CN108324365A - 组合的清创器和凝固器 - Google Patents
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Abstract
本发明题为“组合的清创器和凝固器”。本发明提供了一种医疗设备,所述医疗设备包括插入管,所述插入管包括外管,所述外管具有近侧端部和被配置用于插入到体腔内的远侧端部,以及邻近远侧端部穿过外管的壁的径向切割窗口开口。所述插入管还包括内管,所述内管容纳在外管内并被配置成在外管内旋转,并且包括在内管旋转时横贯径向切割窗口开口的切割刀片。医疗设备还包括设置在插入管的远侧端部的外表面上方的导电元件和沿着插入管从近侧端部延伸到远侧端部并且被联接以将能量提供到导电元件的导体。
Description
技术领域
本发明整体涉及侵入式医疗探头,并且具体地讲涉及被配置成在鼻腔和鼻旁窦内执行治疗的侵入式医疗探头。
背景技术
功能性鼻窦内窥镜手术(FESS)为用于治疗慢性鼻窦炎的常见手术类型。在典型的FESS手术中,通常去除或修改解剖结构,以便进入鼻旁窦内的开口。例如,在FESS手术期间,可将一个或多个刚性外科器械(例如,刚性内窥镜)插入到鼻孔内,以便执行操作,例如,从鼻腔和鼻旁窦的开口去除骨和粘膜组织,以及扩大此类开口以改善鼻窦引流和缓解鼻窦炎症状。可在FESS外科手术期间治疗的其他类型的组织包括息肉和骨生长。
以引用方式并入本专利申请的文献被视为本专利申请的整体部分,但是如果这些并入的文献中限定的任何术语与本说明书中明确或隐含地给出的限定相冲突,则应只考虑本说明书中的限定。
以上描述给出了本领域中相关技术的总体概述,并且不应当被解释为承认了其包含的任何信息构成对抗本专利申请的现有技术。
发明内容
根据本发明的实施方案,提供了一种医疗设备,所述医疗设备包括插入管,所述插入管包括外管和内管,所述外管具有近侧端部和被配置用于插入到体腔内的远侧端部,以及邻近远侧端部穿过外管的壁的径向切割窗口开口,内管容纳在外管内并被配置成在外管内旋转,并且包括切割刀片,所述切割刀片在内管旋转时横贯径向切割窗口开口。所述医疗设备还包括设置在插入管的远侧端部的外表面上方的导电元件和沿着插入管从近侧端部延伸到远侧端部并且被联接以将能量提供到导电元件的导体。
在一些实施方案中,远侧端部的外表面包括外管的外表面。在另外的实施方案中,远侧端部的外表面包括内管的外表面。在远侧端部的外表面包括内管的外表面的实施方案中,导体可被配置成在切割刀片关闭径向切割窗口时将能量提供到导电元件。
在另外的实施方案中,切割刀片包括第一切割刀片,并且所述医疗设备包括设置在径向切割窗口开口的边缘上的第二切割刀片。在一些实施方案中,第二切割刀片包括被配置成抓持体腔组织的一组抓持齿。在补充的实施方案中,导电元件可设置在第二切割刀片上方。
在另外的实施方案中,远侧端部包括外管远侧端部,其中内管具有内管远侧端部和内管近侧端部,并且所述医疗设备包括邻近内管远侧端部穿过内管的壁的径向抽吸窗口开口,所述径向抽吸窗口开口被配置成以特定旋转角度横贯径向切割窗口开口,并且其中内管近侧端部被联接到抽吸装置,所述抽吸装置被配置成通过径向抽吸窗口开口取出碎屑。在所述医疗设备包括径向抽吸窗口开口的实施方案中,切割刀片可设置在径向抽吸窗口开口的边缘上。
在另外的实施方案中,所述医疗设备可包括输入装置,所述输入装置可独立地控制内管的旋转以及能量向导电元件的提供,以便改变切割时间和加热时间的比率。在补充的实施方案中,体腔可选自由鼻腔和鼻旁窦组成的组。在一些实施方案中,能量包括射频能量。
根据本发明的实施方案,还提供了一种方法,所述方法包括提供插入管,所述插入管被配置用于插入到体腔内并且包括具有近侧端部和远侧端部的外管以及容纳在外管内并被配置成在外管内旋转的内管;在外管中配置邻近远侧端部穿过外管的壁的径向切割窗口开口;在内管中定位当内管旋转时横贯径向切割窗口的切割刀片;提供设置在外管的远侧端部的外表面上方的导电元件;以及提供导体,该导体沿着插入管从近侧端部延伸到远侧端部并且被联接以将能量提供到导电元件。
附图说明
本文参照附图,仅以举例说明的方式描述本发明,在附图中:
图1为根据本发明的实施方案的被配置成使用组合清创器和凝固器的医疗探头执行手术的医疗系统的示意性图解说明图;
图2为根据本发明的实施方案的医疗探头的示意性剖面图;
图3和图4为根据本发明的实施方案的医疗探头的远侧端部的示意性剖面图;以及
图5和图6为根据本发明的实施方案的示出医疗手术期间位于鼻腔中的医疗探头的远侧端部的详细示意性图。
具体实施方式
概述
各种治疗手术诸如功能性鼻窦内窥镜手术(FESS)通常使用插入到患者身体的腔内的一个或多个侵入式医疗探头。用于FESS手术中的侵入式医疗探头的示例包括被配置成切割骨和组织的清创器(也称为剃刮器和切割器),以及被配置成执行软组织的凝固和血管的止血的凝固器。
本发明的实施方案将清创器和凝固器的功能组合到单个医疗探头内。如下文所述,所述医疗探头包括插入管,所述插入管包括具有近侧端部和被配置用于插入到体腔内的远侧端部的外管,以及邻近远侧端部穿过外管的壁的径向切割窗口开口。插入管还包括容纳在外管中并被配置成在外管内旋转的内管。内管包括切割刀片,所述切割刀片在内管旋转时横贯径向切割窗口开口,从而切割(即,“清除”)突出到径向切割窗口开口内的任何骨和组织。
在本发明的实施方案中,所述医疗探头还包括设置在插入管的远侧端部的外表面上方的导电元件。在一些实施方案中,导电元件设置在外管的外表面上方,并且所述医疗探头包括沿着外管从近侧端部延伸到远侧端部并且被联接以将能量(例如,射频能量)提供到导电元件的导体。在接收能量时,导电元件被配置成在医疗手术期间将能量投射到体腔内,以便凝固体腔中的流体。
所述医疗探头还可包括沿着径向切割窗口开口的边缘设置的另外的切割刀片。在一些实施方案中,所述另外的切割刀片可包括被配置成在医疗手术期间抓持体腔组织的一组抓持齿。在导电元件设置在外管的外表面上方的实施方案中,导电元件也可设置在另外的切割刀片上方并且联接到导体,从而允许另外的切割刀片执行凝固。
在一些实施方案中,内管的远侧端部可包括被配置成在内管旋转时横贯径向切割窗口开口的径向抽吸窗口开口。当内管在其近侧端部联接到抽吸装置(本文中也称为抽吸模块)时,所述医疗探头可被配置成在医疗手术期间通过径向抽吸窗口开口取出碎屑(例如,体腔组织和凝固的血液)。
在另外的实施方案中,所述医疗探头可被配置成将能量向远侧端部的传输限制在内管相对于外管以特定旋转角度定位的时间。例如,在导电元件设置在外管上方的实施方案中,所述医疗探头可被配置成将能量向导电元件的传输限制在径向切割窗口开口与径向抽吸窗口开口对准的时间,从而允许内管中的抽吸以取出凝固的碎屑。在另外的实施方案中,内管的旋转和传输到导电元件的能量可各自被独立地控制,从而允许操作者改变清除时间和凝固时间的比率。
系统描述
图1为根据本发明的实施方案的医疗系统20的示意性图解说明图,所述医疗系统20包括组合清创器和凝固器的功能的医疗探头22以及控制台26。在图1所示的示例中,医疗系统20可用于针对患者28进行基于导管的微创鼻窦手术。
医疗探头22包括可由操作者32抓握并操纵的柄部30,以便将插入管35的远侧端部34插入到患者28的内腔(诸如鼻腔或鼻旁窦)中。在本发明的实施方案中,插入管35包括外管36和内管,所述内管容纳在外管中并被配置成在外管内旋转。内管在下文描述于参考图3和图4的说明中。
医疗探头22通常包括位置传感器(未示出),所述位置传感器产生指示远侧端部34在患者28中的当前位置的信号。在操作中,控制台26可接收信号并且将所指示的位置配准到预先采集的图像(例如,计算机断层图像),以便产生实时图像38。在一些实施方案中,控制台26可通过将指示远侧端部34的当前配准位置的图标叠加在预先采集的图像上来产生实时图像38。控制台26可将实时图像作为关于手术的信息呈现在显示器40上。
位置传感器的示例包括基于磁场的位置传感器和基于阻抗的位置传感器。磁位置跟踪技术在例如上文参考的美国专利5,391,199和6,690,963中和美国专利5,443,489、6,788,967、5,558,091、6,172,499和6,177,792中描述,所述专利的公开内容以引用方式并入本文。基于阻抗的位置跟踪技术在例如美国专利5,983,126、6,456,864和5,944,022中有所描述,所述专利的公开内容以引用方式并入本文。
以举例的方式,假设显示器40包括平板显示器,诸如液晶显示器、发光二极管显示器、有机发光二极管显示器或等离子体显示器。然而,也可采用其他显示装置来实现本发明的实施方案。在一些实施方案中,显示器40可包括触摸屏,所述触摸屏被配置成除了呈现图像38之外,还接收来自操作者32的输入。
基于从医疗系统20的医疗探头22和其他部件接收的信号,控制台26驱动显示器40以更新图像38,以呈现远侧端部34在患者体内的当前位置,以及关于正在进行的手术的状态信息和指导。在一些实施方案中,操作者32可使用一个或多个输入装置42操纵图像38。在显示器40包括触摸屏显示器的实施方案中,操作者32可通过触摸屏显示器操纵图像38。
图2为根据本发明的一个实施方案的医疗探头22的示意性剖面图。外管36包括邻近远侧端部34的径向切割窗口开口50。在本发明的实施方案中,探头22包括设置在插入管35的远侧端部上方的导电元件52。在一些实施方案中,导电元件52设置在外管36的外表面54上方。外表面54通常包括隔离聚合物,诸如TeflonTM或聚氨酯,并且导电元件52通常包括被配置成将能量投射到患者28体内以便执行凝固的薄金属层(例如,金)。
医疗探头22还包括通常呈一根或多根导线形式的导体56。在导电元件52设置在外管36上方的实施方案中,导体56从外管的近侧端部58沿着外管延伸到远侧端部34。柄部30包括在近侧端部58处联接到导体56的凝固模块60,并且导体在远侧端部34处联接到导电元件52。凝固模块60将能量(例如,射频能量)传输到导电元件52,并且被配置成监测和控制凝固参数,诸如传输到导电元件的能量的水平和持续时间。导电元件52将传输的能量投射到患者28的体腔(例如,鼻腔和/或鼻旁窦)内以便产生可用于凝固体腔中的流体(例如,血液)的热。
远侧端部34包括沿着径向切割窗口开口50的一个或多个边缘设置的外部刀片62。在图2所示的构型中,外部刀片62可包括可用于在医疗手术期间抓持体腔中的组织的一组抓持齿。在一些实施方案中,外部刀片62可涂覆有导电元件52,从而允许抓持齿在医疗手术期间执行凝固。
柄部30还包括马达64和抽吸模块66。马达64和抽吸模块66的细节和操作在下文描述于参考图3和图4的说明中。尽管图2中的构型示出了从缆线68接收电能量的柄部30中的柄部部件(即,凝固模块60、马达64和抽吸模块66),但由任何其他电能量源为柄部部件供电被认为在本发明的实质和范围内。例如,柄部可包括将电能量传输到柄部中的模块的电池。
图3和图4为根据本发明的实施方案的包括容纳在外管36内的内管70的远侧端部34的示意性剖面图。内管70的近侧端部联接到马达64,所述马达64被配置成使内管在外管36内旋转,如箭头72所指示,并且内管70的远侧端部包括切割刀片74,所述切割刀片74在马达64使内管在外管36内旋转时横贯径向切割窗口开口50,如图3和图4所示。在操作中,因凝固(即,由于导电元件52产生的热)或切割(即,通过切割刀片74)产生的任何碎屑可在碎屑正被产生时被取出。
在图3所示的构型中,内管70的远侧端部包括径向抽吸窗口开口76,和沿着径向抽吸窗口开口的边缘设置的切割刀片74。在操作中,当马达64使内管70旋转时,径向抽吸窗口开口76在马达64使内管在外管36内旋转时以特定旋转角度横贯径向切割窗口开口50。另外,远侧端部34可联接到抽吸模块66,使得碎屑(例如,组织和/或凝固的血液)可在径向抽吸窗口开口76与径向切割窗口开口50对准时从体腔内取出,如图3所示。
在一些实施方案中,导电元件52设置在内管70的外表面(未示出)上方。在这些实施方案中,导体56可从内管70的近侧端部延伸到远侧端部34,并且医疗系统20可被配置成将能量向导电元件52的传输限制在径向抽吸窗口开口76与径向切割窗口开口50相背对的时间,即,切割刀片74的旋转使径向切割窗口50关闭的时间,如图4所示。在操作中,当马达64使内管70旋转时,凝固模块60可例如在切割刀片74关闭径向切割窗口50时使传输到设置在内管上方的导电元件的能量脉动。
图5和图6为根据本发明的实施方案的示出在医疗手术期间与位于窦腔82中的窦组织80接触的远侧端部34的示意性详细视图。在图5中,操作者32将远侧端部34定位在窦腔82内,使得外部刀片62的抓持齿抓持窦组织80。在医疗手术期间,切割刀片74去除窦组织中的一些窦组织,如图6所示。另外,由导电元件52产生的热可凝固窦腔82内的血液或流体,并且任何碎屑84(例如,由导电元件凝固的血液和/或由切割刀片74切割的窦组织)可经由径向抽吸窗口开口76从窦腔移除。
在本发明的实施方案中,操作者32可利用输入装置42(或者任何其他类型的输入装置,诸如踏板开关或柄部30上的按钮)来独立地控制凝固模块60、马达64和抽吸模块66。这使得操作者32能够控制能量从凝固模块60向导电元件52的流动以便改变凝固时间,并且能够控制能量向马达64的流动以便改变切割刀片74的切割时间和速度(即,通过控制内管70的旋转)。
在另外的实施方案中,医疗系统20可被配置成独立地控制内管的旋转和传输到导电元件的能量。例如,控制台26可包括操作者32可操纵以便控制马达64的第一给定输入装置42和操作者32可操纵以便控制凝固模块60的第二给定输入装置42。在另选的实施方案中,医疗系统20可包括操纵者32可操纵以便独立地控制马达64和凝固模块60的其他类型的输入装置(例如,踏板开关)。通过允许操作者32独立地控制马达64和凝固模块60,医疗系统20使得操作者32能够改变清除(即,使用切割刀片74切割组织)时间和凝固(即,使用导电元件52加热窦腔82中的血液)时间的比率。
应当理解,上述实施方案以举例的方式被引用,并且本发明不限于上文具体示出和描述的内容。相反,本发明的范围包括上述各种特征的组合和子组合以及它们的变型和修改,本领域的技术人员在阅读上述说明时将会想到所述变型和修改,并且所述变型和修改并未在现有技术中公开。
Claims (24)
1.一种医疗设备,所述医疗设备包括:
插入管,所述插入管包括:
外管,所述外管具有近侧端部和被配置用于插入到体腔内的远侧端部,以及邻近所述远侧端部穿过所述外管的壁的径向切割窗口开口,和
内管,所述内管容纳在所述外管内并被配置成在所述外管内旋转,并且包括在所述内管旋转时横贯所述径向切割窗口开口的切割刀片;
导电元件,所述导电元件设置在所述插入管的所述远侧端部的外表面上方;以及
导体,所述导体沿着所述插入管从所述近侧端部延伸到所述远侧端部并且被联接以将能量提供到所述导电元件。
2.根据权利要求1所述的医疗设备,其中所述远侧端部的所述外表面包括所述外管的外表面。
3.根据权利要求1所述的医疗设备,其中所述远侧端部的所述外表面包括所述内管的外表面。
4.根据权利要求3所述的医疗设备,其中所述导体被配置成在所述切割刀片关闭所述径向切割窗口时将所述能量提供到所述导电元件。
5.根据权利要求1所述的医疗设备,其中所述切割刀片包括第一切割刀片,并且所述医疗设备包括设置在所述径向切割窗口开口的边缘上的第二切割刀片。
6.根据权利要求5所述的医疗设备,其中所述第二切割刀片包括被配置成抓持体腔组织的一组抓持齿。
7.根据权利要求5所述的医疗设备,其中所述导电元件设置在所述第二切割刀片上方。
8.根据权利要求1所述的医疗设备,其中所述远侧端部包括外管远侧端部,其中所述内管具有内管远侧端部和内管近侧端部,并且所述医疗设备包括邻近所述内管远侧端部穿过所述内管的壁的径向抽吸窗口开口,所述径向抽吸窗口开口被配置成以特定旋转角度横贯所述径向切割窗口开口,并且其中所述内管近侧端部被联接到抽吸装置,所述抽吸装置被配置成通过所述径向抽吸窗口开口取出碎屑。
9.根据权利要求8所述的医疗设备,其中所述切割刀片设置在所述径向抽吸窗口开口的边缘上。
10.根据权利要求1所述的医疗设备,并且所述医疗设备包括输入装置,所述输入装置独立地控制所述内管的旋转以及所述能量向所述导电元件的提供,以便改变切割时间和加热时间的比率。
11.根据权利要求1所述的医疗设备,其中所述体腔选自由鼻腔和鼻旁窦组成的组。
12.根据权利要求1所述的医疗设备,其中所述能量包括射频能量。
13.一种方法,包括:
提供插入管,所述插入管被配置用于插入到体腔内并且包括具有近侧端部和远侧端部的外管以及容纳在所述外管内并被配置成在所述外管内旋转的内管;
在所述外管中配置径向切割窗口开口,所述径向切割窗口开口邻近所述远侧端部穿过所述外管的壁;
在所述内管中定位切割刀片,所述切割刀片在所述内管旋转时横贯所述径向切割窗口;
提供导电元件,所述导电元件设置在所述外管的所述远侧端部的外表面上方;以及
提供导体,所述导体沿着所述插入管从所述近侧端部延伸到所述远侧端部并且被联接以将能量提供到所述导电元件。
14.根据权利要求13所述的方法,其中所述远侧端部的所述外表面包括所述外管的外表面。
15.根据权利要求13所述的方法,其中所述远侧端部的所述外表面包括所述内管的外表面。
16.根据权利要求15所述的方法,其中所述导体在所述切割刀片关闭所述径向切割窗口时将所述能量提供到所述导电元件。
17.根据权利要求13所述的方法,其中所述切割刀片包括第一切割刀片,并且所述方法包括将第二切割刀片设置在所述径向切割窗口开口的边缘上。
18.根据权利要求17所述的方法,其中所述第二切割刀片包括被配置成抓持体腔组织的一组抓持齿。
19.根据权利要求17所述的方法,并且所述方法包括将所述导电元件设置在所述第二切割刀片上方。
20.根据权利要求13所述的方法,其中所述远侧端部包括外管远侧端部,其中所述内管具有内管远侧端部和内管近侧端部,并且所述方法包括:提供邻近所述内管远侧端部穿过所述内管的壁的径向抽吸窗口开口,所述径向抽吸窗口开口被配置成以特定旋转角度横贯所述径向切割窗口开口;以及在所述内管近侧端部处提供抽吸装置的联接,所述抽吸装置被配置成通过所述径向抽吸窗口开口取出碎屑。
21.根据权利要求20所述的方法,并且所述方法包括将所述切割刀片设置在所述径向抽吸窗口开口的边缘上。
22.根据权利要求13所述的方法,并且所述方法包括使用一个或多个输入装置独立地控制所述内管的旋转以及所述能量向所述导电元件的提供,以便改变切割时间和加热时间的比率。
23.根据权利要求13所述的方法,其中所述体腔选自由鼻腔和鼻旁窦组成的组。
24.根据权利要求13所述的方法,其中所述能量包括射频能量。
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Also Published As
Publication number | Publication date |
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RU2017146166A (ru) | 2019-06-27 |
EP3345557B1 (en) | 2022-04-06 |
IL256630B (en) | 2022-10-01 |
IL256630A (en) | 2018-02-28 |
EP3345557A1 (en) | 2018-07-11 |
CN108324365B (zh) | 2023-06-16 |
AU2018200130A1 (en) | 2018-07-26 |
CA2991353A1 (en) | 2018-07-10 |
JP2018110859A (ja) | 2018-07-19 |
US20180193052A1 (en) | 2018-07-12 |
IL256630B2 (en) | 2023-02-01 |
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