JP2000175933A - Ultrasonic cauterization therapeutic apparatus - Google Patents

Abstract

PROBLEM TO BE SOLVED: To prevent an outflow and burn unevenness of the cells and cytoplam of a lesion and to perform cauterization for a short time by degrading the intensity of ultrasonic waves for the cauterization of the lesion. SOLUTION: The ultrasonic cauterization therapeutic apparatus has at least >=2 stepwise irradiation modes of ultrasonic waves, a preheating mode and a cauterization mode, when carrying out the treatment of the lesion. First, the peripheral region inclusive of the lesion is irradiated with the ultrasonic waves at and for the intensity and irradiation time to the extent of not giving rise to the thermally denaturation of the tissue by the preheating mode, by which this region is preliminarily heated. Next, the preliminarily heated lesion is further irradiation with the ultrasonic waves by the cauterization mode, by which the tissue is cauterized to cause thermally denaturated necrosis. The lesion 30 is previously heated to the temperature lower than the thermally denaturation temperature but near to this temperature and, therefore, even if the intensity of the ultrasonic waves with which the lesion is irradiated by the cauterization mode is low, the rapid heating of the tissue of the lesion up to the temperature at which the thermally denaturation of the tissue occurs. The lesion, such as cancer or tumor is cauterized without the destruction of the cell membranes and without the collapse of the intercellular bond, by which the thermally denaturated necrosis of the lesion is made possible.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an ultrasonic ablation treatment apparatus for performing treatment by heating and cauterizing an affected part such as a cancer or a tumor using ultrasonic waves.

[0002]

2. Description of the Related Art Conventionally, an ultrasonic cautery treatment apparatus performs treatment by heating and cauterizing an affected part such as a cancer or a tumor using ultrasonic waves. In such an ultrasonic cautery treatment apparatus, in order to avoid the influence of the movement of the affected part due to the patient's breathing or the like, it is considered that the intensity of the ultrasonic wave is increased and the cautery treatment is performed in a time as short as possible.

[0003] As a conventional technique as described above, a therapeutic method (G) in which an ultrasonic wave generated by a piezo element is sharply focused on an affected area to heat a tumor portion to 80 ° C or higher, and the tumor tissue is instantaneously thermally denatured and necrotic. ．Vallancien et.al: Progress in
Urol. 1991, 1, 84-88 [EDAP company paper], USP-5150711 [EDAP company patent]) and the like are known. In this treatment, only a narrow area near the focal point is instantaneously heat-denatured and necrotic.

[0004]

In the conventional ultrasonic cautery treatment apparatus, it is necessary to increase the intensity of the ultrasonic wave in order to heat the affected tissue in a short time to perform thermal degeneration and necrosis. At this time, the affected tissue may be destroyed due to the mechanical destruction of the ultrasonic waves or the boiling of the tissue due to excessive heating of the heat-denatured region. In the example of the heat denaturation part shown in FIG. 4, a hole 25 is formed in the upper part, and the white denaturation part 26 has a crack.
When such a phenomenon occurs, the cytoplasm may flow out due to the destruction of the cell membrane, the bonds between the cells may be torn, and the unablated tumor cells may be dissipated. When the cytoplasm and cells in the affected area flow out in this way, they circulate in the body in the bloodstream, which may cause unexpected side effects.

Further, in the case of high-intensity ultrasonic waves, the sound pressure gradient of the sound field tends to be steeper than that of low-intensity ultrasonic waves, and the gradient of the temperature distribution in the tissue tends to be steeper. As shown in FIG. 4, the shape of the denatured portion becomes elongated and oval and sharp,
If the affected area is cauterized by multiple ultrasonic irradiations,
As shown in FIG. 2A, spots are formed in the temperature distribution depending on the position of the affected part, so that the affected part is not cauterized uniformly and may cause burning spots.

When this burning occurs, it becomes difficult for the ultrasonic cautery treatment apparatus to achieve the desired complete treatment of cancer and tumor.

SUMMARY OF THE INVENTION The present invention has been made to solve the above-mentioned problems. The present invention reduces the intensity of ultrasonic waves for cauterizing an affected area, thereby preventing outflow and burning of cells and cytoplasm of the affected area and shortening the time. It is an object of the present invention to provide an ultrasonic cautery treatment apparatus capable of performing cauterization completely in a short time.

[0008]

Means for Solving the Problems In order to achieve the above object, a feature of the invention of claim 1 is to irradiate an ultrasonic wave generated from an ultrasonic wave source toward an affected part in a body,
In an ultrasonic ablation treatment apparatus for performing ablation treatment of the affected part, the ultrasonic wave is irradiated to the affected part in a plurality of steps.

According to the first aspect of the present invention, the ultrasonic irradiation step is, for example, two steps, the affected part is heated to a temperature lower than the heat denaturation temperature in the first step, and then the affected part is thermally denatured in the next step. By cauterizing by heating above the temperature, even if the intensity of the ultrasonic waves is low, the affected part which has been heated to a certain extent in advance can be heated to the heat denaturation temperature in a short time. Thereby, since the gradient of the temperature distribution of the affected part can be moderated, the outflow and burning of cells and cytoplasm of the affected part are prevented,
In addition, complete cauterization can be performed in a short time.

A second aspect of the present invention is an ultrasonic ablation treatment apparatus for performing ablation treatment of an affected part by irradiating an ultrasonic wave generated from an ultrasonic wave source toward an affected part in a body. An ultrasonic wave generating means for generating ultrasonic waves in a two-stage mode of a mode and a cauterization mode, wherein in a preheating mode, a predetermined irradiation area is heated to a temperature lower than a heat denaturation temperature by the ultrasonic waves, and in a cautery mode, And heating the irradiated area to a temperature higher than the thermal denaturation temperature.

A feature of the invention according to a third aspect of the present invention resides in that there is provided a position control means for moving the ultrasonic wave source and scanning an irradiation area set in accordance with a step of applying the ultrasonic wave.

[0014] A feature of the invention according to claim 4 is that, by presetting the generation time of the ultrasonic wave from the ultrasonic generation source,
A control means for controlling heating of an irradiation area set according to each irradiation step of the ultrasonic wave to a predetermined temperature is provided.

A fifth aspect of the present invention is characterized in that a sensor means for detecting the temperature of the ultrasonic irradiation area, a judging means for judging whether the temperature detected by the sensor means has reached a predetermined temperature, When the determination unit determines that the detected temperature has reached a predetermined temperature, the control unit stops the generation of ultrasonic waves from the ultrasonic generation source.

According to a sixth aspect of the present invention, there is provided a sensor for detecting the temperature of the ultrasonic irradiation area, and a display for displaying the temperature detected by the sensor or a two-dimensional temperature distribution created from the temperature. Means for stopping the generation of ultrasonic waves from the ultrasonic wave source when a stop signal is generated by the stop operation.

According to a seventh aspect of the present invention, there is provided a sensor for detecting the temperature of the ultrasonic irradiation area, a determining means for determining whether or not the temperature detected by the sensor has reached a predetermined temperature; When the determination unit determines that the detected temperature has reached a predetermined temperature, the display unit displays a guide recommending that the user stop the irradiation of the ultrasonic wave, and a stop signal is generated by the stop operation. A stop means for stopping the generation of ultrasonic waves from the ultrasonic generation source when generated.

The display means of the invention of claim 8 also displays a guide recommending the start of ultrasonic irradiation.

According to a ninth aspect of the present invention, there is provided means for changing the size of the focal point of the ultrasonic wave generated from the ultrasonic wave generating source in accordance with the irradiation step of the ultrasonic wave.

A feature of the invention according to claim 10 is that, during the irradiation of the ultrasonic wave to the irradiation area, a part or all of the information indicating the operation state of the apparatus and the state of the irradiation area and the information regarding the ultrasonic irradiation are included. An informing means for informing the user visually or audibly is provided.

In the eleventh aspect of the present invention, the preheating area is the affected area and its surrounding area, the cauterizing area is the affected area, and the preheating area is wider than the cauterizing area.

According to a twelfth aspect of the present invention, the temperature of the irradiation area detected by the sensor means is displayed, or a two-dimensional temperature distribution of the irradiation area is created and displayed from the temperature detected by the sensor means. The display means is provided.

According to a thirteenth aspect of the present invention, there is provided an ultrasonic ablation treatment apparatus for performing ablation treatment on an affected part by irradiating an ultrasonic wave generated from an ultrasonic wave source to an affected part in a body. It is provided with sensor means for detecting the temperature of the sound wave irradiation area, and display means for displaying the temperature detected by the sensor means or a two-dimensional temperature distribution created from the temperature.

According to a fourteenth aspect of the present invention, there is provided a stop means for stopping the generation of ultrasonic waves from the ultrasonic generation source when a stop signal is generated by a stop operation.

[0023]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is a block diagram showing a first embodiment of the ultrasonic ablation treatment apparatus of the present invention. The ultrasonic cautery treatment device is an ultrasonic transducer 1 that generates ultrasonic waves.
And a coupling film 2 coupled to the ultrasonic vibrator 1 for transmitting ultrasonic waves emitted from the ultrasonic vibrator 1 to a living tissue, and supplying energy (drive power) to the ultrasonic vibrator 1. An energy supply unit 3, a position control unit 4 for moving the ultrasonic transducer 1, an operation unit 5 for inputting tumor data and the like, and operating the device, and a treatment mode display for notifying a user of the treatment to the device user It has a voice warning unit 6, a control unit 7 for performing cooperative control of each unit, and a memory 8 for storing treatment mode data.

By bringing the coupling film 2 into close contact with the surface of the schematically illustrated living body 20, ultrasonic waves are generated.
It is transmitted to the affected part 30 within 0. The memory 8 stores treatment mode data such as preheating mode data 81 and cauterization mode data 82 for performing stepwise ultrasonic irradiation. Further, the space between the ultrasonic oscillator 1 and the coupling film 2 is filled with an ultrasonic wave propagation medium such as degassed water.

Next, the operation of the present embodiment will be described. When the user inputs data such as the size, shape, and depth of the affected part from the operation unit 5 and instructs to start treatment, the control unit 7 reads the preheating mode data 81 in the memory 8 and sets the preheating mode. Start.

In response to an instruction from the control unit 7, the energy supply unit 2 drives the ultrasonic vibrator 1 to generate ultrasonic waves having an optimum intensity and irradiation time for heating the living tissue to such an extent that thermal denaturation does not occur. Electric power is supplied to the ultrasonic vibrator 1. Thereby, the ultrasonic wave for preheating is output from the ultrasonic vibrator 1 and irradiated to the affected part 30. In this preheating mode, the ultrasonic waves generated from the ultrasonic transducer 1 may be intermittent or continuous.

At this time, the position controller 4 moves the ultrasonic transducer 1 to uniformly heat the affected area 30 and its surrounding area 31 according to an instruction from the controller 7, and scans the area. By these procedures, as shown in FIG. 2 (B), when the temperature of the affected area 30 and its surrounding area 31 rises to such a level that thermal denaturation does not occur, the irradiation time elapses and the energy supply unit 3 sends the ultrasonic wave to the ultrasonic vibrator 1. Is stopped, and the control unit 7 ends the preheating mode.

Next, the control section 7 reads the cautery mode data 82 from the memory 8 and starts the cautery mode.

In accordance with an instruction from the control section 7, the energy supply section 3 has an optimum intensity and irradiation that are heated to such an extent that thermal denaturation of the tissue of the living body 20 does not occur and cell membrane destruction and collapse of intercellular bonds do not occur. The ultrasonic vibrator 1 is supplied with driving power for generating ultrasonic waves for a time from the ultrasonic vibrator 1. Thereby, ultrasonic waves are intermittently irradiated from the ultrasonic transducer 1 to cauterize the affected part 30.

As a result, as shown in FIG. 2B, the temperature of the affected part 30 further increases by a maximum ΔT2 from the temperature heated in the preheating mode, and the temperature of the lowest part also exceeds the heat denaturation temperature. Is cauterized uniformly. At that time, FIG.
Since the intensity of the ultrasonic wave can be reduced as compared with the case where the temperature is increased by the maximum ΔT1 required to thermally denature the affected part 30 from the state where the preliminary heating is not performed as in (A), the temperature distribution in the tissue is reduced. The gradient becomes gentle, and the affected area 12 is cauterized uniformly. At that time, the position control unit 33 moves the ultrasonic transducer 1 and scans the above-mentioned area in order to uniformly cauterize the entire affected part 30 to cause thermal degeneration and necrosis according to an instruction from the control unit 7.

Here, when the affected area 30 and the surrounding area 31 were raised by 10 ° C. in the preheating mode, an experimental result was obtained in which the intensity of the ultrasonic wave in the cautery mode could be reduced to about の of the conventional intensity. In addition, when the ultrasonic intensity was the same as that of the related art, and when the affected area 30 and the surrounding area 31 were raised by 10 ° C., an experimental result was obtained in which the irradiation time could be reduced to about half that of the related art.

In the preheating mode and the cauterization mode, the control unit 7 displays the current mode, irradiation time, ultrasonic wave intensity and other parameters indicating the treatment state on the treatment mode display / voice warning unit 6 or Notify by voice.

According to the present embodiment, the affected part 30 is irradiated with ultrasonic waves in two stages of the preheating mode and the cauterization mode. As shown in, to raise the temperature of the affected area 30 and its surrounding area 31 to a predetermined temperature lower than the heat denaturation temperature, and then, by cauterizing mode ultrasonic irradiation, to cauterize the affected area 30 to the heat denaturation temperature or higher, In the cautery mode, as shown in FIG. 2A, an ultrasonic wave having a lower intensity than a conventional case in which ultrasonic waves necessary for thermally denaturing the affected part 30 are irradiated at a time from a state where preheating is not performed. Can be used to thermally denature the affected area.

As a result, the sound pressure gradient of the ultrasonic wave becomes gentle, so that the cell membrane of the diseased part 30 is not destroyed and the bonds between the cells are not broken, and the cytoplasm flows out or the bonds between the cells are torn. Inconveniences such as dissipation of cauterized tumor cells can be prevented, and safe treatment can be performed. In addition, since burnout does not occur, complete treatment can be performed without leaving uncauterized portions.

Further, since the affected part 30 is preliminarily heated in the pre-heating mode, the affected part 30 can be heated in a shorter time than in the prior art.
Is heated above the heat denaturation temperature to complete denaturation necrosis, and treatment with few side effects can be performed.

In the above embodiment, the size of the focal point of the ultrasonic wave generated from the ultrasonic vibrator 1 is constant in the preheating mode and the cauterization mode.
The focal point of the ultrasonic wave may be changed depending on the mode so as to increase the focal point of the ultrasonic wave in the preheating mode in which the heating range is wide.

In the above embodiment, the affected part 30 or the surrounding area 31 is scanned by automatically moving the ultrasonic vibrator 1 by the position control unit 4, but the operator manually operates the ultrasonic vibrator 1 manually. May be moved. In this case, the control unit 7
Is a message to the surgeon such as "Please perform preheating" or "Please stop heating" and "Please perform cauterization" near the end of preheating mode or cauterization mode. Is displayed as a treatment guide for the operator, the same effect as above can be reliably obtained.

FIG. 3 is a block diagram showing a second embodiment of the ultrasonic cautery treatment apparatus according to the present invention. In this example,
It has a temperature detecting means 9 for detecting the temperature of the affected part. Thus, a feedback loop for controlling the energy supply unit 3 by the control unit 7 based on the temperature detected by the temperature detection unit 9 is formed. Although this point is different from the first embodiment shown in FIG. 1, other configurations are the same.
As a method of realizing the temperature detecting means 9, for example, MR
I, X-ray CT, use of a temperature measurement function of an imaging probe, insertion of a thermocouple, and the like.

Next, the operation of this embodiment will be described. In the preheating mode and the cauterization mode, the control unit 7 monitors the temperature detected by the temperature sensor 9 and, when the temperature reaches a preset temperature, cuts off the driving power supplied from the energy supply unit 3 to the ultrasonic vibrator 1. End each mode. At this time, the control unit 7 displays the detected temperature of the temperature sensor 9 or the two-dimensional temperature distribution of the affected part 30 on the treatment mode display / voice warning unit 6.

According to the present embodiment, the end time of the irradiation of the ultrasonic wave from the ultrasonic vibrator 1 is controlled by the actual measurement value of the affected part 30 by the temperature sensor 9. Ultrasonic irradiation time can always be properly controlled,
The affected part 30 is accurately heated to the temperature set in each mode,
Or it can be cauterized. In particular, in the cautery mode, stable and safe treatment can be performed without problems such as overburning of the affected part or insufficient cauterization.

In this embodiment, since the temperature or temperature distribution of the affected part 30 during the treatment is displayed on the treatment mode display / voice warning part 6, even when the operator moves the ultrasonic transducer 1 manually. Since the temperature or the temperature distribution of the affected part 30 can be known in real time, the operator performs appropriate treatment while watching the temperature or the temperature distribution by appropriately moving the ultrasonic vibrator 1 so as not to cause burning and the like. Can be.

In such a case, the control unit 7 judges the temperature or temperature distribution of the affected part 30 during the treatment, and gives the operator "indicating what state the preliminary heating should be performed until". By displaying a treatment guide to the patient, the same effect as described above can be surely obtained.

In the first and second embodiments, the ultrasonic irradiation is performed in two stages of the preheating mode and the cauterization mode. However, after the ultrasonic irradiation in three or more stages and the preheating mode, for example, Even when the cautery mode is set in two stages, the same effect can be obtained.

[0044]

As described above in detail, according to the ultrasonic ablation treatment apparatus of the present invention, a stepwise ultrasonic irradiation method for cauterizing the affected area after preheating the area surrounding the affected area is performed. By taking, reduce the intensity of ultrasound for cauterizing the affected area, prevent outflow and burning of cells and cytoplasm of the affected area,
Cauterization can be performed in a short time.

According to the ultrasonic cautery treatment apparatus of the fifth aspect, the feedback control for stopping the irradiation of the ultrasonic wave when the temperature reaches a predetermined temperature is performed regardless of the condition of the affected part. Problems such as heating of the affected part above the thermal denaturation temperature and overburning of the affected part in the cauterization mode can be eliminated, and safer treatment can be performed.

According to the ultrasonic cautery treatment apparatus according to the seventh aspect, the operator is required to manually move the ultrasonic wave source to scan an affected part, and to use the ultrasonic wave in the preheating mode or the cautery mode. When manually stopping the irradiation of
Since the guide for notifying the irradiation stop timing is displayed, the effect of the two-stage ultrasonic irradiation can be reliably obtained.

According to the ultrasonic cautery treatment apparatus of the tenth aspect, for example, it is the current ultrasonic irradiation stage,
Since the intensity of the ultrasonic wave, the irradiation time of the ultrasonic wave, and the like are displayed, the user can easily grasp the current treatment state and perform safe and accurate treatment.

According to the ultrasonic cautery treatment apparatus of the twelfth aspect, since the current temperature or the two-dimensional temperature distribution of the affected part is displayed, the operator manually moves the ultrasonic wave generating source to move the affected part or the like. When scanning, by looking at the temperature or the two-dimensional temperature distribution, it is possible to appropriately adjust the moving speed and the moving place of the ultrasonic wave source, and to easily perform treatment without spotting and without overheating. Can be.

[Brief description of the drawings]

FIG. 1 is a block diagram showing a first embodiment of an ultrasonic ablation treatment apparatus of the present invention.

FIG. 2 is a diagram showing a temperature distribution of an affected area and its surroundings in a preheating heating mode and an ablation mode by the ultrasonic ablation treatment apparatus shown in FIG. 1;

FIG. 3 is a block diagram showing a second embodiment of the ultrasonic ablation treatment apparatus of the present invention.

FIG. 4 is a diagram showing the shape of a heat-denatured portion of a tissue when ultrasonic treatment is performed by a conventional ultrasonic ablation treatment apparatus.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Ultrasonic transducer 2 Coupling film 3 Energy supply part 4 Position control part 5 Operation part 6 Treatment mode display / voice warning part 7 Control part 8 Memory 9 Temperature sensor (temperature detection means) 20 Living body 30 Affected part 31 Affected part peripheral area 81 Preheating mode data 82 Cauterization mode data

Claims (14)

[Claims] 1. An ultrasonic ablation treatment apparatus for performing ablation treatment of an affected part by irradiating an ultrasonic wave generated from an ultrasonic source toward an affected part in a body, wherein the ultrasonic wave is directed toward the affected part. An ultrasonic ablation treatment apparatus characterized in that irradiation is performed in a plurality of stages. 2. An ultrasonic ablation treatment apparatus for performing ablation treatment of an affected part by irradiating an ultrasonic wave generated from an ultrasonic wave source toward an affected part in a body, wherein a preheating mode and a cauterization mode are provided. In the preheating mode, a predetermined irradiation area is heated to a temperature lower than a heat denaturation temperature by the ultrasonic wave, and in the cauterization mode, a predetermined irradiation area is heated to a heat denaturation temperature. An ultrasonic ablation treatment apparatus characterized by heating and cauterizing as described above. 3. The apparatus according to claim 1, further comprising a position control unit that moves the ultrasonic wave source and scans an irradiation area set according to an irradiation step of the ultrasonic wave.
Or the ultrasonic cautery treatment device according to 2. 4. A control for heating an irradiation region set according to each irradiation step of the ultrasonic wave to a predetermined temperature by presetting a generation time of the ultrasonic wave from the ultrasonic wave generation source. The ultrasonic ablation treatment apparatus according to any one of claims 1 to 3, further comprising means. 5. A sensor for detecting a temperature of an ultrasonic irradiation area, a determining unit for determining whether a temperature detected by the sensor has reached a predetermined temperature, and a detecting unit for detecting whether the temperature has reached a predetermined temperature. The ultrasonic wave according to any one of claims 1 to 3, further comprising control means for stopping generation of ultrasonic waves from the ultrasonic wave generation source when it is determined that the temperature has reached a predetermined temperature. Cautery treatment device. 6. A sensor for detecting the temperature of the ultrasonic irradiation area, a display for displaying the temperature detected by the sensor or a two-dimensional temperature distribution created from the temperature, and stopping by a stop operation. The ultrasonic ablation treatment apparatus according to any one of claims 1 to 3, further comprising stopping means for stopping generation of ultrasonic waves from the ultrasonic generation source when a signal is generated. 7. A sensor for detecting a temperature of an irradiation area of the ultrasonic wave, a judging unit for judging whether or not the temperature detected by the sensor has reached a predetermined temperature; When it is determined that the temperature has reached a predetermined temperature, display means for displaying a guide for recommending that the user stop the irradiation of the ultrasonic wave, and when a stop signal is generated by a stop operation, the ultrasonic wave is generated. The ultrasonic ablation treatment apparatus according to any one of claims 1 to 3, further comprising a stop unit configured to stop generation of the ultrasonic wave from the source. 8. The ultrasonic cautery treatment apparatus according to claim 7, wherein said display means also displays a guide recommending the start of ultrasonic irradiation. 9. The apparatus according to claim 1, further comprising means for changing a size of a focal point of an ultrasonic wave generated from said ultrasonic wave generating source in accordance with a step of irradiating said ultrasonic wave. An ultrasonic ablation treatment apparatus according to the above. 10. While the ultrasonic wave is being irradiated onto the irradiation area, a part or all of the information indicating the operation state of the apparatus and the state of the irradiation area and the information on the ultrasonic irradiation is visually recognized by the user. The ultrasonic ablation treatment apparatus according to any one of claims 1 to 9, further comprising an informing means for instructively or aurally informing. 11. The pre-heating area is the affected area and its surrounding area, the ablation area is the affected area, and the pre-heating area is wider than the ablation area. An ultrasonic ablation treatment apparatus according to any one of claims 10 to 10. 12. A display device for displaying the temperature of the irradiation area detected by the sensor means or for creating and displaying a two-dimensional temperature distribution of the irradiation area from the temperature detected by the sensor means. 6. The method according to claim 5, wherein
Or the ultrasonic ablation treatment apparatus according to 7. 13. An ultrasonic ablation treatment apparatus for performing ablation treatment on an affected part by irradiating an ultrasonic wave generated from an ultrasonic wave source toward an affected part in a body, wherein the temperature of an ultrasonic irradiation area is reduced. An ultrasonic ablation treatment apparatus, comprising: sensor means for detecting; and display means for displaying a temperature detected by the sensor means or a two-dimensional temperature distribution created from the temperature. 14. An ultrasonic ablation treatment apparatus according to claim 13, further comprising a stop means for stopping the generation of ultrasonic waves from said ultrasonic generation source when a stop signal is generated by a stop operation. .