DE3328039A1 - Crushing device for concrements in the body of a living being - Google Patents

Abstract

The invention relates to a device for the contactless crushing of a concrement (1) in a patient (19), e.g. a calculus in the kidney (15). The required force is exerted upon the concrement (1) by a shock wave. The shock wave generator used is a shock tube (3) which is known per se and which essentially generates plane waves. The plane waves are focused on the concrement (1) by means of a lens (61; 66). For location of the concrement (1) in the patient (19) the shock tube (3) is operated, according to a first embodiment, with a low amplitude and is thus used as an emitter for the acoustic location signal. A second embodiment envisages the use of an ultrasonic transducer (41) as the emitter for the acoustic location signal. In both cases, the receiver unit may comprise a two-dimensional array for transmission or for reflection. It is also possible to use an elongate single cell or multi-cell ultrasound array (41) which can be rotationally adjusted about a longitudinal axis and is located next to the shock tube (3). <IMAGE>

Description

Smashing facility for concretions in the grain

of a living being The invention relates to a device for contactless Smashing a calculus in the body of a living being with a Shock wave generator that can be directed to a target area in the body via a coupling medium is, with a device for receiving and processing acoustic signals, the interaction of an acoustic transmission signal with the body of the living being and / or arise with the coupling medium, and with a device for sending this acoustic transmission signal.

Devices of this type are used in medicine, e.g. for Destroying stones in the human kidney. They are particularly beneficial as they avoid any interference with the body. It is not necessary surgically proceed. There is also no need to bring probes and devices to the concrement. A risk of infection or injury, e.g. when inserting the probe or during operations, can not occur with contactless shattering.

A device of the type mentioned is in DE-AS 23 51 247. Here is in a focusing chamber, which is called a semicircular ellipsoid of revolution is formed, In a first focal point, a spark discharge between two electrodes brought about. This causes a shock wave, the wave front of which changes after all Sides, i.e. spreads out spherically. On the wall of the ellipsoid of revolution the waves are reflected. They collect in the second focal point of the ellipsoid of revolution. In this second focal point, in which the calculus is placed, the reflected ones hit Waves in at the same time. The concrement becomes under the bundled impact of the shock waves destroyed. The coupling between one half of the ellipsoid and the body, in where the calculus is located is done via a thin film that has no air gaps rests against the body. The focusing chamber is filled with water.

This facility has the disadvantage that changes in the Shock wave energy only within small limits and only with a considerable amount of equipment Effort by changing the distance between the underwater electrodes are possible. Farther is disadvantageous that the mutual spacing of the electrodes to generate high-intensity Shock waves usually have to be a few millimeters, creating the shock wave source has no point-like geometry and imaging errors occur when focusing can. In addition, the underwater electrodes use up a lot with every discharge so that their service life is limited, which requires regular maintenance of the device makes necessary.

The above-mentioned circumstances are already recognized in DE-OS 25 38 960. According to this publication, the cited disadvantages can be eliminated by that instead of the spark gap, one located outside the focusing chamber Giant pulse laser is used. Its beam is expanded by a beam splitter and then through a lens system located in the wall of the focusing chamber in a burning point of the rotational elliptical focusing chamber united. A shock wave is triggered here, e.g. by concentrating the bundle of energy on an absorbent stick or highly absorbent liquid.

With this device too, it becomes a difficult-to-manufacture rotational elliptical Reflexons used. In addition, the efficiency of such a device to be seen as qering with laser. Furthermore, it must be stated that the radiation geometry is fixed once and for all and that bypassing e.g.

Ribs or other bones are not possible, so an adjustment to the body anatomy is only possible to a limited extent.

In DE-OS 29 02 331 a device for transcutaneous, bloodless Desolation of small reticular and broom reiser varices is described. As wave generators At the same time controllable ultrasonic elements are used, which are arranged parabolically are so that their sound energies meet in a focal point where the to destructive varice is placed. The entire arrangement of the ultrasonic elements is Can be moved lengthways by means of a worm drive and an adjusting screw. Through this Different distances between the focal point and the applicator end can be set. With this device, the power of the ultrasonic crystals is to smash concretions not sufficient deep inside a human body. The exact setting of the individual ultrasonic transducers both in terms of location and energy is therefore not critical. Switching off individual ultrasonic crystals for the purpose of adjustment the ultrasonic energy in the focal point is not provided.

In DE-OS 31 19 295 a device for destroying concretions is in body cavities with the aid of a large-area ultrasonic transducer as Vibration generator described. There is a focusing ultrasonic transducer with a pulse peak power of at least 100 kW are used. There is the possibility of different Zones of the body that lie on the sound path to the calculus and interfere with it, fade out by changing the radiation surface.

There is also shown an embodiment in which the individual annular Ultrasonic elements that form the transducer are arranged on a spherical surface are. About a change in performance according to the type and depth of the Nothing is said in concrete terms. In addition, the effort for such Device, especially with regard to the formation of the annular ultrasonic elements, be considerable.

In addition, it should be noted that such ultrasound equipment has only limited results Peak performances of the radiated sound energy are possible. In addition, is such a device requires a large number of ultrasonic transducers, which requires high assembly and control costs. In addition, is with ultrasonic transducers to observe an undesirable pulse-shaped undershoot, only with a considerable Effort is to be reduced.

In DE-AS 27 22 252 a device for spatial location is described by concrements, the device being integrated into a smashing device of concrements. This so-called lithotripter comprises a coupling device in the form of an ellipsoid with a shock wave source in focus. On the wall of the coupling device Both ultrasonic transmitters and ultrasonic receivers are arranged. The ultrasound machines are aligned so that the common point of intersection of their radiating waves intersect in the body-side, second focal point of the ellipsoid.

In DE-OS 29 13 251 a device for smashing of Kidney stones or the like. The shock wave generator is in one housed closed, with water-filled housing.

A reflector that reflects the shock wave is the shock wave generator assigned. The coupling of the shock wave to the patient's body takes place via a deformable, resilient sack or pouch. The sack is with one, the shock wave highly conductive medium, e.g.

Filled with water. The device described comprises a reflector, at which imaging errors are not unlikely.

In the magazine "Akustische Beihefte", 1962, issue 1, pages 185 - 202, is the structure of a so-called shock wave tube, as it is in principle in the present invention used is described. In front of a flat coil, through Separated by an insulating film, there is a copper membrane. To this copper membrane connects a pipe filled with water. By applying a voltage in the area from 2 - 20 kV to the flat coil, a magnetic field is induced in the copper membrane, which causes repulsive forces that push the membrane away from the coil. Through this a level shock wave is created, which in the water-filled pipe becomes a steep shock wave and is available at the end of the pipe for experiments. Such a system is used Shock tube e.g.

to investigate substances in chemistry.

The object of the present invention is to provide a locating device for the concrement inside the living being to indicate in connection with a particularly advantageous selected shock wave generator particularly expedient and accurate is working.

According to a first embodiment, this object is achieved according to the invention solved in that as a shock wave generator a known per se, essentially flat shock wave generating shock wave tube is provided, and that as a transmitter for the acoustic transmission signal is provided by the shock wave tube.

According to a second embodiment, this object is achieved according to the invention solved in that as a shock wave generator a known per se, essentially flat shock wave generating shock wave tube is provided, and that as a transmitter for an ultrasonic transducer is provided for the acoustic transmission signal.

The locating device according to these two embodiments enables Finding the calculus while simultaneously focusing the shock wave tube on the concrement. More than one shock wave tube can also be used here. The adjustment effort on the shock wave tube is reduced, which is also a Means saving time in treating patients.

Further advantages and details of the invention emerge from the The following description of exemplary embodiments with reference to the drawings in conjunction with the subclaims.

1 shows an elevation of a disintegration device according to FIG the invention with eight shock wave tubes and with an ultrasonic location system, FIG. 2 shows a section along the line II-II through the device according to FIG. 1, FIG. 3 shows a section along the line 111-111 through the device according to FIG. 1, FIG. 4 shows a shock wave tube according to the prior art, FIG. 5 shows a longitudinal section through a shock wave tube to which a lens is assigned, FIG. 6 shows a longitudinal section through several shock wave tubes to which a common lens is assigned, and FIG. 7 a section corresponding to Figure 3 with a standing patient and with a shock wave decoupling device.

Figures 1 to 3 show the detail of a device for contactless Smashing a calculus in the body of a living being 1. The device comprises two arcuate lines 2a and 2b, each with four per se known shock wave tubes 3. The two lines 2a, 2b lie on a spherical surface, and the shock wave tubes 3 are placed next to each other, for which purpose a holding frame 4 can serve. However, they lie not too tight, so that a mechanical fine control device 5, e.g. several guides with a fine-pitch spindle, can be conveniently accommodated and operated can.

When arranging several identical, cylindrical shock wave tubes 3 care should be taken that the extensions of their center axes 7 are meet in a common point of intersection 11 and that the shock wave tubes 3 are the same Have a distance from this intersection 11. The outlet openings 12 of the shock wave tubes 3 thus lie on a circle around the intersection point 11. The central axes of the the shock waves emanating from the shock wave tubes 3 run along the central axes 7. Depending on the embodiment, the shock waves hit the intersection 11 at the same time, which is preferred for some applications, or staggered in time or offset a. The latter embodiment can be advantageous if the calculus 1 should be exposed to a longer exposure time overall.

The fine control device 5 includes the possibility of each shock wave tube 3 to move individually in the direction of the central or longitudinal axis 7. Changed thereby the distance between the shock wave tube opening 12 and the common point of intersection 11 of the individual longitudinal axes 7. This is indicated by an arrow 5a.

To adjust the depth of the intersection point 11 in the patient's body 19, the fine adjustment 5 also enables the holding frame 4 to be displaced with all shock wave tubes 3 mounted on it. A double arrow 5c indicates this at.

The calculus 1 is arranged at the aforementioned intersection point 11. In the case shown, it is a stone in a kidney 15. One pulled out Line 17 symbolizes the body surface of the patient 19, who is in front of the smashing device is placed.

Each shock wave tube 3 comprises a flat coil 21 with a connection is connected to common ground 23.

The other terminal of the flat coil 21 is summarized with the corresponding connections of other flat coils 21 of the same arc 2a or 2b a first electrode 25a or 25b of a suitable switching device such as one Spark gap 27a or 27b or a vacuum or SF6 switch connected. One second electrode 29a or 29b of the spark gap 27a or

27b is applied to a capacitor 31a, 31b. In parallel with the capacitor 31a, 31b is a first resistor 33a and 33b, respectively. This parallel connection is due to A charging voltage is applied via a second resistor 35a, 35b connected in series Ua or Ub. Between the two electrodes 25a, 25b and 29a, 29b of the spark gap 27a or 27b is a control electrode 37a or 37b, with the help of which the relevant Spark gap 27a, 27b is ignited.

Between the two parallel rows 2a, 2b of shock wave tubes 3 is a locating device 39, which is used for receiving and transmitting Ultrasonic signals is suitable. This is used for contactless Locate the position of the calculus 1. In the present example, it is an ultrasound localization device. The locating device 39 comprises a parallel arrangement 41 of ultrasonic elements (see.

Figures 1 and 3), which via a signal line 42 with a transmitting and / or receiving device 43 is connected. The arrangement 41 is pivotable a tripod with a support rod 43a, through which the signal lines at the same time 42 can be guided from and to the ultrasonic transducer elements.

As a result, the arrangement 41 can be rotated about its longitudinal axis, which is achieved by a double arrow 44 is shown. An alternative embodiment to this arrangement 41 of the ultrasonic elements consists in the fact that the ultrasonic elements directly each individual shock wave tube 3 are assigned. Another possibility is to to design the ultrasonic transducer elements as a surface array.

With the aid of the locating device 39, the patient 19 is placed in such a way that that the calculus 1 to be destroyed is at the intersection 11 of the central axes 7 the shock tube 3 is located. The coupling between shock wave tube opening 12 and patient 19 is filled with a coupling medium e.g. water 47, flexible sack 49 (see FIG. 3) produced. This can in particular from a elastic material with an acoustic impedance similar to that of water is exist.

EPDM rubber is preferred. The sack 49 is preferred attached to the circumference of the shock tube 3.

It is important to ensure that the sack 49 has no air gap on the body of the patient 19 is applied. The concern can be through acoustic controls with the help the ultrasound device can be checked for correctness. To the adjustment effort To keep the shock wave tubes 3 as small as possible, it is useful to keep the wall of the sack 49 like that to be formed, as there are folds 51 on the sides are.

These folds 51 have a function similar to bellows and allow to place the shock wave tubes 3 closer or further away from the patient 19 as well as To absorb tilting movements in all directions. This changes accordingly the position of the intersection 11 in the patient 19. An individual adjustment change the shock wave tube 3 itself is not necessary. This benefit is said to be special considered significant.

The coupling can also take place via a water bath 52 in a tub, in which the patient 19 is located.

The shock wave tube arrangement is in a recess in the wall 52a of the tub used (Figure 2).

If the calculus 1 is in said intersection 11, you can the shock waves are triggered at the same time.

The number of connected shock tubes 3 depends on the size and consistency of the calculus 1 and that given by the patient's anatomy Geometry and is set accordingly. The individual shock waves go through the water bag 49 and the body on separate paths up to the intersection point 11.

There they meet at the same time and give a part of theirs Energy to the concrement 1 by pressure and pulling effect. This will destroy it or at least damaged. About the reception possibility of the locating device 39 for the concrement 1 can be a success of the due to the reflected shock wave The shattering process can be controlled.

There are applications conceivable in which the shock waves predetermined volume range in which the calculus 1 is located, in an adjustable time sequence can run through. The setting of the temporal shift is via the fine adjustment device 5 by changing the distance along the double arrow 5a possible. Another variant of this is a time delayed one Triggering of the individual shock waves.

FIG. 3 shows an exemplary embodiment in which the control electrode -n 37a, 37b are connected to a control unit 53 separately from one another. The control unit 53 applies voltage pulses to the control electrodes in the desired sequence 37a and 37b of the individual shock wave tubes 3 of rows 2a and 2b, respectively, and thereby causes the ignition processes. The setting of the distance between the calculus 1 and the Shock wave tube opening 12 does not take place here via the mechanical fine control device 5, but by staggered triggering of the individual shock waves.

This allows the arrangement of the shock wave tubes 3 on an arc of a circle omitted. The alignment of the shock wave tubes 3 on the concrement 1 must, however still be given.

The time shift can be implemented, for example, by giving each Shock wave tube 3 has its own circuit with its own switching device 54 and control components are assigned, which via the common control unit 53 operate. The control unit 53 also enables adjustment of Amplitude and pulse shape of the individual shock waves. This will continue to enable to locate the concrement 1 directly with the help of the shock wave tube 3, by setting the amplitude of the shock wave to be correspondingly small. In figure 3, two switching devices 54a, 54b are shown for this purpose.

It is particularly advantageous in the present invention that in the As a rule, not all shock wave tubes 3 always have to be connected. this makes possible a selection of the participating shock tubes 3 so that only those with optimal radiation path are preferred.

Shock tubes 3 where obstacles, e.g.

Bones in the shock wave travel path are observed at the shock wave output is not switched on.

Figure 4 shows a longitudinal section through a typical embodiment of a shock wave tube 3 The capacitor 31 is connected to ground 23, its other connection is connected to the second electrode 29 of the spark gap 27. The first electrode 25 of the spark gap 27 is at the beginning of the flat coil 21 tied together. The end of this flat coil 21 is connected to ground 23. In front of the flat coil 21 an insulating film 55 is arranged, which a copper membrane 57 from the flat coil 21 electrically isolated. The copper membrane 57 is on the edge with a liquid, e.g. water-filled cylindrical pipe section 59 connected. The end of the pipe section 59 is designated as shock tube opening 12. The water bag can be used directly here 49 connect.

Between the first and second electrodes 25 and 29 of the spark gap 27 is the control electrode 37.

If a voltage pulse is applied to this control electrode 37, then the spark gap 27 is ignited and thus conductive. The stored in the capacitor 31 Energy is discharged into the flat coil 21, which thus very quickly becomes a magnetic Field builds up. An opposing field is induced in the copper membrane 57, which causes that the copper membrane 57 is repelled by the flat coil 21. This knocking out the copper membrane 57 creates a pressure wave in the water. The pressure wave settles continued to the shock wave tube opening 12, while in the course of the pipe section 59 and then the wave front gains steepness.

With suitable dimensioning of the components of the shock wave tubes 3, the pressure amplitude of the shock waves in the target area 1 is large enough to achieve the desired To achieve the effect of concretion rubble.

FIG. 5 shows a section longitudinally through a shock wave tube 3 according to FIG FIG. 4, at the opening 12 of which an acoustic converging lens 61 is mounted. The collecting lens 61 can in the direction of the double arrow 63, that is, along the central or longitudinal axis 7 of the shock wave tube 3 can be displaced. With this displaceable arrangement of the The converging lens 61 can then be used for fine adjustment of the entire shock wave tube 3 can be omitted according to double arrow 5a in FIG. By moving the converging lens 61 their #focal points 65 are shifted accordingly, their distance from the Shock wave tube opening 12 can thus be varied. In the one lying on the body side The concrement 1 to be smashed is located at the focal point 65 of the converging lens 61. This arrangement of the converging lens 61 is expedient in all shock wave tubes 3 made. Alternatively, there is the possibility that several or all shock wave tubes 3 are located in front of a common converging lens 66. An arrangement FIG. 6 shows this. Between four parallel shockwave tubes 3 and the body of the patient 19 is a single converging lens 66. Its diameter is large enough to capture all of the plane waves emitted. In terms of the position of the focal point 65 of the lens 66 and its displaceability, the same applies as for the arrangement according to Figure 5. The advantage of this solution is that not every Shock tube 3 needs to be aligned individually, but only one Parallel positioning of all shock wave tubes 3 is necessary. The overall arrangement only has a focal point 65, which is congruent with the con crement 1 is adjusted.

FIG. 7 shows an overall view of the disintegration device with a coupling device for the shock waves. The one for entry and exit The shockwave in question area of the patient 19 is wearing an abdominal band 67 covered. The abdominal bandage 67 lies on the body of the patient 19 without any air gaps and is filled with a filling, e.g. water, that conducts the shock waves well. On the side facing away from the body, the shock waves are emitted by an area Ultrasonic receiver 69 collected for transmission. The shock tubes 3 are attached to an angled support arm frame 71, which allows pivoting in all directions. This is advantageous for the destruction of extensive calculus or for patient movements track the common point of intersection 11 during the treatment. The support arm frame 71 can be firmly connected to a wall of the treatment room. To this Holding arm 71 can, for example, also include the parts of the fine adjustment 5, which allows the shift along the double arrow 5c.

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Claims (6)

Claims 9 device for the contactless smashing of a calculus located in the body of a living being with a shock wave generator, which can be aligned to a target area in the body via a coupling medium, with a Device for receiving and processing acoustic signals transmitted by Interaction of an acoustic transmission signal with the body of the living being and / or arise with the coupling medium, and with a device for sending this acoustic Transmission signal that is used as a shock wave generator a known, essentially flat shock wave generating shock tube (3) is provided, and that the shock wave tube as a transmitter for the acoustic transmission signal (3) is provided. 2. Device for the contactless smashing of one in the body of a Living being located calculus with a shock wave generator that has a Coupling medium can be directed to a target area in the body with a device for receiving and processing acoustic signals caused by interaction an acoustic transmission signal with the body of the living being and / or with the coupling medium arise, and with a device for sending this acoustic transmission signal, d a d u r c h e k e n n n z e i c h n e t that as a shock wave generator a per se known, substantially planar shock wave generating shock wave tube (3) is provided and that the transmitter for the acoustic transmission signal is an ultrasonic transducer (41) is provided. 3. smashing device according to claim 2, d a -d u r c h g e k It is noted that the receiving device (41; 69) is an ultrasound array includes, which is rotatable about its longitudinal axis (Fig. 3). 4. smashing device according to one of claims 1 to 3, d a d u r c h g e k e n n z e i c h -n e t that the receiving device (41) besides the shock wave tube (3) aligned with the target area (1) is arranged (Fig 3). 5. smashing device according to one of claims 1 to 3, d a it is indicated that the receiving device (69) is a surface array for transmission (Fig. 7). 6. smashing device according to one of claims 1 to 4, d a d u r c h e k e n n n z e i c h -n e t that the receiving device is an area array included for reflection.