JPH06209901A - Device for pneumoperitoneum - Google Patents

Abstract

PURPOSE:To correctly detect the clogging condition of a pneumoperitoneum tube, and also to enhance safety by accurately controlling the operation for pneumoperitoneum. CONSTITUTION:A device for pneumoperitoneum is provided with a control part 27 by which the magnitude of the pressure change inside a pneumoperitoneum tube 8 at the time when a pneumoperitoneum gas is injected into or withdraw from the pneumoperitoneum tube 8 is detected, end the clogging condition of the pneumoperitoneum tube 8 is judged on the basis of the detected data of this pressure change.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a pneumoperitoneum device that supplies carbon dioxide to the body and secures the field of view of the endoscope during observation or treatment of the abdominal cavity with the endoscope.

[0002]

2. Description of the Related Art Generally, for example, the following work has been conventionally performed when performing medical treatment on the abdominal cavity of a patient under endoscopic observation. First, a pneumoperitoneum inserter such as a pneumoperitoneum is inserted into the abdomen of a patient, and CO ₂ is injected from the body of the pneumoperitoneum device connected thereto via a pneumoperitoneum tube to inflate the abdomen. Then, the intra-abdominal region to be treated is expanded, the observation visual field necessary for the treatment in the abdominal cavity is secured, and the treatment process can be grasped sufficiently.

Next, the pneumoperitoneum is pulled out, and a trocar is inserted while expanding this hole from the same hole. Further, two or three trocars are inserted, and a laparoscope, forceps and the like are inserted into each trocar to perform treatment.

By the way, in this type of pneumoperitoneum, a decompressor, a valve, a pressure sensor, etc. are provided in the middle of the pneumoperitoneum for supplying CO ₂ gas for pneumoperitoneum from the gas supply source to the pneumoperitoneum in the main body of the device. There is provided a pressure control mechanism for controlling the pressure inside the abdominal cavity using the. As the pressure control mechanism, for example, as disclosed in German Patent No. 3000218, one configured to perform gas supply from a gas supply source such as a gas cylinder with one tube and pressure measurement in the abdominal cavity, Alternatively, as disclosed in German Patent No. 7508556, a pneumoperitoneum tube for supplying gas from a gas supply source such as a gas cylinder is provided, and for measuring the pressure in the abdominal cavity separately from the pneumoperitoneum tube. It is known that a tube is provided so that air supply and pressure measurement in the abdominal cavity are performed separately.

[0005]

During use of the pneumoperitoneum device, the tip opening of the pneumoperitoneum or trocar hits the abdominal wall during the use of the pneumoperitoneum, or a foreign substance enters the pneumoperitoneum or trocar from the abdominal cavity. Alternatively, when a doctor steps on the pneumoperitoneum or the like, a pneumoperitoneum conduit for CO ₂ gas for pneumoperitoneum from the gas supply source on the main body of the pneumoperitoneum such as the pneumoperitoneum tube, the pneumoperitoneum, or the trocar to the abdominal cavity. It may be clogged, broken or blocked. Hereinafter, these are collectively referred to as a tube clogging.

However, German Patent 3000218
In the pneumoperitoneum device configured to perform insufflation with a single tube and pressure measurement in the abdominal cavity as described in Japanese Patent Publication No. JP-A-2004-96242, when the pneumoperitoneum tube is clogged, the current pressure in the abdominal cavity (hereinafter, abdominal pressure (Referred to) is an appropriate value, but the air inside the tube becomes high pressure due to the air supply operation after the time when clogging occurs.
The control unit of the pressure control mechanism may cause a malfunction of determining that the abdominal pressure exceeds the set pressure (hereinafter referred to as overpressure). In this case, the pressure in the tube is displayed on the pneumoperitoneum device main body, and the pneumoperitoneum device having a warning function warns of overpressure. That is, although the abdominal cavity is not actually overpressure, the pneumoperitoneum erroneously issues an overpressure warning, so the doctor determines that the abdominal cavity is overpressure, and releases CO ₂ in the abdominal cavity into the atmosphere. There is a risk that it will be released and the abdominal pressure will drop below the set pressure.

Further, as in German Patent No. 7508556, in a pneumoperitoneum device having a structure in which two tubes are used for insufflation and pressure measurement in the abdominal cavity, a measuring tube is used before the abdominal pressure reaches a set pressure. If a clog occurs in the tube, even if the actual abdominal pressure changes, there is a risk that the pressure state below the set pressure will be maintained in the measurement tube without being changed. Therefore, in this case, the control unit of the pressure control mechanism erroneously determines the measured value of the pressure state in the measurement tube as the abdominal pressure and continues the air supply operation, so that the actual abdominal pressure reaches the set pressure. However, there is a possibility that the insufflation operation is further continued and the abdominal cavity becomes overpressured.

Therefore, in the above-mentioned conventional structure, it is difficult to accurately control the pneumoperitoneum when the pneumoperitoneum duct is clogged, and there is a problem in improving safety.

The present invention has been made in view of the above circumstances, and an object thereof is to be able to correctly detect a clogging state of the pneumoperitoneum, and to accurately control the pneumoperitoneum to improve safety. An object is to provide a pneumoperitoneum device that can be designed.

[0010]

DISCLOSURE OF THE INVENTION The present invention provides a gas supply conduit having an insufflation tube connected to an insufflation insert inserted through the abdominal wall and inserted into the abdominal wall. While supplying gas for pneumoperitoneum into the abdominal wall through
In a pneumoperitoneum device comprising a pressure detection means for detecting the pressure in the gas supply pipeline and a control means for controlling the supply of the pneumoperitoneum gas based on the detected pressure, the gas in the gas supply pipeline is Detecting the magnitude of pressure change in the gas supply line when inflowing or outflowing abdominal gas,
A determination means for determining the clogging state of the gas supply line based on the detection data of the pressure change is provided.

[0011]

[Function] When the gas is allowed to flow into or out of the abdominal cavity through the gas supply conduit, the volume inside the abdominal cavity normally becomes a relatively large total volume of the volume inside the abdominal cavity and the capacity of the gas supply conduit. The pressure in the gas supply line when the gas flows in or out of the abdominal cavity through the gas supply line changes gently. Also, in the process of pneumoperitoneum, if the gas supply line is clogged, the communication between the gas supply line and the abdominal cavity is blocked at the clogged part, and the volume inside the abdominal cavity decreases. The pressure inside the gas supply pipe changes abruptly when the gas flows in or out. Therefore, the clogging state of the gas supply pipeline is determined by the determination means based on the detection data of the magnitude of the pressure change in the gas supply pipeline when the gas for insufflation flows into or out of the gas supply pipeline. It was made to let.

[0012]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS A first embodiment of the present invention will be described below with reference to FIGS.
Will be described with reference to. FIG. 1 shows a schematic configuration of the whole pneumoperitoneum device, and 1 is a main body of the pneumoperitoneum device. CO is attached to the main body 1 of the pneumoperitoneum via a connection mouthpiece 2 and a connection hose 3.
A cylinder 4 as a gas supply source filled with _two gases is connected.

Further, the pneumoperitoneum device body 1 has a first connector 5a for connecting an insufflation inserter, a second connector 5b for connecting an aspiration inserter, and a third connector for connecting a suction pump. Connectors 5c are provided respectively. Then, a pneumoperitoneal trocar (insertion tool) 7 inserted through the abdominal wall 6 of the living body is connected to the first connector 5a via a pneumoperitoneum tube (gas supply conduit) 8 and A suction trocar 9 that is inserted through the abdominal wall 6 of the living body is connected to the connector 5b via a suction tube 10, and a suction pump 11 is connected to the third connector 5c via a tube 12. .

In the main body 1 of the pneumoperitoneum, an air supply line 13 is provided.
Is provided. The base end of the air supply conduit 13 is connected to the connection mouthpiece 2, and the other end is connected to the first connector 5a. In this air supply line 13, in order from the connection mouthpiece 2 side,
A first decompressor 14, a second decompressor 15, a first opening / closing valve 16, an intermediate tank 17, and a second opening / closing valve 18 are sequentially provided.

Further, the first decompressor 1 is provided in the air supply line 13.
One end of the high-speed air supply line 19 is connected between the No. 4 and the second decompressor 15. The other end of the high-speed air supply conduit 19 is connected between the second opening / closing valve 18 and the first connector 5a. A third pressure reducer 20, a flow rate sensor 21, a flow rate sensor 21,
The third opening / closing valve 22 is sequentially interposed.

An inflow port of an exhaust valve 23 is connected to a pipe line between the third opening / closing valve 22, the second opening / closing valve 18, and the first connector 5a. The outlet port of the exhaust valve 23 is open to the atmosphere.

Further, one end of the suction conduit 24 is connected to the second connector 5b. The other end of the suction conduit 24 is connected to the third connector 5c via a pinch valve 25.

A pressure sensor (pressure detecting means) 26 is connected to the intermediate tank 17. This pressure sensor 2
Reference numeral 6 is connected via a signal line to a control unit 27 formed by, for example, a microcomputer and its peripheral circuits. Further, the control unit 27 includes the first opening / closing valve 1
6, the second opening / closing valve 18, the flow rate sensor 21, the third opening / closing valve 22, the exhaust valve 23, the pinch valve 25 are connected via signal lines, respectively, the abdominal cavity overpressure warning LED 28, and the tube clogging warning. LED 29 and speaker 30 are connected to each other via signal lines. The control unit 27 detects the magnitude of the pressure change in the pneumoperitoneum tube 8 when the pneumoperitoneum gas is let out from the inside of the pneumoperitoneum tube 8, and the pneumoperitoneum is detected based on the detection data of the pressure change. A judging means for judging the clogging of the tube 8 is provided.

Next, the operation of the above configuration will be described with reference to the flowchart of FIG. First, when performing a medical treatment in the abdominal cavity of a patient under endoscopic observation, the patient's abdominal wall 6
Is set in a state in which a pneumoperitoneal trocar 7 and a suction trocar 9 are pierced into the abdominal cavity and are inserted into the abdominal cavity, and the pneumoperitoneum device body 1 is used in this state.

During the pneumoperitoneum operation of the main body 1 of the pneumoperitoneum, the first opening / closing valve 16 is first opened. Then, the high-pressure CO ₂ gas supplied from the cylinder 4 is, for example, 3 kgf / cm ² by the first pressure reducer 14. Decompressed to
Subsequently, in a state where the pressure is reduced to, for example, 50 mmHg by the second pressure reducer 15, the intermediate tank 17 is filled via the first opening / closing valve 16.

After the intermediate tank 17 is filled with gas, the first opening / closing valve 16 is closed and the second opening / closing valve 1 is closed.
8 is opened. And CO ₂ in the intermediate tank 17
Gas flows from the second opening / closing valve 18 to the first connector 5a,
It is injected into the abdominal cavity through the pneumoperitoneum tube 8 and the trocar 7 in order. The pressure in the intermediate tank 17 gradually drops with this CO ₂ gas injection operation, but the pressure drop characteristic at this time is measured by the pressure sensor 26, and the abdominal pressure of the abdominal pressure is measured by the controller 27 based on this measurement data. P _a is calculated.

In the pneumoperitoneum device in which the abdominal pressure P _a is measured and inflated by one pneumoperitoneum tube 8 as in the present embodiment, the outlet pressure of the pneumoperitoneum device is abdominal due to the resistance of the trocar 7 or the like. to become greater than the pressure P _a, at the time of measurement of the abdominal cavity pressure P _a need to stop the air supply operation. Therefore, in this case, the opening / closing operation of the second opening / closing valve 18 is repeated, and the air feeding operation into the abdominal cavity and the second opening / closing operation of the second opening / closing valve 18 are repeated.
The operation of measuring the abdominal pressure P _a when closing the opening / closing valve 18 is alternately performed (step S1 in FIG. 2).

In the air supply operation of step S1,
Since the CO ₂ gas in the intermediate tank 17 is filled with CO ₂ gas and then the CO ₂ gas in the intermediate tank 17 is guided into the abdominal cavity, an intermittent air supply operation is performed. And inefficiency. Therefore, step S2
In less than the predetermined set pressure P _s belly cavity pressure P _a is set in advance to be measured by the pressure sensor 26 (P _a <
If it is determined that the state is P _s ), the high-speed insufflation operation of the next step S3 (hereinafter, referred to as high-speed insufflation) is also used.

At the start of this high-speed air supply operation, the third opening / closing valve 22 is opened, and the first decompressor 14 turns the valve 3 on.
kgf / cm ² The CO ₂ gas, which has been decompressed up to this point, flows into the high-speed air supply conduit 19 side as the third opening / closing valve 22 opens. The CO flowing into the high-speed air supply line 19 side
₂ gas is further 50 mm by the third decompressor 20
In the state of being depressurized to Hg, it is injected into the abdominal cavity through the flow rate sensor 21, the third opening / closing valve 22, and sequentially through the first connector 5a, the pneumoperitoneum tube 8, and the trocar 7.

In the main body 1 of the pneumoperitoneum, step S
2 and measurement and high-speed air of with air to abdominal cavity pressure P _a, which is measured by the pressure sensor 26 reaches the set pressure P _s in is repeated. Then, the abdominal pressure P _a reaches the set pressure P _s , it is determined that P _a = P _s , and that state is determined in step S
The abdominal pressure measurement in the next step S5 is performed until it is determined in 4 that the predetermined set time t _s1 has been reached. In this case, the first opening / closing valve 16 and the third opening / closing valve 22
Is closed and the second opening / closing valve 18 is left open, the value of the pressure sensor 26 is measured as the abdominal pressure, and the abdominal pressure P _a
When is lower than the set pressure P _s , the air supply while measuring again and the high speed air supply are repeated.

In step S2, it is determined that P _a = P _s , and that state is determined in step S4 for a predetermined set time t.
_When it is determined that the state has reached _s1 , in the next step S6, a confirmation operation for checking whether or not the tube 8 is clogged is performed at each set time t _{s1 in} step S4. That is, when the tube 8 is clogged when the abdominal pressure P _a reaches the set value P _s , even if the abdominal pressure P _a falls below the set pressure P _s , the inside of the tube 8 and the intermediate tank 17 are reduced. The pressure remains unchanged at the set value P _s , and the abdominal pressure P _a may decrease without the doctor's knowledge. Therefore, abdominal cavity pressure P _a reaches the set pressure P _s, when you are measuring a second abdominal cavity pressure P _a remain open close valve 18, confirmation or clogging is not in the tube 8 is performed.

The process for determining the clogging of the tube 8 in step S6 is performed according to the flowchart of FIG. That is, as shown in steps S7 to S9, the exhaust valve 23 is opened for a short time t _s2 , so that the CO ₂ gas is supplied to the tube 8
It is discharged from the inside to the conduit side in the insufflation apparatus body 1 through the connector 5a, and is discharged into the atmosphere through the exhaust valve 23.

FIG. 4 shows an example of changes in the pressure in the intermediate tank 17 at this time. Here, the set pressure P ₁ is, for example, 10 m
It is set to mHg, and it is assumed that the abdominal pressure P _a reaches the set pressure P ₁ and is now 10 mmHg. In this state, the exhaust valve 23 is opened (step S7), and the exhaust valve 23 is closed after a predetermined set time t _s2 , for example, 100 msec (step S9), so that the CO ₂ in the tube 8 is reduced.
The pressure state on the tube 8 side when the gas is released into the atmosphere is measured by the pressure sensor 26 (step S1).
0).

In this case, in the normal case where the tube 8 is not clogged, as shown in FIG. 4, the measured value P ₂ measured by the pressure sensor 26 is kept in a relatively small pressure drop state with respect to the set pressure P ₁ . To be done. Note that dP is the width of pressure drop.

That is, in the normal case where the tube 8 is not clogged, even if the CO ₂ gas in the tube 8 is released to the atmosphere through the exhaust valve 23, the tube 8 and the abdominal cavity are maintained in a communicating state. Therefore, CO ₂ flows back into the tube 8 from the abdominal cavity, and the pressure in the tube 8 becomes equal to the pressure state in the abdominal cavity. Here, dP is 0.5 mm due to the decrease in abdominal pressure due to the release of CO ₂ gas into the atmosphere.
It becomes Hg.

When the tube 8 is clogged, the measured value P ₃ measured by the pressure sensor 26 drops relatively large with respect to the set pressure P _{1 as shown in} FIG.

That is, in this case, when the exhaust valve 23 is opened, only the CO ₂ gas with which the upstream side of the clogging portion in the tube 8 is filled is released into the atmosphere.
The pressure in the tube 8 approaches the atmospheric pressure, and the pressure drop width d
P becomes as large as 7 mmHg, for example. Thus, the size of dP is different when the tube 8 is clogged and when it is not clogged. As a result, when the pressure sensor 26 measures the pressure drop width dP in the tube 8 when the exhaust valve 23 is opened for a short time t _s2 , when dP is larger than a predetermined set value dP _s1 (for example, 2 mmHg) ( For dP ≧ dP _s1 ) the tube 8 is clogged, and dP is a predetermined set value dP
_{When it is} smaller than _s1 (dP <dP _s1 ), it can be judged that the tube 8 is normal (step S11).

Since the abdominal pressure P _a reaches the set pressure P _s and the air supply is stopped during the process of determining the clogging of the tube 8, if the above judgment is repeated and the tube 8 is not clogged, the abdominal cavity is detected. The internal gas flow path of the pneumoperitoneum body 1 is contaminated by the CO ₂ gas flowing back from the inside. For example, the exhaust valve 2
When 3 is opened for 100 msec, a backflow of about 50 cm occurs with respect to the total length of the tube 8 of 2 m. Therefore,
After judging the clogging of the tube 8, the tube 8
If it is determined that the CO ₂ gas is normal, the contaminated CO ₂ gas in the tube 8 is injected into the abdominal cavity by supplying the same amount of CO ₂ gas as the counter-flowing CO ₂ gas by the air supply while performing the measurement. Can be pushed back to.

If it is determined in step S11 that the tube 8 is clogged, the tube 8 clog warning process is performed in step S12. In the clogging warning process for the tube 8, the tube clogging warning LED 29 is turned on and a warning operation is performed in which the speaker 30 is sounded with a comparatively low sound (a lower sound level than the warning sound when the abdominal cavity is overpressure, which will be described later). Be done.

Further, thereafter, the measurement is performed while supplying air as shown in step S13 of FIG. This is because the pressure drops due to the determination of whether the tube 8 is clogged, the intermediate tank 17, the tube 8, and the tube of the pneumoperitoneum device body 1 connecting the intermediate tank 17 and the tube 8. This is because the pressure in the conduit is increased again and the pressures in the conduit of the tube 8 and the pneumoperitoneum device body 1 are measured. And based on the pressure value measured here,
It is again determined whether the tube 8 is clogged (step S14). Further, the above operation is repeated, and the tube 8 waits until it returns to normal.

Further, when it is judged in step S2 that P _a > P _s and the abdominal pressure P _a calculated based on the value of the pressure sensor 26 exceeds the set pressure P _s , the following two cases are performed. The situation is possible. That is, it is considered that the abdominal pressure actually exceeds the set pressure P _s and that the pressure in the intermediate tank 17 does not drop due to air supply after the tube 8 is clogged.

Therefore, in this case, it is confirmed whether or not the tube 8 is clogged by the same method as when the abdominal pressure P _a reaches the set pressure P _s and the air supply is stopped (step S1).
5). At this time, if the abdominal cavity pressure P _a exceeds the set pressure P _s are lit abdominal overpressure warning LEDs 28, with a warning operation is performed sounded loudly than when the warning processing Kapika 30 clogged , Abdominal pressure P _a is set pressure P
_The pinch valve 25 is opened until the time _s is reached, and the suction operation is performed (steps S16 to S18).

In step S19, when the flow rate Q measured by the flow rate sensor 21 at the time of high-speed air supply becomes 0, the tube 8 is clogged, so the abdominal pressure P _a becomes the set pressure P _s . The same operation as when exceeding is performed (step S15).

Therefore, in the above-mentioned structure, when the tube 8 is broken or clogged during the operation of the pneumoperitoneum device body 1, the state is automatically detected, and the abdominal cavity is detected when the pressure in the duct is increased. Since it is possible to give a warning to a user such as a doctor by distinguishing between the case where the tube 8 is overpressure and the tube 8 clogged state, when the tube 8 is clogged and broken, the abdominal cavity is erroneously overpressured. It is possible to prevent an erroneous operation of making a judgment and sucking CO ₂ gas in the abdominal cavity. for that reason,
In spite of the fact that the abdominal pressure P _a is actually appropriate as in the conventional case, there is no fear of a mistaken operation such as a user such as a doctor opening CO ₂ in the abdominal cavity to the atmosphere, and a pneumoperitoneum operation is performed. Can be accurately controlled to improve safety.

When the tip opening of the trocar 7 or the pneumoperitoneum hits the abdominal wall in the abdominal cavity, the pressure at the tip opening of the trocar 7 or the pneumoperitoneum can be quickly lowered. , The air is sent while the tip opening of the pneumoperitoneum or the like hits the abdominal wall in the abdominal cavity, and the pressure of the tip opening of the trocar 7, pneumoperitoneum, etc. increases,
It is possible to prevent the air pressure from being directly applied to the living body.

Next, a second embodiment of the present invention will be described with reference to FIG.
It will be described with reference to FIGS. FIG. 6 shows a schematic configuration of the whole pneumoperitoneum device. A cylinder 44 as a gas supply source filled with CO ₂ gas is connected to a main body 41 of the pneumoperitoneum via a connection mouthpiece 42 and a connection hose 43.

Further, the pneumoperitoneum device body 1 is provided with a first connector 45a for connecting the pneumoperitoneum inserter and a second connector 45b for connecting the measuring inserter. Then, a pneumoperitoneal trocar (insertion tool) 47 inserted through the abdominal wall 6 of the living body is connected to the first connector 45a via a pneumoperitoneum tube (gas supply conduit) 48, and the second connector 45a is connected to the second connector 45a. A trocar 49 for measurement, which is inserted through the abdominal wall 46 of the living body, is connected to the connector 45b via a measurement tube 50.

Further, in the pneumoperitoneum device main body 41, the air supply conduit 5 is provided.
1 and measuring line 52 are provided respectively. The base end of the air supply line 51 is connected to the connection mouthpiece 42, and the other end is connected to the first connector 45a. Further, a first pressure reducer 53, a second pressure reducer 54, a flow rate sensor 55, and a first opening / closing valve 56 are sequentially provided in this air supply pipe line 51 in order from the connection mouthpiece 42 side.

In addition, the first decompressor 53 is provided in the air supply line 51.
And one end of the branch pipe 57 is connected between the second pressure reducer 54 and the second pressure reducer 54. The other end of the branch pipe 57 is connected between the first opening / closing valve 56 and the first connector 45a. A third pressure reducer 58 and a second opening / closing valve 59 are sequentially provided in this branch conduit 57 in order from the first pressure reducer 53 side.

Further, the third pressure reducer 58 of the branch line 57 is provided.
One end of the measurement pipe line 52 is connected between the second open / close valve 59 and the second open / close valve 59. The other end of this measuring line 52 is the third
Is connected to the second connector 45b via the open / close valve 60.

A first pressure sensor 61 is connected to the conduit between the first on-off valve 56, the second on-off valve 59 and the first connector 45a. Further, a second pressure sensor 62 is connected between the third opening / closing valve 60 and the second connector 45b in the measurement pipe line 52.

Reference numeral 63 is a control unit formed by, for example, a microcomputer and its peripheral circuits. The control unit 63 includes a flow rate sensor 55 and a first opening / closing valve 5.
6, the second opening / closing valve 59, the third opening / closing valve 60, the first pressure sensor 61, and the second pressure sensor 62 are connected via signal lines, respectively, and the abdominal overpressure warning LE is also provided.
The D64, the air supply tube clogging warning LED 65, and the measurement tube clogging warning LED 66 are connected to each other via signal lines.

The control section 63 includes the pneumoperitoneum tube 4
There is a determination means for detecting the magnitude of the pressure change in the pneumoperitoneum tube 48 when the pneumoperitoneum gas is allowed to flow into the chamber 8, and determining the clogging state of the pneumoperitoneum tube 48 based on the detection data of this pressure change. It is provided.

Next, the operation of the above configuration will be described.
When the insufflation operation is performed by the insufflation apparatus body 1, first, the first opening / closing valve 56 is opened. Then, the high-pressure CO ₂ gas supplied from the cylinder 44 is, for example, 3 kgf / cm ² by the first pressure reducer 53. The pressure is reduced to 50 mmHg by the second pressure reducer 54, and then injected into the abdominal cavity through the first opening / closing valve 56, the first connector 45a, the pneumoperitoneum tube 48, and the trocar 47 in this order. To be done.

At this time, since the third opening / closing valve 60 is held in the closed state, the measurement trocar 49, the measurement tube 50, the second connector 45b, and the measurement pipe line 52 are provided.
The abdominal pressure P _a can be measured by the second pressure sensor 62 through the duct on the downstream side of the third opening / closing valve 60 in. In this case, the value measured by the second pressure sensor 62 is equal to the abdominal cavity pressure P _a, abdominal cavity pressure P _a is measured by the pressure sensor 62 at the same time as air into the peritoneal cavity.

Therefore, in this embodiment, since the air supply and the measurement can be performed separately by the two tubes 48 and 50, the abdominal pressure P _a can be controlled by the single tube 8 shown in the first embodiment. need not be repeated alternately measuring operation of the air operation and abdominal cavity pressure P _a, as measured insufflation and abdominal apparatus feel performing.

Then, insufflation is continued until the abdominal pressure P _a measured by the second pressure sensor 62 reaches the set pressure P _s , and the second
The abdominal pressure P _a measured by the pressure sensor 62 is set pressure P _s.
When the pressure reaches 6 or exceeds the set pressure P _s , the pressure sensor 6
By the output of 2, the first opening / closing valve 56 is closed to stop the air supply. Here, when the abdominal cavity pressure P _a exceeds the set pressure P _s warning lights peritoneal overpressure warning LEDs 64.

Here, the flow rate Q measured by the flow rate sensor 55 becomes 0 when the aeration tube 48 is completely clogged or when the anesthesia is cut off, and the abdominal pressure P _a is 50 mmHg. That is the case.

Therefore, the measured value Q by the flow sensor 55
When becomes 0, the pressure sensor 61 and the pressure sensor 62
If the measured values do not match, it is determined that the air supply tube 48 has become clogged, the LED 65 for air supply tube clogging warning is lit, and the pressure sensor 61 and the pressure sensor 6
Wait until the two measurements agree.

When the measuring tube 50 is clogged during the above-described air supply operation, even if the abdominal pressure P _a reaches the set pressure P _s , it cannot be detected by the insufflation apparatus main body 41 and air supply is continued. There is a risk that In addition, the clogging of the air supply tube 48 cannot be determined. Therefore, the tube clogging determination process shown in the flowchart of FIG. 7 for confirming the clogging state of the measuring tube 50 is performed at regular intervals.

In this tube clogging determination process, the CO ₂ gas depressurization value is reduced to 20 by opening the third on-off valve 60 for a short time t _s2 as shown in steps S7 'to S9'.
A pressure reducer 58 of 0 mmHg, a third opening / closing valve 60,
Flow into the measuring tube 50 through the connector 45b in order. At this time, the pressure is measured by the pressure sensor 62 (step S10 ').

FIGS. 8 and 9 show an example of changes in pressure measured by the pressure sensor 62 at this time. Here, the width dP of the pressure increase is larger than a certain set value dP _s2 (in this case, for example, 2 mmHg) as shown in FIG. 9 (dP ≧ dP _s2 ).
If so, the measuring tube 50 is clogged, and if not as shown in FIG. 8, it can be determined that the measuring tube 50 is normal (step S11 ′).

Further, when the measuring tube 50 is clogged, the measuring tube clogging warning LED 66 is turned on to perform the warning operation in step S12 ', and the air feeding tube 48 sends the air as follows. The qi operation and the measurement operation are alternately performed.

First, by opening the first opening / closing valve 56, CO ₂ gas is injected into the abdominal cavity. After that, the valve 56 is closed to stop the air supply, and then the pressure sensor 61
To measure the abdominal pressure P _a . The air operation and the measurement operation and between a smaller abdominal cavity pressure P _a is set pressure P _s, are alternately repeated. When the abdominal pressure P _a reaches the set pressure P _s , the valve 56 is closed to stop the air supply, and the pressure sensor 61
The abdominal pressure P _a is measured with.

Further, the measured abdominal pressure P _a is the set pressure P _s.
When the value exceeds Q, or when the measured value Q of the flow rate sensor 55 becomes 0, as in the first embodiment, the abdominal pressure P is actually exceeded.
It is possible that _a is overpressure and that the air supply tube 48 is clogged.

Therefore, the second opening / closing valve 59 is closed for a short time.
Upon opening, CO ₂ gas is made to flow into the air supply tube 48 from the connector 45a, and it is confirmed whether or not the air supply tube 48 is clogged by the same method as in the case of the measurement tube 50.

Here, when air is fed after the air feeding tube 48 is clogged, the pressure in the air feeding tube 48 may rise to the reduced pressure value of the second pressure reducer 54 of 50 mmHg. is there. In this case, since the pressure reduction value of the third pressure reducer 58 is set to 200 mmHg, even in that case, the pressure in the air supply tube 48 is sufficiently increased,
It can be distinguished from the case where the abdominal pressure P _a becomes 50 mmHg due to lack of anesthesia or the like.

When the air supply tube 48 is clogged, the air supply tube clogging warning LED 65 is turned on and the pressure sensor 61 waits until the value starts decreasing.

[0064] Therefore, the configuration described above air operation using two tubes 48 and 50, also in the belly apparatus mind performing measurement operations of the abdominal cavity pressure P _a separately fast measuring tube 50 When clogging occurs, it can be switched to automatically measure the abdominal pressure P _{a by} the insufflation tube 48, so that there is no fear of excessive insufflation into the abdominal cavity above the set pressure P _s , which is safe. It is possible to improve the sex.

Further, since the clogging state of each of the measuring tube 50 and the air feeding tube 48 can be detected and notified to the doctor, the safety can be further improved. It should be noted that the present invention is not limited to the above-mentioned embodiments, and it is needless to say that various modifications can be made without departing from the gist of the present invention.

[0066]

According to the present invention, the magnitude of the pressure change in the gas supply line when the gas for insufflation is caused to flow in or out of the gas supply line is detected, and the detected data of this pressure change is detected. Based on this, a judgment means for judging the clogging state of the gas supply line is provided, so that the clogging state of the pneumoperitoneum tube can be correctly detected, and the pneumoperitoneum operation is accurately controlled to improve safety. You can

[Brief description of drawings]

FIG. 1 is a schematic configuration diagram of an entire apparatus according to a first embodiment of the present invention.

FIG. 2 is a flowchart showing a pneumoperitoneum operation.

FIG. 3 is a flowchart showing a tube clogging determination processing operation.

FIG. 4 is a characteristic diagram showing a change state of the pressure in the pipeline when the tube is not clogged.

FIG. 5 is a characteristic diagram showing a change state of the pressure in the pipeline when the tube is clogged.

FIG. 6 is a schematic configuration diagram of an entire apparatus according to a second embodiment of the present invention.

FIG. 7 is a flowchart showing a tube clogging determination processing operation.

FIG. 8 is a characteristic diagram showing a change state of the pressure in the pipeline when the tube is not clogged.

FIG. 9 is a characteristic diagram showing a change state of the pressure in the pipeline when the tube is clogged.

[Explanation of symbols]

6, 46 ... Abdominal wall, 7, 9, 47, 49 ... Trocar (insert), 8, 48 ... Pneumoperitoneum (gas supply line), 2
6, 61, 62 ... Pressure sensor (pressure detection means), 27,
63 ... Control part.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Kenji Noda 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Inventor Takeo Usui 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Inventor Naoki Seki 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. An abdominal wall is inserted into the abdominal wall through an abdominal wall insertion tool provided with a gas supply pipeline connected to the abdominal cavity tube, and the abdominal wall is inflated into the abdominal wall through the gas supply pipeline. A gas for gas supply, and a pneumoperitoneum device comprising a pressure detection means for detecting the pressure in the gas supply pipe and a control means for controlling the supply of the gas for insufflation based on the detected pressure, The magnitude of the pressure change in the gas supply line when the gas for insufflation is caused to flow in or out of the gas supply line is detected, and the gas supply line is detected based on the detection data of the pressure change. A pneumoperitoneum device comprising a determination means for determining a clogging state of the pneumoperitoneum.