CN1245410A - 水下操作的电外科发生器和系统 - Google Patents

水下操作的电外科发生器和系统 Download PDF

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CN1245410A
CN1245410A CN97181655A CN97181655A CN1245410A CN 1245410 A CN1245410 A CN 1245410A CN 97181655 A CN97181655 A CN 97181655A CN 97181655 A CN97181655 A CN 97181655A CN 1245410 A CN1245410 A CN 1245410A
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科林·查尔斯·戈布尔
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Abstract

一种电外科系统用的射频发生器,该系统包括一个具有被浸入导电液体而使用的电极的电极组件。所述发生器具有控制电路,用于在峰值射频输出电压达到预定的阈值限制的极少周期时间内快速地减少至少传送输出功率的50%。按照这种方式,可以在比如没有明显蒸汽产生的食盐水中实施组织凝结。可将限制峰值电压的方法用于组织脱水方式或组织切割方式,以限制电极处蒸汽泡的尺寸,避免电极灼热。该发生器具有带串联谐振输出电路的推挽输出级,由一射频振荡器按一般说来与谐振输出电路的谐振频率不同的频率驱动该输出级。通过改变形成推挽输出对的开关晶体管的导通时间以及通过改变激振频率与串联谐振输出电路的谐振频率之间的频率间隔,实现功率控制。在又一实施例中,采用有两个推挽对的桥式结构,同时得出又一个功率控制变量:驱动每个晶体管对的信号的相关相位。

Description

水下操作的电外科发生器和系统
本发明涉及一种电外科发生器，特别用于供给电外科能量，但并不仅只属于所谓水下电外科。本发明还涉及一种由发生器和电极组件结合组成的电外科系统。
本说明书中所用术语“水下电外科”系指采用带一个或多个在操作部位被浸入液体的处置电极的电外科器械所实施的外科，一般说来，引入液体是为了膨胀包含操作部位的体腔，或者用以从该部位冲洗掉血液。另一种情况是，可以用浸入自然生成的体液的电极或电极组件实施外科。本发明特别用于泌尿科、子宫颈检查以及关节内窥镜检查的场合。但应予理解的是，本发明的特点在于，还可用于不包含电极浸没的电外科中。
在我们共同的未决欧洲专利申请No.96304558.8(0754437)中描述了水下电外科和腔内外科，即至少通过侵入体腔的外科手术入口来处置活体组织的外科的背景技术，本说明书中将它的内容引为参考文献。
因为电流在被处置组织及导电液体周围的流动所产生的热量趋于引起液体沸腾，所以难于实现那种对应用部位始终浸入液体的组织的有效电外科处置。将电外科能量加给所述电极的同时，随着存在于发生器的负载电阻抗的较大变化，引起由水蒸气替代所述液体断续包围工作电极。虽然通过使用非导电液体可以缓和这种变化，但不能使之完全消失，因为在操作部位排出体液使液体的电导率增高。组织种类不同也会使负载的阻抗变化。这些都影响到难于控制电外科的输出，去对所处置的组织产生稳定的效果。于是，通常采用高功率，以克服这种行为的变化。
按照本发明的第一方面，一种电外科发生器，用于给电子设备提供射频电能，该发生器包括：射频输出级，此级至少有一对电外科输出线端，用于将射频能量传送给所述设备；与输出级连接的电源，用于给输出级提供电能；控制电路，它包括检测装置，用于生成代表输出线端两端表现的射频峰值输出电压的检测信号，其中所述输出级包括连到所述输出线端的串联谐振输出电路和连到所述谐振输出电路的转换装置，而且，其中控制电路可以改变所述转换装置的转换时间间隔，从而响应预定的检测信号条件，减少传送的射频能量。在本发明的优选实施例中，所述串联谐振输出电路包括一个电感和一个电容器的串联组合，并将其连到转换装置，使被转换的射频输出波形显示于所述串联组合两端；所述发生器的输出线端连到所述串联谐振电路，用以接收显示于电感或电容器(最好是电感)两端的射频电压。可将所述串联组合连接在转换装置与接地点或一对电能供送装置的供送端之一的之间；发生器的一个输出线端被连到电感与电容器之间的接点，而其另一线端最好连到所述接地点或所述一个供送端。采用连到转换装置的电容器和连到接地点或供送端的电感，最好通过一个其值比串联谐振组合的电容小的耦合电容器将所述输出线端连到所述电感与电容器的接点。另外，所述转换装置可包括被连接成桥式结构的半导体开关；所述串联组合被连到所述转换装置的反相节点之间。
为了在比如连到发生器的各电极区域的液体汽化时实现功率的快速减少，把所述转换装置和控制电路安排成可以使转换装置的工作时间减少到造成在已达到预定射频峰值输出电压阈值的100μs内送出的电能至少减少50％的程度(在这种情况下，术语“峰值输出电压，，包括关于峰-峰基线测得的电压)。换句话说，所述发生器响应表示峰值输出电压或峰-峰输出电压值的检测信号。所述转换装置可以包括一对电子开关，以推挽串接方式布置于所述电源的供送端之间，采用使串联谐振输出电路连接到所述电子开关的接点处。于是，为减少输出的电能，在射频的每半个周期，使每个开关(通常是功率MOSFET)的工作时间减少，以造成所需的能量减少。
通过在使输出功率减少一个大于产生汽化需要增加的量意义上造成控制过冲，使蒸汽泡能够破裂。这就使得能够在导电液体的场合下，特别是在食盐水溶液中实施外科手术。可以发生负载阻抗大而快速的变化，而基本上不会引起不希望有的电外科影响。例如，当需要产生电外科脱水时，可以防止由于本设备电极区域周围食盐水的汽化所引致阻抗的任何增大，否则所述设备在为有效地脱水所需功率水平下可能导致不希望有的电弧。当需要电外科组织切割或组织汽化时，可采用输出电压的限制避免电极灼热和/或过度的组织汽化。
为避免所述转换装置中所用半导体功率器件过载，最好由一个在与所述串联谐振输出电路谐振频率不同的频率下工作的振荡器驱动所述转换装置。通过振荡器在高于串联谐振输出电路的谐振频率的激振频率下工作，可以使与切割或汽化相关联的较高阻抗下适合的功率增大，而当振荡器的工作使得在比所述谐振电路谐振频率低的频率下激振该谐振电路，更适合于包含较低负载阻抗的电外科脱水。
最好将参照上面的控制电路布置成：通过减少电子开关在射频输出信号每个周期内的导通时间，使输出功率在输出电压达到预定的检测信号阈值之后大约小于20μs的时间内至少减少50％。实现导通时间的这种选择，与供给电压的任何变化无关。实际上，使用单独一个控制变量，即峰值输出电压或峰-峰值输出电压，使输出功率的减少得以被实现，所述变量与供给电压无关并与传送的输出功率无关，当然，传送的输出功率随负载阻抗及供给的电压变化。因此，按照多种情况，功率减少的启动发生在预设的输出电压阈值相同但输出功率及负载阻抗值不同的情况下。
首先通过在达到输出阈值时使功率元件各周期的导通时间重复产生从峰值水平快速降低到谷值水平，继而使所述导通时间逐渐增大，直到导通时间再次达到它的峰值水平，则可实现直接控制射频输出级的方法；在所述逐渐增大的过程中，要监视射频输出电压。
所述输出级最好包括具有高Q值的输出谐振电路，所述Q值高到足以除去来自该级的开关部件的转换噪音，而不过分减慢对达到预定阈值的输出电压的响应。通常，所述Q值至少为1，并且还足以达到波峰因数低于1.5，波峰因数是输出电压波形的幅值与有效值之比。
本发明的另一方面包括一种水下电外科用的发生器，其输出阻抗在100Ω到250Ω范围，最好在130Ω到190Ω之间。这种发生器的射频输出级可以产生CW(连续波)输出，即具有100％占空因数，或者没有在频率低于r.f.振荡频率条件下的通/断脉冲宽度调制。实际上，所述输出级可以作为开路级工作。
按照本发明的第二方面，给出一种电外科系统，包括：一个用于产生射频能量的发生器，和一个至少有一个浸入导电液体中使用的电极的电外科器械，其中，所述发生器包括输出级，此级至少含有一个射频功率元件、一个串联谐振输出电路和至少一对被安排用以接收所述功率元件的射频能量的输出连接端，所述一对连接端之一连到所说的电极；所述发生器还包括控制级，此级能减少所述功率元件响应超过预定检测信号阈值的检测信号在每个射频周期内的导通时间，所述检测信号表示发生器输出连接端两端所表现的电压，从而在导电液体蒸发时，快速地减少传送给所述电极结构的射频能量。所述电极结构可包括一个前端处置电极和一个置于该前端电极附近的接触液体的电极，此二电极都被所述导电液体包围而使用，而且它们的每一个各自连到所述一对输出连接端之一，使所述控制级在所述前端电极处的导电液体汽化时能减少功率元件的导通时间。给所述电外科器械设置一个电极结构，它有并列的第一和第二电极，用于浸入导电液体中，所述第一和第二电极分别形成在器械最前端处的组织接触电极和与被置于该组织接触电极附近的回流电极。
利用方式选择控制电路，本系统至少可在组织脱水方式与组织切割或汽化方式之间转换。在这种情况下，控制级可自动工作，以调节供给所述电极结构的射频能量，以便在选择脱水方式时，将峰值发生器的输出电压限制在第一值，以及在选择切割或汽化方式时，将其限制在至少一个第二值，所述一个或多个第二值都高于第一值。第一和第二值最好是分别在150v到200v和250v到600v的范围内，这些电压都是峰值电压。
可将所述方式选择控制电路连到驱动所述功率元件的发生器的振荡器，使得在组织脱水方式下振荡器的振荡频率低于所述串联谐振输出电路的谐振频率，而在组织切割或汽化方式下则高于该谐振频率，用以像上面所述的那样，分别在较低阻抗和较高的阻抗情况下改善输出功率。
按照本发明的第三方面，给出一种电外科发生器，用于将射频输出功率提供给电外科器械，所述发生器包括射频输出级，此级至少有一对用于将射频能量传送给所述器械的电外科输出连接端，一个用于对所述输出级提供射频信号的射频振荡器，以及包含检测装置的控制电路，所述检测装置用于生成表示所述输出连接端导出的射频信号的检测信号，其中所述输出级包括一个连到所述输出连接端的串联谐振输出电路，该串联谐振输出电路的谐振频率不同于振荡器的工作频率；并且所述控制电路给出一个反馈信号，用以控制传送的射频能量。
以下将通过参照附图举例说明本发明，其中：
图1是表示本发明电外科系统的示意图；
图2是用于组织脱水的第一种电极组件的局部视图，表示在使用中被浸入导电液体内；
图3是负载特性曲线，表示在导电液体中使用情况下，按照被送出的输出功率由图2所示的电极组件引起负载阻抗的变化；
图4是用于组织汽化的第二种电极组件的局部视图，表示在使用中被浸入导电液体内；
图5是按照本发明的一种发生器的组合电路和方框图；
图6是波形图；
图7是图5发生器部分控制电路的方框图；
图8是与发生器在脱水方式工作时有关的电能与负载阻抗的关系曲线；
图9是用于组织切割或汽化方式时的类似曲线；以及
图10是按照本发明的另一种发生器的组合电路和方框图。
本发明的优选实施例是要供形成双极式电外科用的，它具有浸入导电液体，如生理食盐水中的多个电极。使用由发生器和一种器械组成的系统实施电外科，所述器械具有双电极结构，在被处置的组织与一个电极(下称“回流电极”)之间以食盐水为导体。将另一个电极直接作用于组织上。该另一电极以下称为“有效电极”。
图1示出这样的一个系统。发生器10具有输出插口10S，经连接电缆14以机头12的形式为器械提供射频(RF)输出。可以经连接电缆14中的控制连接头由机头12或者借助脚踏转换装置16实现发生器的运行，有如所示的那样，所述脚踏转换装置16分开经脚踏开关连接电缆18连到发生器10的后部。在所示的实施例中，脚踏转换装置16有两个脚踏开关16A和16B，分别用于选择发生器的脱水方式和汽化方式。发生器前部面板有按钮20和22，分别用于设定在显示器24上指示的脱水功率和汽化功率水平。设置按钮26作为另外的用于在脱水与汽化方式之间选择的装置。
机头12装有可拆的双电极结构电极组件28，如图2的局部视图所示。
图2是电极组件28前端的放大视图。在其最前端处，该组件具有有效电极30，在本实施例中，它由一系列与中心导体32相连的金属丝组成。这些金属丝由不锈钢制成。有效电极30的附近是回流电极36，并由沿纵向和径向展开的绝缘体34与后者隔开。回流电极36作为套管38共轴地布置在内部导体32周围，所述套管38随着管轴40延伸到组件28的最近端，在那里它在机头12中连到连接电缆14中的导体。类似地，内部导体32延伸到所述机头并连到电缆14中的导体。电极组件28具有绝缘外皮42，它覆盖管轴40，并终结于绝缘体34附近，留下作为回流电极36而露出的管轴40的前端。
在作为脱水装置工作时，如图2所示，将电极组件28加于待处置的组织44上，使操作部位浸入生理食盐水溶液(0.9％w/v)，这里表示为包围电极组件28前端部分的液滴46。液体浸泡着有效电极30和回流电极36。
再参看图2，组成有效电极30的金属丝都与该电极组件的内部导体32电连接在一起，形成一个整体的有效电极。绝缘体34是一个绝缘套筒，它的前端部分暴露在有效电极30的露出部分附近。通常，此套筒由陶瓷材料制成，以耐受电弧的损伤。回流电极终结在绝缘体36端部的嵌缝短段处，使得它既沿径向又沿轴向和与组织接触的有效电极30隔开。回流电极的表面面积明显地比有效电极30的大。在电极组件的前端，回流电极的直径通常在1mm到3mm范围内，回流电极露出部分的纵向延伸通常在1mm到5mm之间，与有效电极的纵向间隔在1mm到5mm之间。
实际上，电极组件是双极式的，只有电极30中的一个实际延伸到装置的前端。这意味着，在正常情况下，回流电极保持与被处置组织间隔开，电流路径流经组织和与回流电极36接触的导电液体而存在于两个电极之间。
就双极式电外科能量的传送而言，可以将导电液体46看作为组织的低阻抗区域。由发生器10产生的射频电流经组织44和浸泡的导电液体46在有效电极30与回流电极36之间流动。图2所示的特定电极布置最适合于组织脱水。
各电极间的轴向及径向分离避免了普通双极式布置的小间隔，在这种布置中，两个电极都是接触组织的。于是，就存在一些不希望有的电弧越过绝缘表面的危险，这种情况使得脱水处置能有比较高的能量消耗，而在切割组织或者组织汽化的情况下，防止可以导致内部电极绝缘性的损害的过大的电弧。
可以通过构成部分设备12所形成的导管(未示出)提供浸泡的食盐水。所以，本发明制成处置浸入导电液体介质的组织用的电外科系统，它包括带有机头的电外科器械和器械手柄，在手柄的端部有电极组件，所述组件包括露出于器械最远端的组织接触电极和回流电极，回流电极与组织接触电极电绝缘，并有位于组织接触电极露出部分附近的液体接触表面；所述系统还包括与所述器械的电极组件相连的射频发生器，导电液体(如生理食盐水溶液)储存器，还有导管，它通常是内窥镜的必要部分，用于将所述液体从储存器传送到电极组件区域。传送液体的压力可由一个泵提供，它构成整个设备的一部分。
由于在电极组件28的这个实施例中有效电极30是由不锈钢金属丝制成刷形的，所以该电极是可弯曲的，给出使组织复原的效果，这使电极对组织表面使用角度有很大的自主性。电极30的可弯曲性还导致与所加的压力有关的有效电极的不同接触面积，使得能够改变在整个组织表面脱水的宽度的变化，同时减少处置的时间。
借助经紧靠有效电极30底下并在该电极周围区域的组织44外层流过有效电极30与导电液体46之间的射频电流可以实现脱水。当如图2所示那样采用与导电液体46接触的两个电极，将发生器的输出阻抗设定在与电极组件的负载阻抗相当的水平。为了对组织脱水维持这种配合状态，以下面将要描述的方式使发生器的输出功率得到自动控制，以基本上防止尺寸明显的蒸汽泡出现在有效电极30处，从而避免随之而来的负载阻抗增大。按照这种方式，虽然因热脱水而使组织液被除去，仍可由导电液体使有效电极持续地被浸湿，使阻抗达到对应于导电液体开始沸腾的上限点。因而，本系统能够为脱水传送较高的能量，而没有不希望有的导电液体汽化，去导致不希望有的组织影响。
现在参照图3的曲线描述在电极30和36被浸泡在导电液体46中时电极组件的电气特性。
在首先加给电能的情况下，发生器存在一个初始负载阻抗r，它由电极的几何形状和导电液体的电导率决定。当有效电极触到组织时，r的值改变。r值越高，导电液体汽化的倾向越大。随着电能在组织和导电液体中扩散，导电液体的温度增大。在生理食盐水的情况下，电导率的温度系数为正，而相应的阻抗系数为负，因而使阻抗最初是下降。于是，图3的曲线表示随着传送的能量增大，负载阻抗下降，所述阻抗通过点A降到最小点B，直接与电极接触的食盐水在这一点达到沸点。此时有效电极表面上形成小气泡，同时阻抗开始升高，如从点B到点C抬升的曲线所示的那样。因此，一旦达到沸点，所述设备就显示阻抗的正功率系数占优势。
随着蒸汽泡的形成，到食盐水界面余下的有效电极处(有效电极未被蒸汽泡遮盖的露出区域)的能量密度增大，这进一步加重了界面生成更多的蒸汽泡和更高的能量密度。这是一种剧变的情况，平衡点只能出现在电极被完全包围在蒸汽中的情况下。于是，对于给定的变量设置，存在一个与C点对应的能量阈值，在这一点，达到这种新的平衡。
基于上述，就能理解，图3中点B和C之间的区域表示所能达到的脱水能量的上限。
在形成包围电极的蒸汽泡的时候，阻抗升高到约为1kΩ，有如图3中D点所示那样；实际阻抗值与多个系统变量有关。此后，通过穿过所述蒸汽泡在有效电极与蒸汽/食盐水界面之间放电，使蒸汽得以被保持。
这种工作情况为图4所表示，该图表示另一种电极组件28A，它具有半球形或球形电极30A，代替图2实施例的刷形电极30。如前所述，由插入的绝缘体34A使回流电极36A与有效电极30A前后相接地被隔开。球形电极首选用于组织汽化。
当处于汽化平衡状态时，通过穿过蒸汽泡在有效电极30A与蒸汽至食盐水界面之间放电52，使图4中参考标号50所表示的蒸汽泡得以被保持。大部分能量消耗发生在这个蒸汽泡内，随之便是有效电极的发热。在这种传导过程中，能量消耗的量是所传送能量的函数。从图3将能理解，在比导致蒸汽泡形成所需的功率水平低很多的情况下，可使由虚线表示的汽化方式得以被保持。阻抗/能量特性必然要显示出滞后。在已建立起汽化方式的情况下，这可以被保持在一个比较宽的能量水平范围，有如D点两侧展开的倾斜的特性部分所表示的那样。然而，增加传送的输出能量，超出D点所表示的输出能量，会引起电极温度的迅速升高，可能损毁电极。为了使蒸汽泡破裂，回到脱水方式，需要能量明显地减少，回到A点，使有效电极与正在恢复的食盐水之间直接接触，并使阻抗明显地下降。有效电极处的能量密度也下降，致使食盐水的温度降到沸点以下，随之电极再次处于稳定的脱水平衡。
此后将要描述的发生器具有既保持脱水方式又保持汽化方式的性能。同时，一般地说，图2和4所表示的电极组件可被用于两种方式中的每一种方式，图2的刷形电极因其较宽的潜在有效范围，最好用于脱水方式，而图4的球形电极因其有效电极/回流电极表面积之比很小，最好用于汽化方式。有如图4所见到的那样，在蒸汽泡50相交于组织表面时，发生组织汽化，最好使电极组件在组织表面上方保持一很小的间隔(通常为1mm-5mm)。
如果发生器有足够的输出阻抗，则因为可使输出电压随之突然升高，所以在传送的能量达到图3中C点表示的程度时出现剧变情况。随着增大能量消耗并且有效电极30周围不存在冷却液体，电极温度迅速升高，必然损伤电极。这还会代替所需要的脱水而发生不能控制的组织破坏。为此，最佳的发生器有一个输出的源阻抗，它至少近似与电极结构在潮湿情况下的负载阻抗匹配。
以下描述最佳发生器，它能用于脱水电外科，而基本上没有不希望有的细胞破坏，也能用于电外科切割或汽化，而基本上没有电极的灼热。虽然主要地是供在导电液体膨胀介质中操作用的，但在其它电外科过程中，如存在气态膨胀介质的过程中，或者可能发生快速的负载阻抗改变的过程中也有应用。
参照图5，所述发生器包括射频(RF)振荡器60，它在大约400kHz上下，从300kHz直到HF范围的任何合理的频率条件下工作。振荡器60推动功率输出级62，它由两个功率MOSFET-T1和T2组成，以推挽布置的方式连接在两个供送端Vs和0v之间；该二电能供送端由电能供送级64驱动。
晶体管T1和T2由脉冲宽度控制器64以转换的方式被驱动，而控制器本身由振荡器60驱动。于是每个晶体管T1、T2在RF振荡器60的每个周期内接收一个选通脉冲，这些脉冲都是定时的，使T1在振荡器一种极性的半周期内被转换，并根据所需的输出功率控制选通脉冲的宽度。
连接到由晶体管T1、T2表示的两个电子开关之间接点的是由电容器Cr和电感Lr组成的串联谐振输出电路。这两个元件的串联谐振频率约为400kHz，不过一般地与振荡器60的工作频率不一样。经耦合电容器Cc连接到电容器Cr和电感Lr之间接点的是供给所述发生器输出端66、68的输出振荡变压器65初级绕组的一端。所述初级绕组的另一端接到一个供送端，在这种情况下为接地点0v。耦合电容器Cc比电容器Cr小。
串联谐振电路Cr-Lr对各开关的连接是直接的：不存在插入的第二个串联谐振电路，如并联谐振电路，而且对各开关表现的负载阻抗(在关于激振频率考虑其变化时)在串联谐振电路的谐振频率下表现出最小值占支配定位。
与每个晶体管T1、T2的源极和漏极并联连接的分别是能量再生二极管D1、D2。
晶体管T1、T2按上述方式的转换使得具有图6所示波形的RF激励电压应用于所述晶体管间的接点65。在两个串联谐振元件Cr和Lr的接点处产生一个相应的正弦波形，其振幅与振荡器频率和谐振频率之间的频率差有关，还与跨接在输出端66、68间负载70的阻抗有关。
连接在输出接点66、68间的是电压阈值检测器72，它具有连到“导通”时间控制电路74的输出端72A。
在所述发生器工作过程中，当因外科医生操纵一个启动转换结构而需要电外科能量时，将能量加给电源64，可将所述启动转换结构设置在机头或脚踏开关上(见图1)。经输入端72B，根据发生器前部面板上的控制装置(见图1)，与电源电压无关地设定一个恒定的输出电压阈值。通常，为了脱水或凝结，将阈值设定在150v到200v之间的脱水阈值。当需要切割或汽化输出时，将阈值设定在250或300v到600v范围内的值。这些电压值均为峰值。它们的峰值意味着，为了脱水，至少有低波顶因素的输出RF波形是最好的，以便在使所述电压位于给定值之前给出最大功率。通常要达到1.5或更小的波顶因素。
在最初启动发生器时，脉冲宽度控制器64(连到“导通”时间控制电路74的)的控制输出端64I处于“通”状态，就使组成输出级62的每个晶体管T1、T2在每个振荡周期内都被转换成接通一段最大的导通时间，所说的振荡周期可以是振荡输出的全部半个周期。假设传送能量是足够高的，本电外科器械各电极周围液体介质的温度(或者在气态介质内，组织内所含液体的温度)可以升到液体介质汽化温度的程度，同时，导致负载阻抗的迅速增大，继而使加给线端12两端的输出电压迅速增高。如果需要脱水输出，这是一种不希望有的工作情况。为此，将脱水输出的电压阈值设定成在达到该阈值时产生一个送给“导通”时间控制电路74的触发信号。“导通”时间控制电路74具有实际上迅即降低控制器64产生的选通脉冲宽度的效果，从而实际上迅即减少RF转换器件T1、T2的“导通”时间。
通过考虑图7所示的“导通”时间控制电路74的内部结构，就能理解其后的所述器件T1、T2在振荡器60各个周期“导通”时间的控制。该电路包括RF锯齿波发生器80(借助由振荡器驱动并加给同步输出端74I的同步信号，使其同步于RF振荡频率)，还包括斜波发生器82，利用在达到设定的阈值电压时由电压阈值检测器72的输出端72B(见图5)产生的复位脉冲使它复位。此复位脉冲是上面所提到的启动信号。“导通”时间控制电路74还包括比较器84，用以比较锯齿波发生器80所产生的锯齿波电压和斜波发生器82所产生的斜波电压，以产生一方波控制信号，加给脉冲宽度控制器64的输出端64I。有如图7中的波形图所表示的那样，所示锯齿波和斜波的性质使加给控制器64的方波信号的脉冲信号荷周比在每个复位脉冲之后逐渐增大。于是，在关于输出电压达到所设定的电压阈值的检测“导通”时间实际上迅即减少之后，RF振荡器的“导通”时间逐渐增大，回到初始的最大值。连续重复这种循环，直至所述各电极周围液体的温度降到使汽化不常发生的程度。
对于操作方式来说，发生器的输出电压是重要的。事实上，各种输出方式单纯由输出电压，特别是峰值输出电压决定。输出电压的绝对测量只对多项控制才是必要的。但为了将输出电压限制于预定的限定电压，可在这种发生器中使用简单的信号项目控制(即使用一个控制变量)。因此，图5所示的电压阈值检测器72使RF峰值输出电压与预置的DC阈值电平相比较，并有足够快的响应时间，在RF的半周期内对“导通”时间控制电路74产生复位脉冲。
当因晶体管T1、T2的转换而使串联谐振输出电路在谐振频率附近被激发时，晶体管T1、T2间接点处的电压幅值可以超过电源电压。在这种情况下，当使两个晶体管都断开时，二极管D1、D2将谐振电路的能量回收给电源。采用小于推挽装置的半波转换，导通时给予激发，断开时提供能量回收并抑制激发，就能有中等水平的激发。
进一步考虑发生器的工作之前，回顾图3的阻抗/功率特性。可以理解，最大临界控制阈值在脱水过程中是适用的。由于在有效电极处形成的气泡是不导电的，所以与电极接触的剩余食盐水有较高的能量密度，并因之而有更大的形成蒸汽的倾向。由于有效电极处能量密度的急剧增大，这种不稳定程度导致转变成具有相同能量水平的汽化方式。结果，有效电极局部的阻抗增大。最大吸收能量与形成蒸汽泡之前最接近的电极情况相符，因为这与最大能量分布及潮湿电极的最大面积相符。所以，为了最大的脱水能量，希望电极保持在潮湿状态。使用电压极限检测导致能量降低，使蒸汽泡能够破裂，这又提高了有效电极吸收能量的能力。为此，本说明书所描述的发生器包括一个具有较大过冲的控制封闭系统，通过引起峰值输出电压降到明显低于阈值检测器72设定的峰值输出电压，达到预先规定阈值的峰值电压的反馈激励造成较大的功率迅即下降。这种控制过冲保证回到所需的潮湿状态。
在上面参照图5、6和7描述的发生器中，通过提供给串联谐振输出电路的RF能量的迅即降低，发生响应于电压阈值检测的功率下降。
在本优选实施例中，迅即功率下降至少是从DC电源所能得到的功率(或者至少半电压)的四分之三，或更多。于是，RF级本身得到高速响应。
在典型的脱水事件中，输出电压随负载阻抗增大至达到输出电压阈值的点而增加，因此，在“导通”时发生上述在输出级的迅即下降。这再次导致伴随上述逐渐增大，RF输出电压的迅速下降。当输出电压再次达到阈值电压时，振荡器“导通”时间再次迅即减少，然后再逐渐增大，使输出电压波形重复其先前的图形。再次达到阈值电压，输出电压再次迅即下降，使“导通”时间能够再次增大，等等，直至作业点的条件改变，使得不再形成蒸汽。
继而将会看到，控制电路74、64(图5)以动态方式工作，在这种情况下，是控制输出电压足够迅速且足够程度地保持在与脱水所需水平相符的水平，不使组织因电弧而破坏。为限制输出电压，避免电极灼热和/或过度的组织汽化，可使用同样的技术采用不同的阈值电压。在后一种情况下，可将电压限制设定在250v(最好300v)与600v之间的水平。
由于在汽化方式的过程中有效电极处的能量密度高，大多数被传送的电能消耗在最近电极处。在汽化方式下，希望出现食盐水发热最小，但使所有处在有效电极的蒸汽范围的组织都被汽化。在汽化方式下，有如上面参照图4描述的那样，在蒸汽泡内由电弧维持汽化。汽化过程中增大输出电压的同时引起组织分离体积增大，这是由于蒸汽泡尺寸的增大之故。在组织汽化过程中，蒸汽泡的破裂有较大的影响，这是因为作为食盐水周围较大能量消耗的结果，坏死增大。首先，通过将电极在汽化方式下的阻抗安排成就阻抗而言使器械处于无法匹配的情况，结果是，谐振输出电路的Q值较大，输出电压不会像负载阻抗较低的情况那样快速地变化；其次，有效电极有较大的热容量，可维持蒸汽泡较长的时间，由此可以防止蒸汽泡破裂。
通过在汽化方式过程中限制峰值输出电压，可以避免不希望有的蒸汽泡尺寸的增大，在汽化方式情况下，这可以通过对电压阈值检测器72(如图5所示)调换不同的阈值电压而方便地得以实现。
本发明的本优选发生器中的电压阈值检测器72的电路和“导通”时间控制电路74(如图5所示)是有如我们的未决欧洲专利申请No.96304558.8中所描述和表示的那样。
如上所述，一方面对于脱水，另一方面对于切割或组织汽化，可以加给不同的阈值电压。因此，如图5所示那样，所述发生器包括一个方式选择控制电路86。实际上，这是由启动机头或脚踏开关决定的产生输出的微信息处理控制系统(未示出)的一部分。于是，对于脱水输出而言，所示方式选择控制电路经输入端72B将阈值检测器76设定成第一个值，而对于切割或汽化而言，设定一个与之不同的、较高的阈值电压。通过根据究竟是需要脱水亦或是切割/汽化将RF振荡器的频率设定为不同的值，还可以得到多种改善的结果。因此，对于脱水而言，所示方式选择控制电路经控制输入端60I将一频率控制信号加给RF振荡器，以将振荡器频率设定为低于Cr-Lr串联谐振组合的谐振频率。相反，当需要切割或组织汽化时，将RF振荡器设定成其频率高于所述谐振频率。较低的频率具有使功率与负载阻抗特性的关系曲线斜交的效果，从而增大了在低阻抗下可以得到的能量，正如在脱水过程中所遇到的那样。较高的振荡器频率具有使功率与负载阻抗特性的关系曲线拉平并有利于较高阻抗的效果，正如当浸入的液体蒸发时所遇到的那样。这些功率/负载阻抗的变化以图解的方式被表示于图8和图9中，其中fE和fr分别表示激励(即振荡器的)频率和谐振频率。
通过在脱水状态与切割状态之间不断地变换，或者通过变换阈值的位置，可以采用混合方式。
可以采用一种替代上面参照图5描述的发生器，如图10所示，它具有带桥式结构转换装置的输出级。在这种情况下，所述转换装置包括4个功率MOSFET，它们被布置成两对两个晶体管，每一对都布置成推挽结构。第一对是如图10中的晶体管T3和T4所示，第二对则是如晶体管T5和T6所示。由电容器Cr和电感Lr组成的串联谐振输出电路连在两个推挽对T3、T4和T5、T6各自的接点之间，使得当由脉冲宽度和相位控制电路64以相反的相位驱动此二推挽对时，将射频功率信号加在串联组合Cr-Lr两端。有如图5的发生器中对电外科器械的输出是经耦合电容器Cc及隔离变压器65取自电感Lr那样，经转换的射频输出电压表现在线端66、68处，用以连接电外科负载70。另一方面，这种替代的发生器类似于上面参照图5描述的发生器，并且，在图10和图5中，分别对相同的部件使用相同的参考标号。在串联谐振电路Cr-Lr两端产生的电压波形通常与图5发生器所产生的波形相同，即如图6所示。但是，在这种替代的发生器的情况下，通过把相位控制功能引入驱动开关晶体管T3-T6的电路64，可使加给每一对晶体管T3、T4和T5、T6的驱动信号间的相位差从180°的最大值向下变，使输出功率降低。这构成一个改变输出功率的附加变量。实际上，如果需要，可使所述相位差降到输出功率为0的程度，这意味着，比如可使从能量供给部分64得到的供给电压Vs始终保持恒定，以代替使用辅助的降低功率的装置。
继而，概括地说，桥式结构使得在不仅通过减少各晶体管的“导通”时间，还通过改变两对晶体管间的相关相位从180°向下变化使器械电极周围的导电液体蒸发的情况下实现功率快速降低。作为降低输出功率的附加装置，还可以进一步从电容器Cr和电感Lr的串联组合限定的谐振频率改变RF振荡器60的激振频率。
从一般观点看，提供一种射频发生器，用于电外科系统，该系统包括一个电极组件，此组件有两个浸入导电液体的电极。所述发生器具有控制电路，用以使所传送的射频输出功率在达到预定阈值限制的峰值射频输出电压的极小一段周期内快速降低至少50％。按照这种方式，可以在比如没有明显的蒸汽生成的食盐水中实现组织的凝结。可将同样的峰值电压限值技术用于组织的汽化方式或切割方式，以限制电极处蒸汽泡的尺寸和防止电极灼热。本发生器具有带串联谐振输出电路的推挽输出级，一般地说，由射频振荡器按不同于谐振输出电路的谐振频率的频率驱动该输出级。通过改变形成推挽输出的开关晶体管对的导通时间，以及通过改变激振频率与串联谐振输出电路的谐振频率间的频率间隔，实现功率控制。在另一个实施例中，采用桥式结构，此结构使用两个推挽对，同时还给出又一个功率控制变量：驱动每个晶体管对的信号的相关相位。

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1.一种电外科发生器，用于给电子设备提供射频电能，其特征在于，该发生器包括：射频输出级，此级至少有一对电外科输出线端，用于将射频能量传送给所述设备；与输出级连接的电源，用于给输出级提供电能；以及控制电路，它包括检测装置，用于生成代表输出线端两端表现的射频峰值输出电压的检测信号，其中所述输出级包括连到所述输出线端的串联谐振输出电路和连到所述谐振输出电路的转换装置，而且，其中控制电路可以工作，以改变所述转换装置的转换时间间隔，从而响应预定的检测信号条件减少传送的射频能量。
2.如权利要求1所述的发生器，其特征在于，所述串联谐振输出电路包括一个电感和一个电容器的串联组合，并将其连到转换装置，使被转换的射频输出波形显示于所述串联组合两端；所述发生器的输出线端连到所述串联谐振电路，用以接收显示于电感或电容器两端的射频电压。
3.如权利要求2所述的发生器，其特征在于，连接所述输出线端，以接收显示于所述电感两端的射频电压。
4.如权利要求2所述的发生器，其特征在于，将所述串联组合连接在转换装置与接地点或一对电能供送装置的供送端之一的之间；所述发生器的一个输出线端被连到电感与电容器之间的接点。
5.如权利要求4所述的发生器，其特征在于，所述电容器连在所述转换装置与所述接点之间，而所述电感连到所述接点与在所述一个供送端上的接地点之间。
6.如权利要求2所述的发生器，其特征在于，所述转换装置包括被连接成桥式结构的半导体开关元件，所述串联组合被连到所述转换装置的反相节点之间。
7.如权利要求2至6任一项所述的发生器，其特征在于，还包括串联连接的耦合电容器，它被连在所述串联谐振电路与一个输出端线之间的信号路径中。
8.如权利要求7所述的发生器，其特征在于，所述耦合电容器的值比所述串联谐振组合的电容值小。
9.如前述任一权利要求所述的发生器，其特征在于，所述转换装置包括一对电子开关，以推挽串接方式布置于所述电源的一对供送端之间，所述串联谐振输出电路连接到所述电子开关的接点处。
10.如权利要求9所述的发生器，其特征在于，所述转换装置包括两对成桥式结构的电子开关，每一对都以推挽串接方式布置于所述供送端之间，所述串联谐振输出电路被连在一对开关间的连接点与另一对开关间的连接点之间，将所述两对开关布置成使之各以相反的相位被驱动。
11.如前述任一权利要求所述的发生器，其特征在于，将所述转换装置连接成使开关电流在射频下反复通过所述谐振输出电路，并将所述控制电路布置并连到所述转换装置，以足够快速地降低转换装置的射频占空因数，以便在预定的射频峰值输出电压阈值已经达到的100μs内造成被传送的输出功率至少减少50％。
12.如权利要求9和11，或者如权利要求10和11所述的发生器，其特征在于，将所述转换装置连接成使开关电流在射频下反复通过所述谐振输出电路，并将所述控制电路布置并连到所述转换装置，以足够快速地降低转换装置的射频占空因数，以便在预定的射频峰值输出电压阈值已经达到的100μs内造成被传送的输出功率至少减少50％，还将所述控制电路布置成驱动每一个电子开关，以便实现部分周期的转换，从而在每个射频周期内每一个开关都有可以变化的导通时间，两个开关的导通时间都是可以足够快速地被控制的，以便影响所说的在5个射频周期内至少有50％的功率减少。
13.如权利要求11或12所述的发生器，其特征在于，所述控制电路包括一个驱动级，此级有一能产生最初加给此驱动级的控制信号的斜波发生器，以降低所述射频占空因数，造成经所述输出线端被传送的输出功率至少减少50％，然后再以少许快速的速率逐渐增大所述占空因数，直至检测信号表明已再次达到预定的电压阈值。
14.如前述任一权利要求所述的发生器，其特征在于，还包括一个用以驱动转换装置的振荡器，可使该振荡器工作在与所述串联谐振组合的谐振频率不同的频率下。
15.一种电外科系统，包括：一个用于产生射频能量的发生器，和一个至少有一个浸入导电液体中使用的电极的电外科器械，其特征在于，所述发生器包括输出级，此级至少含有一个射频功率元件、一个串联谐振输出电路和至少一对被安排用以接收所述功率元件的射频能量的输出连接端，所述一对连接端之一连到所述的电极；所述发生器还包括控制级，此级能减少所述功率元件响应超过预定检测信号阈值的检测信号在每个射频周期内的导通时间，所述检测信号表示输出连接端两端所表现的峰值输出电压，从而在导电液体蒸发时，快速地减少传送给电极结构的射频能量。
16.如权利要求15所述的系统，其特征在于，所述电极结构包括一个伸出的处置电极和一个与所述处置电极隔开的接触液体的电极，此二电极都被所述导电液体包围而使用，而且它们中的每一个各自连到所述一对输出连接端之一，使所述控制级在所述处置电极处的导电液体汽化时能减少功率元件的导通时间，从而引起处置电极处的蒸汽泡破裂，并减小电负载阻抗。
17.如权利要求16所述的系统，其特征在于，所述电外科器械有一个电极结构，它有并列的第一和第二电极，用于浸入导电液体中，所述第一和第二电极分别形成在器械最前端处的组织接触电极和被置于该组织接触电极附近的回流电极。
18.如权利要求16或17所述的系统，其特征在于，连接在功率元件与输出接点之间的串联谐振电路的谐振频率不同于所述发生器的工作频率。
19.如权利要求15至18任一项所述的系统，至少按组织脱水方式和组织切割或汽化方式之一工作，其特征在于，所述发生器包括一个方式选择控制电路，所述控制级可自动工作，以调节供给所述电极结构的射频能量，以便在选择脱水方式时，将峰值发生器的输出电压限制在第一值，以及在选择切割或汽化方式时，将其限制在至少一个第二值，所述一个或多个第二值都高于第一值。
20.如权利要求18所述的系统，其特征在于，所述第一和第二值分别在150v到200v和250v到600v的范围内，这些电压都是峰值电压。
21.如权利要求15至18任一项所述的系统，至少按组织脱水方式和组织切割或汽化方式之一工作，并有用于驱动所述功率元件的射频振荡器，其特征在于，所述发生器包括一个连到所述振荡器的方式选择控制电路，用以调节振荡器的振荡频率，使得在切割或汽化方式下高于所述串联谐振输出电路的谐振频率，而在脱水方式下低于所述的谐振频率。
22.如权利要求14和7所述的系统，其特征在于，所述耦合电容器和串联谐振电路各元件的值使得振荡器频率与谐振频率之间的差值在1/4(Ccfr/Cr)和(Ccfr/Cr)之间，这里的Cc是耦合电容，Cr是所述串联谐振电路的电容元件，fr是谐振频率。
23.一种电外科发生器，用于将射频输出功率提供给电外科器械，其特征在于，所述发生器包括射频输出级，此级至少有一对用于将射频能量传送给所述器械的电外科输出连接端，一个用于对所述输出级提供射频信号的射频振荡器，以及包含检测装置的控制电路，所述检测装置用于生成表示从所述输出连接端导出的射频信号的检测信号，其中所述输出级包括一个连到所述输出连接端的串联谐振输出电路，该串联谐振输出电路的谐振频率不同于振荡器的工作频率；所述控制电路给出一个反馈信号，用以控制导出的射频能量。
24.如权利要求23所述的发生器，其特征在于，所述输出级是推挽输出级，所述控制电路与工作频率无关地改变形成部分所述输出级的一个或多个半导体器件的导通时间。
25.如权利要求23或24所述的发生器，其特征在于，将所述检测装置布置成生成表示输出连接端两端所表现的射频峰值输出电压的检测信号。
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AR012291A1 (es) 2000-10-18
GB9626512D0 (en) 1997-02-05
ES2183226T3 (es) 2003-03-16
JP2001506895A (ja) 2001-05-29
AU731415B2 (en) 2001-03-29
BR9714228A (pt) 2000-04-18
EP0949886B1 (en) 2002-09-11
WO1998027880A1 (en) 1998-07-02
DE69715452T2 (de) 2003-02-20
EP0949886A1 (en) 1999-10-20
DE69715452D1 (de) 2002-10-17
ZA9711369B (en) 1998-06-22
US6093186A (en) 2000-07-25
AU5328498A (en) 1998-07-17
CA2275405A1 (en) 1998-07-02

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