构件354流动的第2流体导管374。与通电用管366相同，第2流体导管374能够在预定的范围内移动。A second fluid conduit 374 through which a fluid flows to the separation-side holding member 354 is disposed inside the energization tube 366 . Like the energization tube 366, the second fluid conduit 374 can move within a predetermined range.
如图44B所示，在圆筒体362与框架364之间形成有空间。在圆筒体362与框架364之间的空间内配设有圆筒状的刀具368。该刀具368的基端部与配设在柄线324内侧的刀具用推动件368a的顶端部相连接。刀具368固定于刀具用推动件370的外周面。虽未图示，但该刀具用推动件370的基端部与手柄322的刀具驱动杆334相连接。因此，若操作手柄322的刀具驱动杆334，则刀具368借助刀具用推动件370而移动。As shown in FIG. 44B , a space is formed between the cylindrical body 362 and the frame 364 . A cylindrical cutter 368 is arranged in a space between the cylindrical body 362 and the frame 364 . The base end portion of the blade 368 is connected to the distal end portion of a blade pusher 368 a disposed inside the handle 324 . The cutter 368 is fixed to the outer peripheral surface of the cutter pusher 370 . Although not shown, the base end portion of the knife pusher 370 is connected to the knife driving rod 334 of the handle 322 . Therefore, when the knife driving lever 334 of the handle 322 is operated, the knife 368 is moved by the knife pusher 370 .
在该刀具用推动件370与框架364之间形成有第1流体通气路(流体通路)376。而且，在柄线324或手柄322上，形成有用于向外部排出通过了第1流体通气路376的流体的流体排出口(未图示)。A first fluid passage (fluid passage) 376 is formed between the cutter pusher 370 and the frame 364 . Furthermore, a fluid discharge port (not shown) for discharging the fluid passing through the first fluid passage 376 to the outside is formed on the handle 324 or the handle 322 .
如图44B及图45所示，在圆筒体362的顶端，作为输出构件、能量释放部配设有圆环状的第1高频电极378。在该第1高频电极378上固定有第1通电线378a的顶端。第1通电线378a经由主体侧保持构件352、柄线324、手柄322与线缆28相连接。As shown in FIG. 44B and FIG. 45 , an annular first high-frequency electrode 378 is disposed on the top end of the cylindrical body 362 as an output member and an energy releasing portion. The tip of the first electric wire 378 a is fixed to the first high-frequency electrode 378 . The first electric wire 378 a is connected to the cable 28 via the main body side holding member 352 , the handle wire 324 , and the handle 322 .
在该第1高频电极378的外侧，在比第1高频电极378高的位置处形成有圆筒体362的边缘部362a。即，主体侧保持构件352的边缘部362a比第1高频电极378靠近于离开侧保持构件354的后述的头部384。Outside the first high frequency electrode 378 , an edge portion 362 a of the cylindrical body 362 is formed at a position higher than the first high frequency electrode 378 . That is, the edge portion 362 a of the main body side holding member 352 is closer to a head portion 384 described later of the separation side holding member 354 than the first high frequency electrode 378 .
如图44A及图44B所示，在主体侧保持构件352的圆筒体362的外周面上配设有第1流体导管372。第1流体导管372配设在圆筒体362的边缘部362a的外侧。而且，在第1流体导管372中的、配设在边缘部362a外侧的部分形成有开口(接合维持辅助部)372a。第1流体导管372从主体侧保持构件352的圆筒体362的外周面沿着柄线324的外周面配设，在柄线324的基端、手柄322部分与软管18a相连结。As shown in FIGS. 44A and 44B , a first fluid conduit 372 is arranged on the outer peripheral surface of the cylindrical body 362 of the main body side holding member 352 . The first fluid conduit 372 is disposed outside the edge portion 362 a of the cylindrical body 362 . Furthermore, an opening (joint maintenance assisting portion) 372a is formed in a portion of the first fluid conduit 372 disposed outside the edge portion 362a. The first fluid conduit 372 is arranged along the outer peripheral surface of the handle 324 from the outer peripheral surface of the cylindrical body 362 of the main body side holding member 352 , and is connected to the hose 18 a at the base end of the handle 324 and the handle 322 .
离开侧保持构件354具有通电用柄线382、头部384及流体导管386，该通电用柄线382具有连接器部382a。头部384形成为大致半球状。通电用柄线382的连接器部382a形成在靠近通电用柄线382一端的一侧。通电用柄线382的横截面呈圆形，且一端形成为锥形，另一端固定于头部384。通电用柄线382的连接器部382a在靠近通电用柄线382一端的一侧形成能够与通电用管366的突起366a相配合的凹槽状。通电用柄线382的除连接器部382a以外部分的外表面因涂敷等而绝缘。The away-side holding member 354 has a handle wire 382 for electricity supply, a head portion 384 , and a fluid conduit 386 , and the handle wire 382 for electricity supply has a connector portion 382 a. The head portion 384 is formed in a substantially hemispherical shape. The connector part 382a of the handle wire 382 for electricity is formed in the side close to the end of the handle wire 382 for electricity. The shank wire 382 for conduction has a circular cross section, one end is tapered, and the other end is fixed to the head 384 . The connector portion 382 a of the current-conducting handle 382 is formed in a groove shape on a side close to one end of the current-conducting handle 382 , which can be fitted with the protrusion 366 a of the current-conducting tube 366 . The outer surface of the portion of the shank wire 382 for energization other than the connector portion 382a is insulated by coating or the like.
在通电用柄线382上，以贯穿一端与另一端的方式形成有第1及第2管路388a、388b。第1管路388a形成为贯穿通电用柄线382的中心轴。当离开侧保持构件354的通电用柄线382的连接器部382a与主体侧保持构件352的通电用管366的突起366a相嵌合了时，第1管路388a与主体侧保持构件352的第2流体导管374相连通。第2管路388b与通电用管366和第2流体导管374之间的第2流体通气路(流体通路)379相连通。First and second conduits 388a and 388b are formed on the handle wire 382 for conduction so as to pass through one end and the other end. The first pipe line 388a is formed so as to pass through the center axis of the handle wire 382 for conduction. When the connector portion 382a of the energization handle 382 of the separation side holding member 354 is fitted with the protrusion 366a of the energization tube 366 of the main body side holding member 352, the first pipe line 388a and the first connection of the main body side holding member 352 The 2 fluid conduits 374 are in communication. The second pipe line 388b communicates with the second fluid passage (fluid passage) 379 between the energization tube 366 and the second fluid conduit 374 .
在头部384上形成有头部384的边缘部384a。在该边缘部384a的内侧，配设有圆环状的第2高频电极390作为输出构件、能量释放部。在该第2高频电极390上固定有第2通电线390a的一端。第2通电线390a的另一端与通电用柄线382电连接。An edge portion 384 a of the head portion 384 is formed on the head portion 384 . Inside the edge portion 384a, an annular second high-frequency electrode 390 is arranged as an output member and an energy releasing portion. One end of a second electric wire 390 a is fixed to the second high-frequency electrode 390 . The other end of the second energization wire 390a is electrically connected to the handle wire 382 for energization.
在头部384的边缘部384a与第2高频电极390之间形成有圆环状的流体放出槽392。该流体放出槽392与通电用柄线382的第2管路388b相连通。另外，第2高频电极390的表面处于被拉入头部384的边缘部384a的状态。即，离开侧保持构件354的边缘部384a的接触面比第2高频电极390靠近主体侧保持构件352。因此，从与第2高频电极390相接触的生物体组织L1、L2放出的蒸气、液体进入流体放出槽392。An annular fluid discharge groove 392 is formed between the edge portion 384 a of the head portion 384 and the second high-frequency electrode 390 . The fluid discharge groove 392 communicates with the second conduit 388b of the energization handle 382 . In addition, the surface of the second high-frequency electrode 390 is pulled into the edge portion 384 a of the head portion 384 . That is, the contact surface of the edge portion 384 a of the separation-side holding member 354 is closer to the main body-side holding member 352 than the second high-frequency electrode 390 . Therefore, vapor and liquid released from the living tissues L1 and L2 in contact with the second high-frequency electrode 390 enter the fluid discharge groove 392 .
在第2高频电极390的内侧，以圆环状形成有用于接收配设在主体侧保持构件352上的刀具368的刀具接收部394。Inside the second high-frequency electrode 390 , a tool receiving portion 394 for receiving the tool 368 arranged on the main body side holding member 352 is formed in an annular shape.
而且，流体放出槽392连通于头部384及通电用柄线382的第2管路388b。第2管路388b与通电用管366的第2流体通气路(流体通路)379相连通。在柄线324或手柄322上，形成有用于向外部排出通过了第2流体通气路379的流体的流体放出口(未图示)。Furthermore, the fluid discharge groove 392 communicates with the head portion 384 and the second conduit 388b of the stem 382 for energization. The second pipe line 388b communicates with the second fluid passage (fluid passage) 379 of the energization tube 366 . A fluid discharge port (not shown) for discharging the fluid passing through the second fluid passage 379 to the outside is formed on the handle 324 or the handle 322 .
另外，通电用管366借助柄线324及手柄322连接于线缆28。因此，若离开侧保持构件354的通电用柄线382的连接器部382a与通电用管366的突起366a相配合，则第2高频电极390与通电用管366电连接。In addition, the tube 366 for electricity is connected to the cable 28 via the handle wire 324 and the handle 322 . Therefore, when the connector portion 382a of the energization handle 382 of the separation-side holding member 354 is engaged with the protrusion 366a of the energization tube 366 , the second high-frequency electrode 390 is electrically connected to the energization tube 366 .
如图44A及图44B所示，在离开侧保持构件354的头部384的外周面上配设有流体导管386。该流体导管386配设在头部384的边缘部384a的外侧。而且，在流体导管386中的、配设在头部384的边缘部384a外侧的部分形成有开口(接合维持辅助部)386a。该流体导管386从离开侧保持构件354的头部384的外周面连通于通电用柄线382内部的第1管路388a。通电用柄线382的第1管路388a与配设在主体侧保持构件352的通电用管366内侧的第2流体导管374相连接。As shown in FIGS. 44A and 44B , a fluid conduit 386 is arranged on the outer peripheral surface of the head portion 384 of the separation-side holding member 354 . The fluid conduit 386 is disposed outside the edge portion 384 a of the head portion 384 . Furthermore, an opening (joint maintenance assisting portion) 386 a is formed in a portion of the fluid conduit 386 disposed outside the edge portion 384 a of the head portion 384 . The fluid conduit 386 communicates from the outer peripheral surface of the head portion 384 of the separation-side holding member 354 to the first conduit 388 a inside the energization stem 382 . The first conduit 388 a of the energization handle 382 is connected to the second fluid conduit 374 arranged inside the energization tube 366 of the main body side holding member 352 .
接着，说明该实施方式的治疗用处理系统10的作用。Next, the operation of the therapeutic treatment system 10 of this embodiment will be described.
如图46A所示，在主体侧保持构件352相对于离开侧保持构件354闭合的状态下，例如穿过腹壁向腹腔内插入能量处理器具12c的处理部326及柄线324。使能量处理器具12c的主体侧保持构件352及离开侧保持构件354之间与欲处理的生物体组织相对。As shown in FIG. 46A , when the main body side holding member 352 is closed relative to the exit side holding member 354 , for example, the treatment part 326 and the handle wire 324 of the energy treatment device 12 c are inserted into the abdominal cavity through the abdominal wall. The body-side holding member 352 and the exit-side holding member 354 of the energy treatment device 12c face the living tissue to be treated.
为了利用主体侧保持构件352及离开侧保持构件354夹持欲处理的生物体组织L1、L2，操作手柄322的处理部开闭旋钮332。此时，使其相对于手柄322例如向右转动。这样，如图46B所示，使通电用管366相对于柄线324的框架364向顶端部侧移动。因此，能够张开主体侧保持构件352与离开侧保持构件354之间，使离开侧保持构件354离开主体侧保持构件352。The treatment part opening and closing knob 332 of the handle 322 is operated in order to clamp the living tissues L1 and L2 to be treated by the main body side holding member 352 and the separation side holding member 354 . At this time, it is rotated, for example, to the right relative to the handle 322 . In this way, as shown in FIG. 46B , the tube 366 for current conduction is moved toward the distal end side with respect to the frame 364 of the handle wire 324 . Therefore, the space between the main body side holding member 352 and the separation side holding member 354 can be opened, and the separation side holding member 354 can be separated from the main body side holding member 352 .
然后，将欲处理的生物体组织L1、L2配置在主体侧保持构件352的第1高频电极378与离开侧保持构件354的第2高频电极390之间。将离开侧保持构件354的通电用柄线382插入主体侧保持构件352的通电用管366内。在该状态下，使手柄322的处理部开闭旋钮332例如向左转动。因此，离开侧保持构件354相对于主体侧保持构件352闭合。这样，能够将处理对象的生物体组织L1、L2保持在主体侧保持构件352与离开侧保持构件354之间。Then, the living tissues L1 and L2 to be treated are arranged between the first high-frequency electrode 378 of the main body side holding member 352 and the second high frequency electrode 390 of the separation side holding member 354 . The current conduction handle 382 of the separation side holding member 354 is inserted into the current conduction tube 366 of the main body side holding member 352 . In this state, the treatment part opening and closing knob 332 of the handle 322 is turned to the left, for example. Accordingly, the exit-side holding member 354 is closed relative to the main body-side holding member 352 . In this way, the living tissues L1 and L2 to be treated can be held between the main body side holding member 352 and the separation side holding member 354 .
在该状态下，操作脚踏开关、手动开关，从能量源14经由线缆28分别向第1高频电极378及第2高频电极390供给能量。第1高频电极378经由生物体组织L1、L2向第1高频电极378与第2高频电极390之间通入高频电流。因此，第1高频电极378与第2高频电极390之间的生物体组织L1、L2被加热。In this state, the foot switch and the manual switch are operated to supply energy from the energy source 14 to the first high-frequency electrode 378 and the second high-frequency electrode 390 through the cable 28 . The first high-frequency electrode 378 passes a high-frequency current between the first high-frequency electrode 378 and the second high-frequency electrode 390 via the living tissues L1 and L2 . Therefore, the living tissues L1 and L2 between the first high-frequency electrode 378 and the second high-frequency electrode 390 are heated.
此时，从该生物体组织L1、L2被加热了的部分产生蒸气、液体等流体。在此，在第1高频电极378固定于主体侧保持构件352的状态下，在离开侧保持构件354侧露出的第1高频电极378的表面位于比主体侧保持构件352的边缘部362a稍微低的位置。同样，在第2高频电极390固定于离开侧保持构件354的状态下，在主体侧保持构件352侧露出的第2高频电极390的表面位于比离开侧保持构件354的头部384的边缘部384a稍微低的位置。At this time, fluids such as vapor and liquid are generated from the heated parts of the living tissues L1 and L2. Here, in a state where the first high-frequency electrode 378 is fixed to the main body-side holding member 352 , the surface of the first high-frequency electrode 378 exposed on the side of the away-side holding member 354 is located slightly lower than the edge portion 362 a of the main body-side holding member 352 . low position. Similarly, in the state where the second high-frequency electrode 390 is fixed to the separation-side holding member 354, the surface of the second high-frequency electrode 390 exposed on the side of the main body-side holding member 352 is located closer to the edge of the head portion 384 of the separation-side holding member 354. part 384a slightly lower position.
因此，主体侧保持构件352的边缘部362a通过流体放出槽392、第2管路388b向通电用管366内的第2流体通气路379放出从与第1高频电极378相接触的生物体组织L1产生的流体。另外，离开侧保持构件354的边缘部384a向圆筒体362与框架364之间的第1流体通气路376放出从与第2高频电极390相接触的生物体组织L2产生的流体。因而，主体侧保持构件352的边缘部362a及离开侧保持构件354的边缘部384a分别起到防止从生物体组织L1、L2产生的流体向主体侧保持构件352及离开侧保持构件354的外部漏出的势垒部(堤坝)的作用。Therefore, the edge portion 362a of the main body side holding member 352 releases the fluid from the living tissue in contact with the first high-frequency electrode 378 to the second fluid passage 379 in the energization tube 366 through the fluid discharge groove 392 and the second pipeline 388b. Fluid produced by L1. In addition, the edge portion 384 a of the separation-side holding member 354 discharges the fluid generated from the living tissue L2 in contact with the second high-frequency electrode 390 to the first fluid passage 376 between the cylindrical body 362 and the frame 364 . Therefore, the edge portion 362a of the main body side holding member 352 and the edge portion 384a of the separation side holding member 354 prevent the fluid generated from the living tissues L1, L2 from leaking out of the main body side holding member 352 and the separation side holding member 354, respectively. The role of the barrier (dam).
这样，在主体侧保持构件352与离开侧保持构件354处于闭合的状态下，通过使主体侧保持构件352的边缘部362a与离开侧保持构件354的边缘部384a相抵接，而使从生物体组织L1产生的流体流入第1流体通气路376，使从生物体组织L2产生的流体流入第2流体通气路379。因此，从生物体组织L1、L2产生的流体从第1及第2流体通气路376、379流向手柄322侧，然后向能量处理器具12d的外部排出。In this way, when the main body side holding member 352 and the separation side holding member 354 are in a closed state, by making the edge portion 362a of the main body side holding member 352 abut against the edge portion 384a of the separation side holding member 354, the tissue from the living body The fluid generated from L1 flows into the first fluid passage 376 , and the fluid generated from the living tissue L2 flows into the second fluid passage 379 . Therefore, the fluid generated from the living tissues L1 and L2 flows toward the handle 322 through the first and second fluid passages 376 and 379, and then is discharged to the outside of the energy processing device 12d.
在接合了生物体组织L1、L2之后，使粘接剂分别从第1及第2流体导管372、386的开口372a、386a流入。这样，在已处理的生物体组织L1、L2的外周面上涂布含有接合辅助剂的粘接剂。因此，生物体组织LT的外周面被粘接剂涂敷。After the living tissues L1 and L2 are bonded, the adhesive is flowed in from the openings 372a and 386a of the first and second fluid conduits 372 and 386, respectively. In this way, the adhesive containing the joining auxiliary agent is applied to the outer peripheral surfaces of the treated living tissues L1 and L2. Therefore, the outer peripheral surface of the living tissueLT is coated with the adhesive.
如以上说明那样，根据该实施方式，能够获得以下效果。As described above, according to this embodiment, the following effects can be obtained.
通过一边测量生物体组织L1、L2的阻抗Z、一边进行生物体组织L1、L2的接合处理，能够使生物体组织L1、L2彼此的接触面C1、C2更可靠地紧密接触。另外，在进行了生物体组织L1、L2彼此的接合处理之后，利用粘接剂等对已接合处理的生物体组织LT的外周进行涂敷，从而能够防止水分进入所接合处理的生物体组织LT的接合部C。因此，能够长时间维持生物体组织L1、L2的接触面C1、C2紧密接触的状态(生物体组织LT接合的状态)。By performing the joining process of the living tissues L1 and L2 while measuring the impedance Z of the living tissues L1 and L2 , it is possible to bring the contact surfaces C1 and C2 of the living tissues L1 and L2 into close contact more reliably. In addition, after the bonding process of the living tissues L1 and L2 is performed, the outer periphery of the bonded living tissue LT is coated with an adhesive or the like, so that moisture can be prevented from entering the bonded living tissue. LT junction C. Therefore, the state in which the contact surfaces C1 and C2 of the living tissues L1 and L2 are in close contact (the state in which the living tissues LT are joined) can be maintained for a long period of time.
(第13实施方式)(thirteenth embodiment)
接着，使用图47A及图47B说明第13实施方式。该实施方式是第12实施方式的变形例，对与第12实施方式中所说明的构件相同的构件或起到相同作用的构件标注相同的附图标记，省略详细的说明。Next, a thirteenth embodiment will be described using FIG. 47A and FIG. 47B . This embodiment is a modified example of the twelfth embodiment, and the same members as those described in the twelfth embodiment or members having the same functions are denoted by the same reference numerals, and detailed description thereof will be omitted.
如图47A及图47B所示，在主体侧保持构件352及离开侧保持构件354上，取代第12实施方式中所说明的流体导管372、386(参照图44A及图44B)而配设有含有接合辅助剂的无孔、多孔质状、网状等各种片状的覆盖构件(接合维持辅助部)396、398。覆盖构件396、398由与第7实施方式中所说明的覆盖构件224、234相同的成分形成。As shown in FIGS. 47A and 47B , instead of the fluid conduits 372 and 386 (see FIGS. 44A and 44B ) described in the twelfth embodiment, the main body-side holding member 352 and the separation-side holding member 354 are provided with Non-porous, porous, and mesh-like covering members (bonding maintenance auxiliary parts) 396 and 398 of various sheet shapes of the bonding auxiliary agent. The covering members 396 and 398 are formed of the same components as the covering members 224 and 234 described in the seventh embodiment.
覆盖构件396、398分别形成为大致圆环状。即，覆盖构件396、398在其内侧具有开口396a、398a。配设在主体侧保持构件352上的覆盖构件396的开口396a供主体侧保持构件352的通电用管366突出。配设在离开侧保持构件354上的覆盖构件398的开口398a供离开侧保持构件354的通电用柄线382突出。The covering members 396, 398 are each formed in a substantially annular shape. That is, the covering members 396, 398 have openings 396a, 398a inside thereof. The opening 396 a of the cover member 396 disposed on the main body side holding member 352 allows the current conduction tube 366 of the main body side holding member 352 to protrude. The opening 398 a of the covering member 398 provided on the separation-side holding member 354 allows the conduction handle 382 of the separation-side holding member 354 to protrude.
通过以该状态进行处理，能够对生物体组织L1、L2的外周进行涂敷，从而能够防止水分渗入生物体组织L1、L2。By treating in this state, the outer peripheries of the living tissues L1, L2 can be coated, and the infiltration of moisture into the living tissues L1, L2 can be prevented.
在该实施方式中，说明了使用高频电极378、390的情况，但是也优选的是使用加热器、激光等其他能量。In this embodiment, the case of using the high-frequency electrodes 378 and 390 has been described, but it is also preferable to use other energy such as a heater or laser light.
至此，参照附图具体说明了几个实施方式，但是本发明并不限定于上述实施方式，包括在不脱离其主旨的范围内能够进行的所有实施方式。Heretofore, several embodiments have been specifically described with reference to the drawings, but the present invention is not limited to the above-mentioned embodiments, and includes all possible embodiments without departing from the gist thereof.
产业上的可利用性Industrial availability
根据本发明，能够提供一种能够防止水分进入生物体组织的接合面、能够长时间维持接合面彼此紧密接触的状态的治疗用处理器具及治疗用处理装置。According to the present invention, it is possible to provide a therapeutic treatment tool and a therapeutic treatment device capable of preventing moisture from entering the joint surfaces of living tissues and maintaining a state in which the joint surfaces are in close contact with each other for a long period of time.
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201510020663.4ACN104644262B (en) | 2009-08-11 | 2009-08-11 | Therapeutic treatment appliance, therapeutic treatment device and therapeutic treatment method |
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN200980161891.6ACN102596078B (en) | 2009-08-11 | 2009-08-11 | Treatment instrument for treatment, treatment device for treatment, and treatment method for treatment |
| CN201510020663.4ACN104644262B (en) | 2009-08-11 | 2009-08-11 | Therapeutic treatment appliance, therapeutic treatment device and therapeutic treatment method |
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN200980161891.6ADivisionCN102596078B (en) | 2009-08-11 | 2009-08-11 | Treatment instrument for treatment, treatment device for treatment, and treatment method for treatment |
| Publication Number | Publication Date |
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| CN104644262Atrue CN104644262A (en) | 2015-05-27 |
| CN104644262B CN104644262B (en) | 2017-04-12 |
| Application Number | Title | Priority Date | Filing Date |
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| CN201510020663.4AExpired - Fee RelatedCN104644262B (en) | 2009-08-11 | 2009-08-11 | Therapeutic treatment appliance, therapeutic treatment device and therapeutic treatment method |
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| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20030236518A1 (en)* | 2002-05-15 | 2003-12-25 | Marchitto Kevin S. | Method and device for anastomoses |
| US20080195091A1 (en)* | 2007-02-14 | 2008-08-14 | Tomoyuki Takashino | Curative treatment system, curative treatment device, and treatment method for living tissue using energy |
| US20080230583A1 (en)* | 2002-04-16 | 2008-09-25 | Tyco Healthcare Group Lp | Surgical Stapler and Method |
| US20080294222A1 (en)* | 2007-05-22 | 2008-11-27 | Schechter David A | Apparatus for attachment and reinforcement of tissue, apparatus for reinforcement of tissue, methods of attaching and reinforcing tissue, and methods of reinforcing tissue |
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US20080230583A1 (en)* | 2002-04-16 | 2008-09-25 | Tyco Healthcare Group Lp | Surgical Stapler and Method |
| US20030236518A1 (en)* | 2002-05-15 | 2003-12-25 | Marchitto Kevin S. | Method and device for anastomoses |
| US20080195091A1 (en)* | 2007-02-14 | 2008-08-14 | Tomoyuki Takashino | Curative treatment system, curative treatment device, and treatment method for living tissue using energy |
| US20080294222A1 (en)* | 2007-05-22 | 2008-11-27 | Schechter David A | Apparatus for attachment and reinforcement of tissue, apparatus for reinforcement of tissue, methods of attaching and reinforcing tissue, and methods of reinforcing tissue |
| Publication number | Publication date |
|---|---|
| CN104644262B (en) | 2017-04-12 |
| Publication | Publication Date | Title |
|---|---|---|
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