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EP0133665B1 - Apparatus for the smashing at a distance of calculus - Google Patents

Apparatus for the smashing at a distance of calculus Download PDF

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Publication number
EP0133665B1
EP0133665B1 EP84108750A EP84108750A EP0133665B1 EP 0133665 B1 EP0133665 B1 EP 0133665B1 EP 84108750 A EP84108750 A EP 84108750A EP 84108750 A EP84108750 A EP 84108750A EP 0133665 B1 EP0133665 B1 EP 0133665B1
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EP
European Patent Office
Prior art keywords
shock wave
shock
lens
tube
wave
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired
Application number
EP84108750A
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German (de)
French (fr)
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EP0133665A3 (en
EP0133665A2 (en
Inventor
Karlheinz Dr. Pauli
Helmut Dr. Reichenberger
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Siemens AG
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Siemens AG
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Publication of EP0133665A3 publication Critical patent/EP0133665A3/en
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    • G—PHYSICS
    • G10—MUSICAL INSTRUMENTS; ACOUSTICS
    • G10K—SOUND-PRODUCING DEVICES; METHODS OR DEVICES FOR PROTECTING AGAINST, OR FOR DAMPING, NOISE OR OTHER ACOUSTIC WAVES IN GENERAL; ACOUSTICS NOT OTHERWISE PROVIDED FOR
    • G10K9/00—Devices in which sound is produced by vibrating a diaphragm or analogous element, e.g. fog horns, vehicle hooters or buzzers
    • G10K9/12—Devices in which sound is produced by vibrating a diaphragm or analogous element, e.g. fog horns, vehicle hooters or buzzers electrically operated
    • G—PHYSICS
    • G10—MUSICAL INSTRUMENTS; ACOUSTICS
    • G10K—SOUND-PRODUCING DEVICES; METHODS OR DEVICES FOR PROTECTING AGAINST, OR FOR DAMPING, NOISE OR OTHER ACOUSTIC WAVES IN GENERAL; ACOUSTICS NOT OTHERWISE PROVIDED FOR
    • G10K11/00—Methods or devices for transmitting, conducting or directing sound in general; Methods or devices for protecting against, or for damping, noise or other acoustic waves in general
    • G10K11/18—Methods or devices for transmitting, conducting or directing sound
    • G10K11/26—Sound-focusing or directing, e.g. scanning
    • G10K11/30—Sound-focusing or directing, e.g. scanning using refraction, e.g. acoustic lenses

Definitions

  • the invention relates to a device for the contactless smashing of a concrement located in the body of a living being with a shock wave generator which can be aligned with a target area in the body.
  • Devices of this type are used in medicine, e.g. to destroy stones in the kidney of humans. They are particularly beneficial because they avoid any intervention in the body. It is not necessary to operate surgically. There is also no need to bring probes and devices to the concrement. A risk from infection or injury, e.g. when inserting the probe or operations, can not occur in contactless smashing.
  • a device for crushing concrements is described in DE-AS 2351 247.
  • a spark discharge is brought about between two electrodes in a first focal point.
  • This causes a shock wave, the wavefront of which extends on all sides, i.e. spreads spherically.
  • the waves are reflected on the wall of the ellipsoid of revolution. They collect in the second focal point of the ellipsoid of revolution.
  • the reflected waves arrive simultaneously in this second focal point, in which the concrement is placed.
  • the concrement is destroyed under the collision of the shock waves.
  • the coupling between the ellipsoid of revolution and the body in which the concrement is located takes place via a thin film that lies against the body without an air gap.
  • the focus chamber is filled with water.
  • This device has the disadvantage that changes in the shock wave energy are possible only within small limits and only with considerable expenditure on equipment by changing the distance between the underwater electrodes.
  • a further disadvantage is that the mutual distance between the electrodes for generating high-intensity shock waves generally has to be a few millimeters, as a result of which the shock wave source has no punctiform geometry and imaging errors can occur during focusing.
  • the underwater electrodes wear heavily with each discharge, so that their lifespan is limited, which necessitates regular maintenance of the device.
  • the device according to DE-AS 2351247 also entails the fact that the patient's body is separated from the high-voltage spark gap only by the coupling film which is in contact with the body and by the water. Damage to the coupling foil carries a certain risk for the patient.
  • DE-OS 2 902 331 describes a device for transcutaneous, bloodless obliteration of small reticular and spider vein varices.
  • controllable ultrasound elements are used as the wave generator, which are arranged parabolically so that their sound energies meet at a focal point in which the varice to be destroyed is placed.
  • the entire arrangement of the ultrasonic elements is longitudinally displaceable by means of a worm drive and an adjusting screw. This allows different distances of the focal point from the applicator end to be set.
  • the power of the ultrasound crystals is not sufficient to crush stones in the deep interior of a human body.
  • the exact setting of the individual ultrasonic vibrators with regard to both the location and the energy is therefore not critical. Switching off individual ultrasonic crystals for the purpose of adjusting the ultrasonic energy in the focal point is not provided.
  • DE-OS 3119 295 describes a device for destroying concrements in body cavities with the aid of a large-area ultrasound transducer as a vibration generator.
  • a focusing ultrasonic transducer with a pulse peak power of at least 100 kW is used.
  • An embodiment is also shown in which individual ring-shaped ultrasonic elements, which form the transducer, are arranged on a spherical surface. None is said about a change in performance according to the type and depth of the concretion.
  • the effort for such a device, in particular with regard to the formation of the ring-shaped ultrasound elements should be considerable.
  • shock tube As it is used in principle in the present invention, is described.
  • a copper membrane is located in front of a flat coil, separated by an insulating film.
  • a tube filled with water connects to this copper membrane.
  • a voltage in the range of 2-20 kV to the flat coil, a magnetic field is induced in the copper membrane, which causes repulsive forces that suddenly push the membrane away from the coil.
  • Such a shock wave tube is used e.g. for substance studies in chemistry.
  • a device according to the preamble of claim 1 is known from JP-B 5 540 257.
  • the object of the present invention is to increase the operational reliability of such a device, to obtain an image on a target area with the smallest possible imaging error and to reduce maintenance work.
  • this object is achieved in that a shock wave generator, known per se and producing the flat shock wave, with an electrical coil and a membrane arranged in front of it is provided as the shock wave generator.
  • this device uses a shock wave generator that generates plane waves, the shock waves coming from only one direction have to be bundled and focused.
  • imaging errors are less likely than if spherical waves proceeding from a spark gap and traveling in all directions have to be focused.
  • the temporal and spatial reproducibility of the shock wave is significantly improved when generated with a shock wave tube compared to the generation with a spark gap.
  • there is no maintenance work due to wear and tear of the electrodes in a spark gap. Because a shock wave tube generates the shock waves with the help of electromagnetic forces and does not require a spark gap.
  • a shock wave tube is constructed in such a way that it contains a copper membrane at one end of a tube filled with liquid, preferably with water, which is arranged in front of a flat coil, separated by an insulating film. Due to a current pulse in the flat coil, the copper membrane is repelled by it and thereby generates the shock wave in the liquid.
  • the copper membrane itself and the pipe section adjoining it are usually connected to a common reference potential, i.e. they are grounded. There is therefore no high voltage at the coupling medium that conducts the shock wave, which increases the electrical safety of patient and staff.
  • FIG. 1 shows a shock wave tube 1 known per se, consisting of a jacket 2, a flat coil 3 with two electrical connections 5 and 7, an insulating film 9, a copper membrane 11 and a metallic tube piece 13, in front of an acoustic converging lens 15 , which has a focal point F, placed.
  • the pipe section 13 is filled with a liquid 14, e.g. filled with water.
  • the shock wave tube 1 is coupled to a body 19 via a coupling medium 17 with water-like acoustic properties.
  • the body 19, e.g. a patient has a concretion 23, e.g. a kidney stone.
  • the converging lens 15 can be displaced relative to the jacket 2 of the shock tube 1 via a fine adjustment 24 with a bolt 24a and a locking edge 24b in the direction of a double arrow 25.
  • the bolt 24a is guided in a slot-shaped recess 24c in the casing 2.
  • the shock wave tube 1, the converging lens 15 and the fine adjustment 24 are mounted on a common frame, tripod or a mounting plate 26.
  • This mounting plate 26 is mounted on a bearing 26a which can be pivoted on all sides and is displaceable in all spatial directions. As a result, the shock wave tube 1 can be aligned with the concretion 23 such that the focal point F lies in the concretion 23.
  • the copper membrane 11 and the pipe section 13 are electrically connected to a protective potential such as earth 27, as is the one connection 7 of the flat coil 3.
  • the other connection 5 of the flat coil 3 is connected to a supply and via a switch 29, which includes an auxiliary contact 31 Control unit 33 out.
  • a high voltage U is generated in the supply and control unit 33 via a capacitor / resistance circuit (not shown). This can be several kilovolts, for example 20 kV. The voltage U can be adjustable.
  • a control signal which is supplied from the supply and control unit 33 to the auxiliary contact 31 via a control line 35, causes the switch 29 to close.
  • a part of the energy stored in the (not shown) capacitor of the supply and control unit 33 is discharged abruptly into the flat coil 3, which builds up a magnetic field very quickly.
  • a current is induced in the copper membrane 11, which is opposite to the current in the flat coil 3 and a magnetic opposing field testifies. The copper membrane 11 is knocked away from the flat coil 3 by the force of the opposing field.
  • This knocking away of the copper membrane 11 creates a flat shock wave, ie an abrupt compression in the liquid 14 upstream of the membrane 11.
  • This shock wave shows a steep pressure increase, for example to 200 bar.
  • the pressure wave gains steepness in its course through the pipe section 13, the converging lens 15 and the patient's body 19.
  • the shock wave After passing through the converging lens 15, the shock wave is shaped such that it converges at the focal point F.
  • the concrement 23 is placed there, and the focused shock wave releases part of its energy content to the concrement 23, which is brittle compared to the environment, by means of tensile or compressive forces. These forces break up the concrement 23 into several parts and thus cause it to be broken up.
  • This explained crushing device offers the considerable advantage that the grounded copper membrane 11 and the grounded pipe section 13 do not represent a source of danger for the patient 19 or the operating personnel.
  • the electrical safety of the device can be improved for the operating personnel by an additional insulating sheath (not shown), e.g. in the form of a plastic coating of the outer surface of the jacket 2, can be increased.
  • an additional insulating sheath e.g. in the form of a plastic coating of the outer surface of the jacket 2
  • a sack 37 filled with the coupling medium 17 is used at the point of entry of the shock wave in the patient 19, there is a double security for the patient 19 from the high electrical voltage. This security is determined on the one hand by the insulating bag wall and on the other hand by the insulating film 9 in front of the flat coil 3.
  • the switch 29 can also be integrated in the supply and control unit 33. It can also be located away from the shock tube assembly. Since a spark gap does not necessarily have to be used for triggering, namely e.g. Vacuum or, more recently, SF6 switches are also out of the question, eliminating the need for complex maintenance and operating work that would be associated with the spark gap.
  • FIG. 2 shows a shock wave tube 1 known per se, to which a system 40 of acoustic lenses for imaging a flat shock wave onto a concrement 23 in the body of a patient 19 is assigned.
  • the acoustic lens system 40 consists of a diverging lens 42, a condenser 44 and a converging lens 46 and has a focal point F.
  • the preferred material for the acoustic lens system 40 is acrylic glass or polystyrene.
  • the plane shock wave generated in the shock wave tube 1 is widened in its cross section by the diverging lens 42. The shock wave is then directed in parallel by the capacitor 44 and then focused on the focal point F by the converging lens 46.
  • the configurations of the shock wave tube 1 and the holding device described for FIG. 1 also apply to this embodiment of the imaging system.
  • the entire system 40 of acoustic lenses can be displaced relative to the shock wave tube 1 in the axial direction of the double arrow 25.
  • the advantage of this exemplary embodiment is that the shock wave enters the patient's body 19 over a larger cross section of the body surface. This makes it possible to keep the energy density in the patient's tissue, in particular on the body surface 48, low.

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  • Physics & Mathematics (AREA)
  • Engineering & Computer Science (AREA)
  • Acoustics & Sound (AREA)
  • Multimedia (AREA)
  • Surgical Instruments (AREA)

Description

Die Erfindung betrifft eine Einrichtung zum berührungslosen Zertrümmern eines im Körper eines Lebewesens befindlichen Konkrements mit einem Stosswellengenerator, der auf ein Zielgebiet im Körper ausrichtbar ist.The invention relates to a device for the contactless smashing of a concrement located in the body of a living being with a shock wave generator which can be aligned with a target area in the body.

Einrichtungen dieser Art werden in der Medizin eingesetzt, z.B. zum Zerstören von Steinen in der Niere des Menschen. Sie sind besonders vorteilhaft, da sie jeglichen Eingriff in den Körper vermeiden. Es ist nicht notwendig, operativ vorzugehen. Auch das Heranführen von Sonden und Geräten an das Konkrement entfällt. Eine Gefährdung durch Infektionen oder Verletzungen, z.B. beim Einführen der Sonde oder Operationen, kann beim berührungslosen Zertrümmern nicht auftreten.Devices of this type are used in medicine, e.g. to destroy stones in the kidney of humans. They are particularly beneficial because they avoid any intervention in the body. It is not necessary to operate surgically. There is also no need to bring probes and devices to the concrement. A risk from infection or injury, e.g. when inserting the probe or operations, can not occur in contactless smashing.

Eine Einrichtung zur Konkrementenzertrümmerung ist in der DE-AS 2351 247 beschrieben. Hier wird in einer Fokussierungskammer, die als Teil eines Rotationsellipsoids ausgebildet ist, in einem ersten Brennpunkt eine Funkenentladung zwischen zwei Elektroden herbeigeführt. Diese verursacht eine Stosswelle, deren Wellenfront sich nach allen Seiten, d.h. kugelförmig ausbreitet. An der Wand des Rotationsellipsoids werden die Wellen reflektiert. Sie sammeln sich im zweiten Brennpunkt des Rotationsellipsoids. In diesem zweiten Brennpunkt, in dem das Konkrement plaziert ist, treffen die reflektierten Wellen gleichzeitig ein. Unter dem gebündelten Anprall der Stosswellen wird das Konkrement zerstört. Die Ankopplung zwischen dem Rotationsellipsoid und dem Körper, in welchem sich das Konkrement befindet, geschieht über eine dünne Folie, die luftspaltlos am Körper anliegt. Die Fokussierungskammer ist mit Wassergefüllt.A device for crushing concrements is described in DE-AS 2351 247. In a focusing chamber, which is designed as part of an ellipsoid of revolution, a spark discharge is brought about between two electrodes in a first focal point. This causes a shock wave, the wavefront of which extends on all sides, i.e. spreads spherically. The waves are reflected on the wall of the ellipsoid of revolution. They collect in the second focal point of the ellipsoid of revolution. The reflected waves arrive simultaneously in this second focal point, in which the concrement is placed. The concrement is destroyed under the collision of the shock waves. The coupling between the ellipsoid of revolution and the body in which the concrement is located takes place via a thin film that lies against the body without an air gap. The focus chamber is filled with water.

Diese Einrichtung bringt den Nachteil mit sich, dass Änderungen der Stosswellenenergie nur in geringen Grenzen und nur mit einem erheblichen apparativen Aufwand durch Änderung des Abstands der Unterwasserelektroden möglich sind. Weiterhin ist nachteilig, dass der gegenseitige Abstand der Elektroden zur Erzeugung von intensitätsstarken Stosswellen in der Regel einige Millimeter betragen muss, wodurch die Stosswellenquelle keine punktförmige Geometrie besitzt und Abbildungsfehler bei der Fokussierung entstehen können. Ausserdem nutzen sich die Unterwasserelektroden bei jeder Entladung stark ab, so dass ihre Lebensdauer begrenzt ist, was eine regelmässige Wartung der Einrichtung erforderlich macht.This device has the disadvantage that changes in the shock wave energy are possible only within small limits and only with considerable expenditure on equipment by changing the distance between the underwater electrodes. A further disadvantage is that the mutual distance between the electrodes for generating high-intensity shock waves generally has to be a few millimeters, as a result of which the shock wave source has no punctiform geometry and imaging errors can occur during focusing. In addition, the underwater electrodes wear heavily with each discharge, so that their lifespan is limited, which necessitates regular maintenance of the device.

Obengenannte Umstände sind bereits in der DE-OS 2538960 erkannt. Gemäss dieser Druckschrift können die zitierten Nachteile dadurch behoben werden, dass anstelle der Funkenstrecke ein ausserhalb der Fokussierungskammer befindlicher Riesenimpulslaser eingesetzt wird. Dessen Strahl wird durch einen Strahlteiler aufgeweitet und dann durch ein in der Wand der Fokussierungskammer befindliches Linsensystem in einem Brennpunkt der rotationselliptischen Fokussierungskammer vereinigt. Hier wird eine Stosswelle ausgelöst, z.B. durch Konzentration des Energiebündels auf einen absorbierenden Stift oder eine stark absorbierende Flüssigkeit. Auch bei dieser Einrichtung wird ein schwierig herzustellender rotationselliptischer Reflexionskörper verwendet. Ausserdem ist der Wirkungsgrad einer solchen Einrichtung mit Laser als gering anzusehen.The above-mentioned circumstances are already recognized in DE-OS 2538960. According to this document, the disadvantages cited can be remedied by using a giant pulse laser located outside the focusing chamber instead of the spark gap. Its beam is expanded by a beam splitter and then combined in a focal point of the rotationally elliptical focusing chamber by a lens system located in the wall of the focusing chamber. A shock wave is triggered here, e.g. by concentrating the bundle of energy on an absorbent stick or a highly absorbent liquid. This device also uses a rotationally elliptical reflection body that is difficult to manufacture. In addition, the efficiency of such a device with a laser can be regarded as low.

Die Einrichtung nach der DE-AS 2351247 bringt ausserdem den Umstand mit sich, dass der Körper des Patienten nur durch die Koppelfolie, die am Körper anliegt, und durch das Wasser von der Hochspannungsfunkenstrecke getrennt ist. Beschädigungen der Koppelfolie bergen ein gewisses Risiko für den Patienten in sich.The device according to DE-AS 2351247 also entails the fact that the patient's body is separated from the high-voltage spark gap only by the coupling film which is in contact with the body and by the water. Damage to the coupling foil carries a certain risk for the patient.

In der DE-OS 2 902 331 ist ein Gerät zur transkutanen, unblutigen Verödung von kleinen retikulären und Besenreiser-Varicen beschrieben. Als Wellengenerator sind gleichzeitig ansteuerbare Ultraschallelemente verwendet, die parabolisch angeordnet sind, damit sich ihre Schallenergien in einem Brennpunkt treffen, in dem die zu zerstörende Varice plaziert ist. Die gesamte Anordnung der Ultraschallelemente ist mittels eines Schneckentriebes und einer Stellschraube längsverschiebbar. Hierdurch können verschiedene Abstände des Brennpunkts vom Applikatorende eingestellt werden. Bei diesem Gerät ist die Leistung der Ultraschallkristalle zum Zertrümmern von Konkrementen im tiefen Innern eines menschlichen Körpers nicht ausreichend. Die genaue Einstellung der einzelnen Ultraschallschwinger sowohl hinsichtlich des Ortes als auch der Energie ist daher unkritisch. Ein Abschalten einzelner Ultraschallkristalle zwecks Einstellung der Ultraschallenergie im Brennpunkt ist nicht vorgesehen.DE-OS 2 902 331 describes a device for transcutaneous, bloodless obliteration of small reticular and spider vein varices. At the same time, controllable ultrasound elements are used as the wave generator, which are arranged parabolically so that their sound energies meet at a focal point in which the varice to be destroyed is placed. The entire arrangement of the ultrasonic elements is longitudinally displaceable by means of a worm drive and an adjusting screw. This allows different distances of the focal point from the applicator end to be set. With this device, the power of the ultrasound crystals is not sufficient to crush stones in the deep interior of a human body. The exact setting of the individual ultrasonic vibrators with regard to both the location and the energy is therefore not critical. Switching off individual ultrasonic crystals for the purpose of adjusting the ultrasonic energy in the focal point is not provided.

In der DE-OS 3119 295 ist eine Einrichtung zum Zerstören von Konkrementen in Körperhöhlen unter Zuhilfenahme eines grossflächigen Ultraschallwandlers als Schwingungserzeuger beschrieben. Es kommt ein fokussierender Ultraschallwandler mit einer Pulsspitzenleistung von wenigstens 100 kW zur Anwendung. Hier besteht die Möglichkeit, verschiedene Zonen des Körpers, die auf dem Schallweg zum Konkrement liegen und dabei stören, durch Verändern derAbstrahlfläche auszublenden. Es wird auch eine Ausführungsform dargestellt, bei der einzelne ringförmige Ultraschallelemente, die den Wandler bilden, auf einer Kugeloberfläche angeordnet sind. Über eine Veränderung der Leistung entsprechend der Art und Tiefenlage des Konkrements ist nichts ausgesagt. Ausserdem dürfte der Aufwand für eine solche Einrichtung, insbesondere im Hinblick auf die Ausbildung der ringförmigen Ultraschallelemente, beträchtlich sein.DE-OS 3119 295 describes a device for destroying concrements in body cavities with the aid of a large-area ultrasound transducer as a vibration generator. A focusing ultrasonic transducer with a pulse peak power of at least 100 kW is used. Here it is possible to hide different zones of the body, which lie on the sound path to the calculus and interfere with it, by changing the radiation area. An embodiment is also shown in which individual ring-shaped ultrasonic elements, which form the transducer, are arranged on a spherical surface. Nothing is said about a change in performance according to the type and depth of the concretion. In addition, the effort for such a device, in particular with regard to the formation of the ring-shaped ultrasound elements, should be considerable.

Ausserdem ist anzumerken, dass bei einem solchen Ultraschallgerät nur begrenzte Spitzenleistungen der abgestrahlten Schallenergie möglich sind. Darüber hinaus ist bei einem solchen Gerät eine grosse Anzahl von Ultraschallwandlern erforderlich, was hohen Montage- und Steueraufwand erfordert. Ausserdem ist bei Ultraschallwandlern ein unerwünschtes pulsförmiges Unterschwingen zu beobachten, das nur mit erheblichem Aufwand zu reduzieren ist.In addition, it should be noted that with such an ultrasound device, only limited peak outputs of the emitted sound energy are possible. In addition, a large number of ultrasonic transducers is required in such a device, which requires high assembly and control costs. In addition, an undesirable pulse is in ultrasonic transducers To observe undershoots that can only be reduced with considerable effort.

In der Zeitschrift «Akustische Beihefte», 1962, Heft 1, Seiten 185-202, ist der Aufbau eines sogenannten «Stosswellenrohres», wie es im Prinzip in der vorliegenden Erfindung verwendet wird, beschrieben. Vor einer Flachspule, durch eine Isolierfolie getrennt, befindet sich eine Kupfermembran. An diese Kupfermembran schliesst ein mit Wasser gefülltes Rohr an. Durch Anlegen einer Spannung im Bereich 2-20 kV an die Flachspule wird in der Kupfermembran ein Magnetfeld induziert, welches Abstosskräfte bewirkt, die die Membran von der Spule schlagartig wegdrücken. Hierdurch entsteht eine ebene Schockwelle, die im wassergefüllten Rohr zu einer steilen Stosswelle wird und am Rohrende für Experimente zur Verfügung steht. Eingesetzt wird ein solches Stosswellenrohr z.B. zu Stoffuntersuchungen in der Chemie. Ferner ist eine Einrichtung gemäss Oberbegriff des Anspruchs 1 aus der JP-B 5 540 257 bekannt.In the magazine "Akustische Beihefte", 1962, Issue 1, pages 185-202, the structure of a so-called "shock tube", as it is used in principle in the present invention, is described. A copper membrane is located in front of a flat coil, separated by an insulating film. A tube filled with water connects to this copper membrane. By applying a voltage in the range of 2-20 kV to the flat coil, a magnetic field is induced in the copper membrane, which causes repulsive forces that suddenly push the membrane away from the coil. This creates a flat shock wave that becomes a steep shock wave in the water-filled pipe and is available for experiments at the end of the pipe. Such a shock wave tube is used e.g. for substance studies in chemistry. Furthermore, a device according to the preamble of claim 1 is known from JP-B 5 540 257.

Aufgabe vorliegender Erfindung ist es, bei einer derartigen Einrichtung die Betriebssicherheit zu erhöhen, eine Abbildung auf ein Zielgebiet mit möglichst kleinem Abbildungsfehler zu erhalten und Wartungsarbeiten zu reduzieren.The object of the present invention is to increase the operational reliability of such a device, to obtain an image on a target area with the smallest possible imaging error and to reduce maintenance work.

Diese Aufgabe wird erfindungsgemäss dadurch gelöst, dass als Stosswellengenerator ein an sich bekanntes, die ebene Stosswelle erzeugendes Stosswellenrohr mit elektrischer Spule und davor angeordneter Membran vorgesehen ist.According to the invention, this object is achieved in that a shock wave generator, known per se and producing the flat shock wave, with an electrical coil and a membrane arranged in front of it is provided as the shock wave generator.

Da diese Einrichtung einen Stosswellengenerator verwendet, der ebene Wellen erzeugt, müssen die nur aus einer Richtung kommenden Stosswellen gebündelt und fokussiert werden. Hierbei sind Abbildungsfehler weniger wahrscheinlich, als wenn von einer Funkenstrecke ausgehende, in alle Richtungen laufende Kugelwellen fokussiert werden müssen. Die zeitliche und räumliche Reproduzierbarkeit der Stosswelle ist bei Erzeugung mit einem Stosswellenrohr im Vergleich zur Erzeugung mit einer Funkenstrecke wesentlich verbessert. Ausserdem entfallen Wartungsarbeiten, die durch Verschleiss und Abbrand der Elektroden bei einer Funkenstrecke anfallen. Denn ein Stosswellenrohr erzeugt die Stosswellen mit Hilfe elektromagnetischer Kräfte und benötigt keine Funkenstrecke.Since this device uses a shock wave generator that generates plane waves, the shock waves coming from only one direction have to be bundled and focused. Here, imaging errors are less likely than if spherical waves proceeding from a spark gap and traveling in all directions have to be focused. The temporal and spatial reproducibility of the shock wave is significantly improved when generated with a shock wave tube compared to the generation with a spark gap. In addition, there is no maintenance work due to wear and tear of the electrodes in a spark gap. Because a shock wave tube generates the shock waves with the help of electromagnetic forces and does not require a spark gap.

Ein Stosswellenrohr ist so aufgebaut, dass es am einen Ende eines mit Flüssigkeit, bevorzugt mit Wasser gefüllten Rohres eine Kupfermembran enthält, die - durch eine Isolierfolie getrennt - vor einer Flachspule angeordnet ist. Aufgrund eines Stromimpulses in der Flachspule wird die Kupfermembran von dieser abgestossen und erzeugt dabei die Stosswelle in der Flüssigkeit. Die Kupfermebran selber und das an sie anschliessende Rohrstück werden in der Regel auf ein gemeinsames Bezugspotential gelegt, d.h. sie sind geerdet. Es liegt also keine Hochspannung an dem die Stosswelle leitenden Koppelmedium an, wodurch die elektrische Sicherheit von Patient und Personal erhöht ist.A shock wave tube is constructed in such a way that it contains a copper membrane at one end of a tube filled with liquid, preferably with water, which is arranged in front of a flat coil, separated by an insulating film. Due to a current pulse in the flat coil, the copper membrane is repelled by it and thereby generates the shock wave in the liquid. The copper membrane itself and the pipe section adjoining it are usually connected to a common reference potential, i.e. they are grounded. There is therefore no high voltage at the coupling medium that conducts the shock wave, which increases the electrical safety of patient and staff.

Weitere Vorteile und Einzelheiten der Erfindung ergeben sich aus der nachfolgenden Beschreibung eines Ausführungsbeispiels anhand der Zeichnungen in Verbindung mit den Unteransprüchen. Es zeigen:

  • Fig. 1 einen seitlichen Schnitt durch eine Zertrümmerungseinrichtung nach der Erfindung mit einer Sammellinse und
  • Fig. 2 einen seitlichen Schnitt durch eine Zertrümmerungseinrichtung nach der Erfindung mit einem System akustischer Linsen.
Further advantages and details of the invention emerge from the following description of an exemplary embodiment with reference to the drawings in conjunction with the subclaims. Show it:
  • Fig. 1 shows a side section through a smashing device according to the invention with a converging lens and
  • Fig. 2 shows a side section through a smashing device according to the invention with a system of acoustic lenses.

In Figur 1 ist ein an sich bekanntes Stosswellenrohr 1, bestehend aus einem Mantel 2, aus einer Flachspule 3 mit zwei elektrischen Anschlüssen 5 und 7, aus einer Isolierfolie 9, aus einer Kupfermembran 11 und aus einem metallischen Rohrstück 13, vor einer akustischen Sammellinse 15, die einen Brennpunkt F besitzt, plaziert. Das Rohrstück 13 ist mit einer Flüssigkeit 14, z.B. mit Wasser, gefüllt.FIG. 1 shows a shock wave tube 1 known per se, consisting of a jacket 2, a flat coil 3 with two electrical connections 5 and 7, an insulating film 9, a copper membrane 11 and a metallic tube piece 13, in front of an acoustic converging lens 15 , which has a focal point F, placed. The pipe section 13 is filled with a liquid 14, e.g. filled with water.

Über ein Koppelmedium 17 mit wasserähnlichen akustischen Eigenschaften ist das Stosswellenrohr 1 an einen Körper 19 angekoppelt. Der Körper 19, z.B. ein Patient, hat in seiner Niere 21 ein Konkrement 23, z.B. einen Nierenstein.The shock wave tube 1 is coupled to a body 19 via a coupling medium 17 with water-like acoustic properties. The body 19, e.g. a patient has a concretion 23, e.g. a kidney stone.

Die Sammellinse 15 ist über eine Feinregulierung 24 mit Bolzen 24a und Feststellrand 24b in Richtung eines Doppelpfeils 25 relativ zum Mantel 2 des Stosswellenrohrs 1 verschiebbar. Der Bolzen 24a wird dabei in einer schlitzförmigen Aussparung 24c im Mantel 2 geführt.The converging lens 15 can be displaced relative to the jacket 2 of the shock tube 1 via a fine adjustment 24 with a bolt 24a and a locking edge 24b in the direction of a double arrow 25. The bolt 24a is guided in a slot-shaped recess 24c in the casing 2.

Das Stosswellenrohr 1, die Sammellinse 15 und die Feinregulierung 24 sind auf einem gemeinsamen Gestell, Stativ oder einer Montageplatte 26 montiert. Diese Montageplatte 26 ist auf einem Lager 26a angebracht, welches allseitig schwenkbar und in allen Raumrichtungen verschiebbar ist. Dadurch kann das Stosswellenrohr 1 auf das Konkrement 23 so ausgerichtet werden, dass der Brennpunkt F im Konkrement 23 liegt.The shock wave tube 1, the converging lens 15 and the fine adjustment 24 are mounted on a common frame, tripod or a mounting plate 26. This mounting plate 26 is mounted on a bearing 26a which can be pivoted on all sides and is displaceable in all spatial directions. As a result, the shock wave tube 1 can be aligned with the concretion 23 such that the focal point F lies in the concretion 23.

Die Kupfermembran 11 und das Rohrstück 13 sind elektrisch an ein Schutzpotential wie Erde 27 gelegt, ebenso der eine Anschluss 7 der Flachspule 3. Der andere Anschluss 5 der Flachspule 3 ist über einen Schalter 29, der einen Hilfskontakt 31 umfasst, in eine Versorgungs- und Steuereinheit 33 geführt.The copper membrane 11 and the pipe section 13 are electrically connected to a protective potential such as earth 27, as is the one connection 7 of the flat coil 3. The other connection 5 of the flat coil 3 is connected to a supply and via a switch 29, which includes an auxiliary contact 31 Control unit 33 out.

Über eine (nicht gezeigte) Kondensator/Widerstandsschaltung wird in der Versorgungs- und Steuereinheit 33 eine Hochspannung U erzeugt. Diese kann mehrere Kilovolt, z.B. 20 kV betragen. Die Spannung U kann dabei einstellbar sein. Ein Steuersignal, welches von der Versorgungs- und Steuereinheit 33 über eine Steuerleitung 35 an den Hilfskontakt 31 gegeben wird, bewirkt das Schliessen des Schalters 29. Ein Teil der in dem (nicht gezeigten) Kondensator der Versorgungs-und Steuereinheit 33 gespeicherten Energie entlädt sich dabei schlagartig in die Flachspule 3, die sehr schnell ein magnetisches Feld aufbaut. In der Kupfermembran 11 wird ein Strom induziert, der dem Strom in der Flachspule 3 entgegengerichtet ist und ein magnetisches Gegenfeld erzeugt. Durch die Kraftwirkung des Gegenfeldes wird die Kupfermembran 11 von der Flachspule 3 weggeschlagen. Dieses Wegschlagen der Kupfermembran 11 erzeugt eine ebene Stosswelle, d.h. eine schlagartige Kompression in der der Membran 11 vorgelagerten Flüssigkeit 14. Diese Stosswelle zeigt einen steilen Druckanstieg, z.B. auf 200 bar. Die Druckwelle gewinnt in ihrem Lauf durch das Rohrstück 13, die Sammellinse 15 und den Körper 19 des Patienten noch an Steilheit. Nach dem Durchgang durch die Sammellinse 15 ist die Stosswelle so geformt, dass sie im Brennpunkt F konvergiert. Dort ist das Konkrement 23 plaziert, und die fokussierte Stosswelle gibt einen Teil ihres Energieinhalts durch Zug- oder Druckkräfte an das im Vergleich zur Umgebung spröde Konkrement 23 ab. Diese Kräfte zerlegen das Konkrement 23 in mehrere Teile und bewirken so seine Zertrümmerung.A high voltage U is generated in the supply and control unit 33 via a capacitor / resistance circuit (not shown). This can be several kilovolts, for example 20 kV. The voltage U can be adjustable. A control signal, which is supplied from the supply and control unit 33 to the auxiliary contact 31 via a control line 35, causes the switch 29 to close. A part of the energy stored in the (not shown) capacitor of the supply and control unit 33 is discharged abruptly into the flat coil 3, which builds up a magnetic field very quickly. A current is induced in the copper membrane 11, which is opposite to the current in the flat coil 3 and a magnetic opposing field testifies. The copper membrane 11 is knocked away from the flat coil 3 by the force of the opposing field. This knocking away of the copper membrane 11 creates a flat shock wave, ie an abrupt compression in the liquid 14 upstream of the membrane 11. This shock wave shows a steep pressure increase, for example to 200 bar. The pressure wave gains steepness in its course through the pipe section 13, the converging lens 15 and the patient's body 19. After passing through the converging lens 15, the shock wave is shaped such that it converges at the focal point F. The concrement 23 is placed there, and the focused shock wave releases part of its energy content to the concrement 23, which is brittle compared to the environment, by means of tensile or compressive forces. These forces break up the concrement 23 into several parts and thus cause it to be broken up.

Je nach Grösse und Konsistenz des Konkrementes 23 muss dieser Einstrahlvorgang mehrmals wiederholt werden.Depending on the size and consistency of the calculus 23, this irradiation process must be repeated several times.

Diese erläuterte Zertrümmerungseinrichtung bietet den beachtlichen Vorteil, dass die geerdete Kupfermembran 11 und das geerdete Rohrstück 13 keine Gefahrenquelle für den Patienten 19 oder das Bedienungspersonal darstellen. Die elektrische Sicherheit der Einrichtung kann für das Bedienungspersonal durch eine (nicht gezeigte) zusätzliche isolierende Umhüllung, z.B. in Form einer Kunststoffbeschichtung der äusseren Fläche des Mantels 2, noch gesteigert werden. Bei Verwendung eines mit dem Koppelmedium 17 gefüllten Sacks 37 an der Eintrittsstelle der Stosswelle in den Patienten 19 ergibt sich eine doppelte Sicherheit für den Patienten 19 von der elektrischen Hochspannung. Diese Sicherheit wird zum einen durch die isolierende Sackwand und zum anderen durch die Isolierfolie 9 vor der Flachspule 3 bestimmt.This explained crushing device offers the considerable advantage that the grounded copper membrane 11 and the grounded pipe section 13 do not represent a source of danger for the patient 19 or the operating personnel. The electrical safety of the device can be improved for the operating personnel by an additional insulating sheath (not shown), e.g. in the form of a plastic coating of the outer surface of the jacket 2, can be increased. When a sack 37 filled with the coupling medium 17 is used at the point of entry of the shock wave in the patient 19, there is a double security for the patient 19 from the high electrical voltage. This security is determined on the one hand by the insulating bag wall and on the other hand by the insulating film 9 in front of the flat coil 3.

Der Schalter 29 kann im übrigen in der Versorgungs- und Steuereinheit 33 integriert sein. Er kann auch von der Stosswellenrohranordnung entfernt gelegen sein. Da zum Auslösen nicht notwendigerweise eine Funkenstrecke verwendet werden muss, es kommen nämlich z.B. auch Vakuum- oder neuerdings auch SF6-Schalter in Frage, entfallen aufwendige Wartungs- und Betriebsarbeiten, die mit der Funkenstrecke verbunden wären.The switch 29 can also be integrated in the supply and control unit 33. It can also be located away from the shock tube assembly. Since a spark gap does not necessarily have to be used for triggering, namely e.g. Vacuum or, more recently, SF6 switches are also out of the question, eliminating the need for complex maintenance and operating work that would be associated with the spark gap.

Figur 2 zeigt ein an sich bekanntes Stosswellenrohr 1, dem ein System 40 akustischer Linsen zur Abbildung einer ebenen Stosswelle auf ein Konkrement 23 im Körper eines Patienten 19 zugeordnet ist. Das System 40 akustischer Linsen besteht aus einer Zerstreuungslinse 42, einem Kondensator 44 und einer Sammellinse 46 und hat einen Brennpunkt F. Das bevorzugte Material für das System 40 der akustischen Linsen ist Acrylglas oder Polystyrol. Die im Stosswellenrohr 1 erzeugte ebene Stosswelle wird durch die Zerstreuungslinse 42 in ihrem Querschnitt aufgeweitet. Die Stosswelle wird sodann durch den Kondensator 44 parallel gerichtet und danach durch die Sammellinse 46 auf den Brennpunkt F fokussiert.FIG. 2 shows a shock wave tube 1 known per se, to which a system 40 of acoustic lenses for imaging a flat shock wave onto a concrement 23 in the body of a patient 19 is assigned. The acoustic lens system 40 consists of a diverging lens 42, a condenser 44 and a converging lens 46 and has a focal point F. The preferred material for the acoustic lens system 40 is acrylic glass or polystyrene. The plane shock wave generated in the shock wave tube 1 is widened in its cross section by the diverging lens 42. The shock wave is then directed in parallel by the capacitor 44 and then focused on the focal point F by the converging lens 46.

Die zu Figur 1 beschriebenen Ausgestaltungen des Stosswellenrohrs 1 und der Haltevorrichtung gelten auch für diese Ausführungsform des Abbildungssystems. So ist hier das gesamte System 40 akustischer Linsen relativ zum Stosswellenrohr 1 in axialer Richtung des Doppelpfeils 25 verschiebbar.The configurations of the shock wave tube 1 and the holding device described for FIG. 1 also apply to this embodiment of the imaging system. Here, the entire system 40 of acoustic lenses can be displaced relative to the shock wave tube 1 in the axial direction of the double arrow 25.

Vorteil dieses Ausführungsbeispiels ist, dass die Stosswelle über einen grösseren Querschnitt der Körperoberfläche in den Körper 19 des Patienten eintritt. Hierdurch ist es möglich, die Energiedichte im Gewebe des Patienten, insbesondere an der Körperoberfläche 48, klein zu halten.The advantage of this exemplary embodiment is that the shock wave enters the patient's body 19 over a larger cross section of the body surface. This makes it possible to keep the energy density in the patient's tissue, in particular on the body surface 48, low.

Claims (8)

1. Apparatus for remote shattering of a calculus (23) in the body (19) of a living organism which can be directed at a target area (21) in the body (19), having a shock-wave genarator which produces a substantially level shock-wave, a lens arrangement (15, 40) associated with the shock- wave generator which focusses the schock wave, by way of a coupling medium (17), on to a focal point (F) in the target area (21), and a fluid (14) between the shock wave generator and the lens arrangement (15; 40), characterised in that a shock wave tube (1) known per se, which produces a level shock wave, is provided with an electric coil (3) and a membrane (11) arranged in front of it.
2. Apparatus according to claim 1, characterised in that the lens arrangement is a lens system (40) consisting of several lenses (42,44,46) which enlarges the diameter of the shock wave on the body surface (48) in comparison to that in the shockwave tube (1
3. Apparatus according to claim 1 or claim 2, characterised in that to direct the shock wave tube (1) on to the target area (21) a mechanical arrangement is provided.
4. Apparatus according to claim 3, characterised in that the mechanical arrangement includes a precision drive (24) which serves to adjust the depth of the focal point (F) in the body (19).
5. Apparatus according to claim 3, characterised in that the mechanical arrangement includes a precision drive (26, 26a) which serves to adjust the focal point (F) at right angles to the direction of radiation of the shock wave.
6. Apparatus according to any one of claims 1 to 5, characterised in that the lens system (40) consists of an acoustic dispersing lens (42), a condenser (44) and an acoustic converging lens (46) (Figure 2).
7. Apparatus according to any one of claims 1 to 6, characterised in that the lens arrangement (15; 40) serves as the closure for the shock wave tube (1
8. Apparatus according to any one of claims 1 to 7, characterised in that the outer casing (2) of the shock wave tube (1) is electrically placed at a protective potential (27).
EP84108750A 1983-08-03 1984-07-24 Apparatus for the smashing at a distance of calculus Expired EP0133665B1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE19833328051 DE3328051A1 (en) 1983-08-03 1983-08-03 DEVICE FOR CONTACTLESS CRUSHING OF CONCRETE
DE3328051 1983-08-03

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EP0133665A2 EP0133665A2 (en) 1985-03-06
EP0133665A3 EP0133665A3 (en) 1985-04-03
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US4674505A (en) 1987-06-23
EP0133665A3 (en) 1985-04-03
DE3328051A1 (en) 1985-02-14
DE3472209D1 (en) 1988-07-28
EP0133665A2 (en) 1985-03-06

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