JPH0382459A - Device for dissolving calculus in living body - Google Patents

Abstract

PURPOSE:To detect leakage of calculus dissolving agent into an unnecessary part so as to take a safe countermeasure in use of a device for introducing the calculus dissolving agent into a human body cave so as to dissolve a calculus therein by providing a sensor means for detecting leakage of the dissolving agent. CONSTITUTION:During treatment, when a dissolving agent leaks into the duodenum 4 from the gallbladder 10, a filler 25 consisting of cholesterol filled in a recess 23 in a tip 23 of a sensor 7 which has be previously set is dissolved. Accordingly, a pair of electrodes 24a, 24b in the recess 23 are exposed, and are then made into contact with each other by their resiliencies or are communicated with each other through the intermediary of body fluid. A communication signal is processed by a sensor device body 18. Further, a control device 16 determines a dissolving agent leak signal so as to control the operating of a system. Further, the circulation of the dissolving agent is stopped, and the oscillation of an oscillator 15 is stopped. Further, a warning lamp and a lamp is energized to inform the operator. thereby it is possible to ensure a safety.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Application Field] The present invention relates to an in-vivo stone dissolving device that removes in-vivo stones using a dissolving agent.

[Prior Art] In recent years, various methods have been considered for removing stones such as gallstones that occur in living bodies. Common methods include surgical removal and endoscopically introducing basket forceps into the body cavity to grasp and remove the stone.

However, surgical removal methods place a heavy burden on the patient.

Furthermore, the endoscopic method of using basket forceps is limited to stones in areas where the basket forceps can be introduced, and it is often impossible to remove the stone depending on conditions such as the size of the stone.

On the other hand, there is also known a method of crushing a stone by intensively irradiating shock waves such as ultrasonic waves from outside the body toward the stone site within the body (Japanese Patent Application Laid-open No. 120846/1984).

This method requires a large-scale device and does not remove the stone itself.

[Problems to be Solved by the Invention] However, recently, a stone dissolution method has been proposed in which stones in the living body are (directly) removed using a dissolving agent (Japanese Patent Application Laid-Open No. 1983-1999).
-40541 publication). This is an excellent method of placing a stone-dissolving agent into the gallbladder where the gallstones are located and attempting to chemically dissolve the gallstones.

The dissolving agent in this method is, for example, methyl monoether (MTBE) for cholesterol gallstones.

However, this stone-dissolving agent is biocompatible in the gallbladder and has the effect of dissolving cholesterol gallstones, but if this stone-dissolving agent leaks from the gallbladder and reaches the duodenum via the cystic duct and the common bile duct, it can cause severe pain to the patient. cause to happen.

Also, as with other litholytic agents, leakage and absorption is generally harmful.

The present invention has been made in view of the above-mentioned problems, and its purpose is to provide an in-vivo stone dissolving device that can detect and safely treat the leakage of a stone dissolving agent to areas other than the required areas. It is about providing.

[Means and effects for solving the problems] In order to solve the above problems, the present invention provides an in-vivo stone dissolving device that dissolves and removes stones by introducing a stone dissolving agent into a body cavity where a stone exists. A sensor means is provided for detecting a stone-dissolving agent leaking out of a certain body cavity.

According to this, the presence of leakage of the calculus dissolving agent can be detected, so that the leakage can be detected and safely treated.

[Embodiment] FIGS. 1 to 3 show a first embodiment of the present invention. FIG. 1 schematically shows the structure of an apparatus for dissolving stones in a living body. In the figure, 1 is a patient (living body) placed on a bed 2. As shown in FIG. The insertion portion 3a of the endoscope 3 is orally introduced into the upper gastrointestinal tract of the patient 1 to the vicinity of the duodenal papilla 5 of the duodenum 4. Further, a perfusion catheter 6 and a sensor 7 to be described later are inserted through an insertion channel (not shown) of the endoscope 3.

The perfusion catheter 6 is introduced from the common bile duct 8 to the cystic duct 9 or the gallbladder 10 using the endoscope 3 or a guide wire (not shown).

Then, a stone-dissolving agent is introduced into the gallbladder 10 through this catheter 6, or the stone-dissolving agent is perfused. The sensor 7 is located near the duodenal papilla 5 of the duodenum 4 or within the range from the common bile duct 8 to the cystic duct 9.

An ultrasound irradiation device g111 is installed on the outer surface of the abdomen of the patient 1 corresponding to the gallbladder 10. The ultrasonic irradiation device 11 has an ultrasonic vibrator 12 for observation and an ultrasonic vibrator 13 for stirring irradiation, and the ultrasonic vibrator 12 for observation is connected to the ultrasonic observation device 14 . The stirring irradiation ultrasonic vibrator 13 is connected to an oscillation signal 15 via an amplifier 14. The ultrasonic observation device 114 and the oscillator 15 are controlled by the control device FIL1.
6.

Also, a perfusion drive device f! to which the above-mentioned perfusion catheter 6 is connected! 17 and a sensor device main body 18 to which the sensor 7 is connected.
is also connected to the control device 16.

Note that one external control command section and a monitor 20 are connected to the control device 16.

On the other hand, as shown in FIG. 1, the sensor 7 has a tip 22 made of Teflon attached to the tip of a flexible tube 21, and a recess 23 is formed at the tip of the tip 22. be. Inside this recess 23, a pair of electrodes 24a, 2
The tips of the recesses 4b are provided facing each other, and the recess 23 is further filled with a filler 25 made of cholesterol.

When filling this filling material 25, a pair of electrodes 2
The tips of 4a and 24b are separated from each other. Also,
When there is no filler 25, the tips of the pair of electrodes 24a, 24b are brought into contact by their own elastic force. Note that even when there is no filling material 25, the pair of electrodes 24a, 2
Even if the tips of the electrodes 24a and 24b are separated, the body fluid interposed between them is generally conductive, so the electrodes 24a and 24 are not necessarily separated.
The tips of b do not need to contact each other.

Further, conductive wires 26a and 26b respectively connected to the pair of electrodes 24a and 24b are connected to the sensor device main body 18 through the tube 21.

Next, the operation of this in-vivo stone dissolving device will be explained.

First, as shown in Figure 2, in the upper gastrointestinal tract of patient 1,
The insertion section 3a of the endoscope 3 is orally inserted and introduced to the vicinity of the duodenal papilla 5 of the duodenum 4. Then, if necessary, through the insertion channel of the endoscope 3,
A perfusion catheter 6 is introduced from the common bile duct 8 through the cystic duct 9 to the gallbladder 10 using a guide wire or the like. In these situations, the ultrasound irradiation device 11 and the ultrasound observation device 14
It can be observed on the monitor 20.

On the other hand, the sensor 7 is inserted into the vicinity of the duodenal papilla 5 of the duodenum 4 or the common bile duct 8 through the insertion channel of the endoscope 3.
The distal tip 22 is positioned within the cystic duct 9 from the cystic duct 9.

And perfusion drive system fl! 17 to introduce the stone-dissolving agent into the gallbladder 10 through the catheter 6, and perfuse the stone-dissolving agent as necessary. In this way, the gallstones 27 in the gallbladder 10 are dissolved by the dissolving agent. Generally, gallstones 27 are cholesterol-based, and therefore, a dissolving agent capable of dissolving them, such as methyl t-ether (MTBE), is used.

In this case, the oscillator 15 is operated and the ultrasonic irradiation device 1
Ultrasonic waves are irradiated from the stirring irradiation ultrasonic vibrator 13 of No. 1 toward the gallbladder 1110. This stirs the dissolving agent and promotes the dissolving action on the gallstones 27.

Furthermore, the state of the dissolving action can be observed on the monitor 20 using the ultrasonic observation device 14.

By the way, during this procedure, if the dissolving agent leaks from the gallbladder 10 to the duodenum 4 side, the filling 25 made of cholesterol that has been filled in the recess 23 of the distal tip 22 of the sensor 7 installed in advance will dissolve. do. Therefore, the pair of electrodes 24a and 24b in the recess 23 are exposed and come into contact with each other by their own elastic force or are electrically connected via their body fluids or the like. This conductive signal is transmitted to the sensor device main body 18.
Processed in Then, the control device 16 determines the leakage signal of the solvent and controls the operation of the system.

For example, the perfusion operation of the dissolving agent is stopped. The oscillation operation of the oscillator 15 is stopped. Further, a warning buzzer and lamp (not shown) are activated to notify the operator. Further, the stone dissolving agent is removed by suction into the gallbladder 10 through the catheter 6.

``Furthermore, a procedure is performed to remove the dissolving agent that has leaked into the duodenum 4 by suction using a catheter or the like. In this way, safety is ensured when the dissolving agent leaks from the gallbladder 10 to the duodenum 4 side.

FIG. 4 shows a second embodiment of the invention. This is an example of another sensor 30. This sensor 30 has a recess 31 opened on the side surface of the tip 22 made of Teflon.
A pair of opposing electrodes 24 are formed in the recess 31.
a and 24b are installed, and a filling material 25 made of cholesterol is further filled therein. The other configurations are the same as those of the first embodiment. This sensor 30 can be used in substantially the same manner as in the above embodiment. However, it is possible to efficiently detect the solution from the side surface of the distal tip 22.

5 to 7 show a third embodiment of the present invention. In this embodiment, the gallbladder jaw 10a of the gallbladder 10 is plugged with a plug 40. A sensor is incorporated into this stopper 40 as described later.

The plug 40 is formed by fitting a member 42 that absorbs and expands the dissolving agent used on the outer periphery of a core member 41, and the expanding member 42 is made of, for example, silicone when the dissolving agent is MTBE. is formed into a so-called sponge shape.

Further, the core member 41 is made of, for example, Teflon, which is not dissolved by the dissolving agent that is also used.

Further, a collar 43 is formed at one end of the core member 41, and a spherical portion 44 is formed at the other end of the core member 41. A recess 45 is formed in this spherical portion 44 . Inside this recess 45,
A pair of electrodes 24a of the sensor.

24b are provided with their tips facing each other. moreover,
This recess 45 is filled with a filling 46 made of cholesterol.
It is filled with. Then, when filling this filling material 46, a pair of electrodes 24a.

Make sure that the tip of 24b is separated. Furthermore, when there is no filler 25, the tips of the pair of electrodes 24a, 24b are brought into contact by their own elastic force. In addition, filling 2
5, even if the tips of the pair of electrodes 24a, 24b are separated, the body fluid interposed between them is generally conductive, so the tips of the electrodes 24a, 24b do not necessarily come into contact with each other. Good too.

Furthermore, electrode cords 26a and 25b are connected to the pair of electrodes 24a and 24b, respectively. The electrode cords 26a, 26b are led to the collar 43 side through the core member 41, and are collected into a cord 48 and led out. Note that this cord 48 is connected to the sensor device main body 18 as in the first embodiment.

In this example, the treatment is percutaneous. That is, as shown in FIG. 7, the plug 40 is percutaneously introduced into the gallbladder 10 by a surgical procedure and placed in the gallbladder jaw 10a. Then, MT as a solubilizer 50 is introduced into the gallbladder 10 through four catheters percutaneously introduced into the gallbladder 1o.
Introduce BE. The fat swelling member 42 of the stopper 40 is expanded from the state shown in FIG. 5 to the state shown in FIG. 6 by the dissolving agent 5o,
As shown in FIG. 7, the gallbladder jaw 10a of the gallbladder 1o is completely closed.

A solubilizing agent 5° is injected through the tip holes 49m of the four catheters, and the solubilizing agent is suctioned through the side hole 49b of the catheter 49 to perfuse the solubilizing agent 50. In this way, the gallstones 27 in the gallbladder 10 are dissolved and removed.

Incidentally, in this embodiment, since the gallbladder jaw 10a portion of the gallbladder 10 is occluded with the stopper 40, it is possible to prevent the dissolving agent 50 from leaking to the duodenum 4 side.

However, even with this, if the dissolving agent 50 leaks into the duodenum side 4 for some reason, the leaked dissolving agent will damage the filling 46 made of cholesterol filled in the recess 45 of the spherical portion 44. Dissolved and its recess 45
A pair of electrodes 24a and 24b inside are exposed. Therefore, the pair of electrodes 24a and 24b are brought into contact and conductive, and leakage of the dissolving agent 50 is detected.

Then, as in the case of the first embodiment, measures are taken to ensure safety by stopping the perfusion of the solution 50 and collecting the solution 50.

In this embodiment, as in the case of the first embodiment, an ultrasound irradiation device 11 is provided to observe the treated area,
The dissolving agent 50 may also be stirred.

FIG. 8 shows a fourth embodiment of the present invention. This embodiment is based on the core member 41 of the plug 40 in the third embodiment.
An introduction hole 51 opening toward the flange 43 is formed at the flange 43, and a large number of holes 52 communicating with the introduction hole 51 are formed on the circumferential surface corresponding to the inner surface of the fat-swelling member 42.

In this embodiment, one end surface side portion of the fat swelling member 42 is connected to the gallbladder 1.
The fat swelling member 42 is brought into contact with the dissolving agent not only directly but also from the inner surface of the fat swelling member 42 through the introduction hole 51 and the introduction hole 51. therefore,
The fat expansion member 42 can be expanded easily and quickly.

Other aspects are the same as those of the third embodiment.

9 and 10 show an improved version of the catheter 49 in the third embodiment. That is, an adsorbent 55 is attached to the outer periphery of the catheter 49 to adsorb gas generated by evaporation of the dissolving agent. Since MTBE is particularly volatile, in this way, the MTBH gas 60 vaporized within the gallbladder 1o can be removed by adsorption, as shown in FIG.

Note that the present invention is not limited to the above embodiments. For example, the member of the distal tip and the member of the stopper are not limited to Teflon, but may be made of other materials such as metal as long as they are not soluble in the dissolving agent. In addition, the types of solubilizers include natural limonene acid agent Lifcol (d-limonene), etc.
You can choose from a variety of options. It can also be applied to other intravesical stones, such as intravesical stones, in which case sodium hexametaphosphate solution or dimethyl sulfoxide CDMSO
) etc. can be used.

[Effects of the Invention] As explained above, according to the present invention, it is possible to detect leakage of a calculus dissolving agent to a site other than the required site and safely treat the leakage.

[Brief explanation of drawings]

1 to 3 show a first embodiment of the present invention,
FIG. 1 is a side cross-sectional view of the vicinity of the tip of the sensor, FIG. 2 is an anatomical view of the biological structure around the liver, and FIG. 3 is a schematic explanatory diagram of the configuration of the dissolving device. FIG. 4 is a side sectional view of the vicinity of the tip of the sensor in the second embodiment of the present invention. Figures 5 to 7
The figures show a third embodiment of the present invention, with FIGS. 5 and 6 being sectional views of the stopper, and FIG. 7 being an explanatory view of the state of use. 8th
The figure is a side sectional view of a stopper in a fourth embodiment of the present invention. FIG. 9 is a side sectional view of the catheter, and FIG. 10 is a diagram showing the catheter in use. b...catheter, 7...sensor, 10...gallbladder, 16...control device, 18...sensor device main body, 2
4a. 24b... Electrode, 25... Filler, 27... Gallstone, 50... Dissolving agent.

Claims (1)

[Claims] In an in-vivo stone dissolution device that dissolves and removes a stone by introducing a stone-dissolving agent into a body cavity in which a stone exists, a sensor means is provided to detect the stone-dissolving agent leaking out of the body cavity in which the stone is located. Characteristic in-vivo stone dissolution device.