CN105078569B - Sympathetic nerve mapping ablating device and system - Google Patents
Sympathetic nerve mapping ablating device and system Download PDFInfo
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- CN105078569B CN105078569B CN201410220552.3A CN201410220552A CN105078569B CN 105078569 B CN105078569 B CN 105078569B CN 201410220552 A CN201410220552 A CN 201410220552A CN 105078569 B CN105078569 B CN 105078569B
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Abstract
The present invention provides a kind of sympathetic nerve mapping ablating device and system.The device includes guiding catheter, mapping ablation pipe and handle portion, and guiding catheter is the hollow tube of both ends open, and it is outer that it is sheathed on mapping ablation pipe；The leading portion of mapping ablation pipe can stretch out and structure in the shape of a spiral from the head end opening of guiding catheter, multiple electrodes that mapping and ablation can be carried out to sympathetic nerve are laid with the preceding section surface of mapping ablation pipe, and each electrode is respectively provided with the mapping wire and ablation wire of connecting detection device respectively and power generator；Handle portion is connected with guiding catheter, and it, which has, can control mapping to melt the part that pipe stretches out or retracted guiding catheter from the head end opening of guiding catheter.The device of the present invention can dominate point to sympathetic nerve from artery externa in operation and carry out accurately mapping and ablation, realize and targetedly detect and melt the sympathetic nerve related to illness, and avoid injury of blood vessel and the complication because for the treatment of initiation to greatest extent.
Description
Technical field
The present invention relates to a kind of medicine equipment, and in particular to a kind of sympathetic nerve mapping ablating device and system.
Background technology
Hypertension is a kind of global public disease, and not only the incidence of disease is high, and harm is huge, and it is cerebral apoplexy, hat
Worry, heart failure, the Major Risk Factors of vascular disease and renal failure, also increasingly cause load of the public to health problem
Sorrow.Particularly, intractable hypertension is a kind of high malignant disease of fatal rate in the case where being treated without active drug, and its patient
Need to take the antihypertensive drugs of a variety of different mechanism of action simultaneously to control systolic pressure and diastolic pressure, not only increase to a certain extent
Added the financial burden of patient, while also added the adverse reaction of medicine to a certain extent, thus for hypertension, especially
It is a kind of brand-new therapeutic modality for the treatment of needs of intractable hypertension.
Medical research is it has been proved that many disease senesiss of disease can be attributed to being overexcited for human body sympathetic nerve, example
Such as, kidney is mainly adjusted by sympathetic nerve autonomous control and netted postganglionic neuron, sympathetic nerve by kidney circulation,
The urinary function of kidney and the endocrine function of kidney adjust the rotation of water and electrolyte, so as to be played to blood pressure important
Adjustment effect.As the relation of sympathetic nerve and hypertension is gradually recognized, sympathetic nerve removes art and therefore is also regarded as treating
A kind of effective method of hypertension.However, this do not screen and blindly melt remove sympathetic nerve operation method
Clinically often lead to patient with operation and be associated with more serious bowel dysfunction, postural hypotension and bladder function and sexual function
The complication such as disorder, eliminated completely from the fifties in last century.
With the development of Minimally Invasive Surgery technology, go sympathetic nerve to treat hypertension through intubation intervention kidney, be from 2009
Since a kind of new mechanotherapy method for being risen in world's medical domain, this method overturned conventional all hypertension and controlled
Tradition is treated, its security treated and validity are by multiple clinical research confirmations.The apparatus of Medtronic Inc. at present
(SimplicityTM) it is uniquely to obtain the commercial product of FDA approvals and be applied to clinical treatment, it is by ablation catheter that it, which treats principle,
It is inserted into through femoral artery in the arteria renalis of left and right and discharges RF energy, ablation catheter head need to be generally close on arteria renalis inner membrance,
RF energy is discharged to melt 6~8 points, with the sympathetic nerve endings on high temperature arteria renalis vascular wall, is reached reduction and is handed over
Feel nerve excitability, reduce the secretion of kidney catecholamine and increase the purpose of renal hemodynamic, so as to treat some sympathetic nerve mistakes
Degree is excited diseases related, and these diseases also include diabetes, renal failure, arrhythmia cordis and sleep-disorder etc. in addition to hypertension.
Interventional therapy method in above-mentioned Renal vascular, avoids the wound of open surgery, but current clinical treatment knot
Fruit can not still meet needs, be primarily present two shortcomings：1. existing apparatus does not enter to the stomodaeal nervous system of renal periarterial
Rower is surveyed, thus can not confirm which/effect of which spot ablations is preferable, or more suit the medicine to the illness, therefore it uses multiple spot to draw in the net
The ablation of formula, multiple spot ablation (6~8 points) is typically carried out in the blood vessels, want to cover effective site whereby, but meeting
Cause the point-like damage of arteria renalis inner membrance more；2. the ablating electrode of existing apparatus is melted in Endovascular, RF energy
Have to pass through vascular wall and reach outer membrane, sympathetic nerve endings that could be on ablation vessels wall and externa, it is therefore necessary to use
Larger energy, but larger or excessive RF energy can cause injury of blood vessel, particularly blood vessel internal membrane damage heavier, it is postoperative
Complication is difficult to avoid that, therapeutic effect is influenceed very big.Based on above feature and problem, this treatment method since development,
Also there are some reports with treatment-related complication and contraindication, forming cicatricial kidney after being melted such as arteria renalis inner membrance multiple spot moves
Hypertension recurrence, the arteria renalis of the ablation catheter caused by single-point energy is too high caused by arteries and veins is narrow are perforated, arteria renalis artery dissection
Knurl etc., in addition this method may not apply to the patient of contrast medium sensitivity and there is arterial embolism, abdominal aorta to have in lower limb
Obvious atheromatous plaque or the arteria renalis patient in congenital malformation.
So ablation of the more scientific minimal invasive techniques realization to target sympathetic nerve is explored, by the side effect for the treatment of and simultaneously
Hair disease is preferably minimized, and the clinical treatment and application for relevant disease have very important significance.
The content of the invention
The present invention provides a kind of sympathetic nerve mapping ablating device, can in operation from artery externa to sympathetic god
Accurately mapping and ablation is carried out through dominating point, accomplishes more accurately to put ablation, is not only beneficial to improve therapeutic effect, and can be most
Avoid to limits injury of blood vessel and the complication triggered by ablation.
The present invention also provides a kind of sympathetic nerve mapping ablation system, and its electrode can realize mapping and ablation work(simultaneously
Can, and the system is provided simultaneously with multiple electrodes, and multiple electrodes are simultaneously in place, during so as to not only avoid single electrode multi-pass operation
Location difficulty, it is thus also avoided that change electrode caused by displacement；The system utilizes the detector pair sympathetic god related to illness
Through being detected, and the sympathetic nerve melted according to testing result to needs targetedly melts, and may be used also after ablation
Ablation effect is judged by mapping, it is more convenient in actual applications.
A kind of sympathetic nerve mapping ablating device provided by the invention, including guiding catheter, mapping ablation pipe and handle portion,
The guiding catheter is the hollow tube of both ends open, and it is outer that it is sheathed on the mapping ablation pipe；
The leading portion of mapping ablation pipe can stretch out and structure in the shape of a spiral from the head end opening of the guiding catheter, in institute
The preceding section surface for stating mapping ablation pipe is laid with multiple electrodes that mapping and ablation can be carried out to sympathetic nerve, and each electrode
It is respectively provided with the mapping wire and ablation wire of connecting detection device respectively and power generator；
The handle portion is connected with the guiding catheter, and it, which has, can control the mapping to melt pipe from the guiding catheter
Head end opening stretch out or retract the part of the guiding catheter.
According to sympathetic nerve mapping ablating device provided by the present invention, the mapping melts pipe by medical macromolecular materials
It is made, its both ends open and is shaped as helicoidal structure in advance, seal wire, the seal wire energy is equipped with mapping ablation pipe
Make the mapping ablation pipe substantially linearly, also, when mapping ablation pipe is stretched from the head end opening of the guiding catheter
When going out, its extension can be drawn to small part and in the shape of a spiral structure because the seal wire melts pipe tail end from the mapping.
Further, the material of the seal wire is medical metal material or medical alloy material.
The present invention also provides a kind of sympathetic nerve mapping ablation system, including any of the above-described described sympathetic nerve mapping disappears
Melt device, detector and power generator, wherein, the multiple electrodes of the mapping ablation pipe pass through mapping wire and ablation wire
It is connected respectively with the detector and the power generator.
The present invention also provides a kind of side that artery sympathetic nerve mapping and ablation are carried out using any of the above-described device or system
Method, comprise the following steps：
1) arteries is isolated using the head end of the guiding catheter；
2) the mapping ablation pipe is made to be stretched from the head end opening of the guiding catheter using the part of the handle portion
Go out or retract the guiding catheter, so as to carry out multiple spot or single-point mapping and ablation to artery sympathetic nerve.
The implementation of the present invention program, at least has the advantage that：
1st, mapping ablating device of the invention changes the method that PCI is carried out in traditional intravascular, and it passes through blood vessel
Outer membrane dominates to sympathetic nerve clicks through rower survey and ablation, without transmitting large energy to externa inside intravascular
Can be achieved targetedly to detect and melt the sympathetic nerve related to illness, required energy ratio from inner membrance melt it is small,
Therefore the damage to blood vessel is small, can avoid injury of blood vessel and the complication triggered by ablation to greatest extent.
2nd, mapping ablating device of the invention has multiple electrodes that can realize mapping function and ablation functionality simultaneously, and it can
Mapping and ablation are separately or concurrently carried out with multiple sites to sympathetic nerve, not only required site is than existing multiple spot hauling type
Ablation method is few, can be stepped up ablation energy with ascending, is accurately positioned and the progress of appropriate energy so as to realize
Ablation, the precision and efficiency of ablation increase；In addition, it can also judge to disappear by the mapping function of electrode after ablation
Melt effect, be advantageous to avoid melting the defects of incomplete, the effect of so as to improve treatment.
3rd, the site that mapping ablating device of the invention may insure to be melted under the guiding of mapping result is sympathetic
The position that nerve endings dominates, is handled by selective denervation, avoids blindly a variety of drawbacks caused by ablation；In addition its
Using less energy carry out repeatedly melt repeatedly, so as to avoid because ablation energy greatly and caused by injury of blood vessel.
4th, present system is simple in construction, easy to operate, and it can melt the state of pipe to the mapping and enter as needed
Row control, so as to realize single-point or multiple spot mapping and ablation, clinical application range is extensive, such as can be applied to belly, Urology Surgery
Deng in routine operation and open surgery, particularly it can be achieved without larger operative incision, therefore can be applied to minimally invasive hand
Art.
Brief description of the drawings
Fig. 1 is the structural representation of the sympathetic nerve mapping ablation system of the embodiment of the present invention 1；
Fig. 2 is the sectional view of the sympathetic nerve mapping ablating device of the embodiment of the present invention 1；
Fig. 3 is the structural representation of the head end of the sympathetic nerve mapping ablating device of the embodiment of the present invention 1；
Fig. 4 is the sectional view of the head end of the sympathetic nerve mapping ablating device of the embodiment of the present invention 1；
Fig. 5 is the front view of the sympathetic nerve mapping ablating device of the embodiment of the present invention 1 in a state of use；
Fig. 6 is the left view of the sympathetic nerve mapping ablating device of the embodiment of the present invention 1 in a state of use.
Embodiment
To make the object, technical solutions and advantages of the present invention clearer, below in conjunction with the embodiment of the present invention, to this hair
Technical scheme in bright embodiment is clearly and completely described, it is clear that described embodiment is that a part of the invention is implemented
Example, rather than whole embodiments.Based on the embodiment in the present invention, those of ordinary skill in the art are not making creativeness
The every other embodiment obtained under the premise of work, belongs to the scope of protection of the invention.
The sympathetic nerve mapping ablating device of the present invention, including guiding catheter, mapping ablation pipe and handle portion, guiding catheter
For the hollow tube of both ends open, it is outer that it is sheathed on mapping ablation pipe；The leading portion of mapping ablation pipe can be opened from the head end of guiding catheter
Mouthful stretch out and structure in the shape of a spiral, being laid with the preceding section surface of mapping ablation pipe multiple can carry out mapping to sympathetic nerve and disappear
The electrode melted, and each electrode is respectively provided with the mapping wire and ablation wire of connecting detection device respectively and power generator；Hand
Shank is connected with guiding catheter, and it has and mapping can be controlled to melt pipe and stretch out from the head end opening of guiding catheter or retract guiding lead
The part of pipe.
In the present invention, " mapping " refers to detecting one or more physiology clinical indices of sympathetic nerve,
It can determine whether to need to melt the sympathetic nerve in mapping site by testing result；" ablation " refers to utilizing energy
Damage and remove site to be ablated, be i.e. the sympathetic nerve in the mapping site that mapping result is positive；" head end " is referred to using friendship
Front end when feeling neural mapping ablating device in a forward direction, " leading portion "/" front end " are referred to close to guiding catheter head end
One section/one end, " back segment "/" tail end " refer to one section/one end away from guiding catheter head end.
Further, sympathetic nerve mapping ablating device of the invention can carry out the mark of single-point or multiple spot to sympathetic nerve
Survey and melt.Specifically, when from the beginning end opening stretches out guiding catheter to mapping ablation pipe, the extension of mapping ablation pipe is formed
The helicoidal structure of multiple electrodes is distributed with, so as to carry out multiple spot mapping and ablation to sympathetic nerve；When from the beginning mapping ablation is managed
When end opening stretches out guiding catheter, the head end electrode of mapping ablation pipe is exposed by head end opening from guiding catheter, so as to handing over
Sense nerve carries out single-point mapping and ablation.
The head end of guiding catheter, which should have, to be beneficial into operative incision and beneficial to the soft tissue of separation sympathetic peripheral
Shape, such as it can be in flat.Head end can be small as much as possible, and guiding catheter should have certain length,
Applied with utilizing in Minimally Invasive Surgery.Guiding catheter can be made up of high polymer material or metal material, such as polyether block acyl
Amine, polyimides, thermoplastic poly propylhomoserin, stainless steel, aluminium alloy, titanium alloy etc..
Mapping ablation pipe should can produce deformation, and it both can be substantially linearly, is thus placed in guiding catheter,
It can also structure in the shape of a spiral, wound so as to realize to form arteries, such as it can be made up of memorial alloy, also may be used
To be made up of the medical macromolecular materials for being shaped as helicoidal structure in advance.In the embodiment of the invention, mapping ablation
Pipe is made up of medical macromolecular materials, its both ends open and is shaped as helicoidal structure in advance, is equipped with mapping ablation pipe
Seal wire, seal wire can make mapping ablation pipe substantially linearly, also, be stretched out when mapping melts pipe from the head end opening of guiding catheter
When, its extension can be drawn to small part and in the shape of a spiral structure because seal wire melts pipe tail end from mapping.
The medical macromolecular materials that mapping ablation pipe is made should be flexible, such as can be polyvinyl chloride, natural rubber
Glue, polyethylene, polyamide, polypropylene, polystyrene, silicon rubber, polyester, polytetrafluoroethylene (PTFE), polymethyl methacrylate and poly-
Urethane etc.；It is preferably wherein polytetrafluoroethylene (PTFE).Also, the spiral internal diameter of the helicoidal structure formed by mapping ablation pipe can
With the external diameter equal to or less than target blood, it is preferably less than, so as to form close, stable contact to target blood.
Seal wire should have certain rigidity and elasticity, and it should can resist the elasticity of mapping ablation pipe, so that in advance
Moulding mapping ablation pipe is basic linearly and is placed in guiding catheter.When mapping ablation pipe is opened from the head end of guiding catheter
When mouth stretches out, after mapping ablation pipe tail end extracts at least part seal wire out, mapping ablation pipe can be formed under natural resiliency effect
Helicoidal structure, wound so as to be formed to target blood；And after the completion of mapping and ablation, seal wire is inserted into mapping again and disappeared
Melt in pipe, so that the screw diameter of mapping ablation pipe expands, to release the winding to target blood, and be in substantially again
Linearly and it is arranged in guiding catheter.The material of seal wire can be medical metal material or medical alloy material, such as stainless
Steel, cobalt-base alloys, titanium-base alloy etc..
Electrode should can by discharge electro photoluminescence so as to sympathetic nerve carry out mapping, can also discharge RF energy from
And sympathetic nerve is melted.When mapping melt pipe from the head end opening of guiding catheter stretch out and during structure in the shape of a spiral, cloth
Region provided with multiple electrodes should be located at least in the inner ring of helicoidal structure.For example, electrode can annularly and spacer sleeve
It is located on mapping ablation pipe.
Electrode can be made up of metal material, such as platinum, platinumiridio, gold, silver etc..The present invention does not make to the number of electrode
It is particularly limited to, as long as its number does not influence the preparation and use of apparatus of the present invention, the number of electrode for example can be 2~8.And
And each electrode can have independent numbering, it can be corresponding with the numbering on detector and power generator, so as to pass through
Detector and power generator control the sympathetic nerve on corresponding electrode pair relevant position to be accurately detected and melted.Energy
It can be radio-frequency signal generator to measure generator.
Handle portion, which should have, is beneficial to the shape that operator grips, and it can be manufactured by high polymer material, such as polyformaldehyde,
Acrylonitrile-butadiene-styrene copolymer, makrolon, polyamide, polymethyl methacrylate etc..It can be controlled in handle portion
The part that mapping ablation pipe stretches out or retracted guiding catheter from the head end opening of guiding catheter can be carried out according to common sense in the field
Conventional arrangement, such as it can be push-pull mechanism, be specifically as follows and be arranged on handle portion tail end and connect with mapping ablation pipe tail end
It the pull bar connect, can be axially moveable mapping ablation pipe by promoting or stretching pull bar, or can be in handle portion table
Cavity is opened up on face and the push rod being fixedly connected with mapping ablation pipe is set in cavity；It can also be catch mechanism, specifically may be used
To set the part that pipe can be melted to mapping and forms clamping in above-mentioned cavity, such as can be set on mapping ablation pipe raised
Portion, and the depressed part matched with the lug boss is set on the components；It can also be stop mechanism, specifically can be in above-mentioned sky
Chamber is set forms block stopped etc. to above-mentioned lug boss.
The device of the present invention can be used for, to sympathetic nerve, especially carrying out mapping and ablation to arteria renalis sympathetic nerve, its
Pipe is melted by the mapping of structure in the shape of a spiral to realize to arterial vascular winding, so as in needle holder being applied to surgery Minimally and direct-view
Point is dominated to sympathetic nerve from artery externa in operation and carries out accurately mapping and ablation, and arteries need not be passed through
Inside transmits large energy to the outer membrane of vascular wall, therefore can avoid blood vessel internal membrane damage to greatest extent.Apparatus of the present invention
The connection corresponding with detector and energy measuring device generator, therefore can be to multiple on sympathetic nerve respectively of the multiple electrodes of upper setting
Site is separately or concurrently accurately detected and melted, so as to avoid blindly drawback and injury caused by ablation.In addition,
Because the device has mapping function concurrently, therefore less energy can be used repeatedly melt repeatedly, so as to avoid because disappearing
Melt energy it is big and caused by injury of blood vessel and other complication.
In the embodiment of the invention, handle portion can include taper knob and promotion part, and taper knob offers logical
The tail end connection of Kong Bingyu guiding catheters, the tail end of the channeled conduit of back segment of mapping ablation pipe enters in through hole, and mapping
The seal wire melted in pipe stretches out from through hole tail end；The first cavity connected with through hole is provided with taper knob surface, promotion part is set
Put in the first cavity, it can control mapping ablation pipe to be axially moveable, so as to stretch out or move back from the head end opening of guiding catheter
Return guiding catheter.Wherein, through hole can be axially extending bore, and promotion part can be above-mentioned push rod, catch mechanism or stop mechanism.
Further, promotion part can include the move portion and drive division for mutually forming engagement, and at least portion of drive division
Divide and stretched out from the first cavity；Move portion is set in outside mapping ablation pipe, and it can drive mapping to disappear under the driving of drive division
Melt pipe to be axially moveable.For example, in move portion inner surface setting chute and move portion both ends can be made to form end face, positioned at shifting
Mapping ablation pipe between dynamic portion both ends end face is provided with one or more can be formed with the end face at the move portion both ends and contacted
Lug boss, lug boss can be axially moveable in chute.
The promotion part, move portion is axially moveable by rotating (rotation) drive division, and is moved axially in move portion
When, its both ends end face forms with lug boss and contacted, so that mapping ablation pipe moves axially therewith, and then melts mapping
Pipe stretches out or retracted guiding catheter from the head end opening of guiding catheter.The present invention does not make considered critical to engagement, and engagement need to only expire
Foot can move axially move portion by rotary driving part, and engagement can be engagement between tooth, for example, in move portion and
The surface of drive division sets intermeshing tooth respectively, and engagement can also be the engagement between screw thread, such as can be by move portion
It is arranged to that there is externally threaded hollow tubular structure, drive division is arranged to have female cyclic structure, drive division can cover
It is located at outside move portion, and is matched by internal thread with externally threaded so as to make move portion move vertically when rotating drive division
It is dynamic.The promotion part can make the device of the present invention easily carry out mapping and ablation associative operation.
In the embodiment of the invention, handle portion is also provided with to control what mapping ablation pipe axially rotated
Direction controlling portion, is additionally provided with the second cavity connected with through hole on taper knob surface, and direction controlling portion is arranged on the second cavity
In.For example, direction controlling portion can include fixed part and rotation section, rotation section has the through hole that cross sectional shape is polygon,
It is set in outside mapping ablation pipe, and mapping ablation pipe at least there is subregion can match with the through hole of rotation section, so that
Mapping melt pipe from the head end opening of guiding catheter stretch out preset length when, mapping ablation pipe remain to the portion of being rotated drive and along axle
To rotation；At least part of rotation section is stretched out from the second cavity, and radial direction screw is offered on taper knob, and fixed part is screwed onto footpath
Into screw and it is butted in move portion.
Further, polygon can be regular polygon, such as square, regular hexagon, octagon etc., preferably
For regular hexagon.Direction control unit by the way that by mapping ablation tube portion, to be arranged to section be polygon, and by setting and
Its rotation section to match so that mapping ablation pipe freely moves axially, be advantageous to control mapping ablation pipe in stretching and
In the shape of a spiral during structure spiral direction.
Form can also be offered on taper knob surface, form exposes mapping ablation pipe.Form can be used for mark
The length for surveying ablation pipe stretching guiding catheter measures, so that the more easily practical operation of operator.
In the present invention, the set location of the first cavity, the second cavity with form on taper knob surface does not limit strictly
Fixed, such as the first cavity can be arranged on the rear end of taper knob, the second cavity can be arranged on the front end of taper knob, and form can be with
It is arranged between the first cavity and the second cavity.Also, it can be interconnected between the first cavity, the second cavity and form,
It can separate each other.
The sympathetic nerve mapping ablation system of the present invention, including any of the above-described sympathetic nerve mapping ablating device, detection
Device and power generator, wherein, mapping ablation pipe multiple electrodes by mapping wire and melt wire respectively with detector and
Power generator connects.
When carrying out artery sympathetic nerve mapping and ablation using the device or system of the present embodiment, guiding can be utilized first
The head end of conduit isolates arteries；Secondly mapping is made to melt head end of the pipe from guiding catheter using the above-mentioned part of handle portion
Guiding catheter is stretched out or retracted to opening, so as to carry out multiple spot or single-point mapping and ablation to artery sympathetic nerve.
It is possible to further manipulate the drive division of promotion part, mapping is melted pipe and stretched out from the head end opening of guiding catheter；
Then at least part seal wire is extracted out from mapping ablation pipe tail end and the mapping from the head end opening stretching of guiding catheter is melted pipe
Structure in the shape of a spiral, target artery is formed and wound；Electro photoluminescence is discharged by each electrode again and passes on electro photoluminescence information
To detector, while one or more physiology clinical indices at each electrode stimulating position are monitored, and referred to by physiology clinic
Electrode corresponding to marking the position being positive is given off energy, and positive position is melted.And it is possible to steer direction control unit
Fixed part and rotation section, make mapping melt pipe towards target artery, then fasten fixed part.
Further, after ablation, electro photoluminescence can be discharged by electrode corresponding to positive position, while monitors corresponding sun
One or more physiology clinical indices at property position, and released energy by electrode corresponding to positive position, to positive position
Melted, until one or more physiology clinical indices at positive position are negative.
In the method for the invention, physiology clinical indices include the one or more in blood pressure, heart rate.When each electrode just
Behind position, nerve stimulation is carried out from each electrode release electro photoluminescence (such as electric pulse) respectively, and the physiology such as monitor heart rate, blood pressure is clinical
Index, when the nerve stimulation to a certain position (site) does not cause obvious physiological reaction, this position is defined as negative portion
Position；When the nerve stimulation to a certain position causes heart rate and/or blood pressure to rise, this position is defined as positive position；Then, lead to
Cross the corresponding electrode release ablation energy in positive position to be melted, so as to damage the nerve endings at the position；After ablation
Mapping is carried out again, as positive reaction disappears, is illustrated that this position is melted successfully, as positive reaction still has, is then used phase again
Co-energy or increase energy is melted, mapping again after ablation, until positive reaction disappears；Above-mentioned behaviour is implemented to all sites
After work, mapping is re-started, if each position is negative position, is melted successfully, treatment end；Such as still suffer from male portion
Position, aforesaid operations are repeated, until the positive reaction of all sites disappears, terminate treatment.
Embodiment 1
As depicted in figs. 1 and 2, the sympathetic nerve mapping ablating device of the present embodiment, including the ablation of guiding catheter 1, mapping
Pipe 2 and handle portion 3.
In combination with Fig. 3 and Fig. 4, guiding catheter 1 is the hollow tube of both ends open, and it is sheathed on outside mapping ablation pipe 2, is drawn
Conduit 1 has the head end 11 in flat, and the front end of head end 11 tilts, and guiding catheter 1 has certain length.
With further reference to Fig. 5 and Fig. 6, mapping ablation pipe 2 is made up of polytetrafluoroethylene (PTFE), its both ends open and is shaped as in advance
Helicoidal structure (under relaxed state), is equipped with seal wire 21 in mapping ablation pipe 2, and seal wire 21 can make mapping ablation pipe 2 basic
Linearly, also, when mapping melts pipe 2 and stretched out from the head end opening of guiding catheter 1, its extension can be because seal wire be from mark
Survey the ablation tail end of pipe 2 and be drawn to small part and in the shape of a spiral structure.Also, the spiral internal diameter of the helicoidal structure can be less than
The external diameter of target blood, so as to form close, stable contact to target blood.
Seal wire 21 is made of stainless steel, and it can make pre- moulding mapping ablation pipe 2 basic linearly and be placed in guiding
In conduit 1.When mapping, which melts pipe 2, is stretched out from the head end opening of guiding catheter 1, at least portion is extracted out from mapping ablation pipe 2 tail end
After dividing seal wire 21, mapping ablation pipe 2 can form helicoidal structure under natural resiliency effect, so as to be twined to target blood formation
Around；And after the completion of mapping and ablation, seal wire 21 is inserted into mapping ablation pipe 2 again, so that the spiral of mapping ablation pipe 2
Enlarged-diameter, to release the winding to target blood, and it is again basic linearly and be arranged in guiding catheter 1.
8 electrodes 22 that mapping and ablation can be carried out to sympathetic nerve are laid with the preceding section surface of mapping ablation pipe 2, and
And each electrode 22 is respectively provided with the mapping wire and ablation wire 221 of connecting detection device 4 respectively and power generator 5, electrode 22
Annular in shape and interval is set on mapping ablation pipe 2.
Handle portion 3 includes taper knob 31 and promotion part, and taper knob 31 offers through hole and connected with the tail end of guiding catheter 1
Logical, the tail end of the channeled conduit 1 of back segment of mapping ablation pipe 2 enters in through hole, and the seal wire 21 in mapping ablation pipe 2 is from logical
Hole tail end stretches out；The first cavity 311 connected with through hole is provided with the surface of taper knob 31, promotion part is arranged on the first cavity
In 311.
Promotion part includes mutually forming the move portion 32 and drive division 33 of engagement, and wherein move portion 32 is with externally threaded
Hollow tube, drive division 33 is the female ring of tool, when drive division 33 is set in move portion 32, internal thread and external screw thread phase
Match somebody with somebody, so as to be axially moveable move portion 32 when rotating drive division 33, at least part of drive division 33 is stretched from the first cavity 311
Go out, so as to facilitate the practical operation of operator；Move portion 32 is set in outside mapping ablation pipe 2, and it can be in drive division 31
Driving is lower to drive mapping ablation pipe 2 to be axially moveable.
Further, the inner surface of move portion 32 is provided with chute 321, and the both ends of move portion 32 have an end face 322, and positioned at
Mapping ablation pipe 2 between the both ends end face 322 of move portion 32 is provided with one and can connect with the formation of end face 322 at the both ends of move portion 32
Tactile lug boss 23, lug boss 23 can be axially moveable in chute 321.The promotion part, make movement by rotating drive division 33
Portion 32 is axially moveable, and when move portion 32 moves axially, its both ends end face 322 forms with lug boss 23 and contacted, so as to
Mapping ablation pipe 2 is moved axially therewith, and then mapping is melted pipe 2 and stretch out or move back from the head end opening of guiding catheter 1
Return guiding catheter.
As shown in figure 1, the sympathetic nerve mapping ablation system of the present embodiment, including above-mentioned sympathetic nerve mapping ablation dress
Put, detector 4 and power generator 5, wherein, the multiple electrodes 22 of mapping ablation pipe 2 pass through mapping wire and ablation wire 221
It is connected respectively with detector 4 and power generator 5.
Further, each electrode 22 can have an independent numbering, and with the volume on detector 4 and power generator 5
It is number corresponding, so as to control corresponding electrode 22 to carry out the sympathetic nerve of corresponding site by detector 4 and power generator 5
Accurately detect and melt.
Using device or system progress the artery sympathetic nerve of the present embodiment, for example to arteria renalis sympathetic nerve mapping and disappear
Melt, comprise the following steps：
11st, arteries (arteria renalis blood vessel) is isolated using the head end 11 of guiding catheter 1；
12nd, mapping is melted pipe 2 using the promotion part of handle portion and stretch out or retract guiding from the head end opening of guiding catheter 1
Conduit 1, so as to carry out multiple spot or single-point mapping and ablation to artery sympathetic nerve；It is specifically included：
121st, the drive division 33 of promotion part is manipulated, mapping is melted pipe 2 and is stretched out from the head end opening of guiding catheter 1；
122nd, extract at least part seal wire 21 out from the mapping ablation tail end of pipe 2 and make the head end opening stretching from guiding catheter 1
Mapping ablation pipe 2 structure in the shape of a spiral, target artery is formed and wound；
123rd, electro photoluminescence is discharged by each electrode 22, while monitor each electrode 22 to stimulate caused one or more physiology
Clinical indices；
124th, electrode corresponding to the position for making physiology clinical indices be positive by power generator 5 gives off energy,
To be melted to positive position；
125th, electro photoluminescence is discharged by electrode 22 corresponding to positive position, while caused by the corresponding positive position stimulation of monitoring
One or more physiology clinical indices, wherein, physiology clinical indices include blood pressure and heart rate；
126th, released energy by electrode 22 corresponding to positive position, positive position is melted, until positive position
One or more physiology clinical indices are negative caused by stimulation.
Mapping ablating device/the system of the present embodiment changes the method that PCI is carried out in traditional intravascular, and it is logical
Cross externa to sympathetic nerve dominate click through rower survey and ablation, without inside intravascular by large energy transmit to
Externa is that can be achieved targetedly to detect and melt the sympathetic nerve related to illness, therefore can be avoided to greatest extent
Injury of blood vessel and the complication triggered by ablation；Also, by setting multiple can realize mapping function and to disappear simultaneously
Melt the electrode 22 of function, not only can separately or concurrently carry out mapping and ablation to multiple sites of sympathetic nerve, additionally it is possible to essence
Really mapping ablation site is positioned, the site that may insure to be melted under the guiding of mapping result is sympathetic nerve
The position that tip dominates, is handled by selective denervation, so as to avoid blindly a variety of drawbacks caused by ablation.The dress
Put/system can be applied in the routine operations and open surgery such as belly, Urology Surgery, particularly it is without larger operative incision
It can be achieved, can preferably be applied to Minimally Invasive Surgery.
Embodiment 2
As shown in Fig. 2 the present embodiment on the basis of embodiment 1, is further set in the first cavity 311 of taper knob 31
Put the direction controlling portion that mapping ablation pipe 2 can be controlled to axially rotate.Specifically, direction controlling portion can include the He of fixed part 34
Rotation section 35, rotation section 35 is in T shape and with the through hole that cross sectional shape is regular hexagon, and it is set in mapping ablation pipe 2
Outside, and end is connected with the tail end of guiding catheter 1, and at least there is mapping ablation pipe 2 subregion can be passed through with rotation section 35
Through hole matches so that mapping melt pipe 2 from the head end opening of guiding catheter 1 stretch out preset length when, mapping ablation pipe 2 remains to
Portion 35 is rotated to drive and axially rotate；The head end of rotation section 35 stretches out from the first cavity 311, consequently facilitating the reality of operator
Border operates；Radial direction screw is offered on taper knob 31, fixed part 34 is screwed onto in radial direction screw and is butted in move portion 35.
Direction control unit can control mapping ablation pipe 2 stretching and during structure in the shape of a spiral spiral direction.
In the present embodiment, direction controlling portion is arranged on the front end of promotion part, and direction controlling portion and promotion part it
Between can form form (i.e. the part that direction controlling portion and promotion part are not provided with the first cavity 311), form exposes mapping and disappeared
Melt pipe 2, its length that can be used for stretching out mapping ablation pipe 2 guiding catheter 1 is observed and measured, so as to more easily operate
The practical operation of person.
Using the present embodiment device or system carry out artery sympathetic nerve mapping and ablation when, mapping melt pipe 2 from
After the head end opening stretching of guiding catheter 1 (i.e. after the step 121 of embodiment 1), it is (that is, loose that direction controlling portion can be operated
Open fixed part 34 and rotate rotation section 35), mapping is melted pipe 2 towards target artery, and to target artery
After forming winding, fixed part 34 is fastened, so as to be accurately positioned.
Finally it should be noted that：Various embodiments above is merely illustrative of the technical solution of the present invention, rather than its limitations；To the greatest extent
The present invention is described in detail with reference to foregoing embodiments for pipe, it will be understood by those within the art that：Its according to
The technical scheme described in foregoing embodiments can so be modified, either which part or all technical characteristic are entered
Row equivalent substitution；And these modifications or replacement, the essence of appropriate technical solution is departed from various embodiments of the present invention technology
The scope of scheme.
Claims (6)
- A kind of 1. sympathetic nerve mapping ablating device, it is characterised in that including guiding catheter, mapping ablation is managed and handle portion,The guiding catheter is the hollow tube of both ends open, and it is outer that it is sheathed on the mapping ablation pipe；The leading portion of mapping ablation pipe can stretch out and structure in the shape of a spiral from the head end opening of the guiding catheter, in the mark The preceding section surface for surveying ablation pipe is laid with multiple electrodes that mapping and ablation can be carried out to sympathetic nerve, and each electrode has There are the mapping wire and ablation wire of connecting detection device respectively and power generator；The handle portion is connected with the guiding catheter, and it, which has, can control the mapping to melt head of the pipe from the guiding catheter End opening stretches out or retracted the part of the guiding catheter；The handle portion includes taper knob and promotion part,The taper knob offers through hole and connected with the tail end of the guiding catheter, described in the back segment warp of the mapping ablation pipe The tail end of guiding catheter enters in the through hole, and the seal wire in mapping ablation pipe stretches out from the through hole tail end；The first cavity connected with the through hole is provided with the taper knob surface, it is empty that the promotion part is arranged on described first In chamber, it can control the mapping ablation pipe to be axially moveable, so as to stretch out or retract from the head end opening of the guiding catheter The guiding catheter；The promotion part includes mutually forming the move portion and drive division of engagement, and at least part of the drive division is from described the One cavity stretches out；The move portion is set in outside the mapping ablation pipe, and it can drive the mapping under the driving of the drive division Ablation pipe is axially moveable；The handle portion is additionally provided with the direction controlling portion that the mapping ablation pipe can be controlled to axially rotate, in the taper knob table The second cavity connected with the through hole is additionally provided with face, the direction controlling portion is arranged in second cavity；The direction controlling portion includes fixed part and rotation section,The rotation section has the through hole that cross sectional shape is polygon, and it is set in outside the mapping ablation pipe, the mapping Ablation pipe at least there is subregion can match with the through hole of the rotation section, so that mapping ablation pipe draws from described When the head end opening of conduit stretches out preset length, the mapping ablation pipe is remained to be driven by the rotation section and turned vertically It is dynamic；At least part of the rotation section is stretched out from second cavity,Radial direction screw is offered on the taper knob, the fixed part is screwed onto in the radial direction screw and is butted on the shifting In dynamic portion；The form for exposing the mapping ablation pipe is offered on the taper knob surface.
- 2. sympathetic nerve mapping ablating device according to claim 1, it is characterised in that the mapping melts pipe by medical High polymer material is made, and its both ends open and is shaped as helicoidal structure in advance, and seal wire is equipped with mapping ablation pipe, The seal wire can make the mapping ablation pipe substantially linearly, also, when the mapping melts pipe from the guiding catheter When head end opening is stretched out, its extension can be drawn to small part from mapping ablation pipe tail end because of the seal wire and be in spiral shell Revolve shape structure.
- 3. sympathetic nerve mapping ablating device according to claim 1, it is characterised in that the material of the seal wire is medical Metal material or medical alloy material.
- 4. sympathetic nerve mapping ablating device according to any one of claims 1 to 3, it is characterised in that when the mapping disappears Melt pipe from the head end opening of the guiding catheter stretch out and in the shape of a spiral structure when, the region for being laid with multiple electrodes is located at least in The inner ring of helicoidal structure.
- 5. sympathetic nerve mapping ablating device according to claim 4, it is characterised in that the electrode it is annular in shape and Spacer is located on the mapping ablation pipe.
- 6. a kind of sympathetic nerve mapping ablation system, it is characterised in that including any described sympathetic nerve marks of claim 1-5 Ablating device, detector and power generator are surveyed, wherein, the multiple electrodes of the mapping ablation pipe pass through mapping wire and ablation Wire is connected with the detector and the power generator respectively.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201410220552.3A CN105078569B (en) | 2014-05-22 | 2014-05-22 | Sympathetic nerve mapping ablating device and system |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201410220552.3A CN105078569B (en) | 2014-05-22 | 2014-05-22 | Sympathetic nerve mapping ablating device and system |
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| CN105078569B true CN105078569B (en) | 2017-11-10 |
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| WO2018006383A1 (en) * | 2016-07-07 | 2018-01-11 | 四川锦江电子科技有限公司 | Inter-electrode discharge ablation apparatus |
| CN108523990B (en) * | 2018-01-30 | 2020-08-07 | 青岛大学附属医院 | Microwave ablation therapeutic apparatus for treating hysteromyoma |
| CN109805926A (en) * | 2019-03-19 | 2019-05-28 | 苏州润迈德医疗科技有限公司 | Signal measurement apparatus for Intracoronary ECG |
| CN113116512B (en) * | 2019-12-31 | 2022-12-16 | 上海微创电生理医疗科技股份有限公司 | Ablation electrode assembly and ablation catheter |
| CN113995508A (en) * | 2021-11-05 | 2022-02-01 | 杭州佳量医疗科技有限公司 | Medical optical fiber guiding structure and guiding method |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| US7435248B2 (en) * | 2003-09-26 | 2008-10-14 | Boston Scientific Scimed, Inc. | Medical probes for creating and diagnosing circumferential lesions within or around the ostium of a vessel |
| US8409191B2 (en) * | 2004-11-04 | 2013-04-02 | Boston Scientific Scimed, Inc. | Preshaped ablation catheter for ablating pulmonary vein ostia within the heart |
| WO2008157399A1 (en) * | 2007-06-14 | 2008-12-24 | Hansen Medical, Inc. | System and method for determining electrode-tissue contact |
| WO2011008444A1 (en) * | 2009-06-30 | 2011-01-20 | Boston Scientific Scimed, Inc. | Map and ablate open irrigated hybrid catheter |
| US8442613B2 (en) * | 2009-07-29 | 2013-05-14 | Boston Scientific Scimed, Inc | Mapping probe assembly with skived tube body frame |
| WO2013106557A1 (en) * | 2012-01-10 | 2013-07-18 | Boston Scientific Scimed, Inc. | Electrophysiology system |
| US9717555B2 (en) * | 2012-05-14 | 2017-08-01 | Biosense Webster (Israel), Ltd. | Catheter with helical end section for vessel ablation |
| CN103584853B (en) * | 2012-08-17 | 2015-11-04 | 麦德托尼克消融前沿有限公司 | The manufacture method of the mapping catheter of monophasic action potential |
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