JPH1043229A - Perfusion sucking device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To restrain a temporary decrease in an anterior sac pressure in a simple constitution by providing a perfusion flow liquid sump means having an air chamber in a path of a perfusion flow tube. SOLUTION: Perfusion tubes 3a, 3b are connected to a perfusion liquid sump 5 in the midway of a path for guiding a perfusion liquid to the eye E of a patient. The perfusion liquid sump 5 comprises a vertically moving piston and a spring for energizing the piston in the vertical direction. An inflow port connected to the perfusion tube 3a of the perfusion liquid sump 5 is provided on the side face position separate from the lowermost point position of the piston, and an air chamber for confining a moderate quantity of air is secured in the perfusion liquid sump 5. If there is provided on pouring flow liquid sump 5, the supply of perfusion liquid can not follow up an instantaneous increase on the suction caused by the rise of suction to cause a temporary decrease in an anterior sac pressure. By installing the perfusion liquid sump 5, the push- down force is applied to the perfusion by the air pressure in the air chamber 9 so as to prevent anterior sac pressure decrease.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a perfusion suction device used for cataract surgery for removing a clouded lens.

[0002]

2. Description of the Related Art There is known a perfusion suction device for supplying a perfusion solution into an eyeball and sucking and removing the supplied perfusion solution together with a waste tissue in the eyeball. This perfusion suction device is used in cataract surgery or the like for removing a clouded lens. In cataract surgery, a crushing handpiece (hereinafter, referred to as a US (Ultra Sound) handpiece) using an ultrasonic ultrasonic vibration technique called an ultrasonic emulsification and suction method is used because the incision wound can be reduced. Surgical methods have become widespread.

[0003] In the ultrasonic emulsification suction method, ultrasonic vibration is transmitted to a US chip attached to the tip of a US handpiece to crush and emulsify the nucleus of the crystalline lens. During this crushing and emulsification, the perfusate is supplied into the eyeball from the vicinity of the tip of the US chip through the perfusion tube. For suction, a suction pressure is applied to the suction tube connected to the US handpiece by a suction pump or the like, and the crushed nuclei are discharged from the other end of the suction tube together with the perfusate through the suction hole of the US chip. .

[0004]

By the way, when the nucleus of the crystalline lens is crushed and aspirated with a US chip, the cataract nucleus, etc.
If the application of the suction pressure by the suction pump is continued while the suction hole of the chip is closed, the suction pressure in the suction tube increases. However, in this state, when the plugging material such as the nucleus at the tip of the US chip is removed (aspirated) by the ultrasonic vibration of the US chip, there is a problem that the anterior chamber pressure of the eyeball temporarily decreases.

[0005] In view of the above problems, it is an object of the present invention to provide a perfusion suction device that can suppress a transient decrease in anterior chamber pressure with a simple configuration.

[0006]

SUMMARY OF THE INVENTION The present invention is characterized by having the following configuration in order to achieve the above object.

(1) The perfusate from the perfusion bottle is filled with a perfusion tube.
A perfusion solution that supplies air to a surgical eye through a tube and aspirates the supplied perfusion solution together with waste in the eye, the perfusion solution reservoir having an air chamber in the path of the perfusion tube and capable of storing the perfusion solution. Means are provided.

(2) The perfusion suction device of (1) is provided with a control valve for controlling the outflow of perfusate through the perfusion tube, and the perfusion solution reservoir is provided near the control valve on the perfusion bottle side. It is characterized by the following.

(3) The control valve of (2) is a pinch valve.

(4) The perfusate storage means of (1) is characterized in that it has an air discharge means for storing perfusate and discharging air.

(5) The air discharge means of (4) is a piston, and after the air in the perfusion liquid storage means is discharged by moving the piston forward and backward, the perfusate from the perfusion bottle is passed through the perfusion tube. And store it.

(6) The perfusate storage means of (1) has an inlet through which a perfusate flows from a perfusion bottle, and the air chamber is provided at a position higher than the inlet.

(7) The perfusion suction device of (1) has a handpiece connected to a perfusion tube for supplying a perfusion solution to the surgical eye, and the handpiece utilizes ultrasonic vibration. And a crushing tip having a suction hole attached to the tip to crush and emulsify the nucleus of the lens.

[0014]

An embodiment of the present invention will be described below with reference to the drawings. FIG. 1 shows a schematic configuration diagram of a perfusion suction apparatus according to an embodiment. Reference numeral 1 denotes a perfusion bottle for storing a perfusion solution such as a physiological saline solution, and the perfusion bottle 1 is hung on a pole 19. The pole 19 is moved up and down by the up-down driving device 18 and the perfusion bottle 1 is moved.
The height of the can be changed. Depending on the height at which the perfusion bottle 1 is set, the perfusion pressure is adjusted so that the perfusion solution is supplied to the patient's eye E at an appropriate flow pressure (= flow rate or perfusion rate). An infusion tube 2 having an air inlet for taking in air is inserted into the perfusion bottle 1.

Reference numerals 3a and 3b denote perfusion tubes for guiding the perfusate falling from the perfusion bottle 1 to the patient's eye E. The perfusion tube 3a and the perfusion tube 3b are connected to the perfusion solution reservoir 5 in the course of guiding the perfusion solution to the patient's eye E. As shown in the sectional view of FIG. 2, the perfusate reservoir 5 has a piston 23 that can move up and down, a spring 24 that urges the piston 23 in the upward direction, and a piston 23 that maintains the airtightness of the perfusate reservoir 5. O-ring 25 fitted in 23, restricting portion 5a provided on the inner wall of perfusate reservoir 5 for restricting the downward movement amount of piston 23, inflow port 21 connected to perfusion tube 3a, and perfusion An outlet 22 is provided below the reservoir 5 and connected to the perfusion tube 3b. The inflow port 21 is provided at a side position separated from the lowest point of the piston 23 so that an air chamber for confining an appropriate amount of air can be secured in the perfusion liquid reservoir 5. The perfusate reservoir 5 having such a structure is held by a perfusion suction device main body by a holding member (not shown). In addition, since the movable range of the piston 23 can be limited by its length, the limiting portion 5a is not necessarily provided.

The perfusion tube 3 connected to the perfusion solution reservoir 5
A perfusion control valve 4 is provided in the middle of b, and the outflow of the perfusate is controlled by opening and closing the perfusion control valve 4. In this embodiment, a pinch valve is used as the perfusion control valve.
The perfusion solution reservoir 5 is desirably arranged at a position close to the handpiece 6 in order to shorten the length of the path of the perfusion tube, which is one of the resistances to the flow of the perfusion solution.

The other end of the perfusion tube 3b has a crushing US
It is connected to various handpieces such as a handpiece 6 and an I / A handpiece 7 for perfusion suction. The US handpiece 6 uses ultrasonic vibration to crush and emulsify the nucleus of the lens with a US chip having a suction hole attached to the tip, and the crushed nucleus together with the perfusate is passed through the suction hole of the US chip. And aspirate. Various handpieces such as the US handpiece 6 and the I / A handpiece 7 are selected depending on the operation stage, the operation method, and the like, and are used by being reconnected.

Reference numeral 8 denotes a suction tube for discharging the perfusate and crushed nuclei sucked by the US handpiece 6. A suction pump 9 for generating a suction pressure is provided behind the suction tube 8. The drive of the suction pump 9 is controlled by the control unit 10, and the suction flow rate is adjusted. The sucked waste liquid is discharged into the waste liquid bag 12.

Reference numeral 13 denotes a pressure sensor, and reference numeral 14 denotes a solenoid valve. The pressure sensor 13 and the electromagnetic valve 14 are connected to the suction tube 8 via the connection part 15. Pressure sensor 13
Always detects the suction pressure. U due to plugs such as cataract nuclei
When the suction port at the tip of the S chip is closed and the suction pressure in the suction tube 8 becomes higher than the set value, the control unit 10 stops the suction pump 8 based on the detection signal from the pressure sensor 13 and then stops the electromagnetic valve 14. Is opened to return the pressure in the suction tube 8 to a steady value.

Reference numeral 16 denotes a foot switch for starting / stopping perfusion, suction, and ultrasonic emulsification of the US handpiece 6. The foot switch 16 is set according to the operation mode setting.
The perfusion, suction, and emulsification operations can be controlled by the position of the depressed position. For example, as shown in FIG. 3, the position of the foot switch 16 is divided into three stages from position 1 to position 3 depending on the stepping distance, and is used for perfusion, perfusion / aspiration, perfusion /
The function at each position differs depending on each mode of suction / emulsification.

Reference numeral 17 denotes an input unit provided with various switches for setting an operation mode and operating conditions. Reference numeral 18 denotes an up-down driving device for moving the pole 19 up and down, and is constituted by a motor or the like.

The operation of the apparatus configured as described above will be described. Here, the operation related to the anterior chamber pressure of the eyeball in the operation by the ultrasonic emulsification suction method using the US handpiece 6 will be described with reference to the time series change diagram of the anterior chamber pressure shown in FIG.

At the time of surgery, attachment of each tube to the perfusion bottle 1, the perfusion solution reservoir 5, and the US handpiece 6 and other necessary preparations are performed. The vertical drive unit 18 is driven and controlled based on the setting of the perfusion flow rate by the switch of the input unit 17, and the perfusion bottle 1 is arranged at an appropriate height by the vertical movement of the pole 19. The perfusion solution is injected into the perfusion solution reservoir 5 as follows. When the piston 23 of the irrigation fluid reservoir 5 is pushed down to the limit portion 5a with the perfusion control valve 4 closed, the air in the irrigation fluid reservoir 5 is infused into the infusion tube 2 connected to the irrigation tube 3a.
Is exhausted from the air intake. Thereafter, when the piston 23 returns to the original position due to the restoring force of the spring 24, the volume of the irrigation liquid moved by the piston 23 is equal to the volume of the irrigation bottle 1.
From the perfusate reservoir 5. By repeating this operation, the perfusate is injected so that the level of the perfusate is higher than the inlet 21 (the level of the perfusate is at a height substantially corresponding to the maximum movement amount of the piston 23 from the inlet 21). can do). As a result, an air chamber can be formed in the perfusion liquid reservoir 5, and the air in the air chamber formed in the perfusion liquid reservoir 5 is filled with the perfusion liquid related to the height position of the perfusion bottle 1 with respect to the perfusion liquid reservoir 5. It is compressed by falling.

Once the necessary settings on the device side have been made,
Surgery by ultrasonic emulsification and suction is performed. Foot switch 1
The operation mode 6 is set to a perfusion / suction / emulsification mode. While observing the patient's eye with a surgical microscope (not shown), the surgeon makes an incision in the sclera and an anterior capsule, and then uses the US handpiece 6
The US chip is inserted into the eye through the incision. The insertion of the tip is performed while the foot switch 16 is depressed to the position 1 and the perfusion control valve 4 is opened to allow the perfusate to flow. When the perfusate is supplied into the eyeball, the anterior chamber pressure of the eyeball is secured due to the height position of the perfusion bottle 1. The change in the anterior chamber pressure at this time becomes substantially constant after rising as shown in the section A of FIG.

When suction is performed, the foot switch 16 is depressed to the position 2. Foot switch 1
The signal from 6 is input to the control unit 10, and the control unit 10 drives the suction pump 9. The suction pressure generated by driving the suction pump 9 reaches the US handpiece 6 via the suction tube 8 and performs suction from the suction hole of the US handpiece 6. The change in the anterior chamber pressure when the perfusate is aspirated is
As shown in the section B of FIG. 4, the anterior chamber pressure is lower than that in the case of only perfusion because the suction is performed.

When crushing and emulsifying and sucking the lens core, the foot switch 16 is depressed to the position 3. The control unit 10 causes the US handpiece 6 to generate ultrasonic vibration by the position signal from the foot switch 16,
The S chip allows the lens nucleus to be crushed and emulsified.
The surgeon performs crushing and emulsification of the lens by ultrasonic vibration of the US handpiece 6 and performs suction. However, when crushing of hard nuclei and the like cannot be performed, large nuclear fragments temporarily block the suction holes of the US tip. Sometimes. The change in the anterior chamber pressure at this time is the same as the state in which the perfusion fluid is not suctioned because the suction hole is closed and only perfusion is performed (section C in FIG. 4).

Even when the suction hole remains closed, the suction pressure in the suction tube 8 is increased by driving the suction pump 9. When the suction pressure reaches the set value, the suction pump 9 stops,
The suction pressure in the suction tube 8 is fixed at a set value. In this state, if the plugging material is removed or the plugging material in the suction hole is removed (sucked) before the suction pressure reaches the set value, the suction from the suction hole of the US chip is rapidly performed.

Here, when the perfusion solution reservoir 5 is not provided, the supply of the perfusion solution cannot keep up with the suction flow rate which increases momentarily due to the rise of the suction, and therefore, as shown by the dotted line in the section D in FIG. Transient anterior chamber pressure reduction occurs. On the other hand, in the apparatus of the present invention, since the perfusion solution reservoir 5 is provided in the middle of the perfusion tube for supplying the perfusion solution, when the suction hole is closed, the height depends on the height of the perfusion bottle 1. A pressure equivalent to the perfusion pressure is stored at the location of the perfusion fluid reservoir 5 by compressing the air in the perfusion fluid reservoir 5. When the plug is removed from the suction hole, the force that has compressed the air in the perfusion fluid reservoir 5 is released, and the perfusion fluid starts to flow, so that the air in the perfusion fluid reservoir 5 expands and returns to its original volume. As a result, a force acts to push down the perfusate in the perfusate reservoir 5. The magnitude of the perfusion pressure that pushes down the perfusion solution is equal to the perfusion pressure at the position of the perfusion bottle 1, but compared with the case where the perfusion solution is directly guided from the perfusion bottle 1 to the handpiece 6, the perfusion solution is supplied from the perfusion solution reservoir 5. Leading to piece 6 reduces the path length of the perfusion tube,
The line resistance due to the viscosity of the perfusate or the like can be small, and the perfusate can be smoothly supplied to the eyeball. Therefore, the perfusate can be quickly supplied even if a sudden suction is performed, and the change in the anterior chamber pressure is indicated by a solid line in the section D in FIG. Is suppressed.

The operation in the operation by the ultrasonic emulsification and suction method using the US handpiece 6 has been described above.
Even if there is a sudden rise of suction when the handpiece 7 is used, the supply of the perfusate can be performed quickly, so that a temporary decrease in the anterior chamber pressure can be suppressed.

The present invention has been described with reference to the embodiments.
The present invention is not limited to the embodiments, and various modifications are possible. For example, a remote pinch valve that can be remotely operated is used in place of the perfusion control valve 4, and the perfusion fluid reservoir 5 and the remote pinch valve are provided closer to the US handpiece 6, and they are placed in a place that does not interfere with the operation (such as a tray) ). In this case, the supply path of the perfusate can be further shortened while maintaining the perfusion pressure.
Thus, the perfusion solution can be smoothly discharged when the pinch valve is opened or when the aspiration flow rate suddenly increases.

Some modifications are also possible for the perfusate reservoir 5. For example, as shown in FIG. 5A, the perfusion liquid reservoir 30 may be provided with an air outlet 32 for securing an air chamber 31 and a cap 33 for closing the air outlet 32. When injecting the perfusion solution, the perfusion solution is put into the perfusion solution reservoir 30 with the perfusion control valve 4 arranged in the middle of the perfusion tube 3 b closed, and the perfusion solution is kept in the perfusion solution reservoir 30 while securing the air chamber 31. When the perfusion solution is filled, the air outlet 32 is closed with the cap 33. Thereby, the same perfusion solution reservoir as in the embodiment can be configured. Also,
As shown in FIG. 5 (b), the perfusate reservoir 35 is provided with a deformed portion 36 made of resin or the like, which is deformed by hand pressing like a dropper and is restored by restoring force. It may be provided. In this case, by squeezing the deformation portion 36 several times without providing a special valve,
The air in the perfusion solution reservoir 35 is discharged to store the perfusion solution, and the air chamber 37 can be secured.

Such embodiments can be variously modified, and these modifications are also included in the present invention as long as the technical idea is the same as the present invention.

[0033]

As described above, according to the present invention,
It is possible to minimize the delay of the rise of the perfusion pressure in response to the rapid rise of the suction pressure, and to suppress a temporary decrease in the anterior chamber pressure.

[Brief description of the drawings]

FIG. 1 is a schematic configuration diagram of a perfusion suction device according to an embodiment.

FIG. 2 is a detailed view of a perfusion solution reservoir of the perfusion suction device according to the embodiment.

FIG. 3 is an explanatory diagram of a position position of a foot switch.

FIG. 4 is a time-series change diagram of anterior chamber pressure of a surgical eye.

FIG. 5 is a diagram showing a modified example of a perfusion solution reservoir.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Perfusion bottle 3a, 3b Perfusion tube 4 Perfusion control valve 5 Perfusion liquid reservoir 6 US handpiece 23 Piston

Claims (7)

[Claims] 1. A perfusion apparatus for supplying a perfusion solution from a perfusion bottle to a surgical eye through a perfusion tube and aspirating the supplied perfusion solution together with waste in the eye.
A perfusion solution storage means which has an air chamber in the path of the tube and is capable of storing a perfusion solution. 2. The perfusion suction device according to claim 1, further comprising a control valve for controlling the outflow of the perfusion solution through the perfusion tube, wherein the perfusion solution storage means is provided near the control valve on the perfusion bottle side. A perfusion suction device characterized by the above-mentioned. 3. The perfusion suction device according to claim 2, wherein the control valve is a pinch valve. 4. The perfusion suction device according to claim 1, wherein the perfusion liquid storage means has an air discharge means for storing perfusion liquid and discharging air. 5. The air discharging means according to claim 4, wherein the air discharging means is a piston, and after the air in the perfusion liquid storing means is discharged by moving the piston forward and backward, the perfusate from the perfusion bottle is passed through the perfusion tube. A perfusion suction device characterized by being guided and stored. 6. The perfusion suction device according to claim 1, wherein the perfusion solution storage means has an inflow port through which a perfusion solution flows from a perfusion bottle, and the air chamber is provided at a position higher than the inflow port. 7. The perfusion suction device according to claim 1, further comprising a handpiece connected to a perfusion tube for supplying a perfusion solution to a surgical eye, wherein the handpiece utilizes ultrasonic vibration. A perfusion suction device, which is a crushing handpiece for crushing and emulsifying a lens nucleus with a crushing tip having a suction hole attached to a tip thereof.