CN1222843A - Method for ablating interior sections of tongue - Google Patents
Method for ablating interior sections of tongue Download PDFInfo
- Publication number
- CN1222843A CN1222843A CN 97195674 CN97195674A CN1222843A CN 1222843 A CN1222843 A CN 1222843A CN 97195674 CN97195674 CN 97195674 CN 97195674 A CN97195674 A CN 97195674A CN 1222843 A CN1222843 A CN 1222843A
- Authority
- CN
- China
- Prior art keywords
- tongue
- excision
- transporter
- energy
- source
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Pending
Links
Images
Abstract
A method for reducing a volume of a tongue provides an ablative agent source. The ablative agent source is coupled to an ablative agent delivery device. At least a portion of the ablative agent delivery device is advanced into an interior of the tongue. A sufficient amount of an ablative agent is delivered from the ablative agent delivery device into the interior of the tongue to debulk a section of the tongue without damaging a hypoglossal nerve. Thereafter, the ablative agent delivery device is retracted from the interior of the tongue.
Description
Cross reference the application to related application is to be on May 22nd, 1996 applying date, title is the U.S. Patent application 08/651 of " method and apparatus of treatment airway obstruction ", 800 part renewal application, and this patent application 08/651, the 800th, the applying date is on May 3rd, 1996, title is the U.S. Patent application 08/642 of " method of treatment airway obstruction ", 053 part renewal application, and this application 08/642,053 is again to be on February 23rd, 1996 applying date, title is the U.S. Patent application 08/606 of " method of treatment airway obstruction ", 195 part renewal application, and this application 08/606, having quoted the applying date in 195 is August 18 nineteen ninety-five, title is the U.S. Patent application 08/516 of " removing the excision equipment and the system of soft palate tissue ", 781, its invention people is Stuart D.Edwards, Edward J.Gough and David L.Douglass, be to be on May 9th, 1994 applying date, title is the part renewal application of the U.S. Patent application 08/239,658 of " Method for Reducing Snoring by RF Ablationof the Uvula ".All these patent applications are included in this by reference.
The background of invention invention field
The present invention relates to a kind of device for the treatment of airway obstruction, relate in particular to a kind of with extracing energy and/or extracing agent excision tongue inside and select tissue site and do not damage hypoglossal method.Description of Related Art
Sleep apnea syndrome is a kind of medical symptom, when it is characterized in that daytime sleepiness, daystart arm pain, the hypophrenia, arrhythmia, sleep the snoring and roll.Often occurring asphyxia when this is slept by patient causes.Usually this symptom is divided into two types.One type is called " central type sleep apnea syndrome ", and its principal character is that the breathing power that occurs is repeatedly suspended (loss of respiratory effort).Second type is called " obstructive sleep apnea syndrome ", its principal character be because patient's last airway obstruction or near but do not comprise the obstruction of the respiratory tract part of larynx, and cause when sleeping asphyxia repeatedly.
Therefore, improvement up to now comprise various internal medicine, surgery the measure of physics.Medical treatment comprises the medicine that adopts except that central nervous system's inhibitor (as tranquilizer or ethanol), as medicines such as protriptyline, medroxyprogestetone acetate, acetazolamide, theophylline, nicotine.Said medicine is useful sometimes, but takes effect seldom fully.In addition, medicine often has undesirable side effects.
Surgical operation comprises Uvulopalatopharyngoplasty (uvulopalatopharyngoplasty), tonsil enucleation, serious retrognathia is implemented surgical correction and tracheostomy.In a kind of operation process, make jaw (jaw) remove (dislodged), and draw forward, so that can enter at the bottom of the tongue.These operations may be effective, but have very high operation risk concerning the patient, and these operations often are unacceptable concerning the patient.
Naturopathy comprise lose weight, nasopharynx air flue, nose CPAP (the constant pressurization of air flue) and the tongue holding device that uses various night.These Therapeutic Method have some effects, but trouble, and the patient feels under the weather, and the patient is unwilling to continue in a long time to use usually.Losing weight may be effective, but the patient seldom can accomplish.
In the patient who suffers from the central type sleep apnea syndrome, adopt phrenic nerves constant speed (phrenicnerve pacing) or diaphragm constant speed (diaphragmatic pacing) always.Phrenic nerves constant speed or diaphragm constant speed comprise and adopt electricity irritation to adjust and control the diaphragm that the patient is subjected to the domination of phrenic nerves bilateral, to help or to support ventilation.This constant speed (pacing) is seen people's such as J.Mugica Direct Diaphragm Stimulation, people's such as J.Mugica PACEvol.10 Jan-Feb.1987, the Part II, Preliminary Test of a Muscular Diaphragm PacingSystem on Human Patients is (from Neurostimulation:An Overview 1985, pp 263-279, and the ElectricalActivation of Respiration of in June, 1993 Nochomovitez in IEEE Eng. medical science and biological volume.
Yet, it is found that many patients still have obstructive sleep apnea to a certain degree, and aggravation when inspiratory force is increased by speed setter.Movable caused ventilation by diaphragm makes that also going up air flue subsides when air-breathing, and pulls down patient's tongue along throat, and makes patient's dysphagia.So these needs of patients use tracheostomy as appropriate treatment.
Measure the ventilation volume of lung by people such as F.Kaeko in the physiology larynx pacemaker that Physiological LaryngealPacemaker describes among the Trans Am Soc Artif Intern Organ, and stimulate appropriate nerve to open glottis, with the treatment dyspnea.For the treatment sleep apnea, this device is invalid.The signal that this device produces is proportional with the ventilation volume of lung, thereby signal produces too lately, and the indication that can't treat as sleep apnea.Owing to block, normally there is not ventilation volume in the sleep apnea.
A kind of therapy measure is a tracheostomy in the obstructive sleep apnea.Yet this surgical operation can cause tangible morbid state, and from the angle of beauty treatment says be many patients unacceptable.Other surgical operation comprises the tongue that stretches as much as possible, and the structure of excising and removing the part tongue and may make the air flue closure.
Therefore, people need a kind of method that does not adopt surgical operation to treat the obstructive sleep apnea disease.People also need a kind of with extracing energy and/or extracing agent excision tongue inside and select partly and do not damage hypoglossal method.
Summary of the invention
Therefore, the purpose of this invention is to provide and a kind ofly dwindle the volume of the inner selection part of tongue and do not damage hypoglossal method.
Another object of the present invention provides a kind ofly can or extract agent and delivers to and select tissue site to extract that tongue is inner to be selected part and do not damage hypoglossal method by extracing.
These and other objects of the present invention realize with a kind of so long-pending method of tongue body of dwindling.A kind of excision equipment is provided, and it comprises extracts the energy and extracts the energy transporter.At least a portion of extracing the energy transporter enters the inside of tongue.From energy transfer arrangement, abundant energy is sent to the inside of tongue,, but does not damage nervus sublingualis so that dwindle the volume of tongue.Then, extract the energy transporter from inner extraction the out of tongue.
In another embodiment, provide excision agent source.Extracing the agent source links to each other with excision agent transporter.At least a portion of extracing the agent transporter enters the inside of tongue.From extract the agent transporter, abundant excision agent is sent to the inside of tongue,, but does not damage nervus sublingualis so that dwindle the volume of tongue.Then, extract the agent transporter from inner extraction the out of tongue.
The accompanying drawing summary
Fig. 1 is the sectional view that dwindles operation (debulking) device that the present invention adopts.
Fig. 2 is the conduit of operation device and the sectional view of adapter of dwindling shown in Figure 1.
Fig. 3 is the perspective view of adapter shown in Figure 1.
Fig. 4 is and the perspective view that dwindles the relevant excision source transporter of operation device shown in Figure 1.
Fig. 5 is the perspective view that adopts the active excision source transporter of the inventive method.
What Fig. 6 described is the excision district that dwindles the operation device generation with shown in Figure 1.
The sectional view of tongue when Fig. 7 is the mouth closure.
Fig. 8 is the sectional view of mouth when opening.
Fig. 9 is the perspective view of tongue.
Figure 10 is the perspective view of back.
Figure 11 is the sectional view of tongue.
Figure 12 is hypoglossal position and the sectional view that produces the tongue of extracing the district.
Figure 13 is the sectional view of the tongue in a plurality of excisions district.
Figure 14 is the perspective view of the outside of belly (ventral surface) of tongue.
Figure 15 is the sectional view of tongue.
Figure 16 is the block diagram that adopts feedback control system of the present invention.
Figure 17 is the block diagram of analogue amplifier, analog multiplexer and microprocessor that adopts the feedback control system of Figure 16.
Figure 18 is the block diagram of temperature/impedance feedback system that can be used for controlling the cooling medium flow velocity of the conduit by Fig. 1.
Figure 19 is the graphics of the shrinking percentage of tongue after RF extracts.
Figure 20 is the two-dimentional contractible graph of cow tongue tissue when adopting RF to extract.
Figure 21 is the three-dimensional shrinkage figure that extracts the cow tongue tissue because of RF.
Figure 22 is the figure that the percent volume of tongue changed after RF extractd.
Describe in detail
See figures.1.and.2, dwindle operation device 10 shown in the figure, it produces the controlled cell necrosis of the tissue site of selecting and dwindles, and the tissue site of selection includes but is not limited to tongue, lingual tonsil and/or soft palate tissue, includes but is not limited to uvula.To dwindle operation device 10 is mounted to, make one or more excisions source transporter 12 will extract energy and/or extract agent and be sent to the selection tissue site and finish required excision, wherein said excision source transporter includes but is not limited to be used to transmit the device of excision energy and/or excision agent, the excision mode can be that chemistry is extractd (it uses any multiple different chemical compound and mixture to finish excision), ethanol is extractd, diode laser is extractd, laser fiber (harmless) excision, in conjunction with the chemotherapy of extracing, microwave (915MHz and 2.45GHz), ultrasound wave, heat is extractd or low temperature is extractd (heat or the perishing solvent that use is injected by pin, solid or gas), and the RF on all correlated frequencies.Each extracts source transporter 12 can introduce tongue inside by the tongue surface.Dwindle operation device 10 can comprise have or do not have overview function be used for transmit oxygen or narcotic wound intubate, and can draw blood or other secretions.Should be appreciated that dwindling operation device 10 is the various obstructions that are used for treating restriction gas passage in the human body.An embodiment is the treatment sleep apnea, adopt excision source transporter 12, use the various energy, include but is not limited to resistive heating, RF, microwave, ultrasound wave and liquid heat jet (liquid thermal jet), extract (generation necrocytosis) tongue, lingual tonsil and/or Adenoidal selection part.The energy preferably adopts the RF source.Then dwindle art device 10 and can be used for extracing destination organization, comprise (but being not limited to tongue, tonsil, concha nasalis, soft palate tissue, sclerous tissues and mucosal tissue.In one embodiment, dwindle art device 10 and be used for extracing the tongue interior zone, make shortened tongue little, so that increase the sectional area of air flue.The disinfectant member that induces one is introduced disinfectant in the oral cavity, with the infection of the tissue that reduces to extract.
Tongue is implemented dwindle art before, can carry out assessment before the art earlier, assessment comprises health check-up, optical fiber pharyngoscopy, surveys the cranium analysis and supervision is traced in multiple fluctuation before the art.Health check-up lays particular emphasis on head and cervical region.Also comprise the nasal cavity inspection, check the obstruction distortion of nasal septum and concha nasalis; The oropharynx (oropharyngeal) that produces because of long unnecessary soft palate or hypertrophy of tonsils blocks; And because of the plump following pharyngemphraxis that produces of the root of the tongue.
Dwindle in the controlled volume of feedback control sublingua and to be used in air flue forming effective opening.Can adopt various analgesic, as (but being not limited to) lignocaine.Can adopt the digital supersonic measuring system.Ultrasonic measurement makes biological change of shape quantification, and ultrasonic transmission and reception are provided, and adopts piezoelectric transducer (crystal), to catch up with the variation at full speed of data.
Can comprise a disinfectant introducing member 21, and make it the intake intracavity.Disinfectant introduce member 21 can in the oral cavity, introduce dwindle before the art device 10, afterwards or during introducing.In addition, disinfectant introduce member 21 can from the oral cavity, take away dwindle art device 10 in or differently remove constantly.Disinfectant introducing member 21 can be included in and dwindle in the art device 10, is included in the conduit 14 or the outside of conduit 14, and can be to have cavity to be used for the introducer of disinfectant from the selection part in disinfectant source 23 introducing oral cavities.Disinfectant is introduced member 21 and can be moved in the oral cavity, so that an only position in oral cavity is carried out disinfection.This explanation is to point out that the oral cavity is the inside of human body environment that can introduce bacteria infection in the tongue that picked-off, soft palate structure etc.Disinfectant is introduced member 21 and can be slided at conduit 14 or its outside.In addition, it can be one and the coupled optical fiber of light energy source that disinfectant is introduced member 21, and light energy source includes but is not limited to UV source 25.Optical fiber also can slide in the oral cavity.Optical fiber is used for sterilization is selected in the part in whole oral cavity or the oral cavity, and can have various tail end, realizes this purpose.
Suitable disinfection preservative includes but is not limited to Peridex, this is a kind of 0.12% gluconic acid chlorhexidine (i.e. two D-gluconic acids { 1 that contain, 1 '-hexa-methylene two [5-(rubigan) biguanide] }) collutory, moisture in this collutory base material, 11.6% alcohol, glycerol, PEG 40 sorbitan Fructus Aristolochiae acid esters, essence, saccharin sodium and FD﹠amp; C Blue No.1.
Should be appreciated that and to adopt various disinfectant, comprise other electromagnetic wavelength and various chemical analysis.Disinfectant can be before excision, extract during and/or extract the back and introduce.Can be to transmit continuously.The sterilisation level in oral cavity can be selected according to the size in the oral cavity that is sterilized.The disinfectant degree is variable.Sterilization is in order to reduce the infection of the tissue that picked-off.
The size of the cooling segment of tracheal tissue's joint face 22 is people's difference and difference due to illness.Its size is enough to make tongue in the later swelling minimum of transmission of extracing the generation source.Swelling can reduce 50% or above, 75% or more than, and 90% or more than.The amount of cooling water that is provided is enough to make patient to go home having implemented to dwindle in the later short time of operation, and does not have the risk of dysphagia.We find, by sufficient cooling is provided, can improve the excision amount of tongue interior zone in sizable zones.By providing enough big cooling segment, can make the adenoma response minimum at tracheal tissue's joint face 22.
The excision transmission plane 30 of excision source transporter 12 can be adjusted by adjustable or non-adjustable insulation sleeve 32 (Fig. 3,4 and 5).Insulation sleeve 32 can enter and withdraw from along the outer surface of the source of excision transporter 12, so that the length that increases or reduce to extract transmission plane 30.Insulation sleeve 32 can be made with various material, comprises that nylon, polyamides ethamine or other thermoplastic materials make.The size of extracing transmission plane 30 can adopt other method to change, and includes but is not limited to have a plurality of sectional excisions source transporter 12, and these segmentations can be multiplexed, or uses separately.
Specifically with reference to Fig. 4, extract source transporter 12 and have from what the outer surface of conduit 14 extended and enter length 33, and be directed to tongue inside.Entering length 33 is enough to make excision transmission plane 30 to be positioned at the selection tissue site of tongue inside.Extract transmission plane 30 and have enough length, thereby will extract the tissue site that can be sent to selection, produce desired excision level (necrocytosis) in the tissue site of selecting, and can not damage nervus sublingualis.Extract transmission plane 30 and be not the tail end that always is positioned at excision source transporter 12.Insulation 32 also can be positioned at the tail end of excision source transporter 12.In the present embodiment, extract the tail end that transmission plane 30 can not extend to excision source transporter 12.Yet, extract transmission plane 30 and still transmit enough excision energy, produce the necrocytosis that requires in the inner tissue site of selecting of tongue, and do not damage nervus sublingualis and/or tongue surface.In addition, having only a side of excision source transporter 12 or a part is can be insulated.Can also make excision source transporter 12 spread all over whole tongue, comprise near nervus sublingualis.All excisions source transporter 12 is extractd source transporter 12 and just is insulated near hypoglossal place.
In one embodiment, entering length 33 is 1.2 to 1.5cm, and the length of excision energy transmission plane 30 is 5 to 10mm, preferably is about 8mm.
In another kind of embodiment, entering length 33 especially all is enough to touch nervus sublingualis during back passing any tongue surface.
At least a portion that excision source transporter access to plant 20 makes each extract source transporter 12 enters the placement location of tongue inside.Excision source transporter access to plant 20 can also make each extract source transporter 12 and withdraw from.At the placement location place, extract transmission plane and transmit enough excision energy and/or excision effect, dwindling the volume of selection part, and can not damage nervus sublingualis and/or tongue surface.In one embodiment, to enter and will extract source transporter 12 with extractor 20 be that the angles of 60 to 90 degree (preferably 70 degree) are sent to tongue inside from conduit 14 with the longitudinal axis with respect to conduit 14 to the excision source transporter that has or do not have a guide rail 23.
In certain embodiments, excision source transporter 12 has a kind of geometry, include but is not limited to curvilinear structures, it comprises one or more insulating surfaces, or on a side, near-end or tail end place minor insulation, this is the volume for the tissue site that reduces to select, and can not damage nervus sublingualis.In one embodiment, extract source transporter 12 and introduce, and make and to have insulated part 32 near the part of hypoglossal excision source transporter 12 by any place lingual surface.Just as noted, insulated part 32 can be on the different parts of excision source transporter 12.
In an embodiment of the present invention, conduit 14 is handpieces, and among the present invention, conduit 14 will refer to (" handpiece ").Among this embodiment, the handle 16 that separates is also inessential.Dwindle the interior zone that art device 10 is used for treating tongue.The size of handpiece 14 tail ends can make it to be positioned at the oral cavity.Excision source transporter 12 part at least is positioned at handpiece 14.Excision source transporter 12 comprises extracts transmission plane 30.Excision source transporter enters member 20 and 12 couplings of the source of excision transporter, and through demarcating, make that extracing source transporter 12 when handpiece 20 is surperficial near tongue enters in the tongue from handpiece 20, handpiece 20 includes but is not limited to the tail end of handpiece 20.Excision source transporter 20 enters enough distances 33 from handpiece 20, thereby can and/or extract the interior zone that tongue is treated in agent with extracing, and can not damage nervus sublingualis or tongue surface.
Under many application scenarios, it is deflectable requiring the tail end 14 ' of conduit 14.This can adopt mechanical system or adopt memory metal to realize.Control line or other frame for movement can be contained in the inside or the outside of tail end 14 '.In one embodiment, the deflection button on the handle 16 is used for fastening control line by the doctor.This makes tail end 14 ' shrink back, and makes its deflection.Should be appreciated that and to replace control line with other machinery.Deflection can be because tissue site more difficult to get access requires.
In one embodiment, the doctor makes to withdraw from access to plant 20 edges and moves towards the direction of the tail end of adapter 34.Excision source transporter 12 can be installed with spring.When extracing source transporter access to plant 20 when mobile backward, spring makes selected excision source transporter 12 stretch out from conduit 14.
One or more cables 38 make excision source transporter 12 and the energy 40 couplings.The various energy 40 can use with the present invention, include but is not limited to RF, microwave, ultrasound wave, coherent light, incoherent light, ultrasound wave, chemistry excision, ethanol excision, conduction of heat, thermojet, in conjunction with the chemotherapy of RF, and other combination in these sources.Preferably a kind of RF generator of the energy 40.When adopting the RF energy, the doctor adopts with the RF energy 40 coupled foot switch (not shown) and starts the RF energy 40.
One or more pick offs 42 can be positioned at the inner surface or the outer surface of excision source transporter 12, insulation sleeve, perhaps are inserted in the inside of organization of human body individually.The pick off 42 feasible temperature that can accurately measure the place tissue site, so that determine: (ⅰ) scope of Zhai Chuing, whether (ⅱ) excision amount (ⅲ) needs further excision, and the geometrical boundary or the periphery of (ⅳ) extracing part.In addition, pick off 42 can prevent the damage or the excision of non-destination organization.
Pick off 42 can be a kind of traditional pick off, includes but is not limited to critesistor, thermocouple, resistive conductor etc.Right sensors 42 comprises thermocouple, J type, E type, the K type that has constantan, optical fiber, resistive conductor, thermocouple IR detector etc.The reader will be understood that pick off 42 needs not to be heat sensor.
Pick off 42 is measured temperature and/or impedance, and excision is monitored.This has just reduced the damage of target being extractd thing tissue on every side.By the temperature at each some place in guarder's body structure, can determine the periphery extractd, and can determine when and finished excision.If at a time, pick off 42 is judged the excision temperature that has surpassed requirement, then receives suitable feedback signal at the energy 40 places, and regulates the energy that is transmitted.
Dwindle art device 10 and can comprise overview function, include but is not limited to sight glass, magnification eyepiece, optical fiber, video imaging etc.
In addition, can adopt ultrasonic imaging to determine position and/or definite excision amount of excision source transporter 12.On excision source transporter 12, the conduit 14 or on an independent device one or more ultrasonic sensors 44 can be arranged.An imaging probe can be adopted in the selected tissue site or outside.A kind of suitable imaging probe is 21362 types, and it is made and sold by Hewlett-Packard.Each ultrasonic sensor 44 and a ultrasound source (not shown) coupling.
Referring now to Fig. 6, among the figure, conduit 14 is introduced in the oral cavity, and a plurality of excisions source transporter 12 enters the different excision district 46 of generation in the tongue.Utilize RF, dwindle art device 10 and both can be operated under the bipolar fashion, also can be operated under the one pole mode.Among Fig. 6, extracing the source transporter is the RF electrode that is operated under the bipolar electrode mode, produces enough excision districts 46, so that shortened tongue is little, neither can influence nervus sublingualis, and produces bigger air flue.Adopt this to dwindle method, the rear portion of tongue will be moved to the opposite direction of air flue, has consequently increased the diameter of section of air flue.
Use RF, dwindle art device 10 and can also be operated under the single electrode mode.Earth plate can be in easily on the position, for example under the chin.In the present embodiment, make single RF electrode be arranged in tongue, extract district 46 to produce first.Subsequently, the RF electrode is withdrawed from tongue, mobile conduit 14, RF electrode enter another part of tongue again from conduit 14.Produce second and extract district 46.This process can be finished for several times, in tongue, form different excision districts.
More than one excision source transporter 12 can be introduced in the tongue, and under the bipolar electrode mode, be worked.Can make one or more excisions source transporter 12 place several in the tongue again, to produce excision a plurality of connections or disconnected district 46.
Referring now to Fig. 7 to Figure 15, the various dissections of tongue shown in the figure and other organizational structuries.Different anatomical structures is as follows: genioglossus or tongue body are expressed as 48; Geniohyoid is 50; Mylohyoid is 52; Hyoid bone is 54; The tip of the tongue is 56; Ventral surface of tongue is 58; Back is 60; The back of the body (inferior dorsal) is 62 in the tongue; Epiglottis lingual surface (reflex) is 64; The tongue folliculus is 66; Uvula is 68; Gland sample tagma is 70; Lingual margin is 72; Papillae of tongue shape projection is 74; Palatine tonsil is 76; Pharynx is 78; Unnecessary pharynx is organized as 80; Tongue blind pipe (foramencecum) is 82; Nervus sublingualis is 84; Lingual frenum is 86.
Back 60 is divided into preceding 2/3 and interior back 62.Profile is determined by papillae 74 that centers on and blind pipe 82.Interior back 62 is dorsal surface of tongue below the papillae 74 and the last reflecting surface of epiglottis 64.The last reflecting surface of epiglottis 64 is the lingual surface the darkest part contiguous with epiglottis.Tongue folliculus 66 comprises lingual tonsil.
Produce and extract district 46, and do not damage nervus sublingualis 84.This provides bigger air flue, and the treatment of sleep apnea is provided.
In all cases, the generation in the location of excision source transporter 12 and excision district 46 makes nervus sublingualis 84 not picked-off or damages.Can not influence the ability of swallowing and speak.
Figure 16 shows excision source transporter 12 and is positioned on the back 60.First extracts source transporter 12 is positioned near centering on papillae 0.5cm place.Other the excision source transporter 1.6cm of being separated by, and leave the axis of centres 1cm of tongue.In one embodiment, apply the RF of 465MHz.The temperature of excision source transporter 12 tail ends is about 100 degrees centigrade.About 60 degrees centigrade of the temperature of the tail end of insulation sleeve 32.In another kind of embodiment, the temperature at insulation sleeve 32 tail end places be 43 degrees centigrade or more than.The RF energy can be the RF of the short persistent period pulse of low frequency.Realize the precision target location at the excision position that requires.The excision that one or more excisions source transporter 12 can be used for producing three-D volumes.Various excision geometries can be arranged, include but is not limited to rectilinear form, polyhedron-shaped, adjusted shape, symmetric and asymmetric repeatedly.
Below with reference to Figure 17 and Figure 18, an opening or closed circulation feedback system are coupled the pick off 42 and the energy 40.Monitor the temperature of excision source transporter 12 or tissue, and the output of the corresponding adjusting energy 40.In addition, can monitor sterilisation level in the oral cavity.If desired, the doctor can cancel blood circulation closed or open circuit.Can comprise a microprocessor in closure or the open-circuit system,, and regulate power with unlatching or powered-down.Closed circulation system adopts microprocessor 88, as controller, observes temperature, regulates RF power, observed result, presents the result again, and regulate power subsequently.
Adopt pick off 42 and feedback control system, can the tissue near excision source transporter 12 be remained under the temperature of requirement, and can not exceed this temperature.Each is extractd source transporter 20 and links to each other with source that generation is used for the independent output of each excision source transporter.The energy that output keeps transporter 12 places, excision source to select in the time span of selecting.
When using the RF electrode, measure by current sensor 90 by the electric current that the RF electrode transmits.Voltage is measured by voltage sensor 92.Subsequently, at power and impedance computation device 94 place's computing impedance and power.These values may be displayed on user interface and display 96 places.Represent the signal of power and resistance value to receive by controller 98.The signal that can also transmit with the energy in controller 98 generations, measurement and the different excisions of reception representative source.
Control signal is produced by controller 98, and this signal is proportional to the poor of actual measured value and required value.Control signal is used for regulating suitably power output by power circuit 100, extracts the desired power that transporter 12 places, source transmit so that remain on each.
In a similar fashion, the temperature of pick off 42 places detection is provided for keeping the feedback of selected power.Measure actual temperature at temperature measuring equipment 102 places, and temperature is presented on user interface and the display 96.Produce a control signal by controller 98, this control signal is proportional to poor between actual measurement temperature and the desired temperature.Control signal is used for regulating suitably power output by power circuit 100, so that remain on the desired temperature that each pick off place transmits.Can be equipped with a multiplexer, measure electric current, voltage and the temperature at numerous pick offs 42 places.
User interface and display 96 comprise operator's controller and display.Controller 98 can be coupled with imaging system, includes but is not limited to ultrasound wave, CT scan device, X ray, MRI, breast x-ray etc.In addition, also can adopt direct observation and touch imaging.
The output of current sensor 90 and voltage sensor 92 is used for keeping the selected power level in RF electrode place by controller 98.The RF energy that is transmitted has been controlled the amount of power.The power power profile that transmits can be combined in the controller 98, also can form the preset value of the energy that will transmit.Extract source transporter 12 for other, controller 98 can use other pick off that is similar to pick off 90 and 92, so that keep extracing the controlled quentity controlled variable of energy and/or excision agent.
The maintenance of the feedback generation programme-control of circuit, software and controller 98 and the selected power that do not change because of voltage or electric current, and be used for changing: the power that (I) selected, (ⅱ) dutycycle (on-off and power), (ⅲ) bipolar or one pole energy transmits, and (ⅳ) infusion medium transmission, comprise flow velocity and pressure.The temperature that these program variables monitor according to pick off 42 places or other suitable parameters is controlled and change, and be independent of the transmission that the variation of voltage or electric current keeps power.
Input with analogue amplifier 104 links to each other current sensor 90 with voltage sensor 92.Analogue amplifier 104 can be the traditional differential amplifier circuit that adopts pick off 42.The output of analogue amplifier 104 is sequentially connected to the input of A/D converter 108 by analog multiplexer 106.The output of analogue amplifier 104 is the voltage of representing each sensed temperature.Digitized amplifier output voltage is provided to microprocessor 88 by A/D converter 108.Microprocessor 88 can be the 68HC II type that obtains from Motorola.Yet, should be appreciated that the suitable microprocessor that can adopt any kind or general digital or mimic computer come computing impedance or temperature.
Value of calculation (including, but not limited to power and resistance value) may be displayed on user interface and the display 96.In addition, except the numeric representation of power or impedance, the impedance of calculating and performance number can be compared by microprocessor 88 and power and impedance limit value.When this value surpasses predetermined electric power value or resistance value, can provide alarm to user interface and display 96, and in addition, can reduce, revise or interrupt to transmit energy.Control signal from microprocessor 88 can be revised the power level that the energy 40 provides.
Figure 18 is the block diagram that can be used for controlling by the temperature/impedance feedback system of the cooling medium flow velocity of conduit 14.Energy is sent to excision source transporter 12 by the energy 44, and is applied on the tissue.Monitor 110 is determined tissue impedance according to the energy that is sent to tissue, and a resistance value and a setting value that records compared.If the resistance value that records surpasses preset value, then transmit an interrupt signal 112 to the energy 40, stop further transmitting energy to the source of excision transporter 12.If the parameter that the impedance that records or other record is in the acceptable ultimate value, then energy continues to be applied to this tissue.When tissue applies energy, pick off 12 is measured the temperature of tissue and/or the source of excision transporter 12.Comparator 114 receives the signal of the measured temperature of representative, and will be worth and represent the preset signal of desired temperature to compare.If tissue temperature is too high, then comparator 114 sends a signal to flow regulator 116, and expression needs higher cooling medium flow velocity, and when temperature does not surpass desired temperature, keeps former flow velocity.
Example 1
Dwindle art device 10 and be used for determining that two-dimentional cow tongue (bovine) shrinks.Realize the RF volume-diminished with a needle electrode.Four elaborately planned ultrasonic crystal are used for forming a square.Enable control survey, begin to write down 13% volume-diminished, in 4 hours, increase by 4% volume-diminished with 15 watts more subsequently, realize 17% volume-diminished altogether with 15W power.
Example 2
Dwindle art device 10 and be used for determining the three-dimensional shrinkage of cow tongue.Realize the RF volume-diminished with single needle electrode, produce a cube with 8 small ultrasonic crystal.Apply 16 watts at the beginning, produce 17% volume-diminished of cow tongue, apply 25 watts at the beginning and produce 25% volume-diminished, applied 25 watts in 4 hours subsequently and produce other 4% dwindle, dwindle 29% altogether.
Example 3
Realize 35% volume-diminished in the pig body, implementing down at 20 watts at the beginning is that visible three-dimensional is dwindled effect.
Referring now to Figure 19, measure the size of extracing volume with multidimensional numeral sound wave micrometry.Z-direction on average descends 20%, volume contraction 26%.Make three-dimensional tongue tissue contracts owing to aciculiform RF in the body extracts, adopt 20 watts excision as shown in figure 20.With the volume ratio after extracing preceding control volume and extracing.
Figure 20 adopts needle electrode to make the situation of the two dimension contraction that forms in the cow tongue tissue because of RF extracts.There is shown before extracing and the situation after extracing.
What Figure 21 drew is to extract 17% volume contraction of back tissue and the graph of a relation of control under 16 watts.After the excision, the excision under 25 watts causes 25% change in volume.4% regions contract in addition obtains after long-time (4 hours) after excision.
What Figure 22 described is that RF extracts later percent volume variation.16 watts, under 16 watts, carry out 20 minutes excision, under 25 watts, carry out 20 minutes excision; Apply 25 watts (4 hours) (25 watts excisions after 4 hours) after the excision for a long time.
The description of aforementioned preferred embodiment of the present invention is only described for being described.The present invention is not limited to the form of these descriptions.Clearly, to one skilled in the art, can also be by many various modification.Protection scope of the present invention is determined by hereinafter claim and equivalents thereof.
Claims (20)
1. a method that is used to dwindle the volume of tongue is characterized in that, may further comprise the steps:
Provide one to comprise excision equipment and excision energy transporter of extracing the energy;
At least make a part that excision can transporter enter the inside of tongue;
From energy transfer arrangement abundant energy is sent to the inside of tongue,, and does not damage nervus sublingualis so that dwindle the volume of one section tongue; And
Extracting excision out from the inside of tongue can transporter.
2. the method for claim 1 is characterized in that, the described energy is the RF source, and described excision can transporter be the RF electrode.
3. the method for claim 1 is characterized in that, the described energy is coherent source, and described excision can transporter be an optical fiber.
4. the method for claim 1 is characterized in that, the described energy is to add hot fluid, and described excision can transporter be conduit with closed channel, it is configured to hold and adds hot fluid.
5. the method for claim 1 is characterized in that, the described energy is to add hot fluid, and described excision can transporter be conduit with open channel, it is configured to hold and adds hot fluid.
6. the method for claim 1 is characterized in that, the described energy is refrigerative fluid, and described excision can transporter be conduit with closed channel, it is configured to hold and adds hot fluid.
7. the method for claim 1 is characterized in that, the described energy is refrigerative fluid, and described excision can transporter be conduit with open channel, it is configured to hold and adds hot fluid.
8. the method for claim 1 is characterized in that, the described energy is cryogen.
9. the method for claim 1 is characterized in that, the described energy is microwave source, and its energy that provides is from 915MHz to 2.45GHz, and described excision can transporter be a microwave antenna.
10. the method for claim 1 is characterized in that, the described energy is ultrasound source, and described excision can transporter be a ultrasonic transmitter.
11. the method for claim 1 is characterized in that, the described energy is microwave source.
12. the method for claim 1 is characterized in that, makes electrode enter the inside of tongue by the outside of belly of tongue.
13. the method for claim 1 is characterized in that, makes described excision energy transporter enter the inside of tongue by the interior back side of tongue.
14. the method for claim 1 is characterized in that, makes described excision energy transporter enter the inside of tongue by the back side of tongue.
15. the method for claim 1 is characterized in that, makes described excision energy transporter enter the inside of tongue by the tip of the tongue.
16. a method that is used to dwindle the volume of tongue is characterized in that, may further comprise the steps:
An excision agent source that links to each other with excision agent transporter is provided;
At least make a part of extracing the agent transporter enter the inside of tongue;
From extracing the agent transporter abundant excision agent is sent to the inside of tongue,, and does not damage nervus sublingualis so that dwindle the volume of one section tongue; And
Extract excision agent transporter out from the inside of tongue.
17. method as claimed in claim 16 is characterized in that, described excision agent is the mixture of chemical compound or chemical compound.
18. method as claimed in claim 16 is characterized in that, described excision agent comprises alcoholic ingredient.
19. method as claimed in claim 16 is characterized in that, described excision agent is the chemotherapy agent.
20. method as claimed in claim 19 is characterized in that, also comprises the steps:
RF is provided electrode, is used for electromagnetic energy is sent to the inside of tongue.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN 97195674 CN1222843A (en) | 1996-05-22 | 1997-05-22 | Method for ablating interior sections of tongue |
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US08/695,796 | 1996-08-12 | ||
| US08/651,800 | 1996-08-28 | ||
| CN 97195674 CN1222843A (en) | 1996-05-22 | 1997-05-22 | Method for ablating interior sections of tongue |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CN1222843A true CN1222843A (en) | 1999-07-14 |
Family
ID=5179310
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CN 97195674 Pending CN1222843A (en) | 1996-05-22 | 1997-05-22 | Method for ablating interior sections of tongue |
Country Status (1)
| Country | Link |
|---|---|
| CN (1) | CN1222843A (en) |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US11534235B2 (en) | 2019-04-04 | 2022-12-27 | Acclarent, Inc. | Needle instrument for posterior nasal neurectomy ablation |
| US11786296B2 (en) | 2019-02-15 | 2023-10-17 | Accularent, Inc. | Instrument for endoscopic posterior nasal nerve ablation |
-
1997
- 1997-05-22 CN CN 97195674 patent/CN1222843A/en active Pending
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US11786296B2 (en) | 2019-02-15 | 2023-10-17 | Accularent, Inc. | Instrument for endoscopic posterior nasal nerve ablation |
| US11534235B2 (en) | 2019-04-04 | 2022-12-27 | Acclarent, Inc. | Needle instrument for posterior nasal neurectomy ablation |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| US5879349A (en) | Apparatus for treatment of air way obstructions | |
| US6126657A (en) | Apparatus for treatment of air way obstructions | |
| US5836906A (en) | Method and apparatus for treatment of air way obstructions | |
| AU718288B2 (en) | Apparatus for cosmetically remodeling a body structure | |
| US5820580A (en) | Method for ablating interior sections of the tongue | |
| US5730719A (en) | Method and apparatus for cosmetically remodeling a body structure | |
| US5738114A (en) | Method and apparatus for treatment of air way obstructions | |
| US5807308A (en) | Method and apparatus for treatment of air way obstructions | |
| US5817049A (en) | Method for treatment of airway obstructions | |
| CN1272776A (en) | Cell necrosis apparatus using EM energy | |
| US20010051783A1 (en) | Method and apparatus for treatment of air way obstructions | |
| AU725853B2 (en) | Apparatus for cosmetically remodeling a body structure | |
| AU702374B2 (en) | Method and apparatus for treatment of air way obstructions | |
| JP2000511092A (en) | How to remove the inner part of the tongue | |
| CN1222843A (en) | Method for ablating interior sections of tongue | |
| WO1997043969A1 (en) | Apparatus for cosmetically remodeling a body structure | |
| CN1224338A (en) | Apparatus for cosmetically remodeling body structure |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| C06 | Publication | ||
| PB01 | Publication | ||
| C01 | Deemed withdrawal of patent application (patent law 1993) | ||
| WD01 | Invention patent application deemed withdrawn after publication |