JP2005040300A - Energy treatment apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an energy irradiation device improving the using efficiency of energy emitted from an emission part and improving energy accumulation property on a target site while suppressing an emission output. <P>SOLUTION: This energy treatment apparatus 101 adapted to irradiate biotissue with energy comprises an energy emission part 3 for emitting the energy and a reflection means 4 disposed at a position opposite to the energy emission part 3 to reflect energy emitted from the energy emission part 3 toward a treatment site 80. This apparatus is so configured that the energy from the energy emission part 3 can be accumulated on the target site through different routes. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

【００６４】
曲線ＩＩは、超音波振動子３から治療部位Ｐ２に向けて出射したときの超音波エネルギー密度分布である。
曲線ＩＩＩは、超音波が一部治療部位Ｐ２を透過して反射体６で反射した後の超音波エネルギー密度分布である。
曲線Ｉは、曲線ＩＩの超音波エネルギー密度と曲線ＩＩＩの超音波エネルギー密度が加算された状態での超音波エネルギー密度分布である。
【００６５】
この曲線Ｉから明らかなように、治療部位Ｐ２においては、超音波振動子３からの超音波と反射体６からの反射超音波とが重なり合って、超音波エネルギーの集中が高まり治療部位Ｐ２から離れるにしたがって超音波エネルギー密度が漸次小さくなることが認められる。
【００６６】
図９は、出射部３をアプリケータ２の軸線に沿って移動させて超音波を治療部位８０に集中させるための出射部３の他の実施の形態を示す。
本実施の形態の出射部３は、例えば、超音波治療の場合は、超音波振動子１０３と、超音波振動子１０３から出射した超音波を治療部位８０に向かわせるための可動式ミラー１０４とから構成される。
【００６７】
出射部３として超音波出射部を用いた場合、その超音波振動子１０３は、アプリケータ２の軸線方向に延長する１本のアーム１０５を介して、駆動部（図示せず）の摺動部１２９に連結される。超音波振動子１０３は、摺動部１２９によってアプリケータ２の軸線方向に往復移動するようになされる。図１１では、超音波振動子１０３が、支持部１０８の前面側に支持され、支持部１０８がアームの先端に固定される。
【００６８】
一方、ミラー１０４は、その上端が支持部１０８の前面側の上端に軸１１２を介して可動自在に取り付けられ、そのミラーの下端の両側部に突出して設けた係合ピン１０９が、それぞれアプリケータ２内に配置された一対の案内板１１０の、案内溝１１１に係合するように構成される。案内溝１１１は、アーム１０５の軸線方向に沿い且つアプリケータ２の先端側から後端側に向かって、所要の角度θで傾斜するように形成される。このミラー１０４は、アーム１０５が移動することによって係合ピン１０９が案内溝１１１に沿って移動し、これによって軸１１２を中心にミラー面の角度が可変される。
【００６９】
治療の際に、治療部位以外の正常な生体組織、例えば、アプリケータ２に接触している表層部などを加熱しないことが望まれる。このため、アプリケータ２では、超音波振動子１０３の支持部１０８に接続されたアーム１０５をパイプ構造で形成し、このアーム１０５を通してアプリケータ２内、特に出射部３の近傍に冷却液を注入するようにし、摺動部１２９に設けた排液孔１１３を通じて冷却液を排出するように構成することができる。
【００７０】
超音波振動子１０３から出射した超音波は、可動式ミラー１０４のミラー１０４ａの面で反射して治療部位８０照射される。この場合、前述と同様に超音波振動子１０３の超音波出射面に１／２波長板２２を介して超音波を収束させるための音響レンズを装着することができる。なお、図９Ｂに示すように超音波振動子１０３には、配線１１４を通して所要の駆動信号が与えられ超音波振動するようになされる。
【００７１】
次に、図１０を用いて図９に示す出射部３の動作を説明する。
移動制御手段９３を構成する駆動部（図示せず）の摺動部１２９を駆動して出射部３をアプリケータ２の前端部から後端部へ向かって移動させながら、超音波振動子１０３から出射した超音波を治療部位８０に照射する。治療部位８０に照射された超音波の一部は、透過して反射体６で反射し、再び治療部位８０に照射される。反射体６から反射した反射超音波と次の超音波とが、治療部位８０に照射されることは前述と同様である。そして本実施の形態では、超音波振動子１０３のアプリケータ２への軸心方向の移動に伴って、ミラー１０４の係合ピン１０９が案内溝１１１に沿って案内されて、ミラー１０４が超音波振動子１０３とのなす角度βを大きくするように回動する。ミラー１０４の各回動位置における超音波は、必ず治療部位８０に照射される。従って、治療部位８０のみに、常に超音波が照射され、集中することとなり治療部位以外の例えば、表層部などの他の生体組織では、一時的に加熱されるだけで、治療部位８０のみを加熱することが可能となる。
【００７２】
図１１は、出射部を往復移動させるための、駆動部の機構の例を示す。駆動部１３２内には、直動従節式の溝カム１３３が設けられ、溝カム１３３の回転軸１３４は、電気的な駆動手段であるモータ１３５の軸に接続されている。溝カム１３３には偏心した楕円形の溝１３６が設けられており、溝１３６内には、出射部３（図示せず）に連結されたアームの基端に連接されたロッド１３７の基端に設けられたカムフォロア１３８が摺動自在にはめ込まれている。
モータ１３７の回転により、溝カム１３３は回転軸１３４を中心に回転する。その際、カムフォロア１３８は回転せず、溝１３６内を摺動する。回転軸１３４は溝１３６に対して偏心しているので、回転により、ロッド１３７（およびアーム）は直動移動（往復移動）を繰り返すこととなる。
【００７３】
図１２は、出射部３をアプリケータ２の軸線に沿って移動させて超音波を治療部位８０に集中させるための出射部３の他の実施の形態を示す。
本実施の形態のエネルギー治療装置は、前述と同様に超音波の出射部３を備えたアプリケータ２と反射体６を有する反射手段４を備えてなる。
アプリケータ２は、尿道８１内に挿入され、超音波の出射部３が前立腺８３の治療部位８０に対向するように位置したとき、バルーン１６１が拡張し超音波の出射部を尿道表面に密着させる。
【００７４】
超音波の出射部３は、矢印ａで示す範囲をストローク長として往復移動する。出射部３は、最も基端側に位置した時、第１ガイド部１６２より先端側に位置する必要があり、最も先端側に位置した時に第２ガイド部１６３の先端を越えず、かつ開口１６４を超音波が通過しない位置までとすることが望ましい。
【００７５】
超音波は、出射部３の長手方向軸線に対して、側方（好ましくは、略垂直方向）へ出射される。ここで、出射部３の長手方向軸線は、常に第２ガイド部１６３の描く円弧の接線方向となる。そのため、超音波の照射方向は、常にこの円弧を含む円の中心付近（治療部位８０）に向うこととなる。従って、出射部３を往復移動させながら超音波を照射すれば、アプリケータ２の接する生体組織の表面では超音波の出射位置が常に変化するため、照射時間も短く、発生する熱量も少ない。また、生体組織の深部に位置する治療部位８０では、超音波が集中することとなり、生体組織表面を温存しながら深部のみを加熱治療することが可能となる。
【００７６】
次に、反射手段４の各実施の形態について説明する。
図１３に示す本実施の形態に係る反射手段４１は、照射された超音波を反射する１枚の短冊状の反射体６を有し、この反射体６の両端を所定の間隔を置いて配置された１対の支持台３０、３１上に湾曲するように固定し、操作棹７の先端を軸方向に可動自在に配した他方の支持台３１に固定して構成される。操作棹７は、一方の支持台３０に設けた透孔３０ａを軸方向に移動可能に挿通して他方の支持台３１に固定される。この反射手段４１は、操作棹７を移動させることにより、短冊状の反射体６の反射面６ａの曲率が可変する。すなわち、操作棹７を手前に引くことにより、支持台３１が破線位置に移動して反射体６の湾曲が大きくなり、反射面６ａの曲率半径が小さくなる。逆に操作棹７を押せば反射体６の曲率半径が大きくなる。従って、例えば、照射された超音波を治療すべき部位に向け的確に反射したい場合は、操作棹７を引いたり押したりすることで反射体６の曲率が変更され、反射された超音波を治療部位８０に照射する。
図１４Ａ，Ｂに示す本実施の形態の反射手段４２は、中央の幅が広く両端に向って漸次幅が狭くなるように且つ両辺が弓状をなす複数枚の反射素体３３により反射体６が構成される。この複数枚の反射素体３３は、半球状に束ねるように配され、その両端が支持台３０及び３１に一体の軸３４に挿通されるようにして支持される。その他の構成は図１６と同様である。この反射手段４２は、操作棹７の操作により、反射体６の反射面６ａの曲率を可変させることができる。即ち、操作棹７を押すことにより、両支持台３０及び３１間の距離が大きくなり、反射体６の全体の幅が狭まるように変化して反射面６ａの曲率半径が大きくなる。逆に操作棹７を引くことにより、両支持台３０及び３１間の距離が短くなり、反射体６の全体の幅が広がるように変化して反射面６ａの曲率半径が小さくなる。
【００７７】
図１５Ａ，Ｂに示す本実施の形態の反射手段４３は、操作棹７の先端にスプーン形状の反射体６を形成して構成される。この反射手段４３では、例えば、反射体６の中央に出射部３より照射された超音波を検知する超音波センサー３５が設けられると共に、他部にスプーン形状の内部の空気を排出するための空気孔３６と超音波ゼリーを注入するための超音波ゼリー注入孔３７が形成される。この場合、超音波ゼリー注入孔３７は、操作棹７を通してスプーン形状の反射面に連通するように形成される。この反射手段４３を使用するときは、出射部３から例えば超音波が出射された場合、その超音波を反射手段４３に設けた超音波センサー３５により超音波の出力強度が検知される。この超音波センサー３５からの出力を制御部９１にフィードバックすることにより、出射部３の超音波出力を制御できる。また、超音波ゼリー注入孔３７を通して超音波ゼリーをスプーン形状の反射体６内に注入することにより、反射面６ａと生体壁との間の空気が空気孔３６から抜ける。空気が存在すると、超音波の伝播が阻害される。超音波ゼリーの注入により空気が無くなるので、出射部３からの超音波が反射面に良好に到達する。
【００７８】
図１６Ａ〜Ｃは、夫々反射手段４のさらに他の実施の形態を示す。本例は、反射体６に冷却液、例えば冷却水を注入して、治療部位でない部位、即ち反射手段４に接触する生体組織の表面層部分の加温を和らげるように構成した場合である。
【００７９】
図１６Ａに示す反射手段４４は、操作棹７が筒状の外操作棹７Ａと、外操作棹７Ａ内に軸方向に移動可能に配置されたパイプ状の内操作棹７Ｂとからなり、外操作棹７Ａの先端側の皿状部７Ｃ内に前述の図１４と同様の複数枚の反射素体３３からなる反射体６が配置されて成る。反射体６は、その一端が皿状部７Ｃに固定され、その他端が内操作棹７Ｂの先端に固着され、内操作棹７Ｂと共に軸方向に移動可能に配置された支持台３０に固定される。この反射手段４４では、内操作棹７Ｂを前進、後退させることにより、図１４で説明したように反射体６の曲率を変更することができる。一方、反射体６が配置された皿状部７Ｃの周囲は、軟性膜３８によって覆われ、皿状部７Ｃ内が液密的に封止される。軟性膜３８は超音波を阻害しない材料、例えば、シリコンゴム、ラテックスで形成される。この反射手段４４では、パイプ状の内操作棹７Ｂから冷却液（例えば冷却水）１８１を反射体６へ注入し（矢印ａ）、反射体６は配された領域を冷却して後、筒状の外操作棹７Ａを通して冷却液１８１を外部に排出する（矢印ｂ）ようにした冷却手段が構成される。この冷却液１８１は例えば循環して用いることができる。反射体６は、冷却液１８１の循環によって、全体が冷却され、例えば、出射部３より照射された超音波を反射体６で反射するときに発生する反射体６近傍領域の熱を取り除くことができ、治療部位を集中的に温熱治療することができる。
【００８０】
図１６Ｂに示す反射手段４５は、移動可能な支持台３０の透孔を挿通して、パイプ状の内操作棹７Ｂが固定され、この内操作棹７Ｂ内を前進、後退し得るワイヤー１８２が配置され、ワイヤー１８２の先端を反射体６の中央に固着して構成される。その他の構成は、図１６Ａと同様であるので、対応する部分に同一符号を付して重複説明を省略する。この反射手段４５では、ワイヤー１８２を後退、前進させることにより、反射体６の中央部が図において上下に移動し、このため支持台３０が前進、後退して反射体６の曲率を変更することができる。反射体６近傍の冷却は図１６Ａと同様に行うことができる。
図１６Ｃに示す反射手段４６は、反射体６をバイメタル材料で形成し、反射体６の下部にヒーター４０を設置して構成される。その他の構成は、図１６Ａと同様であるので、対応する部分には同一符号を付して重複説明を省略する。この反射手段４６では、ヒーター４０による加熱により湾曲することで反射体６の曲率を変更することができる。反射体６近傍の冷却は、図１６Ａと同様に行うことができる。
【００８１】
図１７は、反射手段４の更に他の実施の形態を示す。本例では挿入時に反射体を狭めて挿入し易くし、挿入後に反射体を所要の大きさに広げるようにする。本実施の形態に係る反射手段４７は、反射体６を、所要の曲率の反射面を有する複数枚の反射素体５１、５２、５３からなり、複数枚の反射素体５１、５２、５３を重ね合せ、互いに広げたときに所要の大きさの反射体となるように形成して成る。即ち、中間で連結されるように２つ折りされた所要の曲率の反射面を有する第１の反射素体５１と、第１の反射素体５１の２つ折りされた部材間に重ね合うように配置された所要の曲率の反射面を有する第２及び第３の反射体５２及び５３とが設けられる。
【００８２】
第２の反射素体５２は、その一端が第１の反射素体５１の２つ折りされた連結部５１Ａに一体の軸５４に回転自在に取り付けられ、その他端が軸５４と同軸線上に配置された第１の回転ギア５５の軸に取り付けられるように形成される。第３の反射素体５３は、その一端が第１の反射体５１の２つ折りされた連結部５１Ａに一体の軸５６に回転自在に取り付けられ、その他端が軸５６と同軸線上に配置された第２の回転ギア５７の軸に取り付けられるように形成される。第１の回転ギア５５は第１の反射素体５１の端部と操作棹７側の基部間に軸支され、第２の回転ギア５７は操作棹７を通じて配置される回転シャフト５８に連結され、両回転ギア５５及び５７は互いに噛み合わされるように構成される。回転シャフト５８には、例えば手動により操作する操作レバー５９が取り付けられる。操作棹７に設けられたハウジング６０には操作レバー５９の案内溝６１が設けられ、操作レバー５９はこの案内溝６１に沿って回動される。さらに、前述特許同様に反射体６の全体を覆う軟性膜３８が形成され、ハウジング６０を通じて反射体６へ冷却液を注入する注入チューブ６３及び冷却液を排出する排出チューブ６４が配置される。反射手段４７の部分と操作棹７とは、連結手段６５によって連結される。
【００８３】
この反射体６は、生体管腔内に挿入する時点では図１８Ａに示すように、３枚の反射素体５１、５２及び５３が折り重なるように細く畳み込まれている。生体管腔内の所定位置に挿入された時点では、操作レバー５９を回動して回転シャフト５８を回転させると、第２の回転ギア５７が回転すると共に、第１の回転ギア５５が逆回転し、両回転ギア５５及び５７に夫々取り付けられている第２の反射素体５２及び第３の反射素体５３が第１の反射素体５１を中心に左右に開かれ、図１８Ｂに示すように目的の広さのスプーン形状の反射体６になる。
【００８４】
上述の反射体６は、所要の曲率を有する凹状の反射面を形成するようにしたが、その他、反射面を平面にして形成することも可能である。
【００８５】
図１９は、本発明に係るエネルギー治療装置の全体的構成の実施の形態を示す。本例は前立腺治療に適用した場合である。本実施の形態に係るエネルギー治療装置１０１は、エネルギー出射部である超音波振動子３を備えたアプリケータ２及び反射手段４を配置する配置装置、即ちアプリケータ２及び反射手段４を保持する配置装置１４と、超音波振動子３及び反射手段４を制御する制御装置５と、モニター９９とを備えて成る。
【００８６】
配置装置１４は、基台１４１の主面上に反射手段４を保持する第１の保持部１４２と、基台１４１の一側より延長する支柱１４３に支持され、第１の保持部１４２に対向してアプリケータ２を保持する第２の保持部１４４と、超音波振動子３及び反射手段４の位置を調整する位置調整機構とを有する。第１の保持部１０２は、反射手段４を保持してスプーン状の反射体６の位置及び向きが任意に調整できるように構成される。例えば、図１９では、第１の保持部１４２に斜線で示した領域内で反射体４の操作棹７が移動し任意の位置、回転位置で保持されるようになされている。
【００８７】
第２の保持部１４４は、断面円形のアプリケータ２を挟持的に保持するように、第１の保持部１４２と同様に蓋部１４４Ａと固定部１４４Ｂに２分割されて構成される。この第２の保持部１４４は支柱１４３に沿って上下動可能の支持体１４８に支持され、支持体１４８を介して上下移動される。この上下移動の制御は例えば図示せざるも磁気センサーを用いた磁気スケールにより行うができる。この構成により、第２の保持部１４４の位置、したがって反射手段４と超音波振動子３との間の距離は、ハンドル１５０を操作して送りネジを有する移送軸（図示せず）を介して支持体１４８を移動させ、磁気スケールにより設定することができる。位置調整機構は、第２の保持部１４８の上下移動、第２の保持部１４４におけるアプリケータ２の軸方向移動と軸を中心としたアプリケータ２回動、第１の保持部１４２における反射手段４の軸方向移動と操作棹７の軸を中心とした反射体の回動と斜線で示す領域内での操作棹７の移動、を夫々行う手段から成る。
【００８８】
支持体１４８上に、更にアプリケータ２内の出射手段３に連結されたアームを軸線方向に移動されるための、移動制御手段９３となる駆動部１５７が、配置される。この駆動部１５７の摺動部１２９にアームが取り付けられる。制御装置５からケーブル１５９通じて供給される電気信号によって駆動部１５７の摺動部１２９が駆動され、アーム、従って、出射部３が軸線方向に移動される。
【００８９】
超音波振動子３を備えたアプリケータ２は、ケーブル１５２を通して制御装置５に接続される。このケーブル１５２は、電気配線、アプリケータ２内の超音波振動子３が配置された領域への冷却液の注入、排出のための冷却液送排出用チューブを含む。また、反射手段４は、冷却液の注入、排出のための冷却液送排出用チューブ１５３出力検知センサーの信号線が制御装置５に接続される。制御装置５は、キー操作部、前述した制御部９１、データベース９２を備え、さらに冷却液タンク等を備え、超音波振動子３から出射される超音波の出力の制御、冷却液の流量制御、反射体６の超音波センサー３５からの検出信号の処理、その他、後述する機能を備えたときには、その機能の制御等を行うように構成される。フットスイッチ１５４を備えることもできる。
【００９０】
一方、アプリケータ２の先端内には、生体組織を観察するための観察手段、例えば内視鏡やＣＣＤカメラ等を設置することができる。この内視鏡を備えた場合、前述の図２で説明したように、アプリケータ２を尿道に挿入した後、内視鏡により尿道を観察することにより前立腺部尿道に特徴的な形状を見出し治療部位８０の前後位置を判定することができる。この内視鏡について説明する
内視鏡は、照明光の照射を兼ねた光ファイバを用いており、先端には結像レンズが設けられる。内視鏡は、エネルギー照射装置の基端部から出し入れ自在に設置されている。内視鏡観察により、超音波の出射部３の位置決めを行うことが出来る。また、ガイド光機能付きにすることによって、視覚的に超音波照射位置を確認できる。更に超音波照射中に連続して照射表面を観察できるため、状態を観察しながら照射条件を最適化することが可能となる。
【００９１】
アプリケータ２及び反射手段４は、配置装置１４によって相互間の距離を制御きるように移動可能に配置されるため、比較的高い硬度のある材料で形成されるのが好ましく、例えばステンレス等で形成することができる。アプリケータ２の構成材料の詳細は後述する。アプリケータ２には、出射部３からのエネルギーを照射するための窓（図示しない）が有り、この窓は、後述する観察手段、本例では内視鏡の観察にも使用することができる。窓の材質は、例えばポリエチレンテレフタレート、石英ガラス、アクリル、ポリスチレン、ポリカーボネート、ポリエチレン、ポリプロピレン、塩化ビニリデン、テフロン（登録商標）、ポリエステル等の透過特性の優れたものを利用することが望ましい。
【００９２】
また、アプリケータ２の生体体腔に挿入される部分には、挿入後の位置固定のために拡張、収縮するバルーンを設けることができる。バルーンの構成材料としては、例えば、ポリオレフィン、ポリエステル、ポリアミド、ラテックス、セルロース等の超音波透過性に優れた材料が好ましい。これにより、バルーンでの超音波の吸収によるエネルギーの損失や発熱を低減することができる。
【００９３】
バルーンを拡張するための作動流体としては、空気、冷却液を用いることができる。作動流体としては、バルーンを拡張・収縮し得るものであれば特に限定されないが、冷却液が好ましい。作動流体として冷却液を用いることにより、超音波照射の際、その冷却液により生体組織の表層部を冷却することができ、これにより、表層部の損傷をより確実に防止することができる。
【００９４】
冷却液の温度は、生体組織の表層部を冷却し得る程度であれば特に限定されないが、０℃〜３７℃以下が好ましく、０℃〜２５℃程度がより好ましい。
【００９５】
作動流体としては、生理食塩水またはリンゲル液等が好ましい。これらを作動流体として用いることにより、何らかの原因で作動流体が体内に漏出した場合、その漏出による影響を低減することができる。
【００９６】
作動流体としては冷却液を用いる場合には、冷却液を循環させるのが好ましく、超音波照射前から超音波照射が終了し、治療を終えるまで冷却液を循環させるのがより好ましい。冷却液を循環されることにより、冷却能率を向上されることができ、超音波照射前から超音波照射が終了するまで冷却液を循環させることにより、表層部をより一層冷却することができる。
【００９７】
排出部には、例えば、一定の圧力を超えると開放する圧力弁を設けるのが好ましい。これにより、冷却液の流量によらず、一定の圧力でバルーンを拡張することができる。
【００９８】
冷却液の温度や冷却液の流量を超音波照射と連動して制御するのが好ましい。これにより、表層部の過剰冷却や過剰加熱を防止することができる。
【００９９】
バルーンに生体組織の表面温度を検出する温度センサーを設けるのが好ましい。この場合には、温度センサーにより生体組織の表面温度を検出し、その情報（検出値）を冷却制御に利用することができる。これにより、効率良く、必要かつ十分に冷却することができる。
【０１００】
バルーンは、ハウジングの超音波出射部以外の全周を囲むように形成されても良い。この場合、バルーンの拡張により、本体の超音波出射部が体腔壁に押し付けられるので、照射目的部と出射部との距離が安定し、照射時の安定性が良い。
【０１０１】
また、アプリケータ２の構成材料としては、例えば、ステンレススチール等の金属などからなる硬質パイプが好ましい。また、その他に本体の構成材料としては、例えば、ポリエチレン、ポリプロピレン等のポリオレフィン、エチレンー酢酸ビニル共重合体（ＥＶＡ）、ポリ塩化ビニル、ポリエチレンテレフタレート、ポリブチレンテレフタレート等のポリエステル、ポリアミド、ポリウレタン、ポリスチレン、ポリカーボネート、フッ素樹脂等、これらのうちの１種を含むポリマーアロイ、またはこれらのうちの２以上を組み合わせたものが挙げられる。
【０１０２】
また、本体の表面には親水性高分子材料や、シリコン、フッ素樹脂等の潤滑性コーティングを施しても良い。これにより本体表面の摩擦を低減し、体腔への挿入をスムーズなものとすることができる。
【０１０３】
潤滑性コーティングに用いる親水性高分子材料としては、例えば、カルボキシメチルセルロース、多糖類、ボリビニルアルコール、ポリエチレンオキサイド、ポリアクリル酸ソーダ、メチルビニルエーテル−無水マレイン酸共重合体、水溶性ポリアミド等が好ましく、これらのうち、特にメチルビニルエーテル−無水マレイン酸共重合体が好ましい。
【０１０４】
親水性高分子材料をコーティングしたエネルギー治療装置を使用する際は、例えば、生理食塩水等に、エネルギー治療装置の表面層を浸す。これにより、表面層が湿潤し、エネルギー治療装置の表面の潤滑性が生じる。このエネルギー治療装置では、親水性高分子材料を含む表面層を有しているので、生体組織に対するエネルギー治療装置の摩擦が減少し、これにより、患者の負担が軽減されるとともに、安全性が向上する。例えば、エネルギー治療装置の体腔内への挿入、体腔内からの引き抜き、体腔内での移動や回転を円滑に行うことができる。
【０１０５】
図２０は、図１９による本実施の形態に係るエネルギー治療装置１０１を使った治療を表すフローチャートである。
まず、ステップＳ１で患者に麻酔をかける。麻酔は全身麻酔でも局所麻酔でも良い。ステップＳ２でアプリケータ２を尿道に挿入する。ステップＳ３で反射手段４を直腸に挿入する。ステップＳ４では、アプリケータ２と反射手段４を配置装置１４に固定する。ステップＳ５では、治療部位の照射位置を決定し、アプリケータ２と反射手段４の位置を調整する。ステップＳ６では、超音波の照射条件を制御装置５に入力する。ステップＳ７では、フットスイッチ１５４を押して治療を開始する。超音波の出射部３は、アプリケータ２の軸線方向に沿って移動しながら超音波を治療部位に照射する。これによって、超音波が治療部位のみに集中して照射される。ステップＳ８では、治療部位の治療が完了したら、ステップＳ９の治療終了に進み、もし、次の治療部位があれば、ステップＳ５に戻り、治療部位がなくなるまでステップＳ５〜Ｓ８を繰り返す。
【０１０６】
図２１は、治療部位の位置調整を行うフローチャートを示す。
ステップＳ１０では、アプリケータ２の軸線を中心とした回転角を決定して、出射部（超音波振動子）３の照射方向を決定する。ステップＳ１１では、超音波を弱くあるいは短時間照射する。ステップＳ１２では、反射体６に付けられた受信体、本例では超音波センサー３５で受信して、超音波を一番強く受ける位置で反射体６を固定する。ステップＳ１３で、調整を終了する。
【０１０７】
上述した本実施の形態に係るエネルギー治療装置１０１によれば、治療部位８０に対して超音波の出射部３からの超音波に加えて反射体６から反射超音波を治療部位で重なり合うように照射することにより、超音波の利用効率と共に超音波の治療部位８０への集積効率を向上することができる。同時に、超音波の出射部３を移動させながら治療部位に照射することにより、更に、超音波の治療部位８０への集積効率を向上することができる。従って、最適な高温度治療の温度に加温をすることを可能にする。
【０１０８】
照射エネルギーとして、深達性を有する超音波を用いることにより、深部にある部位に対する高温度治療を可能にする。
【０１０９】
出射部３の各移動位置から出射される超音波をそれぞれ治療部位に集中させるように出射部３が構成されるので、上記した超音波の治療部位８０への集積効率の向上を可能にする。
【０１１０】
超音波の出射部３を電気的な駆動手段１５７で軸線方向へ繰り返し往復移動させるように構成することにより、周囲の正常な生体組織にダメージを与えることなく、治療部位８０対してのみ集中して超音波照射することができる。超音波の出射出力を小さくしても治療部位に対して適切な加熱温度となるように超音波の集積効率を上げることができる。
【０１１１】
超音波の出射部３を移動させる移動手段を構成する、例えば駆動手段１５７に出射部３の往復移動の移動量を調節する調節手段を備えるときは、超音波照射する際に最適な位置からの超音波治療を可能にする。
【０１１２】
アプリケータ２及び反射手段４は、配置装置１４により、治療部位に応じてアプリケータ２の長軸方向、又は／及び長軸方向に対して垂直方向に移動できるので、超音波の出射部３より照射された超音波を治療部位８０に対して最適な位置に設定することができる。
【０１１３】
アプリケータ２及び反射手段４に対して、冷却手段を備えるので冷却液により生体組織の表層部を冷却することができ、表層部の損傷をより確実に防止することができる。
【０１１４】
超音波の出射部３の超音波出射面に超音波を収束、平行または拡大する音響レンズ２３を設けることにより、治療部位の状態次第で、超音波を広域、狭域に照射したり、超音波を集中的に照射することができる。
【０１１５】
配置装置１４では、超音波の出射部３からの超音波の照射方向を変えるための変更機能を有するので、治療部位に対して、超音波の出射部３を的確な位置に変更することができ設定時間の短縮を図ることができる。
【０１１６】
反射体６の反射面の曲率を可変にすることで、治療部位に深さ方向の位置、面積に応じて照射範囲を可変することができる。
【０１１７】
反射体６に超音波センサー３５を設けることにより、超音波の出力強度を検出することができ、超音波の出射部３から出射する超音波出力の制御、条件の設定の見直し等を行うことができる。
【０１１８】
アプリケータ２に観察手段、例えば内視鏡やＣＣＤカメラ等を配置するときは、治療部位の治療前後の状態を観察することができ、状態を観察しながら照射条件を最適化することが可能となる。
【０１１９】
アプリケータ２や反射手段４に拡張、収縮するバルーンを設けるときは、治療部位の近傍でアプリケータ２を体腔壁に押し付けることができ、治療部位８０と超音波の出射部３との距離が安定し、治療部位に対する超音波照射を安定にすることができる。
【０１２０】
アプリケータ２や反射手段４の表面に親水性高分子材料を含む表面層を形成するときは、アプリケータ２の表面の摩擦を低減し、体腔への挿入、引き抜き、移動、回転をスムーズなものとすることが出来る。
【０１２１】
本実施の形態に係るエネルギー治療装置によれば、反射体６に空気抜きの孔３６及び超音波ゼリー注入孔３７を設けるときは、反射体６に超音波ゼリーを注入することにより、体腔壁に反射体６を密着することができ、超音波を乱反射させず、治療部位８０に正確に反射することができる。
【０１２２】
冷却手段として、本体、反射手段及びバルーンの夫々に設けていることを説明したが、冷却条件に応じて、本体、反射手段及びバルーンの冷却手段を任意に組み合わせて設けることができる。
【０１２３】
本実施の形態では、生体組織に向けて照射されるエネルギーとして、超音波を例に説明したが、本発明はこれに限定されるものではなく、例えば、レーザ光、指向性を持った電磁波等のエネルギーの照射を行うものでもよい。この場合、必要に応じてアプリケータの出射部に対応する部分にエネルギー照射を阻害しないために窓を設けるようにする。
【０１２４】
上例では、本実施の形態としては、加熱治療の対象となる生体組織として、前立腺の場合を例に説明したが、本発明はこれに限定されるものではなく、血管や消化管（食道、腸管など）、腹腔などの生体内から、あるいは体表からエネルギーを照射して高温度治療を行うことが可能な生体組織の全てを含む。
【０１２５】
なお、以上説明した実施の形態は、本発明を限定するために記載されたものではなく、本発明の技術的思想内において当業者により種々変更が可能である。
【０１２６】
【発明の効果】
本発明に係るエネルギー治療装置によれば、エネルギーを出射するエネルギー出射部と、エネルギー出射部から出射されたエネルギーを目的部位に反射するように、エネルギー出射部に相対する位置に設置する反射手段を備えるので、エネルギー利用効率が上がり、出射出力を抑えつつ、目的部位に対するエネルギーの集積、従ってエネルギーの強度を上げることができる。
また、出射部からのエネルギーが異なる経路を通って目的部位に集まるように構成されるので、目的部位に対するエネルギーの集積効率を上げることができる。よって、最適な高温度治療の温度に加温をすることを可能にし、短時間の温熱治療を可能にする。
【０１２７】
本発明に係るエネルギー治療装置によれば、エネルギー出射部と反射手段とを有することにより、エネルギー利用効率が上がり、出射出力を抑えつつ、目的部位に対するエネルギーの集積、従ってエネルギーの強度を上げることができる。同時に、エネルギー出射部を移動させるので、エネルギーを異なる経路を通って目的部位に照射することができる。すなわち、エネルギー出射部を移動させながらエネルギーを目的部位に照射するので、目的部位以外の他の生体組織に影響を与えずに、更に目的部位に対するエネルギーの集積効率を上げることができる。よって、最適な高温度治療の温度に加温をすることを可能にし、短時間の温熱治療を可能にする。
【０１２８】
本発明に係るエネルギー治療装置によれば、エネルギー出射部からの出射エネルギーと、反射手段からの反射エネルギーとが目的部位で重なり合うようにして照射することにより、エネルギー集積が上がり目的部位を最適な温度に加温することができる。
【０１２９】
本発明に係るエネルギー治療装置によれば、エネルギー出射部を含む長尺状の本体を有し、本体内に配置されたエネルギー出射部の位置を本体の軸方向へ移動される移動手段を有するときは、目的部位以外の生体組織の加温を抑えつつ、効率良くエネルギーを目的部位に集積させることができる。
【０１３０】
エネルギー出射部を含む長尺状の本体を有し、本体内に配置されたエネルギー出射部の位置を本体の軸方向へ繰り返し往復移動させる移動手段を有することにより、周囲の正常な生体組織にダメージを与えることなく、目的部位に対してのみ集中してエネルギーを照射することができる。エネルギーの出射出力を小さくしても目的部位に対して適切な加熱温度となるようにエネルギーの集積効率を上げることができる。
【０１３１】
エネルギー出射部としては、各移動位置から出射されるエネルギーをそれぞれ目的部位に集中するようにされてなる移動手段を有するので、上記したエネルギーの目的部位への集積効率の向上を可能にする。
【０１３２】
移動手段としては、エネルギー出射部の往復移動の移動量及び移動速度を調節可能にする移動制御手段を備えるときは、エネルギー照射する際に最適な位置からのエネルギー治療を可能にする。
【０１３３】
配置装置は、エネルギー出射部を含む本体と、反射手段を配置する配置装置を有するので、目的部位との位置をより安定でき、エネルギー照射時も目的部位に対し正確にエネルギーを照射することができる。
【０１３４】
配置装置は、エネルギー出射部を含む本体の保持部と反射手段の保持部と、エネルギー出射部と反射手段の相対位置を調整する機構を有することにより、エネルギー出射部と反射手段を最適な位置で固定することができ、エネルギーの照射を安定して行うことが出来る。
【０１３５】
配置装置を制御する配置制御手段を有することにより、最適な配置でエネルギー照射を効率的に行うことができる。
【０１３６】
配置制御手段がエネルギー出射部からの出射エネルギーと、反射手段からの反射手段からの反射エネルギーとを目的部位で重なり合うように制御するので、より効率且つ短時間で治療を行うことができる。
【０１３７】
配置装置がエネルギー出射部の向きを変更できることにより、目的部位に対して、本体を的確な位置に変更することができ設定時間の短縮を図ることができる。
【０１３８】
エネルギー出射部からの出射エネルギーの照射パターンと、照射時間、照射出力を制御する出射制御手段を有することで、より効率的かつ短時間で治療を行うことができる。
【０１３９】
反射手段に固定反射面または可変反射面を備えることで、目的部位の治療の範囲によって、最適な反射面を使うことができ、より効率的な治療を行うことができる。
【０１４０】
反射手段を反射面の曲率半径が可変できるように形成するときは、目的部位の深さ方向の位置、面積に応じて照射範囲を可変することができる。
【０１４１】
反射手段を制御する反射制御手段を有することで、より効率的かつ短時間で治療を行うことができる。
【０１４２】
反射体にエネルギーの到達効率を検出するエネルギー検出手段を有するときは、出射エネルギーを検出することができ、出射エネルギーの出力の制御、照射条件の設定の見直し等を行うことができる。
【０１４３】
反射体に空気抜きの孔の溝を有することにより、空気を抜いて、体腔壁に反射体を密着することができ、出射部より照射されたエネルギーを乱反射させず、目的部位に正確に反射することができる。
【０１４４】
冷却手段をエネルギー出射部エネルギー出射部を含む本体に備えることにより、冷却液により生体組織の表層部を冷却することができ、表層部の損傷をより確実に防止することができる。
【０１４５】
冷却手段を反射手段に備えることにより、反射手段の周辺の生体組織への温度上昇を防ぐことができ、目的部位の治療を効率良く且つ安定的に行うことができる。
【０１４６】
冷却手段を制御する冷却制御手段を有するので、常に、冷却液により生体組織の表層部を冷却することができ、表層部の損傷をより確実に防止することができるので、短時間且つ効率の良い治療を行うことができる。
【０１４７】
移動制御手段を制御する制御装置を有するので、自動化して効率的且つ短時間で治療をすることができる。
【０１４８】
配置制御手段、または配置制御手段と移動制御手段を制御する制御装置を有するので、それぞれを自動化して効率的且つ短時間で治療をすることができる。
【０１４９】
出射制御手段、または出射制御手段と配置制御手段と移動制御手段のうち２つ以上を制御する制御装置を有するので、それぞれを自動化して効率的且つ短時間で治療をすることができる。
【０１５０】
反射制御手段、または反射制御手段と出射制御手段と配置制御手段と移動制御手段のうち２つ以上を制御する制御装置を有するので、それぞれを自動化して効率的且つ短時間で治療をすることができる。
【０１５１】
冷却制御手段、または冷却制御手段と反射制御手段と出射制御手段と反射制御手段と移動制御手段とのうち２つ以上を制御する制御装置を有するので、それぞれを自動化して効率的且つ短時間で治療をすることができる。
【０１５２】
エネルギー出射部を含む本体に、出射エネルギーの広がり角度を収束、平行、拡大する手段を設けることにより、目的部位の状態次第で、エネルギーを広域、狭域に照射したり、超音波を集中的に照射することができる。
【０１５３】
エネルギー出射部を含む本体に観察手段を有するときは、目的部位の治療前後の状態を観察することができ、状態を観察しながら照射条件を最適化することが可能となる。
【０１５４】
エネルギー出射部を含む本体あるいは反射手段、あるいは本体と反射手段の両方の表面に拡張、収縮するバルーンを有するときは、目的部位の近傍で本体や反射手段を体腔壁に押し付けることができ、目的部位と出射部との距離が安定し、目的部位に対するエネルギー照射及びエネルギーの反射を安定にすることができる。
【０１５５】
エネルギー出射部を含む本体あるいは反射手段、あるいは本体と反射手段の両方の表面に親水性高分子材料を含む表面層を有するときは、本体あるいは反射手段の表面の摩擦を低減し、体腔への挿入、引き抜き、移動、回転をスムーズなものとすることが出来る。
【０１５６】
出射部より照射するエネルギーを超音波にすることで、深部にある部位に対して選択的に照射することを可能にする。
【図面の簡単な説明】
【図１】本発明に係るエネルギー治療装置の基本構成を示す構成図である。
【図２】Ａ 図１のエネルギー治療装置の要部の側面図である。
Ｂ 図２ＡのＡ−Ａ線での断面図である。
【図３】本発明に係るエネルギー治療装置の一実施の形態を示す構成図である。
【図４】本発明に係るエネルギー治療装置のエネルギー出射部分の一実施の形態を示す要部の構成図である。
【図５】Ａ 図４に示す一実施の形態に係るエネルギー出射部を示す斜視図である。
Ｂ 図５Ａのエネルギー出射部の断面図である。
【図６】Ａ 図４のエネルギー治療装置の動作説明図である。
Ｂ 他のエネルギー出射部を用いたエネルギー治療装置の動作説明図である。
【図７】Ａ 本発明に係るエネルギー治療装置に適用される超音波の収束素子の一実施の形態を示す構成図である。
Ｂ 本発明に係るエネルギー治療装置に適用される超音波の収束素子の他の実施の形態を示す構成図である。
【図８】本発明に係るエネルギー治療装置のエネルギー集積をシミュレーションしたグラフである。
【図９】Ａ〜Ｃ 本発明に係るエネルギー出射部の他の実施の形態を示す構成図である。
【図１０】図９のエネルギー出射部の動作説明図である。
【図１１】本発明に係るエネルギー出射部の移動手段の例を示す要部の構成図である。
【図１２】本発明に係るエネルギー治療装置の他の実施の形態を示す要部の構成図である。
【図１３】本発明に係るエネルギー治療装置の反射手段の一実施の形態を示す斜視図である。
【図１４】Ａ 本発明に係るエネルギー治療装置の反射手段の他の実施の形態を示す斜視図である。
Ｂ 図１４ＡのＢ−Ｂ線上の断面図である。
【図１５】Ａ 本発明に係るエネルギー治療装置の反射手段の他の実施の形態を示す斜視図である。
Ｂ 図１５ＡのＣ−Ｃ線上の断面図である。
【図１６】Ａ 本発明に係るエネルギー治療装置の反射手段の他の実施の形態を示す断面図である。
Ｂ 本発明に係るエネルギー治療装置の反射手段の他の実施の形態を示す断面図である。
Ｃ 本発明に係るエネルギー治療装置の反射手段の他の実施の形態を示す断面図である。
【図１７】Ａ 本発明に係るエネルギー治療装置の反射手段の他の実施の形態を示す断面図である。
Ｂ 図１７Ａの反射手段の側面図である。
【図１８】Ａ，Ｂ 図１７の反射手段の動作図である。
【図１９】本発明に係るエネルギー治療装置の一実施の形態を示す全体構成図である。
【図２０】本発明に係るエネルギー治療装置による治療の実施の形態を示すフローチャートである。
【図２１】本発明に係るエネルギー治療装置の位置調整の一実施の形態を示すフローチャートである。
【図２２】エネルギー治療に必要な温度と時間に関するグラフである。
【符号の説明】
１，１０１，２０１・・エネルギー治療装置、２・・アプリケータ、３・・出射部、３ａ・・超音波出射面、４，４１，４２，４３，４４，４５，４７・・反射手段、５・・制御装置、６，２６・・反射体、６ａ・・反射面、７・・操作棹、７Ａ・・外操作棹、７Ｂ・・内操作棹、７Ｃ・・皿状部、１４・・配置装置、２２・・１／２波長板、２３・・音響レンズ、３０，３１・・支持台、３０ａ・・透孔、３３，５１，５２，５３・反射素体、３４・・軸、３５・・超音波センサー、３６・・空気孔、３７・・ゼリー状体注入孔、３８・・軟性膜、４０・・ヒーター、５１Ａ・・連結部、５５・・第１の回転ギア、５４・・一体の軸、５７・・第２の回転ギア、５８・・回転シャフト、５９・・操作レバー、６０・・ハウジング、６１・・案内溝、６３・・注入チューブ、６４・・排出チューブ、６５・・連結手段、８０・・治療部位、８１・・尿道、８２・・直腸、８３・・前立腺、８４・・治療部位以外の部位、８５・・超音波、８５´・・反射超音波、９１・・制御部、９２・・データベース、９３・・移動制御手段、９４・・出射制御手段、９５・・冷却液制御手段、９６・・配置制御手段、９７・・反射制御手段、９８・・エネルギー検出手段、９９・・モニター、１０２・・移動機構、１０３・・超音波振動子、１０４・・可動式ミラー、１０４ａ・・ミラー面、１０５，１２３・・アーム、１０８・・支持部、１０９，１２５・・係合ピン、１１０，１２７・・案内板、１１１，１２８・・案内溝、１１２，１２４・・軸、１２１，１４１・・基台、１２１Ａ・・開口、１２２・・緩衝材、１２３Ａ・・アームの先端部、１２９・・摺動部、１３２、１５７・・駆動部、１３３・・溝カム、１３４・・回転軸、１３５・・モータ、１３６・・楕円形の溝、１３７・・ロッド、１３８・・カムフォロア、１６１・・バルーン、１４２・・第１の保持部、１４４Ａ・・蓋部、１４４Ｂ・・固定部、１４３・・支柱、１４４・・第２の保持部、１４５・・可動ブロック、１４６・・移送軸、１４７，１５０・・ハンドル、１４８・・支持体、１５２，１５９・・ケーブル、１５３・・冷却液送排出用チューブ、１５４・・フットスイチ、１６２・・第１ガイド部、１６３・・第２ガイド部、１６４・・開口、１８１・・冷却液、１８２・・ワイヤー[0001]
BACKGROUND OF THE INVENTION
The present invention is inserted into a living body lumen or lumen such as a digestive tract such as a blood vessel, esophagus or rectum, urethra, abdominal cavity or thoracic cavity, or surgically pressed against a living tissue or pushed against a body surface. BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an energy therapy apparatus for irradiating a living tissue with energy such as ultrasonic waves and laser light to treat a tumor such as cancer or a prostatic hypertrophy at a high temperature.
[0002]
[Prior art]
Utilizing the body cavity of the living body or making a small incision in the living body and inserting a long insertion part into the living body, irradiating the living tissue including the lesion with ultrasonic waves, laser light, etc. energy from this insertion part, A heat treatment technique (hyperthermia, high temperature treatment, ablation, transpiration) is known in which the tissue at the lesion site or the surrounding tissue including the lesion site is eliminated by degeneration, necrosis, coagulation, cauterization, or transpiration.
[0003]
In general, these techniques treat energy by directly irradiating a lesion site located on or near the surface of a living tissue. For example, heating of a lesion site located deep in a living tissue such as the prostate. It is also used for treatment.
[0004]
Patent Document 1 discloses an example of a medical energy irradiation apparatus applied to such a thermal treatment. Patent Document 2 discloses a treatment apparatus applied to high intensity focused ultrasound (HIFU) therapy. This medical energy irradiation apparatus is generally performed in the following procedure, for example, when treating prostate. In other words, a doctor who treats the prostate inserts the insertion part of the medical energy irradiation device into the rectum, causes the position of the emission part to reach the prostate, aligns the position of the emission part with the target site direction, and irradiates energy To do. It is common for a doctor to observe while observing with an image diagnosis using ultrasound.
[0005]
FIG. 22 is a graph showing the relationship between temperature and time for giving damage (necrosis) to living tissue. The tissue becomes necrotic in a short time as the temperature increases. For example, necrotic tissue takes 3 minutes at a temperature of 55 ° C. and 50 hours at a temperature of 45 ° C. (Non-patent Document 1).
[Patent Document 1]
JP 2000-319 A
[Patent Document 2]
US Pat. No. 5,743,863
[Non-Patent Document 1]
Lasers in Surgery and Medicine 18: 22-33 (1996).
[0006]
[Problems to be solved by the invention]
The above-described conventional energy irradiation apparatus for heat therapy is configured to concentrate and irradiate, for example, energy such as a laser beam emitted from an emission unit on a target site. In order to treat the target site while maintaining the warmed state as described above at the time of laser irradiation, it is necessary to increase the efficiency of energy use. In order to increase the efficiency of energy use, the output of the emission is increased, and there is a possibility of damaging normal tissues other than the target site.
[0007]
In view of the above-described points, the present invention provides an energy irradiation apparatus that increases the efficiency of use of energy emitted from an emission unit and increases energy accumulation with respect to a target site while suppressing emission output.
[0008]
[Means for Solving the Problems]
An energy treatment device according to the present invention is an energy treatment device for irradiating an energy living tissue, and an energy emitting unit that emits energy, and an energy emitting unit that reflects the energy emitted from the energy emitting unit to a target site. The reflection means installed at a position opposite to the part and the energy from the emission part gather at the target site through different paths.
[0009]
The energy treatment device according to the present invention is an energy treatment device for irradiating an energy living tissue, and an energy emitting unit that emits energy, and an energy emitting unit that reflects the energy emitted from the energy emitting unit to a target site. Since the reflecting means is provided at a position opposite to the part, the energy from the energy emitting part and the energy reflected by the reflecting means can be used.
Since energy from the emission part gathers at the target site through different paths, the efficiency of energy accumulation at the target site is improved, and heating of living tissue other than the target site can be suppressed.
[0010]
The energy treatment device according to the present invention is an energy treatment device that irradiates a living tissue with energy, and is opposed to the energy emitting unit and the emitting unit so as to reflect the energy emitted from the energy emitting unit to a target site. Reflecting means installed at the position and moving means for moving the position of the energy emitting unit.
[0011]
In the energy treatment apparatus according to the present invention, the energy treatment device includes the energy emitting unit installed in the main body and the reflecting means installed at the position opposite to the energy emitting unit, so the energy from the energy emitting unit and the energy reflected by the reflecting unit And can be used. Since the moving means is provided, the target site is irradiated with energy while moving the energy emitting unit, and the efficiency of energy accumulation at the target site is further improved, and the heating of living tissue other than the target site can be suppressed.
[0012]
The energy treatment device according to the present invention is preferably configured so that the emission energy from the energy emission unit and the reflection energy from the reflection means overlap at the target site.
[0013]
The energy treatment device according to the present invention has a long main body including an energy emitting portion, and has a moving means for moving the position of the energy emitting portion arranged in the main body in the axial direction of the main body. preferable.
[0014]
The energy treatment apparatus according to the present invention has a long main body including an energy emitting portion, and has a moving means for repeatedly reciprocating the position of the energy emitting portion arranged in the main body in the axial direction of the main body. Is preferred.
[0015]
It is preferable that the energy treatment apparatus has moving means in which the energy emitted from each moving position of the energy emitting unit is concentrated on the target site.
[0016]
It is preferable that this energy treatment apparatus has a movement control means that makes it possible to adjust the amount and speed of reciprocation of the energy emitting unit by the moving means.
[0017]
It is preferable that this energy treatment apparatus has a main body including an energy emitting unit and an arrangement device for arranging a reflecting means.
[0018]
The arrangement device preferably includes a holding unit for the main body including the energy emitting unit, a holding unit for the reflecting unit, and a mechanism for adjusting a relative position between the energy emitting unit and the reflecting unit.
[0019]
The energy treatment apparatus preferably has an arrangement control means for controlling the arrangement apparatus.
[0020]
In this energy treatment apparatus, it is preferable that the arrangement control unit controls the emission energy from the energy emission unit and the reflection energy from the reflection unit so as to overlap each other at the target site.
[0021]
In the present energy treatment device, it is preferable that the arrangement device can change the direction of the energy emitting unit.
[0022]
The energy treatment apparatus preferably has an emission control means for controlling the irradiation pattern of the emission energy from the energy emission unit, the irradiation time, and the irradiation output.
[0023]
The reflecting means preferably has a fixed reflecting surface or a variable reflecting surface.
[0024]
The reflecting means preferably has a variable curvature of the reflecting surface, and the curvature is preferably variable so as to reflect energy efficiently.
[0025]
The energy treatment apparatus preferably has a reflection control means for controlling the reflection means.
[0026]
It is preferable that this energy treatment apparatus has an energy detection means for detecting the amount of energy that has reached the reflection means from the energy emitting unit.
[0027]
The reflecting means preferably has air venting means.
[0028]
It is preferable that this energy treatment apparatus has a cooling unit that cools one or more of the energy emitting unit and the living tissue contacting the main body including the energy emitting unit.
[0029]
The energy treatment apparatus preferably includes a cooling unit that cools one or more of the reflecting unit and the biological tissue that contacts the reflecting unit.
[0030]
The energy treatment apparatus preferably includes a cooling control unit that controls the cooling unit.
[0031]
The energy treatment apparatus preferably has a control device for controlling the movement control means.
[0032]
The energy treatment apparatus preferably has a placement control means or a control device that controls the placement control means and the movement control means.
[0033]
The present energy treatment apparatus preferably has a control device for controlling two or more of the extraction control means or the extraction control means, the arrangement control means, and the movement control means.
[0034]
It is preferable that the energy treatment apparatus has a control device that controls reflection control means, or two or more of reflection control means, emission control means, arrangement control means, and movement control means.
[0035]
The energy treatment apparatus preferably includes a cooling control unit, or a control device that controls at least two of the cooling control unit, the reflection control unit, the emission control unit, the reflection control unit, and the movement control unit.
[0036]
It is preferable that this energy treatment apparatus has means for converging, paralleling, and enlarging the spread angle of the emission in the main body including the energy emission unit.
[0037]
It is preferable that this energy treatment apparatus has an observation means for locating and observing the inside of a living body in a main body including an energy emitting unit.
[0038]
It is preferable to have a balloon that expands and contracts for fixing the position on the surface of the main body or the reflecting means including the energy emitting portion, or both the main body and the reflecting means.
[0039]
It is preferable to have a surface layer containing a hydrophilic polymer material on the main body or the reflecting means including the energy emitting portion, or on both surfaces of the main body and the reflecting means.
[0040]
As the emission energy, ultrasonic waves, laser light, or the like can be used. In particular, since ultrasonic waves have deep penetration, it is preferable to use ultrasonic waves as output energy when the energy irradiation apparatus of the present invention is applied to, for example, prostate treatment requiring energy penetration.
[0041]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
[0042]
First, the basic configuration of the energy treatment apparatus according to the present invention will be described with reference to FIG. The present energy treatment device 1 is installed relative to an applicator 2 that is an elongated insertion portion, an energy emitting portion 3 that is installed in the applicator and irradiates a living tissue with energy, and an applicator 2. And reflecting means 4 for reflecting the energy emitted from the emitting portion 3. The reflecting means 4 includes a reflector 6 that forms a plane or a concave surface that substantially reflects energy, and an operating rod 7 for inserting the reflector 6. That is, the reflector 6 is integrally provided at the tip of the operation rod 7.
[0043]
As the emission energy, ultrasonic waves, laser light, directional electromagnetic waves, or the like can be used. The energy treatment apparatus 1 of the present example is applied to an ultrasonic treatment apparatus that uses ultrasonic waves with high deepness as energy. For this reason, an ultrasonic transducer serving as the emitting portion 3 is installed on the distal end side in the applicator 2. Ultrasonic waves are emitted from the ultrasonic transducer 3. As the ultrasonic vibrator, for example, an element such as a piezoelectric ceramic (PZT, barium titanate, etc.), a piezoelectric polymer (PVDF, P (VDF-TrFE), etc.) or the like that changes its shape can be used.
[0044]
In the energy treatment apparatus 1, ultrasonic waves are irradiated from the ultrasonic transducer 3 toward the treatment site 80, ultrasonic waves that have partially transmitted through the treatment site 80 are reflected by the reflector 6, and the reflected ultrasonic waves are again transmitted to the treatment site. 80 is irradiated.
[0045]
Next, a principle usage example of the energy treatment apparatus 1, that is, the ultrasonic treatment apparatus will be described. In this example, the case of applying to the treatment of prostate cancer and prostatic hypertrophy will be described.
[0046]
As shown in FIGS. 1, 2 </ b> A, and 2 </ b> B, the applicator 2 is inserted into the urethra 81, and the reflector 6 is inserted into the rectum 82 through the operation rod 7 at a position corresponding to the applicator 2. The applicator 2 is inserted so that the ultrasonic transducer 3 on the distal end side is located at a position corresponding to the treatment site 80 of the prostate 83. In this case, for example, by observing the urethra with an endoscope provided in the applicator 2, a characteristic shape of the prostate urethra can be found, and the front and back positions of the treatment site 80 can be determined. In this state, the ultrasonic wave 85 is emitted from the ultrasonic transducer 3 toward the treatment site 80 based on the control unit from the control device 5. The emitted ultrasonic wave 85 is irradiated to the treatment site 80 and a part of the ultrasonic wave 85 is reflected by the reflector 6 inserted through the treatment site 80 and inserted into the rectum 82, and the reflected ultrasonic wave 85 ′ from the reflector 6 is reflected. The treatment site 80 is irradiated again. In the treatment site 80, the ultrasonic wave 85 directly from the ultrasonic transducer 3 and the reflected ultrasonic wave 85 ′ from the reflector 6 are irradiated, and the ultrasonic waves 85 and 85 ′ are superposed to superimpose the ultrasonic energy. The strength is increased and ultrasonic waves can be used efficiently. Accordingly, it is possible to selectively treat the prostate by selectively degenerating tissue cells at the treatment site 80, for example, a malignant tumor of prostate cancer or a benign tumor of enlarged prostate.
[0047]
In the present embodiment, the temperature at the treatment site 80 can be treated at a high temperature and does not evaporate, preferably 55 ° C to 100 ° C, more preferably a temperature range around 70 ° C to 90 ° C. As described above, the ultrasonic energy is accumulated at the treatment site 80.
[0048]
As shown in FIG. 2A, the applicator 2 and the reflecting means 4 are fixed to the holding portion 14 and the distance L between them is set to a required distance.
[0049]
The above is the basic configuration of the energy treatment apparatus of the present invention. The present invention uses this basic configuration to increase the concentration of energy on the treatment site. The energy treatment device according to the embodiment of the present invention includes a long applicator, an energy emitting unit installed in the applicator, and energy emitted from the emitting unit installed at a position opposite to the applicator. And a control device for controlling the energy emitting part and the reflecting means, and an arrangement device for arranging the applicator and the reflecting means, and the energy from the emitting part passes through different paths during treatment to the treatment site. Configured to gather.
[0050]
According to the energy treatment device according to the embodiment of the present invention, the energy treatment unit includes the energy emitting unit and the reflection unit, and the treatment site is irradiated with energy from the emission unit through different paths. The energy can be intensively irradiated to the treatment site without heating. It becomes possible to heat to the temperature of optimal heat treatment, and heat treatment for a short time is enabled.
[0051]
An embodiment of the energy treatment apparatus of the present invention will be described with reference to FIG. FIG. 3 is an overall view in which a moving mechanism of the energy emitting unit is added as one mechanism for concentrating the energy from the emitting unit on the treatment site through different paths.
[0052]
The energy treatment apparatus 101 according to the present embodiment includes an applicator 2 that is a long insertion portion, a side-projection type energy emitting unit 3 and an applicator 2 installed in the applicator 2, as described above. The reflecting means 4 including the reflector 6 and the operating rod 7 that reflect the energy emitted from the emitting unit 3 and is installed at a position opposite to each other, and the moving mechanism 102 that moves the energy emitting unit 3 in the axial direction of the applicator 2. And a control device 5. The applicator 2 and the operating rod 7 of the reflecting means 4 are held in a placement device 14 described later outside the living body.
[0053]
The control device 5 includes a control unit 91 configured by a CPU such as a microprocessor, and a database 92 that stores programs executed by the control unit 91 and various data. The control unit 91 supplies a cooling liquid to the emission unit 3, for example, a movement control unit 93 for driving an ultrasonic transducer, an emission control unit 94 for setting an irradiation pattern, the applicator 2, and the reflector 6. Cooling liquid control means 95 for discharging, arrangement control means 96 for setting the distance and direction between the applicator 2 and the reflection means 4, reflection control means 97 for controlling, for example, the radius of curvature of the reflector of the reflection means, and energy emission An energy detecting means 98 for detecting the energy intensity emitted from the unit 3, for example, the ultrasonic intensity, is connected. Furthermore, a monitor 99 such as a cathode ray tube or a liquid crystal is provided as a display means for displaying the calculation result of the input information.
As the coolant control means 95, in order not to heat the surface layer of the living tissue that is not the treatment site by the ultrasonic wave emitted from the ultrasonic transducer 3, that is, the surface layer in contact with the applicator 2 or the reflector 6. The coolant is injected and discharged in a circulating manner.
[0054]
When an ultrasonic transducer is used as the emitting unit 3, the ultrasonic transducer 3 is integrally disposed in the opening 121 </ b> A of the base 121 via the buffer material 122. In this case, the ultrasonic transducer 3 is arranged so that the transducer surface is flush with the lower surface of the base 121. The base 121 integrally including the ultrasonic transducer 3 is rotatably attached to the distal end portion 123 </ b> A of one arm 123 by a shaft 124. The base portion side of the arm 123 is attached to a sliding portion 129 on the drive portion (not shown) side, and reciprocates in the axial direction of the applicator 2 by sliding of the sliding portion 129. Note that the moving means for moving the arm 123, that is, the driving section including the sliding portion 129, includes adjusting means that can adjust the amount and speed of reciprocating movement of the ultrasonic wave emitting section. it can.
[0055]
The base 121 is integrally provided with engaging pins 125 on both side surfaces of the tip opposite to the side attached to the arm 123. The engagement pins 125 are engaged with engagement guide grooves 128 of a pair of guide plates 127 arranged in the applicator 2. The guide groove 128 is formed so as to be inclined at a required angle θ along the axial direction of the arm 123 and from the front end side to the rear end side of the applicator 2. The base 121 integrated with the ultrasonic transducer 3 moves along the guide groove 128 with which the engagement pin 125 engages when the arm 123 moves. As a result, the base 121 rotates about the shaft 124, and the angle α of the ultrasonic wave emission surface 3a is varied. That is, when the engagement pin 125 of the base 121 is positioned at the lower end of the guide groove 128, the ultrasonic output surface 3a is set to a predetermined angle + α so that the ultrasonic output surface 3a rises, and the ultrasonic wave is output between the upper end and the lower end of the guide groove. After the surface 3a is parallel to the axis of the arm 123 (angle α = 0 °), when the engagement pin 125 is positioned at the upper end of the guide groove 128, the ultrasonic emission surface 3a is at an angle −α with the axis of the arm 123. Set to
[0056]
During the treatment, it is desired not to heat normal living tissue other than the treatment site, for example, the surface layer portion in contact with the applicator 2. For this reason, in the applicator 2, an arm 123 connected to the base 121 integrated with the ultrasonic transducer 3 is formed in a pipe structure, and through the arm 123, in the applicator 2, particularly in the vicinity of the ultrasonic transducer 3. The coolant can be injected, and the applicator 2 can be configured to discharge the coolant through a drain tube (not shown).
[0057]
It is desirable that the ultrasonic waves emitted from the ultrasonic transducer 3 converge and irradiate the treatment site 80. For this reason, the convergence means which converges an ultrasonic wave can be arrange | positioned in the middle of the emission path | route of an ultrasonic wave. FIG. 7 shows a configuration for converging ultrasonic waves. In this example shown in FIG. 7A, the ultrasonic transducer 3 is combined with a half-wave plate 22 and an acoustic lens 23 is attached. The ultrasonic wave generated by the ultrasonic transducer 3 passes through the half-wave plate 22, is converged by the acoustic lens 23, and is irradiated to the treatment site 80. Moreover, when irradiating an ultrasonic wave in parallel, it can irradiate to the treatment site | part 80 by changing the acoustic lens 23 into a parallel ultrasonic wave. As shown in FIG. 5A, the ultrasonic transducer 3 is subjected to ultrasonic vibration by being provided with a required drive signal through the wiring 131. In the example of FIG. 7B, a concave reflector 26 is arranged instead of the acoustic lens. By using the concave reflector 26, the ultrasonic wave can be converged. Although not shown, it can be enlarged by an acoustic lens and irradiated to the treatment site 80.
[0058]
Next, with reference to FIG. 3 and FIG. 6, specific usage examples and operations when the energy treatment apparatus 101 according to the present embodiment is applied to the treatment of prostate cancer and prostatic hypertrophy will be described.
First, the applicator 2 is inserted into the urethra 81, and the ultrasonic transducer 3, which is an emitting portion provided at the distal end, is positioned in the vicinity of the treatment site 80 to be irradiated. Further, the reflector 6 is inserted into the rectum 82 through the operation rod 7 and is positioned in the vicinity of the treatment site 80 so as to face the ultrasonic transducer 3.
[0059]
Next, while driving the sliding portion 129 of the drive portion (not shown) constituting the movement control means 93 and moving the ultrasonic transducer 3 from the front end portion to the rear end portion of the applicator 2, The treatment site 80 is irradiated with ultrasonic waves emitted from the vibrator 3. A part of the ultrasonic wave irradiated to the treatment site 80 is transmitted, reflected by the reflector 6, and then irradiated to the treatment site 80 again. The reflected ultrasound reflected from the reflector 6 is irradiated to the treatment site 80. In this embodiment, the base 121 integrated with the ultrasonic transducer 3 moves in the axial direction to the applicator 2, that is, as the applicator 2 moves from the front end side to the rear end side. The pin 125 is guided along the guide groove 128 and rotated so that the angles formed with the axis of the applicator 2 of the ultrasonic wave emitting surface 3a of the ultrasonic transducer 3 become + α, 0, and −α as described above. To do. The ultrasonic wave from each rotational position of the ultrasonic transducer 3 is always applied to the treatment site 80. Therefore, only the treatment site 80 is always irradiated and concentrated with ultrasonic waves, and in other living tissues such as the surface layer portion other than the treatment site 80, for example, the treatment site 80 is heated almost without being heated. It becomes possible. In this way, the ultrasonic transducer 3 can be repeatedly reciprocated in the axial direction of the applicator 2 to perform high temperature treatment.
The high-temperature treatment described above can be performed using the emitting unit shown in FIG. 4 while changing the angle α formed by the emitting unit and the axis of the applicator as shown in FIG. 6A. 6B, even if the arm 123 is attached to the center of the base 121, the high temperature treatment can be performed by changing the angle α similarly to FIG. 6A.
[0060]
Here, prior to ultrasonic therapy, the distance / direction setting unit 96 sets the direction of the emitting unit 3 and the distance between the applicator 2 and the reflector 6. In addition, as will be described later, the ultrasonic intensity from the emission unit 3 is detected by the ultrasonic sensor 35 serving as the ultrasonic detection unit 97 provided on the reflector 6, and is fed back to the control unit 91 to output the ultrasonic wave of the emission unit 3. Adjust the output. Furthermore, at the time of ultrasonic treatment, the coolant is supplied to the reflector 6 as needed in the applicator 2 through the coolant control means 95.
[0061]
FIG. 8 is a graph showing a simulation result of ultrasonic accumulation by the energy treatment apparatus 101 described above. The vertical axis is energy density (fluency: W / cm ² ), The horizontal axis represents the distance (mm) between the ultrasonic transducer 3 and the reflection pair 6.
[0062]
In the graph of FIG. 8, the ultrasonic transducer 3 is arranged at P1 (= 0 mm), the treatment site 80 is present at the position P2 (= 21 mm), and the reflector is arranged at the position P3 (= 30 mm). It represents the ultrasonic energy density at the treatment site P2. The ultrasonic irradiation measurement conditions are as shown in Table 1.
[0063]
[Table 1]

[0064]
A curve II is an ultrasonic energy density distribution when emitted from the ultrasonic transducer 3 toward the treatment site P2.
A curve III is an ultrasonic energy density distribution after the ultrasonic wave partially transmits the treatment site P2 and is reflected by the reflector 6.
A curve I is an ultrasonic energy density distribution in a state where the ultrasonic energy density of the curve II and the ultrasonic energy density of the curve III are added.
[0065]
As is apparent from the curve I, the ultrasonic wave from the ultrasonic transducer 3 and the reflected ultrasonic wave from the reflector 6 overlap each other at the treatment site P2, and the concentration of ultrasonic energy increases and leaves the treatment site P2. It can be seen that the ultrasonic energy density gradually decreases as
[0066]
FIG. 9 shows another embodiment of the emitting unit 3 for moving the emitting unit 3 along the axis of the applicator 2 to concentrate the ultrasonic wave at the treatment site 80.
For example, in the case of ultrasonic treatment, the emitting unit 3 of the present embodiment includes an ultrasonic transducer 103 and a movable mirror 104 for directing the ultrasonic wave emitted from the ultrasonic transducer 103 to the treatment site 80. Consists of
[0067]
When an ultrasonic wave emission part is used as the emission part 3, the ultrasonic vibrator 103 is a sliding part of a drive part (not shown) via one arm 105 extending in the axial direction of the applicator 2. 129. The ultrasonic vibrator 103 is reciprocated in the axial direction of the applicator 2 by the sliding portion 129. In FIG. 11, the ultrasonic transducer 103 is supported on the front side of the support portion 108, and the support portion 108 is fixed to the tip of the arm.
[0068]
On the other hand, the mirror 104 has its upper end movably attached to the upper end on the front surface side of the support portion 108 via a shaft 112, and an engagement pin 109 provided to project on both sides of the lower end of the mirror is respectively provided with an applicator. The pair of guide plates 110 disposed in the base plate 2 are configured to engage with the guide grooves 111. The guide groove 111 is formed so as to be inclined at a required angle θ along the axial direction of the arm 105 and from the front end side to the rear end side of the applicator 2. In the mirror 104, the engagement pin 109 moves along the guide groove 111 by the movement of the arm 105, whereby the angle of the mirror surface is changed around the shaft 112.
[0069]
During the treatment, it is desired not to heat normal living tissue other than the treatment site, for example, the surface layer portion in contact with the applicator 2. Therefore, in the applicator 2, the arm 105 connected to the support portion 108 of the ultrasonic vibrator 103 is formed with a pipe structure, and the coolant is injected into the applicator 2, particularly in the vicinity of the emitting portion 3, through this arm 105. In this way, the cooling liquid can be discharged through the drain hole 113 provided in the sliding portion 129.
[0070]
The ultrasonic wave emitted from the ultrasonic transducer 103 is reflected by the surface of the mirror 104a of the movable mirror 104 and irradiated to the treatment site 80. In this case, an acoustic lens for converging the ultrasonic wave can be attached to the ultrasonic wave emission surface of the ultrasonic transducer 103 via the half-wave plate 22 as described above. As shown in FIG. 9B, the ultrasonic vibrator 103 is ultrasonically vibrated by being given a required drive signal through the wiring 114.
[0071]
Next, the operation of the emitting unit 3 shown in FIG. 9 will be described with reference to FIG.
While driving the sliding portion 129 of the driving portion (not shown) constituting the movement control means 93 to move the emitting portion 3 from the front end portion to the rear end portion of the applicator 2, The treatment site 80 is irradiated with the emitted ultrasonic wave. A part of the ultrasonic wave irradiated to the treatment site 80 is transmitted, reflected by the reflector 6, and then irradiated to the treatment site 80 again. The reflected ultrasonic wave reflected from the reflector 6 and the next ultrasonic wave are applied to the treatment site 80 as described above. In this embodiment, as the ultrasonic transducer 103 moves in the axial direction to the applicator 2, the engagement pin 109 of the mirror 104 is guided along the guide groove 111, and the mirror 104 is ultrasonically moved. It rotates so as to increase the angle β formed with the vibrator 103. The ultrasonic wave at each rotation position of the mirror 104 is always applied to the treatment site 80. Accordingly, only the treatment site 80 is always irradiated and concentrated with ultrasonic waves, and other biological tissues other than the treatment site, for example, other biological tissues such as the surface layer, are only heated temporarily, and only the treatment site 80 is heated. It becomes possible to do.
[0072]
FIG. 11 shows an example of a mechanism of a driving unit for reciprocating the emitting unit. A linearly driven follower type groove cam 133 is provided in the drive unit 132, and a rotating shaft 134 of the groove cam 133 is connected to a shaft of a motor 135 which is an electric drive means. The groove cam 133 is provided with an eccentric elliptical groove 136. In the groove 136, a base end of a rod 137 connected to a base end of an arm connected to the emitting portion 3 (not shown) is provided. A provided cam follower 138 is slidably fitted.
Due to the rotation of the motor 137, the groove cam 133 rotates around the rotation shaft 134. At that time, the cam follower 138 does not rotate but slides in the groove 136. Since the rotating shaft 134 is eccentric with respect to the groove 136, the rod 137 (and the arm) repeats linear movement (reciprocating movement) by rotation.
[0073]
FIG. 12 shows another embodiment of the emitting unit 3 for moving the emitting unit 3 along the axis of the applicator 2 to concentrate the ultrasonic wave at the treatment site 80.
The energy treatment apparatus according to the present embodiment includes the applicator 2 having the ultrasonic wave emitting unit 3 and the reflecting means 4 having the reflector 6 as described above.
When the applicator 2 is inserted into the urethra 81 and positioned so that the ultrasound emitting portion 3 faces the treatment site 80 of the prostate 83, the balloon 161 is expanded to bring the ultrasound emitting portion into close contact with the urethral surface. .
[0074]
The ultrasonic wave emitting section 3 reciprocates with the range indicated by the arrow a as the stroke length. When the light emitting portion 3 is located on the most proximal side, the light emitting portion 3 needs to be located on the distal end side with respect to the first guide portion 162. When the light emitting portion 3 is located on the most distal end side, it does not exceed the distal end of the second guide portion 163, and the opening 164 It is desirable to set to a position where ultrasonic waves do not pass.
[0075]
The ultrasonic wave is emitted laterally (preferably in a substantially vertical direction) with respect to the longitudinal axis of the emission unit 3. Here, the longitudinal axis of the emitting portion 3 is always the tangential direction of the arc drawn by the second guide portion 163. Therefore, the irradiation direction of the ultrasonic wave is always directed to the vicinity of the center of the circle including this arc (the treatment site 80). Therefore, if the ultrasonic wave is irradiated while reciprocating the emission unit 3, the emission position of the ultrasonic wave always changes on the surface of the living tissue that is in contact with the applicator 2, so the irradiation time is short and the amount of heat generated is small. Further, at the treatment site 80 located in the deep part of the living tissue, the ultrasonic wave concentrates, and only the deep part can be heat-treated while preserving the living tissue surface.
[0076]
Next, each embodiment of the reflecting means 4 will be described.
The reflecting means 41 according to the present embodiment shown in FIG. 13 has a single strip-like reflector 6 that reflects the irradiated ultrasonic wave, and both ends of the reflector 6 are arranged at a predetermined interval. The pair of support bases 30 and 31 are fixed so as to be curved, and the tip of the operating rod 7 is fixed to the other support base 31 movably disposed in the axial direction. The operating rod 7 is fixed to the other support base 31 by being inserted through a through hole 30 a provided in one support base 30 so as to be movable in the axial direction. In this reflecting means 41, the curvature of the reflecting surface 6a of the strip-shaped reflector 6 is variable by moving the operating rod 7. That is, by pulling the operating rod 7 forward, the support base 31 moves to the position of the broken line, the curvature of the reflector 6 increases, and the radius of curvature of the reflecting surface 6a decreases. Conversely, if the operating rod 7 is pushed, the radius of curvature of the reflector 6 increases. Therefore, for example, when it is desired to accurately reflect the irradiated ultrasonic wave toward the site to be treated, the curvature of the reflector 6 is changed by pulling or pushing the operation rod 7, and the reflected ultrasonic wave is treated. The part 80 is irradiated.
14A and 14B, the reflecting means 42 according to the present embodiment has a reflector 6 formed by a plurality of reflecting element bodies 33 having a wide central width and gradually narrowing toward both ends and having both sides arcuate. Is configured. The plurality of reflecting element bodies 33 are arranged so as to be bundled in a hemispherical shape, and both ends thereof are supported so as to be inserted into the support bases 30 and 31 through an integral shaft 34. Other configurations are the same as those in FIG. The reflecting means 42 can change the curvature of the reflecting surface 6 a of the reflector 6 by operating the operating rod 7. That is, when the operating rod 7 is pressed, the distance between the support bases 30 and 31 is increased, and the entire width of the reflector 6 is changed so that the radius of curvature of the reflecting surface 6a is increased. On the contrary, by pulling the operating rod 7, the distance between the support bases 30 and 31 is shortened, and the entire width of the reflector 6 is changed so that the radius of curvature of the reflecting surface 6a is reduced.
[0077]
The reflection means 43 of this embodiment shown in FIGS. 15A and 15B is configured by forming a spoon-shaped reflector 6 at the tip of the operation rod 7. In the reflecting means 43, for example, an ultrasonic sensor 35 for detecting the ultrasonic wave irradiated from the emitting portion 3 is provided at the center of the reflector 6, and air for discharging the spoon-shaped internal air to the other portion. An ultrasonic jelly injection hole 37 for injecting the hole 36 and the ultrasonic jelly is formed. In this case, the ultrasonic jelly injection hole 37 is formed so as to communicate with the spoon-shaped reflecting surface through the operation rod 7. When this reflecting means 43 is used, for example, when an ultrasonic wave is emitted from the emitting unit 3, the output intensity of the ultrasonic wave is detected by the ultrasonic sensor 35 provided on the reflecting means 43. By feeding back the output from the ultrasonic sensor 35 to the control unit 91, the ultrasonic output of the emitting unit 3 can be controlled. Further, by injecting the ultrasonic jelly into the spoon-shaped reflector 6 through the ultrasonic jelly injection hole 37, the air between the reflective surface 6 a and the living body wall escapes from the air hole 36. In the presence of air, the propagation of ultrasonic waves is hindered. Since the air is eliminated by the injection of the ultrasonic jelly, the ultrasonic waves from the emission part 3 reach the reflecting surface satisfactorily.
[0078]
16A to 16C show still other embodiments of the reflecting means 4, respectively. In this example, a cooling liquid, for example, cooling water, is injected into the reflector 6 so as to relieve the warming of the portion that is not the treatment site, that is, the surface layer portion of the living tissue that contacts the reflection means 4.
[0079]
The reflecting means 44 shown in FIG. 16A includes an outer operation rod 7A having a cylindrical operation rod 7 and a pipe-shaped inner operation rod 7B arranged in the outer operation rod 7A so as to be movable in the axial direction. A reflector 6 composed of a plurality of reflector bodies 33 similar to that shown in FIG. 14 is arranged in the dish-like portion 7C on the tip side of the flange 7A. One end of the reflector 6 is fixed to the dish-like portion 7C, the other end is fixed to the tip of the inner operation rod 7B, and is fixed to the support base 30 that is arranged to be movable in the axial direction together with the inner operation rod 7B. . In the reflecting means 44, the curvature of the reflector 6 can be changed as described with reference to FIG. 14 by moving the inner operation rod 7B forward and backward. On the other hand, the periphery of the dish-like portion 7C where the reflector 6 is disposed is covered with a soft film 38, and the inside of the dish-like portion 7C is sealed in a liquid-tight manner. The flexible film 38 is formed of a material that does not inhibit ultrasonic waves, such as silicon rubber or latex. In the reflecting means 44, a cooling liquid (for example, cooling water) 181 is injected from the pipe-shaped inner operation rod 7B into the reflector 6 (arrow a), and the reflector 6 cools the area where it is disposed, and then is cylindrical. The cooling means is configured to discharge the cooling liquid 181 to the outside through the external operation rod 7A (arrow b). This cooling liquid 181 can be circulated and used, for example. The entire reflector 6 is cooled by the circulation of the cooling liquid 181, and for example, the heat in the vicinity of the reflector 6 generated when the ultrasonic wave irradiated from the emitting unit 3 is reflected by the reflector 6 can be removed. It is possible to intensively treat the treatment site with hyperthermia.
[0080]
In the reflecting means 45 shown in FIG. 16B, a pipe-shaped inner operation rod 7B is inserted through the through hole of the movable support base 30, and a wire 182 that can move forward and backward in the inner operation rod 7B is disposed. The tip of the wire 182 is fixed to the center of the reflector 6. Since the other configuration is the same as that in FIG. 16A, the same reference numerals are given to the corresponding portions, and the duplicated description is omitted. In the reflecting means 45, the central portion of the reflector 6 moves up and down in the drawing by moving the wire 182 backward and forward, so that the support base 30 moves forward and backward to change the curvature of the reflector 6. Can do. The vicinity of the reflector 6 can be cooled in the same manner as in FIG. 16A.
The reflecting means 46 shown in FIG. 16C is configured by forming the reflector 6 from a bimetal material and installing a heater 40 below the reflector 6. Since other configurations are the same as those in FIG. 16A, the corresponding parts are denoted by the same reference numerals, and redundant description is omitted. In the reflecting means 46, the curvature of the reflector 6 can be changed by being bent by heating by the heater 40. Cooling in the vicinity of the reflector 6 can be performed in the same manner as in FIG. 16A.
[0081]
FIG. 17 shows still another embodiment of the reflecting means 4. In this example, the reflector is narrowed during insertion to facilitate insertion, and the reflector is expanded to a required size after insertion. The reflecting means 47 according to the present embodiment includes the reflector 6 including a plurality of reflecting element bodies 51, 52, and 53 having a reflecting surface having a required curvature. It is formed so as to be a reflector having a required size when overlapped and spread. That is, the first reflective element body 51 having a reflection surface with a required curvature folded in two so as to be connected in the middle and the two folded members of the first reflective element body 51 are arranged to overlap each other. Second and third reflectors 52 and 53 having a reflecting surface having a required curvature are provided.
[0082]
One end of the second reflecting element body 52 is rotatably attached to a shaft 54 integrated with a half-folded connecting portion 51A of the first reflecting element body 51, and the other end is disposed on the same axis as the shaft 54. Further, it is formed so as to be attached to the shaft of the first rotation gear 55. One end of the third reflector 53 is rotatably attached to a shaft 56 integral with a half-folded connecting portion 51A of the first reflector 51, and the other end is disposed on the same axis as the shaft 56. It is formed so as to be attached to the shaft of the second rotation gear 57. The first rotary gear 55 is pivotally supported between the end of the first reflector element 51 and the base on the side of the operating rod 7, and the second rotating gear 57 is connected to a rotary shaft 58 disposed through the operating rod 7. The rotary gears 55 and 57 are configured to mesh with each other. An operation lever 59 that is manually operated, for example, is attached to the rotary shaft 58. The housing 60 provided in the operation rod 7 is provided with a guide groove 61 of the operation lever 59, and the operation lever 59 is rotated along the guide groove 61. Further, a flexible film 38 that covers the entire reflector 6 is formed as in the above-mentioned patent, and an injection tube 63 that injects the cooling liquid into the reflector 6 through the housing 60 and a discharge tube 64 that discharges the cooling liquid are disposed. The part of the reflection means 47 and the operating rod 7 are connected by a connecting means 65.
[0083]
When the reflector 6 is inserted into the living body lumen, as shown in FIG. 18A, the three reflector elements 51, 52 and 53 are folded so as to be folded. When the operation lever 59 is rotated to rotate the rotating shaft 58 at the time when it is inserted into a predetermined position in the living body lumen, the second rotating gear 57 rotates and the first rotating gear 55 rotates in the reverse direction. Then, the second reflecting element body 52 and the third reflecting element body 53 attached to the rotary gears 55 and 57, respectively, are opened to the left and right with the first reflecting element body 51 as the center, as shown in FIG. 18B. Thus, a reflector 6 having a desired size is obtained.
[0084]
The above-described reflector 6 is formed with a concave reflecting surface having a required curvature, but may be formed with the reflecting surface being a flat surface.
[0085]
FIG. 19 shows an embodiment of the overall configuration of the energy treatment apparatus according to the present invention. This example is applied to prostate treatment. The energy treatment apparatus 101 according to the present embodiment is an arrangement apparatus that arranges the applicator 2 and the reflection means 4 including the ultrasonic transducer 3 that is an energy emitting unit, that is, an arrangement that holds the applicator 2 and the reflection means 4. It comprises a device 14, a control device 5 for controlling the ultrasonic transducer 3 and the reflecting means 4, and a monitor 99.
[0086]
The placement device 14 is supported by a first holding portion 142 that holds the reflecting means 4 on the main surface of the base 141, and a support column 143 that extends from one side of the base 141, and faces the first holding portion 142. The second holding portion 144 that holds the applicator 2 and a position adjusting mechanism that adjusts the positions of the ultrasonic transducer 3 and the reflecting means 4 are provided. The 1st holding | maintenance part 102 is comprised so that the position and direction of the spoon-shaped reflector 6 can be adjusted arbitrarily holding the reflection means 4. FIG. For example, in FIG. 19, the operating rod 7 of the reflector 4 is moved within the area indicated by hatching in the first holding portion 142 and is held at an arbitrary position and a rotational position.
[0087]
Similarly to the first holding part 142, the second holding part 144 is divided into two parts, a lid part 144A and a fixing part 144B, so as to hold the applicator 2 having a circular cross section. The second holding portion 144 is supported by a support body 148 that can move up and down along the support column 143, and is moved up and down via the support body 148. For example, the vertical movement can be controlled by a magnetic scale using a magnetic sensor (not shown). With this configuration, the position of the second holding portion 144, and thus the distance between the reflecting means 4 and the ultrasonic transducer 3, is operated via a transfer shaft (not shown) having a feed screw by operating the handle 150. The support 148 can be moved and set by a magnetic scale. The position adjustment mechanism includes vertical movement of the second holding unit 148, axial movement of the applicator 2 in the second holding unit 144 and rotation of the applicator 2 around the axis, and reflection means in the first holding unit 142. 4, and a means for rotating the reflector around the axis of the operating rod 7 and moving the operating rod 7 within the area indicated by the oblique lines.
[0088]
On the support 148, a drive unit 157 serving as a movement control means 93 for moving the arm connected to the emitting means 3 in the applicator 2 in the axial direction is arranged. An arm is attached to the sliding part 129 of the driving part 157. The sliding portion 129 of the driving unit 157 is driven by an electric signal supplied from the control device 5 through the cable 159, and the arm, and hence the emitting unit 3 is moved in the axial direction.
[0089]
The applicator 2 including the ultrasonic transducer 3 is connected to the control device 5 through the cable 152. The cable 152 includes electrical wiring and a cooling liquid feed / discharge tube for injecting and discharging the cooling liquid to and from the region where the ultrasonic transducer 3 in the applicator 2 is disposed. Further, the reflection means 4 is connected to the control device 5 by a signal line of a cooling liquid feed / discharge tube 153 output detection sensor for injecting and discharging the cooling liquid. The control device 5 includes a key operation unit, the control unit 91 and the database 92 described above, and further includes a cooling liquid tank and the like, controls the output of ultrasonic waves emitted from the ultrasonic transducer 3, controls the flow rate of the cooling liquid, When a detection signal processing from the ultrasonic sensor 35 of the reflector 6 and other functions to be described later are provided, the function is controlled. A foot switch 154 can also be provided.
[0090]
On the other hand, an observation means for observing a living tissue, such as an endoscope or a CCD camera, can be installed in the tip of the applicator 2. When this endoscope is provided, as described above with reference to FIG. 2, after the applicator 2 is inserted into the urethra, the urethra is observed with the endoscope, and a characteristic shape of the prostate urethra is found and treated. The front-rear position of the part 80 can be determined. This endoscope will be explained
The endoscope uses an optical fiber also serving as illumination light, and an imaging lens is provided at the tip. The endoscope is installed so as to be freely inserted and removed from the proximal end portion of the energy irradiation device. Positioning of the ultrasonic wave emitting portion 3 can be performed by endoscopic observation. In addition, by providing the guide light function, the ultrasonic irradiation position can be visually confirmed. Furthermore, since the irradiated surface can be observed continuously during ultrasonic irradiation, it is possible to optimize the irradiation conditions while observing the state.
[0091]
Since the applicator 2 and the reflection means 4 are arranged so as to be movable so that the distance between them can be controlled by the arrangement device 14, it is preferable that the applicator 2 and the reflecting means 4 are made of a material having relatively high hardness, for example, stainless steel. can do. Details of the constituent material of the applicator 2 will be described later. The applicator 2 has a window (not shown) for irradiating the energy from the emitting part 3, and this window can also be used for observation means to be described later, in this example, an endoscope. As the material of the window, it is desirable to use a material having excellent transmission characteristics such as polyethylene terephthalate, quartz glass, acrylic, polystyrene, polycarbonate, polyethylene, polypropylene, vinylidene chloride, Teflon (registered trademark), and polyester.
[0092]
In addition, a balloon that expands and contracts to fix the position after insertion can be provided in the portion of the applicator 2 that is inserted into the body cavity. As the constituent material of the balloon, for example, a material excellent in ultrasonic transmission properties such as polyolefin, polyester, polyamide, latex, cellulose and the like is preferable. Thereby, energy loss and heat generation due to absorption of ultrasonic waves by the balloon can be reduced.
[0093]
Air or coolant can be used as the working fluid for expanding the balloon. The working fluid is not particularly limited as long as it can expand and contract the balloon, but a coolant is preferable. By using a coolant as the working fluid, the surface layer of the living tissue can be cooled by the coolant when irradiating with ultrasonic waves, thereby preventing damage to the surface layer more reliably.
[0094]
The temperature of the coolant is not particularly limited as long as it can cool the surface layer portion of the living tissue, but is preferably 0 ° C. to 37 ° C., more preferably about 0 ° C. to 25 ° C.
[0095]
The working fluid is preferably physiological saline or Ringer's solution. By using these as the working fluid, when the working fluid leaks into the body for some reason, the influence of the leakage can be reduced.
[0096]
When a coolant is used as the working fluid, it is preferable to circulate the coolant, and it is more preferable to circulate the coolant until the ultrasonic irradiation is completed and the treatment is completed before the ultrasonic irradiation. By circulating the cooling liquid, the cooling efficiency can be improved, and by circulating the cooling liquid from before the ultrasonic irradiation until the ultrasonic irradiation is completed, the surface layer portion can be further cooled.
[0097]
For example, a pressure valve that opens when the pressure exceeds a certain pressure is preferably provided in the discharge portion. Thereby, the balloon can be expanded with a constant pressure regardless of the flow rate of the coolant.
[0098]
It is preferable to control the temperature of the coolant and the flow rate of the coolant in conjunction with ultrasonic irradiation. Thereby, excessive cooling and excessive heating of the surface layer portion can be prevented.
[0099]
It is preferable to provide a temperature sensor for detecting the surface temperature of the living tissue on the balloon. In this case, the surface temperature of the living tissue can be detected by the temperature sensor, and the information (detected value) can be used for cooling control. Thereby, it can cool efficiently and necessary and sufficiently.
[0100]
The balloon may be formed so as to surround the entire circumference other than the ultrasonic wave emitting portion of the housing. In this case, since the ultrasound emitting part of the main body is pressed against the body cavity wall by expanding the balloon, the distance between the irradiation target part and the emitting part is stabilized, and the stability during irradiation is good.
[0101]
Moreover, as a constituent material of the applicator 2, for example, a hard pipe made of a metal such as stainless steel is preferable. In addition, examples of the constituent material of the main body include, for example, polyolefins such as polyethylene and polypropylene, ethylene-vinyl acetate copolymer (EVA), polyesters such as polyvinyl chloride, polyethylene terephthalate, and polybutylene terephthalate, polyamide, polyurethane, polystyrene, Examples thereof include a polymer alloy containing one of these, such as polycarbonate and fluororesin, or a combination of two or more of these.
[0102]
The surface of the main body may be provided with a hydrophilic polymer material, or a lubricious coating such as silicon or fluororesin. Thereby, the friction on the surface of the main body can be reduced, and the insertion into the body cavity can be made smooth.
[0103]
As the hydrophilic polymer material used for the lubricating coating, for example, carboxymethyl cellulose, polysaccharides, polyvinyl alcohol, polyethylene oxide, sodium polyacrylate, methyl vinyl ether-maleic anhydride copolymer, water-soluble polyamide and the like are preferable. Of these, methyl vinyl ether-maleic anhydride copolymer is particularly preferable.
[0104]
When using an energy treatment device coated with a hydrophilic polymer material, for example, the surface layer of the energy treatment device is immersed in physiological saline or the like. This wets the surface layer and creates lubricity on the surface of the energy treatment device. Since this energy treatment device has a surface layer containing a hydrophilic polymer material, friction of the energy treatment device against living tissue is reduced, thereby reducing the burden on the patient and improving safety. To do. For example, the energy treatment apparatus can be smoothly inserted into the body cavity, pulled out from the body cavity, and moved and rotated within the body cavity.
[0105]
FIG. 20 is a flowchart showing treatment using the energy treatment apparatus 101 according to the present embodiment shown in FIG.
First, in step S1, the patient is anesthetized. Anesthesia may be general anesthesia or local anesthesia. In step S2, the applicator 2 is inserted into the urethra. In step S3, the reflecting means 4 is inserted into the rectum. In step S4, the applicator 2 and the reflecting means 4 are fixed to the placement device 14. In step S5, the irradiation position of the treatment site is determined, and the positions of the applicator 2 and the reflection means 4 are adjusted. In step S <b> 6, ultrasonic irradiation conditions are input to the control device 5. In step S7, the foot switch 154 is pressed to start treatment. The ultrasound emitting unit 3 irradiates the treatment site with ultrasound while moving along the axial direction of the applicator 2. As a result, ultrasonic waves are concentrated and irradiated only on the treatment site. In step S8, when the treatment of the treatment site is completed, the process proceeds to the end of the treatment in step S9. If there is a next treatment site, the process returns to step S5, and steps S5 to S8 are repeated until there is no treatment site.
[0106]
FIG. 21 shows a flowchart for adjusting the position of the treatment site.
In step S <b> 10, the rotation angle about the axis of the applicator 2 is determined, and the irradiation direction of the emitting unit (ultrasonic transducer) 3 is determined. In step S11, ultrasonic waves are weakly or irradiated for a short time. In step S <b> 12, the reflector 6 is fixed at a position that is received by the receiver attached to the reflector 6, in this example, the ultrasonic sensor 35 and receives the ultrasonic wave most strongly. In step S13, the adjustment ends.
[0107]
According to the above-described energy treatment apparatus 101 according to the present embodiment, the treatment site 80 is irradiated with the reflected ultrasound from the reflector 6 so as to overlap the treatment site 80 in addition to the ultrasound from the ultrasound emitting unit 3. By doing so, the collection efficiency of the ultrasonic wave to the treatment site 80 can be improved together with the utilization efficiency of the ultrasonic wave. At the same time, by irradiating the treatment site while moving the ultrasonic wave emitting section 3, it is possible to further improve the collection efficiency of the ultrasonic wave to the treatment site 80. Thus, it is possible to warm to the optimal high temperature treatment temperature.
[0108]
By using ultrasonic waves having deep reachability as irradiation energy, it is possible to perform high temperature treatment on a site in the deep part.
[0109]
Since the emission unit 3 is configured to concentrate the ultrasonic waves emitted from the respective movement positions of the emission unit 3 on the treatment site, it is possible to improve the efficiency of integration of the ultrasonic waves on the treatment site 80 described above.
[0110]
By configuring the ultrasonic wave emitting section 3 to reciprocate in the axial direction repeatedly by the electric driving means 157, it concentrates only on the treatment site 80 without damaging the surrounding normal living tissue. Ultrasonic irradiation can be performed. Even if the output power of the ultrasonic wave is reduced, the ultrasonic wave integration efficiency can be increased so that the heating temperature is appropriate for the treatment site.
[0111]
For example, when the driving unit 157 is provided with an adjusting unit that adjusts the amount of reciprocating movement of the emitting unit 3, the moving unit that moves the ultrasonic emitting unit 3 is used. Enables ultrasound treatment.
[0112]
The applicator 2 and the reflecting means 4 can be moved in the long axis direction of the applicator 2 or / and the direction perpendicular to the long axis direction according to the treatment site by the placement device 14. The irradiated ultrasonic wave can be set at an optimal position with respect to the treatment site 80.
[0113]
Since the applicator 2 and the reflecting means 4 are provided with a cooling means, the surface layer portion of the living tissue can be cooled by the cooling liquid, and damage to the surface layer portion can be prevented more reliably.
[0114]
By providing an acoustic lens 23 for converging, paralleling, or enlarging the ultrasonic wave on the ultrasonic wave output surface of the ultrasonic wave emitting unit 3, the ultrasonic wave may be irradiated in a wide area or a narrow area depending on the state of the treatment site. Can be intensively irradiated.
[0115]
Since the placement device 14 has a change function for changing the direction of ultrasonic irradiation from the ultrasonic output unit 3, the ultrasonic output unit 3 can be changed to an appropriate position with respect to the treatment site. The setting time can be shortened.
[0116]
By making the curvature of the reflecting surface of the reflector 6 variable, the irradiation range can be varied according to the position and area in the depth direction at the treatment site.
[0117]
By providing the ultrasonic sensor 35 on the reflector 6, it is possible to detect the output intensity of the ultrasonic wave, and to control the ultrasonic output emitted from the ultrasonic wave emitting unit 3, review the setting of conditions, and the like. it can.
[0118]
When observing means such as an endoscope or a CCD camera is disposed on the applicator 2, the state of the treatment site before and after treatment can be observed, and the irradiation conditions can be optimized while observing the state. Become.
[0119]
When the applicator 2 or the reflecting means 4 is provided with a balloon that expands or contracts, the applicator 2 can be pressed against the body cavity wall in the vicinity of the treatment site, and the distance between the treatment site 80 and the ultrasound emitting unit 3 is stable. In addition, it is possible to stabilize the ultrasonic irradiation to the treatment site.
[0120]
When a surface layer containing a hydrophilic polymer material is formed on the surface of the applicator 2 or the reflecting means 4, the friction of the surface of the applicator 2 is reduced, and insertion, extraction, movement, and rotation into the body cavity are smooth. It can be.
[0121]
According to the energy treatment device according to the present embodiment, when the air vent hole 36 and the ultrasonic jelly injection hole 37 are provided in the reflector 6, the ultrasonic jelly is injected into the reflector 6, thereby reflecting the body cavity wall. The body 6 can be brought into close contact, and the ultrasonic waves can be accurately reflected to the treatment site 80 without being irregularly reflected.
[0122]
Although it has been described that the cooling means is provided in each of the main body, the reflection means, and the balloon, the cooling means for the main body, the reflection means, and the balloon can be provided in any combination depending on the cooling conditions.
[0123]
In the present embodiment, the ultrasonic wave has been described as an example of the energy irradiated toward the living tissue, but the present invention is not limited to this, for example, laser light, directional electromagnetic waves, etc. It is also possible to irradiate the energy. In this case, if necessary, a window is provided in a portion corresponding to the emission portion of the applicator so as not to inhibit energy irradiation.
[0124]
In the above example, the present embodiment has been described by taking the case of the prostate as an example of the living tissue to be heat-treated, but the present invention is not limited to this, and blood vessels and digestive tracts (esophagus, All living tissues capable of performing high-temperature treatment by irradiating energy from within a living body such as the intestinal tract and the abdominal cavity or from the body surface.
[0125]
The embodiments described above are not described to limit the present invention, and various modifications can be made by those skilled in the art within the technical idea of the present invention.
[0126]
【The invention's effect】
According to the energy treatment device of the present invention, the energy emitting unit that emits energy, and the reflection unit that is installed at a position facing the energy emitting unit so as to reflect the energy emitted from the energy emitting unit to the target site. As a result, the energy utilization efficiency is increased, and the energy accumulation to the target site, and hence the strength of the energy, can be increased while suppressing the output power.
In addition, since the energy from the emitting part is configured to gather at the target site through different paths, the energy accumulation efficiency for the target site can be increased. Therefore, it becomes possible to heat to the temperature of the optimal high temperature treatment, and the heat treatment for a short time is enabled.
[0127]
According to the energy treatment device of the present invention, by having the energy emitting part and the reflecting means, the energy utilization efficiency is improved, and the energy accumulation to the target site, and hence the intensity of the energy, can be increased while suppressing the emission output. it can. At the same time, since the energy emitting unit is moved, the target site can be irradiated with energy through different paths. That is, since the energy is irradiated to the target site while moving the energy emitting unit, the energy accumulation efficiency for the target site can be further increased without affecting other biological tissues other than the target site. Therefore, it becomes possible to heat to the temperature of the optimal high temperature treatment, and the heat treatment for a short time is enabled.
[0128]
According to the energy treatment device according to the present invention, the energy accumulated is increased by irradiating the energy emitted from the energy emitting unit and the reflected energy from the reflecting means so as to overlap each other at the target site, so that the target site has an optimum temperature. Can be warmed.
[0129]
According to the energy treatment device of the present invention, when the apparatus has a long main body including the energy emitting portion and has a moving means that moves the position of the energy emitting portion arranged in the main body in the axial direction of the main body. Can efficiently accumulate energy at the target site while suppressing the heating of living tissue other than the target site.
[0130]
Damage to the surrounding normal living tissue by having a long body including an energy emitting part and moving means for repeatedly reciprocating the position of the energy emitting part arranged in the body in the axial direction of the body Without giving any energy, it is possible to concentrate and irradiate energy only to the target portion. Even if the energy output power is reduced, the energy accumulation efficiency can be increased so that the heating temperature is appropriate for the target portion.
[0131]
Since the energy emitting unit includes moving means configured to concentrate the energy emitted from each moving position on the target site, it is possible to improve the efficiency of accumulation of the energy at the target site.
[0132]
As the moving means, when provided with a movement control means that makes it possible to adjust the moving amount and moving speed of the reciprocating movement of the energy emitting unit, it is possible to perform energy treatment from an optimum position when irradiating energy.
[0133]
Since the placement device has a main body including the energy emitting unit and a placement device for placing the reflecting means, the position with respect to the target portion can be more stabilized, and the energy can be accurately irradiated to the target portion even during energy irradiation. .
[0134]
The placement device includes a holding unit for the main body including the energy emitting unit, a holding unit for the reflecting unit, and a mechanism for adjusting a relative position between the energy emitting unit and the reflecting unit, so that the energy emitting unit and the reflecting unit are positioned at an optimum position. It can be fixed and energy irradiation can be performed stably.
[0135]
By having an arrangement control means for controlling the arrangement apparatus, energy irradiation can be efficiently performed with an optimum arrangement.
[0136]
Since the arrangement control means controls the emission energy from the energy emission unit and the reflection energy from the reflection means so as to overlap each other at the target site, treatment can be performed more efficiently and in a short time.
[0137]
Since the arrangement device can change the direction of the energy emitting unit, the main body can be changed to an appropriate position with respect to the target portion, and the setting time can be shortened.
[0138]
By having an emission control means for controlling the irradiation pattern of the emission energy from the energy emission unit, irradiation time, and irradiation output, treatment can be performed more efficiently and in a short time.
[0139]
By providing the reflecting means with a fixed reflecting surface or a variable reflecting surface, an optimum reflecting surface can be used depending on the range of treatment of the target site, and more efficient treatment can be performed.
[0140]
When the reflecting means is formed such that the radius of curvature of the reflecting surface can be varied, the irradiation range can be varied according to the position and area of the target portion in the depth direction.
[0141]
By having the reflection control means for controlling the reflection means, treatment can be performed more efficiently and in a short time.
[0142]
When the reflector has energy detection means for detecting the energy arrival efficiency, the emission energy can be detected, and the output of the emission energy, the review of the setting of the irradiation conditions, etc. can be performed.
[0143]
By having the air vent hole groove in the reflector, the air can be extracted and the reflector can be closely attached to the wall of the body cavity, and the energy irradiated from the emitting part can be reflected accurately to the target site without irregular reflection. Can do.
[0144]
By providing the cooling means in the main body including the energy emitting portion, the surface layer portion of the living tissue can be cooled by the coolant, and damage to the surface layer portion can be prevented more reliably.
[0145]
By providing the cooling means in the reflecting means, it is possible to prevent a temperature rise in the living tissue around the reflecting means, and the target site can be treated efficiently and stably.
[0146]
Since the cooling control means for controlling the cooling means is provided, the surface layer portion of the living tissue can always be cooled by the cooling liquid, and damage to the surface layer portion can be more reliably prevented, so that the time is short and efficient. Can be treated.
[0147]
Since it has a control device for controlling the movement control means, it can be automated to perform treatment efficiently and in a short time.
[0148]
Since the arrangement control means or the control device for controlling the arrangement control means and the movement control means is provided, each of them can be automated to perform treatment efficiently and in a short time.
[0149]
Since it has a control device that controls two or more of the emission control means, or the emission control means, the arrangement control means, and the movement control means, each of them can be automated to perform treatment efficiently and in a short time.
[0150]
Since it has a control device that controls two or more of the reflection control means, or the reflection control means, the emission control means, the arrangement control means, and the movement control means, it is possible to automate each and treat efficiently and in a short time it can.
[0151]
Since it has a control device that controls two or more of the cooling control means, or the cooling control means, the reflection control means, the emission control means, the reflection control means, and the movement control means, each can be automated to efficiently and quickly Can be treated.
[0152]
By providing the main body including the energy output part with means to converge, parallel and expand the spread angle of the output energy, depending on the state of the target site, the energy can be irradiated over a wide area or a narrow area, or ultrasonic waves can be concentrated. Can be irradiated.
[0153]
When the main body including the energy emitting unit has the observation means, the state of the target site before and after treatment can be observed, and the irradiation conditions can be optimized while observing the state.
[0154]
When the main body or reflecting means including the energy emitting part or a balloon that expands and contracts on the surface of both the main body and the reflecting means, the main body and the reflecting means can be pressed against the body cavity wall in the vicinity of the target part. The distance between the light emitting portion and the emitting portion is stabilized, and energy irradiation and energy reflection with respect to the target portion can be stabilized.
[0155]
When the main body or the reflecting means including the energy emitting portion or the surface layer including the hydrophilic polymer material is provided on both the main body and the reflecting means, the friction of the surface of the main body or the reflecting means is reduced and the body is inserted into the body cavity. Pull out, move and rotate smoothly.
[0156]
It is possible to selectively irradiate the site in the deep part by using ultrasonic waves as the energy irradiated from the emitting part.
[Brief description of the drawings]
FIG. 1 is a configuration diagram showing a basic configuration of an energy treatment apparatus according to the present invention.
FIG. 2A is a side view of the main part of the energy treatment device of FIG.
B is a cross-sectional view taken along line AA in FIG. 2A.
FIG. 3 is a configuration diagram showing an embodiment of an energy treatment device according to the present invention.
FIG. 4 is a configuration diagram of a main part showing an embodiment of an energy emitting portion of the energy treatment device according to the present invention.
5A is a perspective view showing an energy emitting unit according to the embodiment shown in FIG. 4. FIG.
B is a cross-sectional view of the energy emitting portion of FIG. 5A.
6A is an operation explanatory diagram of the energy treatment device of FIG. 4. FIG.
B is an operation explanatory diagram of an energy treatment device using another energy emitting unit.
FIG. 7A is a configuration diagram showing an embodiment of an ultrasonic focusing element applied to the energy treatment device according to the present invention.
It is a block diagram which shows other embodiment of the ultrasonic converging element applied to the energy treatment apparatus which concerns on B this invention.
FIG. 8 is a graph simulating energy accumulation of the energy treatment device according to the present invention.
9A to 9C are configuration diagrams showing another embodiment of the energy emitting unit according to the present invention.
10 is an operation explanatory diagram of the energy emitting unit of FIG. 9;
FIG. 11 is a configuration diagram of a main part illustrating an example of a moving unit of the energy emitting unit according to the present invention.
FIG. 12 is a configuration diagram of a main part showing another embodiment of the energy treatment device according to the present invention.
FIG. 13 is a perspective view showing an embodiment of the reflecting means of the energy treatment apparatus according to the present invention.
FIG. 14A is a perspective view showing another embodiment of the reflecting means of the energy treatment device according to the present invention.
B is a cross-sectional view taken along line BB in FIG. 14A.
FIG. 15A is a perspective view showing another embodiment of the reflecting means of the energy treatment device according to the present invention.
B is a cross-sectional view taken along the line CC of FIG. 15A.
FIG. 16A is a cross-sectional view showing another embodiment of the reflecting means of the energy treatment device according to the present invention.
B is a cross-sectional view showing another embodiment of the reflecting means of the energy treatment device according to the present invention.
C is a cross-sectional view showing another embodiment of the reflecting means of the energy treatment device according to the present invention.
FIG. 17A is a cross-sectional view showing another embodiment of the reflecting means of the energy treatment device according to the present invention.
B is a side view of the reflecting means of FIG. 17A.
18A and 18B are operation diagrams of the reflecting means of FIG.
FIG. 19 is an overall configuration diagram showing an embodiment of an energy treatment device according to the present invention.
FIG. 20 is a flowchart showing an embodiment of treatment by the energy treatment apparatus according to the present invention.
FIG. 21 is a flowchart showing an embodiment of position adjustment of the energy treatment device according to the present invention.
FIG. 22 is a graph regarding temperature and time required for energy treatment.
[Explanation of symbols]
1, 101, 201 ··· Energy treatment device, 2 ·· Applicator, 3 ·· Ejecting portion, 3a ·· Ultrasonic exit surface, 4, 41, 42, 43, 44, 45, 47 ·· Reflecting means, 5 ..Control device 6, 26 ..Reflector, 6a ..Reflection surface, 7 ..Operating rod, 7A ..External operation rod, 7B ..Internal operation rod, 7C. Device, 22 ·· 1/2 wavelength plate, 23 ·· Acoustic lens, 30, 31 ·· Support base, 30a ·· Through hole, 33, 51, 52, 53 · Reflecting element, 34 ·· Axis, 35 · · Ultrasonic sensor, 36 · · Air hole, 37 · · Jelly-like body injection hole, 38 · · Soft film, 40 · · Heater, 51A · · Connection, 55 · · First rotating gear, · · · Integral Shaft, 57 .. second rotating gear, 58 .. rotating shaft, 59 .. control lever, 60 .. housing, 61 .. Inner groove, 63..Infusion tube, 64..Drain tube, 65..Connecting means, 80..Treatment site, 81..urethra, 82..rectum, 83..prostate, 84..site other than treatment site , 85 ·· Ultrasound, 85 '·· Reflected ultrasound, 91 ·· Control unit, 92 ·· Database, 93 ·· Movement control means, 94 ·· Ejection control means, 95 ·· Cooling liquid control means, 96 · · Arrangement control means, 97 ·· Reflection control means, 98 · · Energy detection means, 99 · · Monitor, 102 · · Movement mechanism, 103 · · Ultrasonic transducer, 104 · · Movable mirror, 104a · · · Mirror surface 105, 123 ·· Arm, 108 ·· Supporting part, 109, 125 · · Engagement pin, 110, 127 · · Guide plate, 111, 128 · · Guide groove, 112, 124 · · Shaft, 121, 141 · ·・ Base, 121A ・ ・ Open Mouth, 122 ·· cushioning material, 123A ·· Arm tip, 129 ·· Sliding portion, 132, 157 ·· Drive portion, 133 ·· Groove cam, 134 ·· Rotating shaft, 135 ·· Motor, 136 · ..Oval groove, 137 .. Rod, 138 .. Cam follower, 161 .. Balloon, 142 .. First holding portion, 144 A .. Lid portion, 144 B. Second holding portion, 145,... Movable block, 146, transfer shaft, 147, 150, handle, 148, support, 152, 159, cable, 153, cooling fluid feed / discharge tube・ Foot switch 162 ・ ・ First guide part 163 ・ ・ Second guide part 164 ・ ・ Opening 181 ・ ・ Cooling liquid 182 ・ ・ Wire

Claims (31)

An energy treatment device for irradiating energy biological tissue,
An energy emitting unit for emitting the energy;
Reflecting means installed at a position opposite to the energy emitting unit so as to reflect the energy emitted from the energy emitting unit to a target site;
An energy treatment apparatus characterized in that energy from the emitting part gathers at a target site through different paths. An energy treatment device for irradiating living tissue with energy,
An energy emitting unit for emitting the energy;
Reflecting means installed at a position opposite to the energy emitting unit so as to reflect the energy emitted from the energy emitting unit to a target site;
An energy treatment apparatus comprising: a moving means for moving the position of the energy emitting unit. The energy treatment apparatus according to claim 1 or 2, wherein the energy emitted from the energy emitting unit and the energy reflected from the reflecting means overlap at a target site. It has an elongate main body containing the energy output part, and has the movement means to move the position of the energy output part arranged in the main body in the axial direction of the main body. 2. The energy treatment device according to 2 or 3. It has an elongate main body including the energy emitting portion, and has the moving means for repeatedly reciprocating the position of the energy emitting portion arranged in the main body in the axial direction of the main body. Item 4. The energy treatment device according to Item 2 or 3. 5. The energy treatment apparatus according to claim 2, further comprising: the moving unit configured to concentrate energy emitted from each movement position of the energy emitting unit on a target site. 7. The energy treatment device according to claim 2, further comprising a movement control unit that makes it possible to adjust a moving amount and a moving speed of a reciprocating movement of the energy emitting unit by the moving unit. The energy treatment apparatus according to claim 1, 2 or 7, further comprising: a main body including the energy emitting unit; and an arrangement device for arranging the reflecting means. The arrangement apparatus includes a holding unit for a main body including the energy emitting unit, a holding unit for the reflecting unit, and a mechanism for adjusting a relative position between the energy emitting unit and the reflecting unit. The energy treatment apparatus according to claim 8. The energy therapy apparatus according to claim 8, further comprising an arrangement control unit that controls the arrangement apparatus. 11. The energy treatment apparatus according to claim 10, wherein the arrangement control unit controls the emission energy from the energy emission unit and the reflection energy from the reflection unit to overlap at a target site. The energy treatment device according to claim 8, wherein the placement device can change a direction of the energy emitting unit. 11. The energy treatment apparatus according to claim 1, further comprising an emission control unit that controls an irradiation pattern of the emission energy from the energy emission unit, an irradiation time, and an irradiation output. 4. The energy treatment device according to claim 1, wherein the reflecting means has a fixed reflecting surface or a variable reflecting surface. 15. The energy treatment apparatus according to claim 1, 2, 3 or 14, wherein the reflection means is configured such that a curvature of a reflection surface is variable. 14. The energy treatment device according to claim 1, further comprising reflection control means for controlling the reflection means. 4. The energy treatment device according to claim 1, further comprising energy detection means for detecting an amount of energy that has reached the reflection means from the energy emitting unit. 4. The energy treatment apparatus according to claim 1, wherein the reflecting means includes air venting means. A cooling means for cooling one or more of the energy emitting unit and a living tissue in contact with a main body including the energy emitting unit is provided. The energy treatment device according to 10, 13, 14 or 16. A cooling means for cooling one or more of the reflecting means and biological tissue in contact with the reflecting means is provided. 16. The energy treatment device according to 16. The energy therapy apparatus according to claim 1, further comprising a cooling control unit that controls the cooling unit. The energy therapy apparatus according to claim 7, further comprising a control device that controls the movement control unit. The energy treatment device according to claim 10, further comprising a control device that controls the placement control unit or the placement control unit and the movement control unit. The energy treatment apparatus according to claim 13, further comprising a control device that controls at least two of the extraction control unit or the extraction control unit, the arrangement control unit, and the movement control unit. The energy treatment device according to claim 16, further comprising a control device that controls at least two of the reflection control unit, the reflection control unit, the emission control unit, the arrangement control unit, and the movement control unit. . The control device for controlling two or more of the cooling control means, or the cooling control means, the reflection control means, the emission control means, the reflection control means, and the movement control means. The energy treatment device according to 21. 2. The energy treatment apparatus according to claim 1, wherein the main body including the energy emitting unit has means for converging, paralleling, and enlarging the spread angle of the emission. The energy treatment apparatus according to claim 1, further comprising an observation unit in a main body including the energy emitting unit. 2. The energy treatment apparatus according to claim 1, further comprising a balloon that expands and contracts on a surface of the main body or the reflection means including the energy emitting portion, or both of the main body and the reflection means. 2. The energy treatment apparatus according to claim 1, further comprising: a main body including the energy emitting portion or a reflecting means, or a surface layer containing a hydrophilic polymer material on both surfaces of the main body and the reflecting means. The energy is ultrasonic waves, characterized in that the energy is ultrasound, 1, 7, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, The energy therapy device according to any one of 19, 20, 21, 22, 23, 24, 25, 26, 27, or 28.

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