CN106687060B - 微波消融导管组件、电外科手术处理目标组织的方法以及微波消融系统 - Google Patents
微波消融导管组件、电外科手术处理目标组织的方法以及微波消融系统 Download PDFInfo
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Abstract
这里提供了一种微波消融导管组件(16)。同轴电缆(38)配置成在它的近端(41)处与微波能量源(90)连接,且它的远端(44)与远侧辐射部分(42)连接。同轴电缆(38)包括内部和外部导体(40、32)和位于它们之间的电介质(50)。延伸的工作槽道(18)配置成接收同轴电缆(38),用于将同轴电缆(38)定位在目标组织(T)附近。延伸的工作槽道(18)的内表面(28)的至少一部分导电。延伸的工作槽道(18)的导电内表面(28)可以用作巴伦,以便当同轴电缆(38)的远侧辐射部分(42)被激活时维持同轴电缆(38)的内部和外部导体(40、32)之间的平衡信号。
Description
相关申请的交叉引用
本申请要求申请日为2015年8月18日的美国专利申请No.14/828,682和申请日为2014年8月26日的美国临时专利申请No.62/041,773的优先权,这两篇文献的全部内容被本文参引。
技术领域
本公开涉及一种微波消融导管组件。更特别是,本公开涉及一种包括延伸的工作槽道的微波消融导管组件,该延伸的工作槽道具有导电内表面,该导电内表面用作微波消融导管组件的微波消融导管的电磁屏蔽件或巴伦(balun)。
背景技术
微波消融涉及高频电磁波的应用,用于处理多种病症,包括在器官中或器官的肿瘤,所述器官例如为肝、脑、心脏、肺和肾。已知肿瘤细胞在比对周围健康细胞有害的温度稍低的升高温度下变性。因此,已知的处理方法(例如高热治疗)将肿瘤细胞加热至高于41℃的温度,同时使得相邻的健康细胞保持在较低温度,以避免不可逆的细胞损害。这种方法可以包括施加电磁辐射或微波能量,以便加热组织,并且包括组织的消融和凝固。特别是,微波能量用于消融组织,以便使得癌细胞变性或杀死癌细胞。
普通的微波消融系统通常包括经由供给管线而联接到微波能量源的一个或更多个微波消融导管,该供给管线通常呈同轴电缆的形式。微波消融导管布置在目标组织附近,且微波能量施加给微波消融导管,从而使得目标组织局部加热。微波消融导管通常相对较薄和挠性,以便使得用户能够引导微波消融导管通过前述器官(例如肺)之一的管腔网络。
当处理肺的恶性肿瘤时,微波消融系统通常与电磁引导(EMN)系统结合使用。一种这样的系统在美国专利No.6,188,355以及公开的PCT申请WO00/10456和WO01/67035中描述,这些文献的全部内容被本文参引。EMN系统通常包括:支气管镜;导管组件,该导管组件包括在它的可操纵的远侧末端处的位置传感器;延伸的工作槽道,该延伸的工作槽道延伸超过支气管镜的范围,并成为用于随后的诊断工具通向目标部位的路径;以及计算机系统,该计算机系统向医生或用户提供肺的导航视图。一旦支气管镜插入病人的肺中,具有延伸的工作槽道的导管组件就插入支气管镜中。利用导航系统和可操纵的远侧末端,导管组件和延伸的工作槽道被导航至目标位置。然后,导管组件取出,从而使得延伸的工作槽道保留就位。然后,微波消融导管能够插入延伸的工作槽道内,并被引导至目标位置。
如前所述,微波消融导管通过供给管线而与微波能量源联接,该供给管线通常呈非平衡同轴电缆的形式。由于同轴电缆为非平衡的,因此通常沿同轴电缆存在微波能量损失。另外,同轴电缆可能在传送微波能量的过程中产生明显加热。为了帮助最小化由于非平衡同轴电缆而引起的能量损失,利用呈同轴电缆形式的供给管线的微波消融导管可以包括巴伦或扼流圈(choke)。在微波能量传送至微波消融导管的辐射部分以便消融组织时巴伦或扼流圈帮助平衡微波消融导管的同轴电缆,并基本阻止电流流向外部导体,电流流向外部导体可能导致沿消融导管长度的不希望的组织加热。
尽管前述微波消融导管适用于它们的预定用途,但是微波消融导管上的巴伦是增加的结构,该结构增大了微波消融导管的尺寸,这又可能降低微波消融导管的挠性。
发明内容
可以知道,具有导电内表面的延伸的工作槽道可以证明在外科手术领域中很有利,该导电内表面用作微波消融系统的微波消融导管的电磁屏蔽件和/或巴伦。
本公开的方面将参考附图详细介绍,附图中,相同参考标号表示类似或相同的元件。这里使用的术语“远”是指更远离用户的部分,而术语“近”是指更靠近用户的部分。
这里,编织的意思是通过缠绕三个或更多股线来制造,并将介绍为编织件,实际结构并不这样限制,而是可以包括其它形式,如本领域普通技术人员所知。
本公开的一个方面提供了一种微波消融导管组件,该微波消融导管组件包括消融导管和延伸的工作槽道。消融导管包括:同轴电缆,该同轴电缆有近侧部分和远侧部分;以及辐射器,该辐射器布置在同轴电缆的远侧部分处。同轴电缆还包括内部导体和外部导体。同轴电缆的近侧部分能够与微波能量源操作性连接。延伸的工作槽道配置成接收消融导管,用于将辐射器定位在目标组织附近。延伸的工作槽道包括导电内表面,其中,当将微波能量施加给微波消融导管组件时,沿同轴电缆的外部导体传导的能量被捕获在延伸的工作槽道的导电内表面内,并被防止影响在延伸的工作槽道附近的组织。
包括消融导管和延伸的工作槽道的微波消融导管组件可以通过使用位置感测系统而布置在病人体内。延伸的工作槽道还可以包括在它的近端处的槽缝,该槽缝配置成与位于消融导管上的相应机械接口可释放地接合。机械接口还可以配置成随着槽缝运动,以便将同轴电缆的远侧辐射部分锁定在确定于槽缝内的多个位置中的至少一个中。还可以沿槽缝来提供标记,标记可以配置成表示四分之一波长增量。延伸的工作槽道还可以包括绝缘器,该绝缘器使得导电内表面与延伸的工作槽道附近的组织分开。
微波消融导管组件的消融导管还可以包括一个或多个冷却导管,该冷却导管环绕同轴电缆和辐射器,以便提供用于冷却介质例如气体或液体的路径。延伸的工作槽道还可以提供用于冷却介质的开放或闭合路径,以便冷却介质在延伸的工作槽道内循环或通过该延伸的工作槽道。
本公开的一个方面提供了一种电外科手术处理目标组织的方法。将延伸的工作槽道定位在目标组织附近,该延伸的工作槽道有导电内表面的至少一部分。然后,将具有外部导体的消融导管穿过延伸的工作槽道插入,使得消融导管的辐射器超过延伸的工作槽道的远端延伸。然后,将能量施加给消融导管,以使得电外科手术能量从辐射器发射从而电外科手术处理目标组织。在将能量施加消融导管时,沿消融导管的外部导体传导的任何能量都被捕获在延伸的工作槽道的导电内表面中,从而防止能量影响延伸的工作槽道附近的组织。
电外科手术处理目标组织的方法还可以包括使得消融导管的机械接口与沿提供于延伸的工作槽道上的槽缝确定的至少一个机械接口接合,以便将消融导管的辐射器锁定在处于延伸的工作槽道的远端的远侧的位置中。槽缝可以提供在延伸的工作槽道的近端处,并可以配置成与位于消融导管上的机械接口可释放地联接。还可以沿该槽缝提供标记,该标记可以表示四分之一波长增量。所述方法还可以包括将消融导管的机械接口向远侧运动,以便将消融导管锁定在槽缝内的至少一个其它位置中,以便调节消融导管的内部导体和外部导体之间的信号平衡。延伸的工作槽道的导电内表面还可以包括编织结构。
本公开的一个方面提供了一种微波消融系统。该微波消融系统包括微波能量源、消融导管和延伸的工作槽道。消融导管包括:同轴电缆,该同轴电缆有近侧部分和远侧部分;以及辐射器,该辐射器布置在同轴电缆的远侧部分处。同轴电缆包括内部导体和外部导体,同轴电缆的近侧部分与微波能量源操作性连接。延伸的工作槽道配置成接收消融导管,用于将辐射器定位在目标组织附近。延伸的工作槽道包括导电内表面,其中,在将微波能量施加给消融导管时,沿同轴电缆的外部导体传导的能量被捕获在延伸的工作槽道的导电内表面内,并被防止影响在延伸的工作槽道附近的组织。
附图说明
下面将参考附图介绍本公开的多个实施例,附图中:
图1是EMN系统的示意图,该EMN系统配置成与根据本公开的示例实施例的微波消融导管一起使用;
图2是根据本公开的实施例的微波消融导管的透视图;
图3A是图1中所示的导管引导组件的延伸的工作槽道的远侧部分和近侧部分的透视图;
图3B是图3A中所示的延伸的工作槽道的一个实施例的横剖图;
图4是微波消融导管的透视图,该微波消融导管定位在延伸的工作槽道内,并且远侧辐射部分定位在目标组织内;以及
图5是根据本公开定位在金属海波管内的微波消融导管的透视图。
具体实施方式
本公开涉及一种微波消融导管组件和一种用于将微波消融天线布置在管腔结构(例如在肺中的支气管的路径)内的方法。本公开的实施例包括无扼流圈的微波消融导管或者没有巴伦的微波消融导管。还一些实施例涉及具有变化的巴伦或扼流圈的微波消融导管。本公开的还一些实施例涉及一种改进的微波消融导管组件,该微波消融导管组件具有提高的挠性和减少数目的部件,同时提供足够的治疗效果。
下面详细介绍本公开的实施例;不过,所述实施例只是本公开的实例,本公开可以以多种形式来实施。因此,这里公开的具体结构细节和功能细节不能解释为限制性的,而是作为权利要求的基础和用于教导本领域技术人员的示例基础,以便以实际上任意合适的详细结构来实施本公开。
图1表示了根据本公开的EMN系统10。一个这样的EMN系统10是当前由Covidien LP出售的ELECTROMAGETIC NAVIGATION(电磁导航支气管镜)系统。通常,EMN系统10包括支气管镜72、两种不同类型的导管引导组件11和12中的一个或多个、监视设备74、电磁场产生器76、追踪模块80和计算机系统82。图1表示了躺在手术台70上的病人“P”,该手术台70包括电磁场产生器76。多个传感器78布置在病人“P”上,这些传感器在由电磁场产生器76产生的磁场中的位置能够由追踪模块80来确定。
每个导管引导组件11、12包括延伸的工作槽道18,该延伸的工作槽道18配置成接收包括传感器22的可定位引导导管20。可定位引导导管20与EMN系统10电连接,特别是,追踪模块80能够在管腔网络(例如病人“P”的肺)内导航和追踪传感器22,以便到达指定目标。如在后面更详细所述,延伸的工作槽道18配置成接收仪器,该仪器包括可定位引导导管20和传感器22、活检工具和微波消融导管16以及其它装置,而并不脱离本公开的范围。
图1和2表示了根据本公开一个实施例的消融导管16。消融导管16包括同轴电缆38。同轴电缆38包括与微波能量源90(图1)联接的近端41。冷却源92与消融导管16连接,以便使得冷却流体循环,如后面更详细所述。如图2中更详细所示,远侧辐射部分42提供于同轴电缆38的远端44处,并配置成接收内部导体40。远侧辐射部分42可以由任意合适材料形成。例如,在实施例中,远侧辐射部分42可以由陶瓷或金属,例如铜、金、银等来形成。远侧辐射部分42可以包括任意合适的配置,包括但不局限于钝头配置、扁平配置、半球形配置、尖头配置、杠铃配置、组织穿刺配置等。远侧辐射部分42可以通过钎焊、超声波焊接、粘接剂等而与同轴电缆的远端44联接。在一个实施例中,远侧辐射部分42针对内部导体40密封,以便防止流体接触内部导体40。
供给间隙58处于远侧辐射部分42的近侧,该供给间隙58通过除去同轴电缆38的外部导体32的一部分而形成,以便露出电介质50。近侧辐射部分34处于供给间隙58的近侧,该近侧辐射部分34基本上恰好是同轴电缆38的外部导体32的一部分。近侧辐射部分34、供给间隙58和远侧辐射部分42的位置和尺寸设置成获得用于消融导管16的具体辐射图形,并组合起来统称为消融导管16的辐射器35。如后面更详细所述,辐射器35的在延伸的工作槽道18外部的延伸部分能够消融组织,但是该延伸部分的长度能够根据需要变化,以便调节消融区域的形状和尺寸。
外部导体32通常由编织的导电材料来形成,并沿电介质50延伸,该电介质50位于内部部导体40和外部导体32之间。外部导体32的编织配置的一个优点是它提供了具有挠性的消融导管16,以便在相对狭窄的管腔结构,例如病人的肺的气道内运动。另外,通过使用扁平电线编织和随后通过合适尺寸的模具来进行编织件压缩,编织导体的截面尺寸可以与其它导电结构相比明显减小,同时保持可接受的电性能。消融导管16可以包括一个或多个冷却导管43,该冷却导管43环绕同轴电缆38和辐射器35,这些冷却导管43能够使得冷却介质在同轴电缆38和辐射器35上通过。冷却导管提供了路径,用于冷却液体或气体到达远侧辐射部分和除去由于施加能量而产生的热量。冷却辐射器35和同轴电缆38帮助保证消融处理由加热组织的电磁能量的辐射波来进行,而不是通过同轴电缆38或远侧辐射部分42的局部加热来进行。尽管图2中表示了单个冷却导管43,但是本领域技术人员应当知道,可以使用另外的共管腔导管,以便能够有双向冷却介质流,其中,冷却介质沿向远侧方向通过同轴电缆38和第一冷却导管,到达在消融导管的远端附近的区域,然后沿向近侧方向在第一冷却导管和第二冷却导管之间返回。而且,如本领域技术人员可知,冷却导管43不是完全需要的,消融导管16可以用于未冷却或开放冷却的系统中,如后面更详细所述。
消融导管16的挠性能够变化,以便适应具体的外科手术处理过程、具体的管腔结构、具体的目标组织、临床医生的偏好等。例如,在一实施例中,可以证明使得消融导管16非常有挠性是有利的,以用于运动通过病人的肺的相对狭窄气道而运动。可选地,可以证明使得消融导管16包括较小挠性的部分,例如在消融导管16需要穿刺或穿透目标组织的位置,是有利的。
消融导管的效果之一是能量损失,当通过辐射器35而辐射至组织内的能量被反射和/或沿同轴电缆38的外部导体32向近侧运行时将产生该能量损失,从而导致低效率的系统。在一些情况下,该能量能够引起沿导管长度的加热,并影响外部导体32近侧的组织。如上所述,用于防止该能量沿外部导体横向传递的一种方法是使用巴伦或扼流圈,该巴伦或扼流圈有效地使得能量朝向远侧辐射部分42而反射回来,并提供用于消融处理的有用能量,而不是成为系统中的能量损失。形成用于挠性消融导管的巴伦的方法在美国专利申请No.13/834,581中介绍,该美国专利申请的申请日为2013年3月15日,申请人为Brannan等,标题为“微波能量-传输装置和系统”,该文献整体被本文参引。
不过,为了改善消融导管16的挠性,本公开的一个实施例并不使用巴伦或扼流圈。实际上,如图2中所示,消融导管16依靠在导管引导组件11和12,特别是延伸的工作槽道18的零部件结构上,以控制微波能量从消融导管16发射、基本约束沿外部导体32向下传播的能量,并防止该能量影响组织。
为了进一步阐明导管引导组件11、12的结构怎样影响微波能量的发射,参考图1,该图1表示了两种类型的导管引导组件11、12。两种导管引导组件11、12均可用于EMN系统10,并共用多个公共部件。各导管引导组件11、12包括手柄19,该手柄19与延伸的工作槽道18连接。延伸的工作槽道18的尺寸设置成用于布置在支气管镜72的工作槽道内。在手术中,包括电磁传感器22的可定位引导件20插入延伸的工作槽道18中并锁定就位,使得传感器22延伸超过延伸的工作槽道18的远侧末端25所需的距离。传感器22(因此延伸的工作槽道18的远端)在由电磁场产生器76产生的电磁场内的位置能够通过追踪模块80和计算机系统82而得出。导管引导组件11、12具有不同的操作机构,但是各自包括手柄19,该手柄19能够通过旋转和压缩来操纵,以便操纵延伸的工作槽道18的远侧末端25和/或在可定位引导件20的远端处的传感器22。导管引导组件11在当前市场上由Covidien LP来出售,商标名为手术工具包。类似的,导管引导组件12在当前由Covidien LP来出售,商标名为EDGETM手术工具包。两种工具包都包括手柄19、延伸的工作槽道18和可定位引导件20。对于包括手柄19、延伸的工作槽道18、可定位引导件20和传感器22的更详细说明,参考共同所有的美国专利申请No.13/836,203,该美国专利申请的申请日为2013年3月15日,申请人为Ladtkow等,该文献整体被本文参引。
如图3A中所示,延伸的工作槽道18包括导电内层28和绝缘层34。当消融导管16插入延伸的工作槽道18内,使得辐射器35延伸超过延伸的工作槽道18的远端25,且微波能量通过同轴电缆38而施加给辐射器时,导电内层28形成电磁屏蔽件,该电磁屏蔽件防止沿外部导体32向下传播的辐射能量辐射至与绝缘层34接触的组织。基本上,导电内层28产生法拉第笼,从而显著限制能量穿过延伸的工作槽道18传递。绝缘层34用于附加地使得能量与组织分离。最终,通过冷却介质沿外部导体32通过冷却导管43而有效地除去任何局部加热。具有容纳在延伸的工作槽道18内的冷却的消融导管16的这种布置的结果是由于没有巴伦而在消融导管16中能够获得更大挠性,且没有局部加热缺陷,该局部加热缺陷可能影响没有巴伦的发射控制特征的消融导管。
参考图3A和3B,图中表示了延伸的工作槽道18的局部视图。在一个实施例中,延伸的工作槽道由两层,即不导电或绝缘的外层34以及导电的内层28来形成。绝缘层34可以由医疗级的挠性塑料或聚合物材料来形成。导电内层28可以由编织的金属材料来形成,并基本固定在绝缘层的内表面上,沿延伸的工作槽道18的内壁的整个长度延伸。尽管图3B中表示为这些层同心,但是导电内层28也可以嵌入绝缘外层34中。延伸的工作槽道18可以通过包覆成型塑料来形成,以便形成外部的不导电或绝缘层34。延伸的工作槽道18有近端21和远端25。延伸的工作槽道18形成为接收消融导管16(图2中表示),在至少一个实施例中,为冷却介质提供路径,以便冷却介质在延伸的工作槽道18内循环,或者冷却介质经过延伸的工作槽道18,在两种情况下都可以在通电时冷却消融导管16。
在一个实施例中,轮毂部分26形成于延伸的工作槽道18的近端21处,并包括锁定机构24,该锁定机构24配置成与消融导管16接合。锁定机构24可以包括槽缝27,该槽缝沿轮毂部分26延伸。槽缝27包括多个机械接口29(图4中表示),这些机械接口沿限定槽缝27的相对的壁部分来定位。机械接口29可以呈棘爪、凸起等形式,它们配置成与提供在消融导管16的近端处的相应机械接口33(图2和4中表示)可释放地接合。机械接口33和多个机械接口29之间的接合选择性地将消融导管16在延伸的工作槽道18中锁定就位。应当知道,在本公开的范围内也可以使用其它锁定机构。
在图3A的实施例中,标记沿槽缝27提供于槽缝27的机械接口29(图4中所示)附近,并表示从消融导管16发射的所需频率信号的四分之一波长增量。在实施例中,每个机械接口29(开始于第一机械接口29)表示四分之一波长值;因此,第一机械接口29表示四分之一波长,第二机械接口表示一半波长,如此类推。四分之一波长增量的选择使得能够调整消融导管16和它的使用,以便获得所需的消融图形。
尽管上面参考无扼流圈的消融导管来介绍,但是消融导管16也可以包括变化的扼流圈,如在下面的多个实施例中所述,而并不脱离本公开的范围。例如,在一些实施例中,如在图2中所示,绝缘材料60的薄层(例如一层聚对苯二甲酸乙二醇酯(PET))可以用于覆盖外部导体32的一部分。该层绝缘材料60可以帮助保持外部导体32的编织结构,或者可以形成变化的巴伦结构的部件。
在这种变化的扼流圈中,导电内层28只提供于延伸的工作槽道18的一部分中。导电内层28在绝缘材料60的近端的紧邻近侧的合适位置处短路于微波消融导管16的外部导体32,从而通过导电内层28和绝缘层60的组合来产生扼流圈或巴伦。在一个实例中,导电内层28沿延伸的工作槽道18的内壁延伸一定距离,该距离大致等于从消融导管16发射的合适频率信号的四分之一波长。
一旦消融导管16延伸至延伸的工作槽道18的远端外,在巴伦短路部62和延伸的工作槽道18的导电内层28之间产生接触,从而由延伸的工作槽道18和消融导管16的组合来产生巴伦。应当知道,导电内层28的位置和巴伦短路部的位置需要配合,以便获得合适效果。
在还一实施例中,多个巴伦短路部62可以沿内部导体32以四分之一波长增量来布置,从而产生可调整的微波消融导管,该微波消融导管的位置可以在处理的过程中变化,以便获得所需的组织效果。应当知道,延伸的工作槽道18的内表面28短路于消融导管的外部导体32的实施例将需要使得电接触部布置在消融导管周围的导管上和(如果需要)冷却导管43上,以便获得电短路。
在本公开的可选实施例中,绝缘层30(该绝缘层30可以由聚四氟乙烯(PTFE)形成)可以形成于导电内层28的内表面上,该内表面形成延伸的工作槽道18的内壁。在实施例中,绝缘层30和/或导电内层28可以沿延伸的工作槽道18的内部定位成这样,使得绝缘层30和导电内表面28与一个或多个巴伦短路部62组合而形成巴伦或扼流圈。绝缘层30的内径可以为这样,使得当消融导管16处于前述延伸配置之一时,同轴电缆38的外部导体32滑动接合地经过绝缘层。绝缘层30和/或导电内表面28以及它们相对于外部导体32的最终定向能够在制造过程中进行调节,以便控制整体相位、能量场分部和/或消融导管16的温度响应。
如上所述,消融导管16可以以多种形式与延伸的工作槽道18结合使用,包括冷却和不冷却。在一个冷却实施例中,消融导管16包括一个或多个柱形冷却导管43,该柱形冷却导管43完全封装远侧辐射部分42。在第二冷却配置中,并不使用柱形冷却导管43,而是具有辐射部分42的同轴电缆38简单地穿过延伸的工作槽道18插入,且冷却介质被允许通过延伸的工作槽道18,以便冷却辐射部分42。该实施例为开放式冷却方案,冷却介质能够通过延伸的工作槽道18而逸出至病人。在允许局部冷却同轴电缆38直至绝缘层30(该绝缘层30的尺寸设置成允许同轴电缆38滑动接合)的第三配置中,消融导管16的辐射器35并不被冷却,且引入延伸的工作槽道18内的任何冷却介质可以并不超过绝缘层30,而是同轴电缆38的剩余部分被冷却。巴伦短路部62(当使用时)可以间隔开,这样,它们不会明显阻碍冷却介质的流动。冷却介质(例如CO2气体或去离子水也可以形成巴伦的一部分,从而提供附加绝缘层,该附加绝缘层与导电层28和巴伦短路部62协调操作,以便获得合适效果。
还有,尽管这里所述的微波消融导管16可能是具体的,但是本领域技术人员应当理解,在不脱离本公开范围的情况下,可以使用结构细节更简化或更复杂的其它微波消融导管实施例。
下面参考图1和4介绍使得EMN系统10到达识别目标并且能够处理病人肺内的目标组织的操作。作为初始步骤,通常进行病人“P”的成像。例如,可以获取CT图像,并将图像输入路径规划软件。一个这样的路径规划软件是当前由Covidien LP出售的规划套装。通常,在这样的路径规划软件中,观察图像,临床医生能够识别图像内的目标,并产生路径以便到达该目标。医生或用户可以使用病人“P”的在先CT扫描和软件来构建病人的管腔网络的图示,以便帮助确定和规划通向识别的目标位置的路径。一旦识别和接受了路径,该路径成为导航规划,该导航规划可以输出给导航软件,例如当前由Covidien LP出售的导航套装。
然后,病人“P”处于EMN系统10内,如图1中所示。病人“P”的位置以及在被导航的管腔结构(例如肺)内的特定特征将记录在导航规划的图像上。与追踪模块80一起操作的计算机系统82确定病人“P”的位置,从而确定一组基准坐标,该组基准坐标与导航规划的图像匹配。因此,导航软件能够将传感器22的位置叠加在导航规划的图像上,并在导航规划的图像上向用户显示导管引导组件11、12的操纵结果。这种系统还使得用户能够跟随在导航规划中表示的路径。
EMN系统10使用根据美国专利No.6,188,355以及公开PCT专利申请WO00/10456和WO01/67035的教导(这些文献整体被本文参引)的六自由度电磁位置测量系统。发射器结构76实施为定位在病人“P”下面的板或垫。多个基准传感器78与追踪模块80相互连接,该追踪模块80获得各基准传感器78和传感器22在6个自由度方面的位置。一个或多个基准传感器78(例如,3个基准传感器78)附接在病人“P”的胸部上,它们的6自由度坐标被发送给计算机82,在该计算机中,它们用于计算病人的基准坐标框架。
一旦支气管镜72插入病人“P”的肺中,将包括可定位引导件20和传感器22的延伸的工作槽道18和引导导管组件11、12插入支气管镜72中。支气管镜72与监视设备74连接,且通常包括照明源和视频成像系统。在某些情况下,可以在没有支气管镜的情况下使用可定位引导导管组件12和延伸的工作槽道18。在使得支气管镜72和导管引导组件11、12(该导管引导组件11、12包括延伸的工作槽道18和可定位引导件20)前进至楔入肺的管腔网络内的点之后,延伸的工作槽道18和可定位引导件20沿识别路径进一步前进至目标“T”。当与EMN系统10结合地工作时,引导导管组件11、12用于引导延伸的工作槽道18沿着规划的路径(该规划的路径依赖于传感器22的检测位置,如在导航软件中的图像上显示)通过病人“P”的管腔网络到达目标。
一旦处于识别目标处,可定位引导件20可以取出,延伸的工作槽道18成为通向目标“T”的路径,用于随后的诊断和处理工具(例如,活检工具、导线、进入工具、消融导管16等)。通常,临床医生可以设法获取多个活检样品,以便确认目标“T”需要处理。在一些情况下,目标组织可以直接从管腔内接近(例如,用于COPD(慢性阻塞性肺病;)、哮喘、肺癌等的支气管壁的处理)。不过,在其它实例中,目标在支气管树的管腔壁的外部,且单独使用延伸的工作槽道18和可定位引导件20不能接近目标。可能需要另外的接近工具来穿刺或切割组织,离开管腔,并接近目标组织(例如软组织内的疾病的处理)。在实施例中,目标组织“T”可以被穿刺或穿透,以便能够将消融导管16的辐射器35布置在目标“T”内(例如,在用于处理的物质内的中心)。例如,导线、穿刺工具、活检工具或消融导管16的远侧辐射部分42可以用于穿刺或穿透目标“T”。
当确定目标“T”需要处理(例如消融)时,消融导管16可以通过支气管镜72和延伸的工作槽道18定位,以便能够进行处理。消融导管16的布置可以在延伸的工作槽道18已经被导航至目标“T”之后进行。可选地,特别是在传感器22包含在延伸的工作槽道18内或包含在消融导管16自身内的实施例中,消融导管16的机械接口33可以与锁定机构24的多个机械接口29中的一个接合,延伸的工作槽道18和消融导管16可以一起被导航至目标“T”。在任一情况下,在激活消融导管16之前,辐射器35必须延伸至延伸的工作槽道18的远端25的远侧,原因是有利地用作法拉第笼的导电内表面28(如上所述)也将基本防止辐射逸出延伸的工作槽道18以及防止辐射组织。
一个或多个成像模式可以用于确认消融导管16已经合适定位(例如,在目标“T”内)。例如,计算机断层扫描(CT)、超声波、荧光透视和其它成像模式可以单独或相互组合地使用,以便确认消融导管16已经合适地定位在目标“T”内。使用CT和荧光透视成像模式两者的一种方法在共同待审的美国专利申请No.12/056,123中所述,该美国专利申请No.12/056,123的申请日为2008年3月26日,申请人为Dorian Averbruch,标题为“CT-强化的荧光透视法(CT-Enhanced Fluoroscopy)”,该文献整体被本文参引。一旦确认消融导管16合适地定位在目标组织“T”内,用户可以开始消融处理过程,向目标“T”施加合适水平的微波能量,以便获得合适的消融效果。
在消融处理过程中,当目标“T”的温度升高时,在组织部位处的总阻抗可能变化,这可能导致在内部导体40和外部导体32之间的不平衡信号。根据一个实施例,为了平衡该信号,用户能够使得消融导管16向远侧运动,以便使得消融导管的机械接口33与延伸的工作槽道18上的机械接口29脱开,这使得远侧辐射部分42进一步远离外部导电层28地移动。当需要时,用户可以使得机械接口33与延伸的工作槽道18的一个其它机械接口29(例如,与一半波长相对应的一个机械接口)接合,以便将远侧辐射部分42锁定在该更远位置中。
在本公开的还一可选实施例中,延伸的工作槽道18可以包括或者可以由金属海波管36来代替,如在图5中所示。在该实施例中,金属海波管36包含导电内表面37,并可以可选地在它的外表面上涂覆有绝缘材料,如上面关于EWC 18所述。与导电内层28(见图3A)类似,导电内表面37用作微波消融导管16的电磁屏蔽件。如上所述,金属海波管36配置成接收仪器,所述仪器包括可定位引导导管20和传感器22、活检工具和微波消融导管16以及其它仪器,而并不脱离本公开的范围。在消融处理过程中,金属海波管36或者包括金属海波管36的延伸的工作槽道18插入病人体内,并定位在目标组织“T”附近或组织内。然后,消融导管16布置在金属海波管36内,并延伸经过金属海波管36的远端。在一个实施例中,金属海波管36可以与消融导管16一起插入,该消融导管16具有能够穿刺组织“T”的尖头或穿刺配置(如图5中所示)。尽管图5显示了消融导管16具有尖头配置,但是该消融导管16的端部可以包括任意合适的结构,包括但不局限于:钝头配置、扁平配置、半球形配置、杠铃配置、组织穿刺配置等。一旦消融导管16的末端布置在目标组织“T”中,金属海波管36可以退回,以便露出消融导管16的辐射器35。如上面更详细所述,辐射器35在延伸的金属海波管之外的延伸部能够消融组织,但是该延伸部的长度能够根据需要改变以调节消融区域的形状和尺寸。
尽管已经在附图中显示了本公开的多个实施例,但并不是将本公开局限于此,本公开的范围将如本领域所允许的那样广,说明书也同样地阅读。因此,上面的说明将并不认为是限制,而只是特定实施例的解释。本领域技术人员能够设想在附加权利要求的范围和精神内的其它变化形式。
Claims (13)
1.一种微波消融导管组件,包括:
无扼流圈的消融导管,该消融导管包括:同轴电缆,该同轴电缆具有近侧部分和远侧部分,该同轴电缆的近侧部分能够操作性地连接到微波能量源,同轴电缆包括内部导体和外部导体;以及辐射器,该辐射器布置在同轴电缆的远侧部分处;
挠性的延伸的工作槽道,该挠性的延伸的工作槽道配置成接收无扼流圈的消融导管,用于将辐射器定位在目标组织附近,挠性的延伸的工作槽道被构造成用作巴伦并且包括绝缘外层和编织的导电内表面,该编织的导电内表面延伸所述挠性的延伸的工作槽道的整个长度,其中,无扼流圈的消融导管能够被选择性地接收通过挠性的延伸的工作槽道以调节传递到组织的能量,并且当微波能量施加给无扼流圈的消融导管时,沿同轴电缆的外部导体传导的能量被捕获在挠性的延伸的工作槽道的导电内表面内,并且被防止影响挠性的延伸的工作槽道附近的组织。
2.根据权利要求1所述的微波消融导管组件,还包括位置感测系统,其中:无扼流圈的消融导管和挠性的延伸的工作槽道通过使用位置感测系统而布置在病人体内。
3.根据权利要求1所述的微波消融导管组件,其中:挠性的延伸的工作槽道包括在它的近端处的槽缝,该槽缝配置成与位于无扼流圈的消融导管上的相应机械接口可释放地接合。
4.根据权利要求3所述的微波消融导管组件,其中:所述机械接口能够在槽缝内运动,以便将同轴电缆的远侧辐射部分锁定在限定于槽缝内的多个位置中的至少一个中。
5.根据权利要求4所述的微波消融导管组件,其中:沿槽缝提供标记。
6.根据权利要求5所述的微波消融导管组件,其中:标记表示四分之一波长增量。
7.根据权利要求1所述的微波消融导管组件,其中:绝缘外层构造成使得导电内表面与挠性的延伸的工作槽道附近的组织分开。
8.根据权利要求1所述的微波消融导管组件,其中:同轴电缆的内部导体超过同轴电缆的外部导体向远侧延伸,并与同轴电缆的远侧部分密封接合。
9.根据权利要求1所述的微波消融导管组件,其中:无扼流圈的消融导管还包括一个或多个冷却导管,所述冷却导管环绕同轴电缆和辐射器,以便提供用于冷却介质的路径。
10.根据权利要求9所述的微波消融导管组件,其中:冷却介质是液体或气体。
11.根据权利要求1所述的微波消融导管组件,其中:挠性的延伸的工作槽道提供用于冷却介质在挠性的延伸的工作槽道内循环的闭合路径。
12.根据权利要求1所述的微波消融导管组件,其中:挠性的延伸的工作槽道提供用于冷却介质通过该挠性的延伸的工作槽道的开放路径。
13.一种微波消融系统,包括:
微波能量源;
无扼流圈的消融导管,该消融导管包括:同轴电缆,该同轴电缆具有近侧部分和远侧部分,该同轴电缆的近侧部分与微波能量源操作性连接,同轴电缆包括内部导体和外部导体;以及辐射器,该辐射器布置在同轴电缆的远侧部分处;
延伸的工作槽道,该延伸的工作槽道配置成接收无扼流圈的消融导管,用于将辐射器定位在目标组织附近,挠性的延伸的工作槽道构造成用作巴伦并且包括绝缘外层和编织的导电内表面,该编织的导电内表面延伸所述挠性的延伸的工作槽道的整个长度,其中,无扼流圈的消融导管能够被选择性地接收通过挠性的延伸的工作槽道以调节传递到组织的能量,并且当微波能量施加给无扼流圈的消融导管时,沿同轴电缆的外部导体传导的能量被捕获在挠性的延伸的工作槽道的导电内表面内,并被防止影响挠性的延伸的工作槽道附近的组织。
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JP2017529145A (ja) | 2017-10-05 |
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EP4082463A1 (en) | 2022-11-02 |
EP3185804B1 (en) | 2020-07-01 |
EP3735928B1 (en) | 2022-07-27 |
AU2015306746A1 (en) | 2017-03-02 |
EP3735928A1 (en) | 2020-11-11 |
DK3185804T3 (da) | 2020-08-17 |
CN106687060A (zh) | 2017-05-17 |
EP3185804A1 (en) | 2017-07-05 |
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