CN203524766U - Trans-luminal wall-penetration nerve ablation catheter and equipment thereof - Google Patents
Trans-luminal wall-penetration nerve ablation catheter and equipment thereof Download PDFInfo
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- CN203524766U CN203524766U CN201320071750.9U CN201320071750U CN203524766U CN 203524766 U CN203524766 U CN 203524766U CN 201320071750 U CN201320071750 U CN 201320071750U CN 203524766 U CN203524766 U CN 203524766U
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Abstract
The utility model relates to a trans-luminal wall-penetration nerve ablation catheter and equipment thereof. The catheter body comprises a remote end part, a middle part and a near end part, wherein a wall-penetration ablation electrode is disposed on the remote end part of the catheter body, the front end of the wall-penetration ablation electrode has a well-penetration structure, can be penetrated into and pass through a luminal wall and can act on target tissues. With the utility model, measurement of volume resistance at an ablation part is implemented and conditions of nervous issue distribution and strength are detected by the petal-shaped electrode. The petal-shaped electrode can also provide resistance changes before and after the nervous ablation, reflect changes after the inflation of the nervous issues, guide control and mastering of degree of the nervous issues, increase treatment accuracy and clinical effects and prevent generation of complications.
Description
Technical field
This utility model relates to a kind of medical apparatus and instruments, more specifically relate to a kind of safer, through chamber, wear the neural ablation catheter of wall and equipment thereof efficiently.
Background technology
Neuro vegetative is in generation, differentiation and the progress of numerous disease, to play the key factor of extremely important impact extremely.As, kidney sympathetic nerve, the excessive enhancing of its activity has important effect in numerous disease: as intractable hypertension, chronic cardiac insufficiency, renal insufficiency, carbohydrate metabolism disturbance, polycystic ovarian syndrome etc.And for example vagal impact of being overexcited on digestive tract ulcer is also paid close attention to for a long time and studies for medical circle, and Vagotomy can reduce the secretion of gastric acid.The pathogeny of asthma is still completely not clear and definite so far, but has ample evidence to show that vegetative nerve obstacle is the key factor that development occurs asthma.As far back as the middle of last century, just there is scholar to adopt the trial of surgical resection art treatment intractable hypertension, but abandoned due to concurrent serious complication usually.But these clinical trials have also shown the potential therapeutic value to the blocking-up of kidney sympathetic nerve.In recent years, adopt the percutaneous kidney sympathetic nerve ablation of Wicresoft's interventional technique to start clinically application, and obtained good effect.But, on the one hand, because kidney sympathetic nerve is positioned at the outermost layer of kidney blood vessel wall, and prior art is inserted ablation catheter in renal artery sympathetic nerve being melted adopt, the heat that ablating electrode produces is first conducted to each layer of tube wall by blood vessel, finally could arrive outer, not only a large amount of energy losses is in the blood vessel wall of non-treatment region, and melt orthosympathetic in order to make enough energy arrive blood vessel external realization, must strengthen energy output and the treatment time of ablation catheter, cause the unavoidable damage of local vessel wall; On the other hand, vascular wall tissue transmits not good enough to heat, in renal artery, blood flow rate is very fast, the energy producing at endovascular ablating electrode is taken away by high speed blood flow in a large number, have a strong impact on the therapeutic effect of ablation catheter, affected the raising with clinical therapeutic efficacy of giving full play to of this less invasive techniques potential.In addition, prior art does not have the accurate method of science to the selection of radio frequency ablation site before ablation, and tool bears the character of much blindness; In art, lack the monitoring means to the Real-time and Dynamic of degree of ablation.These are all in the evaluation and the control that affect and restricting the raising of clinical effectiveness and melting quality to some extent.Need badly clinically to design and develop out and can overcome more efficient, safe new type nerve ablation techniques, the method and apparatus that is present in defect in above-mentioned prior art.
Summary of the invention
This utility model is for existing neural ablation techniques and ablation catheter design defect and deficiency, disclose a kind of brand-new design theory through tube chamber, poling wall, Wicresoft, efficient, accurate neural ablating device, reduce to the full extent the infringement of ablation catheter to non-target tube cavity tissue, simultaneously, this utility model is by implementing the measurement of volume impedance to neural ablation site, realize the target nerve that real-time dynamic monitoring melts, instruct control and the assurance of neural degree of ablation, when improving curative effect and treatment degree of accuracy, prevent the generation of complication.
Technical solution provided by the utility model is to provide a kind of for the neural ablation apparatus through tube chamber, poling wall.The basic structure of wherein wearing wall ablating electrode is: ablation catheter leading portion carrying ablating electrode is worn wall section, and its front end is sharp keen acute angle, can have sword, profile is conical, and rhombus etc., have certain length, preferred scope is: 0.01～20mm, and the preferred scope of its diameter is 0.01～2.0mm; Ablation catheter interlude carrying ablating electrode interlude, i.e. strip connection electrode, its front end is worn wall section with ablating electrode and is connected, and rear end is connected on the ablating electrode interface of joystick front end; And wear wall controller, be in the end of ablating electrode, front end is connected with ablating electrode, by position and the form that wall controller changes ablating electrode of wearing on Comprehensive Control handle, end connects ablating electrode interface, by ablating electrode line, is connected with the automatic temperature-controlled RF transmitter that melts; Wherein carrier catheter and ablating electrode are parallel, are long strip type structure, can be solid, can be also the conduit of hollow, with the spatial arrangements relation of ablating electrode can be for side by side, concentric circular etc.; When conduit is hollow conduit, the front end of conduit has opening, in end Access Control handle, the place ahead or rear at joystick have separated interface, be used for pouring into various liquid (contrast agent, saline, medicine) or insert the monitoring apparatus of various tubuloses, conduit, as: endo-luminal ultrasound conduit, foley's tube, optical sectioning imaging conduit etc.The leading portion of carrier catheter is provided with crooked control line, and crooked control line is along conduit major axis, and end is connected with the front end of controlling the crooked controller on joystick.
According to neural ablation apparatus of the present utility model, can also comprise Comprehensive Control handle and Complex interface, its front end is connected with the ends such as the end of ablating electrode, carrier catheter and volume electrical impedance electrode respectively, main body is provided with wears wall control appliance, the crooked control appliance of carrier catheter, volume electrical impedance electrode shape controller etc.Wherein volume electrical impedance electrode comprises the front segment electrode that is arranged on carrier catheter leading portion, and it is preferably many flaps; Its stage casing is electrode connecting line, along carrier catheter chamber major axis, walks; And on volume electrical impedance interface on its end and Complex interface, by comprehensive connecting line, be connected with volume impedance bioelectrical measurement system.Described flap electrode is comprised of two kinds of different metals, when raising, temperature produces thermocurrent, can in the process of radio-frequency (RF) ablation, monitor thus the situation that tissue heats up, its feedback signal is controlled the output of radio frequency generation power, suitable radio frequency power output is provided, and what meet target tissue effectively melts damage.The one group of operational approach after the target tissue impedance location being provided by flap electrode, impedance measurement and record before radio-frequency (RF) ablation, the radio-frequency power output with Temperature Feedback control, radio-frequency (RF) ablation, the steps such as impedance replication of target tissue being formed is a part for content of the present utility model to the controlled damage of target tissue.
Basic composition of wearing the neural ablation system of wall through chamber described in the utility model comprises: through chamber, wear the neural ablation catheter of wall, joystick, Complex interface, comprehensive connecting line, automatic temperature-adjusting control RF emission system and volume electrical impedance monitoring system etc.Wherein ablating electrode is connected with automatic temperature-controlled radiofrequency launcher with comprehensive connecting line by Complex interface, by the wall controller of wearing on joystick, is implemented to wear wall and is moved; Volume electrical impedance electrode is connected with volume electrical impedance monitoring system with comprehensive connecting line by Complex interface.Its basic functional principle is divided into two large divisions, and a part is volume impedance measurement system, for location and the damage situation of target tissue provides verification msg; Another part is to have the temperature controlled close as far as possible nervous tissue of wall electrode pair of wearing to carry out radio frequency damage.
Flap electrode in this utility model is delivered near target tissue and after (being generally renal artery, coeliac artery, bronchus or ureter etc.), flap electrode is launched by conduit induction system and interventional procedure, the flap electrode launching is close to tube wall, the sharp portion branch penetration tube endometrial cavity having on it very close nervous tissue.Function waveform generating means will be according to characteristic frequency and specific waveform to flap electrode on-load voltage, flap electrode forms loop by surrounding tissue and patient's ground electrode, volume impedance measurement system can be presented at distribution of impedance situation on display by detecting the variation of current signal in this loop, and guided operation person selects best radio frequency loading mode.At the flap electrode and the sharp portion thereof that approach target tissue, divide the loading of carrying out radio-frequency voltage, radio-frequency current flows through more in Low ESR tissue, and formation temperature rising, and this process can provide enough tissue injury's energy.The device that the process that temperature raises is had temperature detecting function detects, and thermocurrent signal is sent to radio frequency output device, guarantees that suitable radio-frequency current output loads.In radio frequency loading procedure, temperature around of relevant target tissue, radio-frequency current intensity, volume distribution of impedance situation all can be by the display persons that feeds back to operation technique.After radio-frequency (RF) ablation the information of repeated measure volume distribution of impedance also can with melt before distribution of impedance information compare and the person that is shown to operation technique.
Described wall conduit and the joystick worn through chamber is partly aseptic sterile products, only for disposable.The direct operating of contacts of doctor in operation.Comprehensive connecting line and external monitoring equipment (automatic temperature-controlled RF emission system, volume electrical impedance monitoring system etc.) are non-sterilizing equipment decontaminating apparatus, can reuse, and operative doctor does not directly contact this kind equipment, and operation is completed by other medical personnel.First adopt the requirement of conventional aseptic operation and the existing mature technology of intervention intubate, set up the path that enters tube chamber.It is example that the percutaneous of take is worn wall sympathetic nerve radio-frequency ablation procedure through renal artery, this is generally by Seldinger method puncture vessel and insert vagina vasorum, then intravascular sheath inserts guiding catheter to renal artery, then through chamber, wears the neural ablation catheter of wall from the external tapping insertion of guiding catheter.When the front end of ablation catheter enters after renal artery, first start volume electrical impedance monitoring system, the volume electrical impedance of the preoperative tube chamber of volume electrical impedance electrode pair by catheter proximal end is measured, and determines desirable ablation areas or ablation points.Determine after ablation site, by the catheter controller on joystick make ablating electrode adherent-ablating electrode is pressed close on the lumen wall of ablation site, then by wearing wall controller on joystick, push ablating electrode and implement to wear wall and move, make the ablating electrode of ablation catheter front end wear wall part is punctured on wall of the lumen in tube chamber, its paracentesis depth can be controlled and select according to clinical needs, its designing requirement is only to make as much as possible ablating electrode to approach the nerve of target tissue-need to melt in the scope that tube wall integrity and seal can allow.Reach after the predetermined degree of depth wearing wall ablating electrode, start the neural ablation system of automatic temperature-controlled radio frequency, the radio-frequency (RF) energy of being launched by this system is by radio-frequency electrode-wear wall electrode-surrounding tissue, and electrode surrounding tissue absorbs radio-frequency (RF) energy and generates heat, to neural production ablation around.Because wall ablating electrode is worn in use, the radio-frequency (RF) energy that reaches clinical therapeutic efficacy need to be lower compared with prior art, the time is shorter, also less to the infringement of local wall of the lumen; Meanwhile, puncture ablating electrode can form a Fibrotic cicatrix in the surrounding of puncture needle track, and needle track is sealed voluntarily, guarantees integrity and the seal of tube chamber.
During radio-frequency (RF) ablation, can be in real time or start by phased manner volume electrical impedance monitoring system, the volume electrical impedance of zone of ablation is monitored, for instructing and judging whether radio-frequency (RF) ablation continues or end.Melt after reaching clinical requirement and end radio-frequency transmissions, the wall controller of wearing how improving on operating control handle makes to wear wall ablating electrode and returns in tube chamber, and is retracted in ablation catheter, then withdraws from conduit, completes operation.The design of wearing wall electrode part of wearing the neural ablation catheter of wall through chamber can be varied, only as an example following three kinds: be arranged on (pointed projections type) on the electrode of valvular structure 102, be arranged on the front end (puncture needle type) of rectangular puncture needle and be arranged on (balloon type) in balloon wall.
On elongated tubular ablation catheter described in the utility model, wear wall ablating electrode, preferably be designed to flap, can change form by wearing wall ablating electrode control handle, make it to present and shrink and open configuration in various degree, on flap ablating electrode, have pointed projections, when contraction/closure state, pointed projection does not expose, and when deployed condition, pointed projections exposes, thrust tube wall, make ablating electrode farthest approach kidney sympathetic nerve.
Conduit described in the utility model also comprises a crooked control handle, changes the flexibility of the far-end of conduit by controlling guiding-tube bend control handle, and crooked degree is generally 0～90 degree.
This utility model further comprises a capacity of blood vessel impedance measurement system, and this capacity of blood vessel impedance measurement system is analyzed the signal obtaining on electrical impedance electrode before ablation, and the sympathetic nerve on tube wall is positioned, and instructs the accurate selection of ablating electrode position; The electrical impedance of dynamic analysis tube wall in ablation, evaluates blood vessel and neural lesion ablation degree, instructs the carrying out of melting or the correct time of termination.
This utility model further comprises a temperature sensor monitors system, this systematic analysis is from the signal of the temperature sensor on ablation catheter, then signal is sent to automatic temperature-controlled RF emission system and warning and automatic system recorder memory, guarantee radio-frequency ablation procedure enforcement safely and effectively in the temperature range of design in advance
This utility model further comprises an automatic temperature-controlled radio frequency generation systems, this system is according to the signal of capacity of blood vessel impedance measurement system and feedback, automatically select and regulate best radio-frequency (RF) ablation temperature, control is worn wall radio-frequency ablation electrode to target tissue conveying capacity, reaches regulation and control or melts orthosympathetic clinical therapeutic efficacy.
This utility model further comprises that one is reported to the police and automatically records stocking system, this system is to comprehensively analyzing from each monitoring system signal, when surpassing default secure threshold and alarm, simultaneously to the whole process of ablation and information automatic arranging and storage.
The far-end of wearing wall ablation catheter described in the utility model has a radiopaque labelling at least, facilitates operator to determine the position of conduit.
Separable basic structure and using method of wearing wall ablating electrode:
Separable basic structure of wearing wall electrode is between wall ablating electrode and ablating electrode interlude, to have increased a separable junction point and a segregation apparatus wearing; This junction point make front end wear wall ablating electrode and ablating electrode interlude below temporarily links together, and guarantee that wearing wall ablation catheter can implement to wear wall; After ablative surgery completes, by segregation apparatus, make to wear wall ablating electrode separated with ablating electrode interlude, such result makes to wear wall ablating electrode and will be left in wall of the lumen.
This connected mode and segregation apparatus and complement one another, can adopt that current existing connection--isolation technics has: mechanical methods, chemical mode and ionization property method realize;
Carry the basic structure of wearing wall ablating electrode of medicine: adopt the prior art of carrying drug stent, on the surface of wearing wall ablating electrode, coat the medicine of clinical needs, when radio-frequency (RF) ablation, local organization is discharged to medicine, increase selection and the effect of clinical treatment, prevent and treat the generation of various complication, as, pain, spasm, infection, hypertrophy, thrombosis etc.,, can also on wall electrode, cover carrier and have the orthosympathetic medicine of adjusting wearing meanwhile, realize orthosympathetic regulation and control.When wearing of medicine carrying kept somewhere in wall of the lumen after the separation of wall ablating electrode, entrained medicine can be long-term, with controlling slowly discharges.
Technological innovation of the present utility model with advantage is: that radio-frequency ablation electrode is placed on to renal artery intracavity is different from existing kidney sympathetic nerve radio-frequency ablation technique, the utility model discloses a kind ofly at least a portion ablating electrode to be thrust to the apparatus that carries out kidney sympathetic nerve ablation in vascular wall tissue.Due to this innovative and unique design theory of this utility model, fundamentally overcome the deficiencies in the prior art, make kidney sympathetic nerve radio-frequency ablation procedure safer, more efficiently, more accurate; By being implanted in, radio-frequency electrode in tube wall tissue, carries out ablation, make radio-frequency electrode more effectively approach kidney sympathetic nerve, significantly shortened diffusion length and the time of heat energy in tube wall, also dwindled heat energy in tube wall tissue's internal diffusion scope simultaneously, when improving curative effect, reduced the infringement to local tube wall tissue; Because radio-frequency electrode releases energy in tube wall tissue, not only eliminate intracavity blood flow and may take away rapidly the drawback of endovenous radiofrequency electrode heat energy, and, this utility model allows and utilizes the quick blood flow of intracavity to take away the heat energy of blood vessel wall internal layer, when tube wall is carried out to protection more effectively, and can not affect gathering of the outer field in-house heat energy of blood vessel wall, and can use clinically heat energy still less, shorter time just can reach therapeutic effect, make treatment more effective; By loading medicine wearing on wall electrode, can in tube wall tissue, discharge selectively the various medicines that need clinically, prevent and treat the generation of various complication, as, pain, spasm, infection, hypertrophy, thrombosis etc.; By being implanted into medicine carrying ablating electrode at tube wall after ablation, further realize to the long-term regulation and control of kidney sympathetic nerve provide efficiently, the instrument for the treatment of means accurately.
Accompanying drawing explanation
Fig. 1 a, Fig. 1 b, Fig. 1 c and Fig. 1 d are respectively and through chamber, wear the neural ablation catheter structural representation of wall.
Fig. 2 forms schematic diagram for wear the neural ablation catheter system synthesis interface of wall and body temperature EM equipment module through chamber.
Fig. 3 a, Fig. 3 b, Fig. 3 c and Fig. 3 d are respectively and through chamber, wear the neural ablation catheter flap electrode closure of wall and open configuration, and joystick structural representation.
Fig. 4 is for wearing the neural ablation catheter coronalplane of wall structural representation through chamber.
Fig. 5 a, Fig. 5 b are respectively and through chamber, wear neural ablation catheter (puncture needle type) basic structure of wall and wear wall view.
Fig. 6 a, Fig. 6 b are respectively and through chamber, wear neural ablation catheter (pointed projections type) basic structure of wall and wear wall state coronalplane schematic diagram.
Fig. 7 a, Fig. 7 b, Fig. 7 c and Fig. 7 d are respectively the structural representation of wearing the neural ablation catheter of wall (balloon type) through chamber, and Fig. 7 e is for wearing the operation principle schematic diagram of the neural ablation catheter of wall (balloon type) through chamber.
Fig. 8 a, Fig. 8 b are respectively existing ablation techniques temperature transfer and this utility model is worn wall ablation catheter temperature transfer contrast schematic diagram.
Fig. 9 is for to wear wall ablation schematic diagram through renal artery.
Figure 10 a, Figure 10 b are respectively composite cable structural representation.
| Reference numeral | Counter structure | Reference | Counter structure | |
| 100 | Wear wall radio | 150 | Conduit joystick | |
| 101 | Front | 151 | | |
| 102 | | 152 | | |
| 103 | Flap | 153 | Temperature | |
| 104 | | 154 | Radio- | |
| 105 | Rear | 160 | Puncture radio- | |
| 106 | | 201 | Tunica | |
| 107 | | 202 | Vascular | |
| 110 | | 203 | Blood vessel surrounding | |
| 111 | Catheter directed control | 204 | Blood | |
| 112 | The crooked position of catheter directed | 301 | Blood flow position in | |
| 113 | Catheter electrode is controlled assist handle | 401 | Single-point radio-frequency electrode | |
| 114 | Catheter electrode joystick | 402 | Blood flow | |
| 115 | Flap electrode deployed | 403 | Puncture radio-frequency electrode | |
| 116 | Flap electrode make | 501 | Comprehensive connecting | |
| 120 | Flap electrode open configuration cross section is seen | 502 | | |
| 121 | Flap electrode open configuration side is seen | 503 | Composite cable joint portion | |
| 130 | Conduit leading portion case of | 504 | | |
| 140 | | 507 | Cable connector | |
| 141 | Wear | 508 | Temperature control RF coagulation | |
| 142 | Electrode | 550 | Radio frequency temperature control | |
| 143 | | 560 | Monitor |
The specific embodiment
Operation principle of the present utility model is: because nervous tissue has lower impedance operator, by special flap electrode, can detect the situation that nervous tissue distributes.Before this flap electrode can also provide nerve to melt and melt rear occurred impedance variation, the impedance that will cause target tissue due to tissue degeneratiaon and the dehydration of radio-frequency (RF) ablation increases, and therefore, the change by impedance can reflect the degree of ablation of nervous tissue indirectly.Below in conjunction with the drawings and specific embodiments, launch detailed explanation.
One, obstinate hypertension percutaneous is worn wall sympathetic nerve radio-frequency ablation procedure through renal artery
Fig. 1 a, Fig. 1 b, Fig. 1 c and Fig. 1 d are respectively the structural representation of wearing wall radio frequency ablation catheter (abbreviation ablation catheter) 100 and conduit control handle described in the utility model.Before ablation catheter 100 target approach tube chambers, the lobe type radio-frequency ablation electrode of conduit leading portion is contraction state.Applying conventional interventional technique inserts the ablation catheter of contraction state 100 in a side renal artery.Use volume electrical impedance monitoring system to measure this side renal artery part volume impedance, sympathetic nerve is accurately located, to determine the position of ablating electrode.
Fig. 3 b means a kind of structural representation of ablation catheter 100 flap ablating electrode open configurations.After determining the position of ablating electrode, by wearing wall ablating electrode joystick on control interface, make to wear wall ablating electrode and open, can see and on it, have pointed projections.
Fig. 5 a, Fig. 5 b are related to schematic diagram with wall periphery sympathetic nerve after ablation catheter 100 contractions and open configuration and ablation catheter 100 thrust tube wall.After wearing wall ablating electrode and launching, form close contact with renal artery inwall, and pointed projections to be to thrust in essence tissue, make radio-frequency ablation electrode with in the obvious shortening of the outer field kidney sympathetic nerve distance of blood vessel wall.
Fig. 8 a, Fig. 8 b are existing ablation techniques temperature transfer and this utility model ablation catheter 100 temperature transfer contrast schematic diagrams.Because this utility model is advanced to radio-frequency ablation electrode in tube wall from Endovascular, thereby cause that essence in thermal energy conduction changes: 1, by radio-frequency electrode is implanted in, in tube wall tissue, carry out ablation, make radio-frequency electrode more effectively approach kidney sympathetic nerve, significantly shortened diffusion length and the time of heat energy in tube wall, also dwindled heat energy in tube wall tissue's internal diffusion scope simultaneously, when improving curative effect, reduced the infringement to local tube wall tissue; 2, because radio-frequency electrode releases energy in tube wall tissue; not only eliminate intracavity blood flow and may take away rapidly the drawback of endovenous radiofrequency electrode heat energy; and; this utility model allows and utilizes the quick blood flow of intracavity to take away the heat energy of blood vessel wall internal layer; when tube wall is carried out to protection more effectively; and can not affect gathering of the outer field in-house heat energy of blood vessel wall, and can use clinically heat energy still less, shorter time just can reach therapeutic effect, make treatment more effective.
When wearing wall radio-frequency ablation electrode, arrive after clinical desired location, start radio-frequency (RF) ablation generation systems, system is carried out radio-frequency (RF) ablation by the temperature of Lookup protocol the best.In this operation process, this utility model is monitored the multiple dynamic monitoring means of employing, guarantees the effectiveness of radio-frequency (RF) ablation, will the damage of renal artery wall be dropped to minimum level simultaneously, comprising:
Real-time and Dynamic monitoring temperature: temperature sensor and temperature monitoring system equipment on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process temperature is around carried out real-time dynamic monitoring, this system monitoring to temperature change will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the orthosympathetic prerequisite of kidney, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, prevent arteriorenal excessive damage;
Real-time and Dynamic volume electrical impedance monitoring: volume electric impedance sensor and volume electrical impedance monitoring device on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process volume electrical impedance is around carried out real-time dynamic monitoring, this system monitoring to volume electrical impedance change and will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the orthosympathetic prerequisite of kidney, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, prevent arteriorenal excessive damage;
Real-time and Dynamic intracavity optical sectioning imaging monitoring: intracavity optical sectioning imaging probe and intracavity optical sectioning imaging monitoring device on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process blood vessel wall is around carried out real-time dynamic monitoring, this system monitoring to the change of blood vessel wall optical sectioning imaging will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the orthosympathetic prerequisite of kidney, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, prevent arteriorenal excessive damage,
Real-time and Dynamic endo-luminal ultrasound Imaging: Monitoring: endo-luminal ultrasound imaging probe and endo-luminal ultrasound Imaging: Monitoring system equipment on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process blood vessel wall is around carried out real-time dynamic monitoring, this system monitoring to the change of blood vessel wall ultra sonic imaging will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the orthosympathetic prerequisite of kidney, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, prevent arteriorenal excessive damage,
Finishing, the arteriorenal radio-frequency (RF) ablation of this side is postoperative, and ablation catheter 100 is placed into offside with conventional interventional technique, uses the same method and carries out radio-frequency (RF) ablation.
Except above-mentioned steps, the wall radio frequency ablation catheter 100 of wearing disclosed in the utility model can also carry out medicine carrying radio-frequency ablation electrode and implant region, for the clinical more more options that provide are carried out more effective and safe kidney sympathetic nerve radio-frequency ablation procedure.
By loading medicine wearing on wall electrode, can in tube wall tissue, discharge selectively the various medicines that need clinically, prevent and treat the generation of various complication, as, pain, spasm, infection, hypertrophy, thrombosis etc.,, can also on wall electrode, cover carrier and have the orthosympathetic medicine of the kidney of adjusting wearing meanwhile, realize the orthosympathetic regulation and control of kidney.
After the ablation catheter 100 pointed projections separation of separable release property, be trapped in tube wall.The separation of pointed projections is discharged and can adopt existing isolation technics as electrolytic separation or Chemical Decomposition, or mechanicalness isolation technics, by being implanted into medicine carrying ablating electrode at tube wall after ablation, further realize to the long-term regulation and control of kidney sympathetic nerve provide efficiently, the instrument for the treatment of means accurately.
This utility model can application class like interventional procedure will wear wall radio frequency ablation catheter 100 carry out similar kidney sympathetic nerve ablation in intravenous route inserts renal veins;
This utility model further can application class like interventional procedure will wear wall radio frequency ablation catheter 100 carry out similar kidney sympathetic nerve ablation in urinary tract approach inserts renal pelvis renal calices.
Two, diabetics percutaneous coeliac artery is worn wall sympathetic nerve radio-frequency ablation procedure
Adopt conventional interventional technique conduit selectivity to be inserted into the opening part of patient's celiac trunk, keep the stability of conduit.Through the insertion of this guiding catheter according to the ablation catheter 100 of this utility model design.
When wear in wall radio-frequency (RF) ablation front end arrival coeliac artery trunk through chamber after, first start volume electrical impedance monitoring system.Volume electrical impedance to this tremulous pulse part is measured, and determines position and the direction of radio-frequency (RF) ablation according to measurement data.
By the wall electrode controller of wearing on conduit control handle, penetrating electrodes is adjusted to selected zone of ablation, implement to wear wall, will wear wall ablating electrode and insert in ductus arteriosus wall, and reach the degree of depth of clinical needs.
Start radio-frequency (RF) ablation generation systems, system is carried out radio-frequency (RF) ablation by the temperature of Lookup protocol the best.In this operation process, this utility model is monitored the multiple dynamic monitoring means of employing, guarantees the effectiveness of radio-frequency (RF) ablation, the damage to arterial wall is dropped to minimum level simultaneously, comprising:
Real-time and Dynamic monitoring temperature: temperature sensor and temperature monitoring system equipment on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process temperature is around carried out real-time dynamic monitoring, this system monitoring to temperature change will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the orthosympathetic prerequisite of coeliac artery, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, the excessive damage of prevention coeliac artery;
Real-time and Dynamic volume electrical impedance monitoring: volume electric impedance sensor and volume electrical impedance monitoring device on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process volume electrical impedance is around carried out real-time dynamic monitoring, this system monitoring to volume electrical impedance change and will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the orthosympathetic prerequisite of kidney, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, the excessive damage of prevention coeliac artery;
Real-time and Dynamic intracavity optical sectioning imaging monitoring: intracavity optical sectioning imaging probe and intracavity optical sectioning imaging monitoring device on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process blood vessel wall is around carried out real-time dynamic monitoring, this system monitoring to the change of blood vessel wall optical sectioning imaging will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the orthosympathetic prerequisite of coeliac artery, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, the excessive damage of prevention coeliac artery,
Real-time and Dynamic endo-luminal ultrasound Imaging: Monitoring: endo-luminal ultrasound imaging probe and endo-luminal ultrasound Imaging: Monitoring system equipment on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process blood vessel wall is around carried out real-time dynamic monitoring, this system monitoring to the change of blood vessel wall ultra sonic imaging will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the orthosympathetic prerequisite of coeliac artery, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, the excessive damage of prevention coeliac artery,
Except above-mentioned steps, the wall radio frequency ablation catheter 100 of wearing disclosed in the utility model can also carry out medicine carrying radio-frequency ablation electrode and implant region, for the clinical more more options that provide are carried out more effective and safe kidney sympathetic nerve radio-frequency ablation procedure.
By loading medicine wearing on wall electrode, can in tube wall tissue, discharge selectively the various medicines that need clinically, prevent and treat the generation of various complication, as, pain, spasm, infection, hypertrophy, thrombosis etc.,, can also on wall electrode, cover carrier and have the orthosympathetic medicine of the coeliac artery of adjusting wearing meanwhile, realize the orthosympathetic regulation and control of coeliac artery.
After the ablation catheter 100 pointed projections separation of separable release property, be trapped in tube wall.The separation of pointed projections is discharged and can adopt existing isolation technics as electrolytic separation or Chemical Decomposition, or mechanicalness isolation technics, by being implanted into medicine carrying ablating electrode at tube wall after ablation, further realize to the long-term regulation and control of kidney sympathetic nerve provide efficiently, the instrument for the treatment of means accurately.
Three, asthmatic patient is through trachea/bronchus Chuan Bi vagus nerve branch radio-frequency ablation procedure
Adopt endoscope's guiding or X-ray examination guiding technique conduit selectivity to be inserted in patient's right bronchus, keep the stability of conduit.Through the insertion of this guiding catheter according to the ablation catheter 100 of this utility model design.
After wearing wall radio-frequency (RF) ablation front end through chamber and arriving in right bronchus, first start volume electrical impedance monitoring system.Volume electrical impedance to this bronchus part is measured, and determines position and the direction of radio-frequency (RF) ablation according to measurement data.
By the wall electrode controller of wearing on conduit control handle, penetrating electrodes is adjusted to selected zone of ablation, implement to wear wall, will wear wall ablating electrode and insert in bronchial wall, and reach the degree of depth of clinical needs.
Start radio-frequency (RF) ablation generation systems, system is carried out radio-frequency (RF) ablation by the temperature of Lookup protocol the best.In this operation process, this utility model is monitored the multiple dynamic monitoring means of employing, guarantees the effectiveness of radio-frequency (RF) ablation, the damage to bronchial wall is dropped to minimum level simultaneously, comprising:
Real-time and Dynamic monitoring temperature: temperature sensor and temperature monitoring system equipment on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process temperature is around carried out real-time dynamic monitoring, this system monitoring to temperature change will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the prerequisite of the vagus nerve branch on bronchial wall, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, the excessive damage of prevention bronchial wall;
Real-time and Dynamic volume electrical impedance monitoring: volume electric impedance sensor and volume electrical impedance monitoring device on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process volume electrical impedance is around carried out real-time dynamic monitoring, this system monitoring to volume electrical impedance change and will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under neural prerequisite, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, the excessive damage of prevention coeliac artery;
Except above-mentioned steps, the wall radio frequency ablation catheter 100 of wearing disclosed in the utility model can also carry out medicine carrying radio-frequency ablation electrode and implant region, for the clinical more more options that provide are carried out more effective and safe neural radio-frequency ablation procedure.
By loading medicine wearing on wall electrode, can in tube wall tissue, discharge selectively the various medicines that need clinically, prevent and treat the generation of various complication, as, pain, spasm, infection, hypertrophy, hemorrhage etc.,, can also on wall electrode, cover carrier and have and regulate the bronchus medicine of vagus nerve branch around wearing meanwhile, realize the bronchus regulation and control of vagus nerve branch around.
The separation of pointed projections is discharged and can adopt existing isolation technics as electrolytic separation or Chemical Decomposition, or mechanicalness isolation technics, by being implanted into medicine carrying ablating electrode at tube wall after ablation, further realize to the long-term regulation and control of kidney sympathetic nerve provide efficiently, the instrument for the treatment of means accurately.
According to clinical needs, can be for similarly method, technology and apparatus are to trachea, wall ablation is worn by the vagus nerve branch on the bronchial wall of left side.
Four, duodenal ulcer patients is through duodenum Chuan Bi vagus nerve branch radio-frequency ablation procedure
Adopt endoscope's guiding or X-ray examination guiding technique conduit selectivity to be inserted into patient's duodenum intracavity, keep the stability of conduit.Through the insertion of this guiding catheter according to the ablation catheter 100 of this utility model design.
When wear in wall radio-frequency (RF) ablation front end arrival duodenum through chamber after, first start volume electrical impedance monitoring system.Volume electrical impedance to this enteric cavity part is measured, and determines position and the direction of radio-frequency (RF) ablation according to measurement data.
By the wall electrode controller of wearing on conduit control handle, penetrating electrodes is adjusted to selected zone of ablation, implement to wear wall, will wear wall ablating electrode and insert in duodenal wall, and reach the degree of depth of clinical needs.
Start radio-frequency (RF) ablation generation systems, system is carried out radio-frequency (RF) ablation by the temperature of Lookup protocol the best.In this operation process, this utility model is monitored the multiple dynamic monitoring means of employing, guarantees the effectiveness of radio-frequency (RF) ablation, the damage to duodenal wall is dropped to minimum level simultaneously, comprising:
Real-time and Dynamic monitoring temperature: temperature sensor and temperature monitoring system equipment on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process temperature is around carried out real-time dynamic monitoring, this system monitoring to temperature change will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under the prerequisite of the vagus nerve branch on duodenal wall, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, the excessive damage of prevention duodenal wall;
Real-time and Dynamic volume electrical impedance monitoring: volume electric impedance sensor and volume electrical impedance monitoring device on the Multifunctional catheter that application this utility model provides, conductor housing that can be in operation process volume electrical impedance is around carried out real-time dynamic monitoring, this system monitoring to volume electrical impedance change and will produce the intensity of radio frequency and the foundation of time for controlling neural ablation apparatus, in assurance, effectively melt under neural prerequisite, by the early warning system of system, send various forms of forecasts, prevent the too high of temperature, the excessive damage of prevention intestinal wall;
Except above-mentioned steps, the wall radio frequency ablation catheter 100 of wearing disclosed in the utility model can also carry out medicine carrying radio-frequency ablation electrode and implant region, for the clinical more more options that provide are carried out more effective and safe neural radio-frequency ablation procedure.
By loading medicine wearing on wall electrode, can in tube wall tissue, discharge selectively the various medicines that need clinically, prevent and treat the generation of various complication, as, pain, spasm, infection, hypertrophy, hemorrhage etc.,, can also on wall electrode, cover carrier and have and regulate the intestinal wall medicine of vagus nerve branch around wearing meanwhile, realize the intestinal wall regulation and control of vagus nerve branch around.
The separation of pointed projections is discharged and can adopt existing isolation technics as electrolytic separation or Chemical Decomposition, or mechanicalness isolation technics, by being implanted into medicine carrying ablating electrode at tube wall after ablation, further realize the long-term regulation and control of vagus nerve is provided efficiently, treated accurately.
According to clinical needs, can be for similarly method, technology and apparatus are to coat of the stomach, wall ablation is worn by the vagus nerve branch on the walls such as esophageal wall.
Due to above-mentioned structure and using method, can make some changes and not leave category of the present utility model, it is illustrative that above-mentioned explanation and in question all the elements all can only be interpreted as, but not as to restriction of the present utility model.
Claims (29)
1. through chamber, wear the neural ablation catheter of wall for one kind, this catheter main body comprises distal portions, mid portion and proximal part, it is characterized in that being provided with on catheter main body distal portions and wear wall ablating electrode, described in wear wall ablating electrode front end there is the wall construction of wearing and can penetrate and pass wall of the lumen to act on target tissue.
2. the neural ablation catheter of wall of wearing through chamber as claimed in claim 1, the wherein said wall construction front end of wearing has sharp acute angle.
3. the neural ablation catheter of wall of wearing through chamber as claimed in claim 1, the wherein said wall construction of wearing has sword.
4. the neural ablation catheter of wall of wearing through chamber as claimed in claim 1, the wherein said wall ablating electrode of wearing has valvular structure, can change form and presents and shrink and open configuration in various degree.
5. the neural ablation catheter of wall of wearing through chamber as claimed in claim 4, the wherein said lobe of wearing wall ablating electrode is 6 to 8.
6. the neural ablation catheter of wall of wearing through chamber as claimed in claim 4, wherein has pointed projections on valvular structure, and when contraction state, pointed projection does not expose, and when deployed condition, pointed projections exposes.
7. the neural ablation catheter of wall of wearing through chamber as claimed in claim 4, wherein said valvular structure is comprised of two kinds of different metals, produces thermocurrent when temperature raises.
8. the neural ablation catheter of wall of wearing through chamber as claimed in claim 1, wherein said ablation catheter also comprises rectangular puncture needle.
9. the neural ablation catheter of wall of wearing through chamber as claimed in claim 8, the wherein said wall construction of wearing is arranged on described rectangular puncture needle front end.
10. the neural ablation catheter of wall of wearing through chamber as claimed in claim 1, wherein said ablation catheter also comprises balloon-expandable structure.
The 11. neural ablation catheters of wall of wearing through chamber as claimed in claim 10, the wherein said wall construction of wearing is arranged in described balloon-expandable structure.
The 12. neural ablation catheters of wall of wearing through chamber as claimed in claim 1, wherein said length of wearing wall construction is 0.01～20mm.
The 13. neural ablation catheters of wall of wearing through chamber as claimed in claim 1, the wherein said diameter of wearing wall construction is 0.01～2.0mm.
The 14. neural ablation catheters of wall of wearing through chamber as claimed in claim 1, on wherein said proximal part, be provided with and wear wall controller, strip connection electrode is set on described mid portion, the described wall ablating electrode of wearing is worn wall controller described in being connected to by described strip connection electrode, described strip connection electrode is after implementing puncture and/or melting, can disconnect and wear wall controller and wear being connected between wall ablating electrode, thereby will wear wall ablating electrode, be retained in target tissue site.
The 15. neural ablation catheters of wall of wearing through chamber as claimed in claim 14, wear wall controller and wear being connected between wall ablating electrode described in wherein said strip connection electrode can disconnect by machinery, chemical mode and/or ionization mode.
The 16. neural ablation catheters of wall of wearing through chamber as claimed in claim 1, also comprise electrical impedance electrode, ultrasonic probe and/or optical fault scanheads.
The 17. neural ablation catheters of wall of wearing through chamber as claimed in claim 1, are wherein at least provided with a radiopaque labelling on the far-end of ablation catheter.
The 18. neural ablation catheters of wall of wearing through chamber as claimed in claim 1, wherein said tube chamber is blood vessel, comprises tremulous pulse and vein.
The 19. neural ablation catheters of wall of wearing through chamber as claimed in claim 1, wherein said tube chamber is non-hemocoele passage, comprises any one in respiratory tract, digestive tract, urethra, reproductive tract, biliary tract.
The 20. neural ablation catheters of wall of wearing through chamber as claimed in claim 1, wherein said catheter main body is hollow conduit, wear with described that wall ablating electrode is concentric to be arranged, described hollow conduit front end has opening, can pass through hollow structure perfusion fluid or the insertion instrument of conduit.
21. as claimed in claim 1ly wear the neural ablation catheter of wall, wherein said wearing on wall ablating electrode with medicine through chamber.
22. 1 kinds of neural ablation apparatus, is characterized in that comprising:
A) as described in any one in claim 1 to 21, through chamber, wear the neural ablation catheter of wall;
B) conduit connecting handle: comprise at least one guiding-tube bend control handle, at least one electrode supporting control handle, equipment complex interface, liquid infusion interface.
23. neural ablation apparatus as claimed in claim 22, is characterized in that, change the flexibility of the far-end of conduit by controlling described guiding-tube bend control handle, and crooked degree is 0～90 degree.
24. neural ablation apparatus as claimed in claim 22, is characterized in that carrying out ductography through described liquid infusion interface perfusion contrast agent, also can pour into the temperature that reduces treatment region lower than the liquid of body temperature.
25. neural ablation apparatus as claimed in claim 22, it is characterized in that, this nerve ablation apparatus also comprises at least one tube wall volume impedance measurement system, for analyzing the signal obtaining on electrical impedance electrode, target tissue on tube wall is positioned, the operation of neural ablation apparatus is carried out to feedback control.
26. neural ablation apparatus as claimed in claim 22, it is characterized in that tube wall volume impedance measurement system is according to signal and the feedback of tube chamber volume impedance measurement system, automatically select and regulate best radio-frequency (RF) ablation parameter, the energy of controlling radio-frequency ablation electrode discharges.
27. neural ablation apparatus as described in any one in claim 22 to 26, wherein ultrasonic probe and/or optical fault scanheads are evaluated tectology change preoperative, Shu Zhonghe aftertreatment district tube wall for Real-time and Dynamic, instruct the ablation parameters that changes ablation catheter.
28. neural ablation apparatus as claimed in claim 27, wherein said parameter comprise ablation catheter position, melt temperature, melt the time.
29. neural ablation apparatus as described in any one in claim 22 to 26, it is characterized in that, also have and report to the police and automatically record stocking system, for the comprehensive signal of analyzing from each monitoring system, to surpassing situation and the alarm of default secure threshold, and/or to the whole process of ablation and information automatic arranging and storage.
Priority Applications (8)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201320071750.9U CN203524766U (en) | 2013-02-07 | 2013-02-07 | Trans-luminal wall-penetration nerve ablation catheter and equipment thereof |
| PCT/CN2014/000143 WO2014121664A1 (en) | 2013-02-07 | 2014-02-07 | Radio frequency ablation method, system and radio frequency ablation device thereof |
| EP14748628.6A EP2954865B1 (en) | 2013-02-07 | 2014-02-07 | Radio frequency ablation method, system and radio frequency ablation device thereof |
| US14/766,637 US9993291B2 (en) | 2013-02-07 | 2014-02-07 | Radio frequency ablation method, system and radio frequency ablation device thereof |
| ES14748628T ES2921176T3 (en) | 2013-02-07 | 2014-02-07 | Method, radiofrequency ablation system and radiofrequency ablation device thereof |
| MYPI2015702559A MY179432A (en) | 2013-02-07 | 2014-02-07 | Radio frequency ablation method, system and radio frequency ablation device thereof |
| CN201490000298.XU CN205215353U (en) | 2013-02-07 | 2014-02-07 | Radio frequency melts system and radio frequency melts equipment thereof |
| JP2015556380A JP6453769B2 (en) | 2013-02-07 | 2014-02-07 | Induction cauterization method, system and induction cautery equipment |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201320071750.9U CN203524766U (en) | 2013-02-07 | 2013-02-07 | Trans-luminal wall-penetration nerve ablation catheter and equipment thereof |
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| Publication Number | Publication Date |
|---|---|
| CN203524766U true CN203524766U (en) | 2014-04-09 |
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| CN201320071750.9U Expired - Lifetime CN203524766U (en) | 2013-02-07 | 2013-02-07 | Trans-luminal wall-penetration nerve ablation catheter and equipment thereof |
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| CN (1) | CN203524766U (en) |
Cited By (6)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN103271765A (en) * | 2013-02-07 | 2013-09-04 | 董永华 | Catheter and device for nerve ablation in cavity-passing and wall-penetrating mode and method for nerve ablation |
| CN104257427A (en) * | 2014-08-05 | 2015-01-07 | 上海魅丽纬叶医疗科技有限公司 | Radiofrequency ablation catheter with segment-shaped support structure and equipment thereof |
| WO2017067517A1 (en) * | 2015-10-22 | 2017-04-27 | 上海魅丽纬叶医疗科技有限公司 | Radio frequency ablation device comprising balloon blocking catheter and ablation method therefor |
| EP3139851A4 (en) * | 2014-05-04 | 2017-12-13 | Diros Technology Inc. | Radiofrequency probes with retactable multi-tined electrodes |
| US9993291B2 (en) | 2013-02-07 | 2018-06-12 | Shanghai Golden Leaf Med Tec Co., Ltd | Radio frequency ablation method, system and radio frequency ablation device thereof |
| CN114569245A (en) * | 2016-08-14 | 2022-06-03 | 迪格玛医疗有限公司 | Device and method for nerve ablation in the wall of the gastrointestinal tract |
-
2013
- 2013-02-07 CN CN201320071750.9U patent/CN203524766U/en not_active Expired - Lifetime
Cited By (7)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN103271765A (en) * | 2013-02-07 | 2013-09-04 | 董永华 | Catheter and device for nerve ablation in cavity-passing and wall-penetrating mode and method for nerve ablation |
| CN103271765B (en) * | 2013-02-07 | 2016-05-11 | 上海魅丽纬叶医疗科技有限公司 | Wear the neural ablation catheter of wall, Apparatus for () and method therefor through chamber |
| US9993291B2 (en) | 2013-02-07 | 2018-06-12 | Shanghai Golden Leaf Med Tec Co., Ltd | Radio frequency ablation method, system and radio frequency ablation device thereof |
| EP3139851A4 (en) * | 2014-05-04 | 2017-12-13 | Diros Technology Inc. | Radiofrequency probes with retactable multi-tined electrodes |
| CN104257427A (en) * | 2014-08-05 | 2015-01-07 | 上海魅丽纬叶医疗科技有限公司 | Radiofrequency ablation catheter with segment-shaped support structure and equipment thereof |
| WO2017067517A1 (en) * | 2015-10-22 | 2017-04-27 | 上海魅丽纬叶医疗科技有限公司 | Radio frequency ablation device comprising balloon blocking catheter and ablation method therefor |
| CN114569245A (en) * | 2016-08-14 | 2022-06-03 | 迪格玛医疗有限公司 | Device and method for nerve ablation in the wall of the gastrointestinal tract |
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| C14 | Grant of patent or utility model | ||
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Granted publication date: 20140409 |