JP2009509713A - 食道の処置に関する生理的特性の決定方法及びシステム - Google Patents
食道の処置に関する生理的特性の決定方法及びシステム Download PDFInfo
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- JP2009509713A JP2009509713A JP2008534571A JP2008534571A JP2009509713A JP 2009509713 A JP2009509713 A JP 2009509713A JP 2008534571 A JP2008534571 A JP 2008534571A JP 2008534571 A JP2008534571 A JP 2008534571A JP 2009509713 A JP2009509713 A JP 2009509713A
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Abstract
Description
米国特許5,275,169は、血管の生理的特性を決定するための装置及び方法について記述する。上記装置は、血管の径及び壁コンプライアンスを測定するが、処置を行わない。さらに、上記方法は、血管内でバルーンを膨らますために非圧縮性流体だけを用いることに依存している。他の興味のある特許は、6,010,511、6,039,701、及び6,551,310である。
本発明は、食道のような体の内腔の大きさを測るための方法及びシステムを含む。方法及びシステムは、また、一旦適切な測定がなされた体の内腔を処置(治療)するために提供される。
この明細書で述べた全ての刊行物及び特許出願は、それぞれの個々の刊行物又は特許出願が参考により編入されるよう明確に及び個々に示されているかのように、同じ範囲に参考によりここに編入される。
本発明による多くの治療処置において、所望の処置効果は、組織の切除である。ここで用いられるような用語「切除」は、組織又は細胞壊死をもたらす組織への熱的損傷を意味する。しかしながら、いくつかの治療処置は、切除には及ばない、例えば組織の壊死ではなく、組織の細胞構成において所望の変化に役立つ組織に与えられる攪拌又は損傷のあるレベルの所望の処置効果があるかもしれない。本発明で、後述するように、深い層の機能をそのまま維持しながら組織の上皮において処置効果を創成するために、種々の異なったエネルギーを送り出す器具が利用可能である。
この状態において、食道の径を決定することは困難であり、特に、超音波又は光学の画像診断のような視覚化技術の使用では困難である。さらにまた、目標の組織領域の均一な処置は、食道壁の不規則な表面輪郭のため困難である。
この外形の下では、拡張可能部材の十分な膨張は、内腔壁を適切に膨らます圧力になるであろう。いくつかの実施形態では、それは、内腔の過剰な膨張が発生しないように予防策として圧力センサーか質量流量計(図示せず)を使用するのに望ましいかもしれない。
この実施形態において、アレイ112は、幅0.25mmで、0.3mmの隙間によって分離された、20の平行なバーを有する。回路上のバーは、バルーン116の周面のまわりに20の完全に連続的なリングを形成する。電極アレイ112は、ポリイミド基板の両側に銅から成るラミネートからエッチングすることができる。各銅の一端部は、メッキされた小さなスルーホール128を有し、それは、ラミネートの背面にて、それぞれ2つの銅の結合ブロック156及び158のうちの一つからそれらのバーへの信号通過を可能にする。一つの結合ブロック156は、偶数の番号が付けられたバーのすべてに接続され、一方、他方の結合ブロック158は、奇数の番号が付けられたバーのすべてに接続されている。
その後、ブロック222に示されるように、食道の壁コンプライアンスは、第1の測定された圧力Plと第2の測定された圧力P2との間で計算された内腔径における変化に基づいて決定される。
一つの実施形態において、発生器230は、RF出力のような出力を生成し、供給し、制御する。発生器230の他の機能は、サイジングバルーンの膨張及び収縮を制御し、処置カテーテル及び処置カテーテル内の特定電極へのRF出力及びエネルギーを選択的に供給してサイジングバルーンの径を見積り、及びユーザへ種々の情報を表示することを含む。システムの使用パラメーター及びステータスに関する様々な情報を提供するために、発生器230の前面パネルは、様々な制御、ディスプレイ及びインジケータを組み込む。
所望のエネルギーがすべての所望の場所に提供されるとき、完了インジケータ258は、切除が完了したことを示す。
発生器230は、組織が絶対的なインピーダンス目標に達するのに要する時間のみ除去可能である。例えば、目標のインピーダンス値の範囲は、約5〜10オームの範囲である。別の実施形態では、切除前における組織の初期インピーダンス値から所定の割合にインピーダンス値が減少するまでのみ、発生器230は、除去するかもしれない。さらに別の実施形態では、切除時間は、インピーダンス値が図19に示すグラフの変曲点に到達する点、つまりインピーダンス値が参考点Bと参考点Cとの間にあるとき、に依存することができる。そのようなものとして、インピーダンスがその最小値に到達したとき、つまりインピーダンスが増加し始める点にて、エネルギー供給は、終了することができる。別の実施形態において、切除時間は、特定のレベルを超えるインピーダンス値によって定義可能である。例示的な参考点Dにて示されるように、組織インピーダンス値が初期インピーダンス値よりも高くなった場合、処置範囲は、食道壁が破られるようなレベルに達するかもしれない。そのようなものとして、インピーダンスがその初期値、例えば参考値Cに達する前に、組織へのエネルギーの提供を終えるのが望ましい。
Claims (19)
- 体の内腔内側の組織を処置するための装置であって、
体の内腔内側の組織表面に位置決めされるように適合され、拡張部材に接続される電極構造と、
電極構造へのエネルギーを生成し供給する発生器であって、体の内腔内側の拡張部材を自動的に膨張させ、かつ組織の処置の間、拡張部材内側の圧力を制御するように適合される発生器と、
を備えた組織処置装置。 - 拡張部材は、カテーテルに接続されたバルーンである、請求項1記載の組織処置装置。
- 発生器の設定を格納する記憶装置をさらに備えた、請求項1記載の組織処置装置。
- 記憶装置は、EEPROMである、請求項3記載の組織処置装置。
- 拡張部材を自動的に膨張させ萎ませるポンプをさらに備えた、請求項1記載の組織処置装置。
- 発生器は、膨張可能なバルーンを用いて体の内腔の内径を決定するように適合される、請求項1記載の組織処置装置。
- 発生器は、食道の測定された径に基づいて、時間にわたり組織へ供給されるエネルギー量を制御するように適合される、請求項6記載の組織処置装置。
- 発生器は、食道の測定された径に基づいて、組織へ供給されるエネルギー密度を標準化するように適合される、請求項6記載の組織処置装置。
- 発生器は、食道の測定された径に基づいて、時間にわたり組織へ供給される出力量を制御するように適合される、請求項6記載の組織処置装置。
- 発生器は、電極構造へ供給されるエネルギーを制御するように適合される、請求項1記載の組織処置装置。
- 発生器は、電極構造へ供給される出力を制御するように適合される、請求項1記載の組織処置装置。
- 発生器は、食道の測定された径に基づいて、時間にわたり組織へ供給される出力量を標準化するように適合される、請求項1記載の組織処置装置。
- 発生器は、カテーテルが取り付けられたか否かを検出し、取り付けられたカテーテルの特性を確認するように適合される、請求項1記載の組織処置装置。
- 取り付けられるカテーテルに関する情報を格納するように適合される記憶装置をさらに備える、請求項13記載の組織処置装置。
- 発生器に接続され、電極構造へ供給されるエネルギーを制御するように適合される足踏みスイッチをさらに備える、請求項1記載の組織処置装置。
- ユーザへの情報を表示するディスプレイをさらに備える、請求項1記載の組織処置装置。
- ユーザが電極構造へ供給されるエネルギーを時間にわたり制御するように、発生器は、ユーザにより手動で制御されるように適合される、請求項1記載の組織処置装置。
- 設定された目標値に出力が達するまで電極構造に供給される出力を徐々に増加するように適合される比例積分微分コントローラをさらに備えた、請求項1記載の組織処置装置。
- 体の内腔内側の組織を処置するための装置であって、
体の内腔内側の組織表面に位置決めされるように適合され、拡張部材に接続される電極構造と、
電極構造へ供給されるエネルギーを生成し、供給し、制御する発生器であって、体の内腔の内径を決定するように適合される発生器と、
を備えた組織処置装置。
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US09/714,344 US6551310B1 (en) | 1999-11-16 | 2000-11-16 | System and method of treating abnormal tissue in the human esophagus |
US11/244,385 US20060095032A1 (en) | 1999-11-16 | 2005-10-04 | Methods and systems for determining physiologic characteristics for treatment of the esophagus |
US11/244,385 | 2005-10-04 | ||
PCT/US2006/037930 WO2007044244A2 (en) | 1999-11-16 | 2006-09-29 | Methods and systems for determining physiologic characteristics for treatment of the esophagus |
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US8377055B2 (en) | 2013-02-19 |
US20100234840A1 (en) | 2010-09-16 |
WO2007044244A2 (en) | 2007-04-19 |
US20060095032A1 (en) | 2006-05-04 |
AU2006302688A1 (en) | 2007-04-19 |
EP1931272A2 (en) | 2008-06-18 |
WO2007044244A3 (en) | 2007-07-05 |
EP2799027B1 (en) | 2016-04-13 |
BRPI0616840A2 (pt) | 2011-07-05 |
US20120004654A1 (en) | 2012-01-05 |
JP2013066725A (ja) | 2013-04-18 |
CA2624792A1 (en) | 2007-04-19 |
US8012149B2 (en) | 2011-09-06 |
EP2604212A1 (en) | 2013-06-19 |
US8876818B2 (en) | 2014-11-04 |
EP2604212B1 (en) | 2014-08-06 |
US20130131661A1 (en) | 2013-05-23 |
EP2604213A1 (en) | 2013-06-19 |
JP5222144B2 (ja) | 2013-06-26 |
CA2624792C (en) | 2015-12-01 |
EP1931272B1 (en) | 2014-11-12 |
US20150038958A1 (en) | 2015-02-05 |
EP2799027A1 (en) | 2014-11-05 |
US9555222B2 (en) | 2017-01-31 |
EP2604213B1 (en) | 2014-08-06 |
JP5583734B2 (ja) | 2014-09-03 |
EP1931272A4 (en) | 2010-04-07 |
AU2006302688B2 (en) | 2012-07-12 |
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