JP2011110286A - Electrode catheter device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an electric catheter capable of compatibly attaining enhancement of push-in property when inserting into an affected site, enhancement of flexibility of a catheter during using, and enhancement of cooling capability near an electrode. <P>SOLUTION: The electric catheter includes a catheter tube in which a lumen 6a is formed, a first electrode 11 which is attached to the distal end part of the catheter tube 6, a second electrode 13 which is arranged apart from the first electrode 11 by a predetermined distance in the longitudinal direction, a handle 4 to which the proximal end part of the catheter tube 6 is connected, a stylet 7 which is detachably inserted along the lumen 6a over the length from the first electrode 11 to the handle 4 and is attached and detached from the proximal end of the handle 4, a supply tube 8 in which a supply channel for flowing cooling fluid is formed and a distal end opening part 8b of the supply channel opens in the inner space 11a of the first electrode 11. The distal end 7b of the stylet 7 is detachably attached to an attaching part 11d communicating with the inner space 11a of the first electrode 11. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to an electrode catheter device, and more particularly to an electrode catheter device used for radiofrequency ablation, for example.

  Radiofrequency ablation is widely used for the treatment of liver cancer, breast cancer, lung cancer, cartilage disease, cardiac tachycardia and the like as a minimally invasive treatment method with less burden on patients. The therapeutic instruments are broadly classified into instruments that approach the inner wall of the blood vessel and the inner wall of the heart via a blood vessel, and others. For treatment of liver cancer, lung cancer, cartilage tissue, etc., a monopolar ablation electrode catheter having a single needle-like single electrode or a plurality of deployment electrodes has been used in many cases. In the monopolar type cautery catheter, the temperature of the electrode in contact with the tissue and the impedance during energization are measured to control the flow of high-frequency power that flows between the electrode and the counter electrode attached to the body surface.

  In order to heat and necrotize (cauterize) the target tissue safely and stably in a small number of times, the electrode of the catheter inserted into the body should not be disturbed by the burnt tissue, and the current in the vicinity of the electrode should be prevented as much as possible. It is necessary to be able to cauterize a wide range of tissues. In the deployment electrode, the heating points are dispersed by deploying multiple electrodes, and in the case of a straight needle-shaped electrode, ice-cold physiological saline is circulated inside the electrode needle so that the electrode surface temperature does not rise too much. In addition, the temperature and impedance of the target tissue during the operation are measured to devise a method of flowing high-frequency power, and the burn on the electrode surface has been prevented.

  Among these conventional techniques, in the deployment electrode, since a plurality of electrodes that are pre-plated are deployed in the target tissue from the storage cylinder, the spread of the deployed electrode varies depending on the tissue state, and the ablation range is limited to the vicinity of the electrode. Therefore, there has been a problem that it fluctuates due to fluctuations in the spread of the electrode, and cauterization remains in the target tissue. In addition, although there is no fluctuation in the electrode position with a single electrode of the electrode-cooled straight needle shape, it requires a large amount of power to compensate for the heat lost by cooling, and it is integrated control of the cooling system and power control system There was a problem of becoming a complicated control system.

  A bipolar ablation electrode catheter is known in which at least a pair of electrodes is disposed at the distal end of the catheter, a high-frequency current is passed through the living tissue contacting between the electrodes, and the living tissue contacting the electrodes is cauterized. It has been. According to the bipolar type ablation electrode catheter, it is possible to reduce the power consumption as compared with the monopolar ablation electrode catheter.

  As a type of bipolar cautery electrode catheter, for example, an electrode catheter as shown in Patent Document 1 shown below is known. In the electrode catheter shown in Patent Document 1, the catheter tube is flexible, and a tension member is disposed inside the lumen of the catheter tube through the catheter tube. For this reason, the tension member becomes a mandrel when the electrode catheter is inserted, and the operability when the electrode catheter is inserted into the body or pulled out is excellent.

  However, when a mandrel such as a tension member is arranged inside the lumen of the catheter tube in this way, the passage for flowing a cooling fluid for cooling the heat generated near the electrode attached to the distal end of the catheter tube becomes narrow. Cooling may be insufficient.

  Moreover, in the conventional electrode catheter, since the mandrel such as a tension member is fixed inside the catheter tube, the catheter tube is hard and cannot follow the patient's body movement during the cauterization treatment. It was painful for the patient because it was necessary to suppress the patient's movement.

Special table 2008-539918

  The present invention has been made in view of such a situation, and the object thereof is to achieve both improvement in pushing characteristics at the time of insertion into an affected area, improvement in flexibility of a catheter during use, and improvement in cooling performance in the vicinity of the electrode. An object of the present invention is to provide an electrode catheter that can be used.

In order to achieve the above object, an electrode catheter device according to the present invention comprises:
A catheter tube having a lumen formed therein;
A first electrode attached to the distal end of the catheter tube;
A second electrode disposed at a predetermined interval along the longitudinal direction of the catheter tube with respect to the first electrode;
A handle to which the proximal end of the catheter tube is connected;
A stylet that is removably inserted along the lumen of the catheter tube over a length from the first electrode to the handle, and is detached from the proximal end of the handle;
A supply path for flowing a cooling fluid therein is formed, and a distal end opening of the supply path has a supply tube that opens into the internal space of the first electrode, and
A distal end of the stylet is detachably attached to an attachment portion communicating with the internal space of the first electrode.

  In the electrode catheter according to the present invention, since the catheter tube is flexible, the electrode attached to the distal end of the tube can easily follow the movement of the patient's body position. Further, since the catheter tube can be bent, it is easy to temporarily fix the catheter tube on the skin near the affected part with an adhesive tape or the like on the proximal end side. Therefore, the burden on both the patient and the operator for fixing the electrode placement position can be greatly reduced.

  Further, in the electrode catheter according to the present invention, the removable stylet that penetrates the catheter inner hole and reaches the inside of the distal end electrode enables accurate and reliable puncture of the electrode, so that the electrode can be placed at the ablation site. Be certain. Moreover, if the stylet is removed and removed from the catheter after puncturing, a bendable catheter that can follow body movements is obtained.

  Furthermore, the electrode catheter according to the present invention includes a supply tube for supplying a cooling fluid to the inside of the catheter, and supplies the cooling fluid to the first electrode and the second electrode through the supply tube. It returns through the lumen of the removed catheter tube.

  Since the lumen of the catheter tube from which the stylet has been removed has a sufficient flow path cross-sectional area, it is possible to circulate a sufficient amount of cooling fluid inside the electrode, thereby improving the cooling capacity. That is, in the electrode catheter of the present invention, since the electrode surface in contact with the tissue cells can be cooled from the inside, it is possible to prevent scorching on the electrode surface and to achieve cauterization in a wide range in a short time by stable energization cauterization. be able to.

  In the electrode catheter of the present invention, it is possible to achieve both improvement in pushing characteristics during insertion into an affected area, improvement in flexibility of the catheter during use, and improvement in cooling performance in the vicinity of the electrode.

Preferably, the supply tube has conductivity and is also used as a conductive wire for supplying voltage to the first electrode. By using the supply tube as a conductive wire for supplying voltage to the first electrode, the number of parts can be reduced. The supply tube may be fixed to the inner wall of the catheter tube, or the catheter tube may have a multi-lumen structure, and the supply tube may be disposed inside one lumen. Further, the inner wall itself of one lumen may constitute the supply tube. The supply tube is not necessarily conductive, but is preferably composed of a conductive material. Further, the supply tube is not necessarily fixed to the inner wall of the catheter tube.
Further, a through hole that continues along the axis of the stylet may be formed inside the stylet, and the supply tube is inserted into the through hole, and the stylet is The catheter may be mounted inside the catheter so as to be relatively movable in the axial direction with respect to the supply tube.

  Preferably, a conductive wire embedded in the catheter tube is connected to the second electrode, and a voltage is supplied to the second electrode through the conductive wire. By embedding the conductive wire in the catheter tube, the flow path cross-sectional area of the lumen of the catheter tube is not reduced. The conductive wire may be a net-like reinforcing wire embedded in a resin catheter tube.

  Preferably, the cooling fluid introduced into the supply tube is a liquefied gas. By designing the supply tube so that the liquefied gas is vaporized in the vicinity of the opening at the distal end of the supply tube, the inside of the electrode can be cooled using the heat of vaporization of the liquefied gas. Therefore, the amount of the cooling fluid used can be reduced, and the cooling fluid supply path inner diameter and the lumen inner diameter serving as the cooling fluid return path can be reduced. As a result, the catheter diameter can be reduced, the resistance during puncture can be reduced, and the flexibility of the catheter can be increased.

FIG. 1 is a schematic perspective view of an electrode catheter device according to an embodiment of the present invention. FIG. 2 is a cross-sectional view of the main part of the distal end portion of the catheter in the electrode catheter device shown in FIG. FIG. 3 is a cross-sectional view of the main part of the handle and connector device shown in FIG. FIG. 4 is a schematic perspective view of an electrode catheter device according to another embodiment of the present invention. FIG. 5 is a cross-sectional view of the main part of the distal end portion of the catheter in the electrode catheter device shown in FIG. 6 is a cross-sectional view of the main part of the handle and connector device shown in FIG. FIG. 7 is a schematic perspective view of an electrode catheter device according to still another embodiment of the present invention. FIG. 8 is a cross-sectional view of the main part of the handle shown in FIG.

Hereinafter, the present invention will be described based on embodiments shown in the drawings.
First embodiment

  An electrode catheter device 1 according to the present embodiment shown in FIG. 1 is an ablation catheter system used for high-frequency ablation treatment of lesion tissues such as lung cancer, liver cancer, breast cancer, and cartilage tissue. The electrode catheter device 1 according to this embodiment includes a catheter 2, a connector device 3, a cable 20 that connects the catheter 2 and the connector device 3, and a high-frequency power supply device 30 that is connected to the connector device 3. Yes.

  The catheter 2 has a catheter tube 6, and a first electrode 11 and a second electrode 13 are arranged at a predetermined axial interval at a distal end portion of the catheter tube 6. A handle 4 is connected to the proximal end of the catheter tube 6. A handle 7 a of the stylet 7 is attached to the proximal end of the handle 4.

  As shown in FIG. 2, the first electrode 11 is attached to the distal end 6b of the catheter tube 6 by means such as adhesion or fusion. In the present embodiment, the first electrode 11 has a sharp pointed tip for puncturing. Since the placement of the first electrode 11 and the second electrode 13 at the target cell position is performed under an ultrasound image, the tip shape is a pyramid synthesized from several planes in order to improve ultrasound visibility. It is preferable that it is a shape.

  A hollow portion (internal space) 11a is formed inside the first electrode 11 along the longitudinal direction thereof, and an attachment hole 11b having an inner diameter smaller than the inner diameter of the hollow portion 11a is formed outside the hollow portion 11a. It is formed. The hollow portion 11a has a circular cross section, and the attachment hole 11b also has a circular cross section. The distal end of the attachment hole 11b and the distal end of the hollow portion 11a are connected to each other through the communication space 11c inside the first electrode 11.

  Inside the first electrode 11, a screw hole (attachment portion) is formed concentrically in the proximal end opening 11d of the hollow portion 11a. A male screw formed at the distal end 7b of the stylet 7 is detachably attached to the screw hole. The distal end 7b of the stylet 7 and the proximal end opening 11d of the hollow portion 11a may be detachably connected by means other than screw coupling. For example, a known detachable attachment structure such as a key / keyway can be used.

  The distal end 8a of the supply tube 8 is inserted into the attachment hole 11b. The opening 8b at the distal end 8a of the supply tube 8 opens into the communication space 11c. Since the supply tube 8 also serves as a voltage supply path to the first electrode 11, the supply tube 8 is preferably made of a conductive member, and the distal end portion 8a thereof is inserted into the mounting hole 11b and brazed. Thus, the supply tube 8 and the first electrode 11 are electrically connected.

  Since the first electrode 11 is a tip electrode, the first electrode 11 has a hard and strong mechanical characteristic for puncture, a conductive characteristic that easily transmits heat and electricity, and an acoustic characteristic that easily reflects ultrasonic waves. preferable. From such a viewpoint, the 1st electrode 11 is comprised with metal materials, such as stainless steel, carbon steel, titanium, a cobalt chromium alloy, and a nickel titanium alloy.

  The second electrode 13 disposed at a distance on the proximal side of the first electrode 11 is electrically insulated from the first electrode 11 and provided on the surface of the catheter tube 6. As with the first electrode 11, it is preferable to use a metal material, but the hardness is not necessarily high. Rather, it should be flexible enough to follow the movement of the flexible catheter tube. Therefore, not only a metal tubular thing but a metal coil and a conductive knitting may be sufficient.

  The second electrode 13 is connected to a conduction path 13a extending along the longitudinal direction in the tube wall of the catheter tube 6. The conducting path 13a may be, for example, a coil for reinforcing the tube wall, or may be a conductive wire knitted in a tube shape.

  As shown in FIG. 3, the proximal end 6 c of the catheter tube 6 is bonded or heat-sealed to the handle 4. The handle 4 is made of, for example, polyurethane, ABS resin, polyethylene, ethylene copolymer, polycarbonate, polyester, polyamide, or the like. A ring-shaped terminal 13 b is embedded in a connection portion between the handle 4 and the proximal end of the catheter tube 6. The ring-shaped terminal 13 b is electrically connected to a conduction path 13 a embedded in the tube wall of the catheter tube 6. These conduction path 13 a, ring-shaped terminal 13 b, and conductive wire 12 are insulated from the supply tube 8 inside the handle 4.

  One end 12 a of the conductive wire 12 is connected to the ring-shaped terminal 13 b, and the other end 12 b of the conductive wire 12 passes through the inside of the cable 20 extending from the handle 4 and the female connector 3 b of the connector device 3. The ring-shaped female terminal 16 provided in the connection port 14 is connected.

  A supply tube 8 that reaches the handle 4 through the inside of the catheter tube 6 is also introduced into the cable 20, and the proximal end 8 c of the supply tube 8 is the center of the connection port 14 of the female connector 3 b of the connector device 3. It protrudes at. The fitting projection 18 of the male connector 3a is detachably inserted into the connection port 14 of the female connector 3b. The supply tube 8 and the conductive wire 12 are insulated from each other inside the cable 20 and the female connector 3b.

  On the outer periphery of the fitting convex portion 18, a ring-shaped male terminal 21 is mounted. The ring-shaped male terminal 21 is connected to a conductive wire 32 drawn out from the male connector 3a. The male terminal 21 is connected to the female terminal 16 in a state where the fitting convex portion 18 is inserted into the connection port 14.

  A communication hole 24 is formed in the shaft core of the fitting convex portion 18, and the proximal end 8 c of the supply tube 8 is connected to the communication hole 24 in a state where the fitting convex portion 18 is fitted into the mounting hole 14. The supply tube 8 is inserted and communicated with the communication hole 24. A tube-like connection terminal 22 is embedded in the inner periphery of the communication hole 24, and the connection terminal 22 is electrically connected to at least a part of the male connector 3a. At least a part of the male connector 3 a is made of a conductive material, is electrically connected to the connection terminal 22, and can be electrically connected to a conductive wire 34 drawn out of the connector 3. In addition, the terminals 21 and 22 are insulated by the fitting convex part 18 being comprised with an insulating material.

The communication hole 24 communicates with the cartridge connection port 26 through a communication passage 25 formed inside the male connector 3a. Between the communication passage 25 and the connection port 26,
An opener 28 is attached. When the supply port of the cartridge 40 shown in FIG. 1 is inserted into the connection port 26, the opener 28 opens the plug of the supply port and causes the inside of the cartridge 40 to communicate with the communication passage 25.

  The inside of the cartridge 40 is filled with a liquefied gas such as liquefied nitrogen. In a state where the male connector 3a and the female connector 3b are connected, the liquefied gas inside the cartridge 40 is introduced into the inside from the proximal end 8c of the supply tube 8 through the communication passage 25 and the communication passage 24 of the connector 3. In addition, it is possible to blow out from the distal end opening 8b of the supply tube 8 shown in FIG. 2 to the hollow portion 11a of the first electrode 11.

  As shown in FIG. 1, the conductive lines 32 and 34 drawn out of the connector 3 shown in FIG. 3 are connected to the high frequency power supply device 30 so that a high frequency voltage can be applied between the conductive lines 32 and 34. The high frequency voltage applied through the conductive wire 32 is applied to the second electrode 13 shown in FIG. 2 through the terminal 21, the terminal 16, the conductive wire 12, the terminal 13b, and the conduction path 13a. The high frequency voltage applied through the conductive wire 34 is applied to the first electrode 11 shown in FIG. 2 through a part of the male connector 3a, the terminal 22 and the supply tube 8. In this way, a high frequency voltage is applied between the first electrode 11 and the second electrode 13.

  As shown in FIG. 3, the proximal end of the catheter tube 6 is connected to the handle 4, and the lumen 6 a of the tube 6 communicates with an insertion hole 4 a formed inside the handle 4. The insertion hole 4 a communicates with an attachment / detachment hole 4 b formed on the proximal end side of the handle 4. The insertion hole 4a and the attachment / detachment hole 4b constitute a through-hole of the stylet 7 that extends the axial center of the handle 4 from the distal end to the proximal end.

  A female screw is formed in the attachment / detachment hole 4b, and a male screw formed at the proximal end 7c of the stylet 7 can be detachably coupled to the female screw. At the most proximal end of the stylet 7, a knob 7a is formed. The knob 7 a is located at the proximal end of the handle 4, and the knob 7 a is rotated around the axis with respect to the handle 4, whereby the proximal end 7 c of the stylet 7 is moved with respect to the attachment / detachment hole 4 b of the handle 4. In addition to being detachable, the distal end 7b of the stylet 7 is detachable from the proximal end opening 11d of the first electrode 11 shown in FIG.

  In the embodiment shown in FIGS. 1 to 3, the proximal end 7 c of the stylet 7 is screwed to the attachment / detachment hole 4 b of the handle 4, and to the proximal end opening 11 d of the first electrode 11. Although the distal end 7b of the stylet 7 is screw-coupled, the proximal end 7c and the attachment / detachment hole 4b may be joined by a known detachable joining structure such as a key / keyway, It may not have a structure.

  In the present embodiment, the stylet 7 only needs to have a structure in which the distal end 7b is joined to the hollow portion 11a of the first electrode 11 at a detachable joining point, and the handle 4 is attached to the proximal end 7c. As long as it has a knob 7a protruding from the proximal end and is detachably installed in the lumen 6a of the catheter tube 6, any mode may be used.

  The stylet 7 has a mechanical characteristic that transmits the forward force applied to the handle 4 to the distal end of the catheter 6, and after the cauterization treatment, sufficient strength is required to safely remove the catheter from the body. Therefore, the material of the stylet 7 is preferably a metal material such as stainless steel having a high rigidity, a high-rigidity plastic material such as PEEK, a rod, a tube, or a stranded wire made of carbon fiber, polyimide, or a metal-reinforced plastic material. Used.

  Further, as described above, the supply tube 8 is also preferably a conductive member in order to serve as a voltage supply path to the first electrode 11, and passes through the lumen 6 a of the catheter tube 6 to be liquefied. Since it also serves as a gas supply passage, it is preferably thin and flexible. From this point of view, the supply tube 8 is not particularly limited, but is preferably composed of a metal material such as stainless steel, carbon steel, titanium, cobalt-chromium alloy, nickel alloy, nickel-titanium alloy, or the like.

  The supply tube 8 is designed such that a flow rate of 0.3 to 30.0 Nml / min is obtained when 0.5 MPa of dry air is supplied to its proximal end. A smaller outer diameter of the supply tube 8 is preferable because it does not impair the flexibility of the catheter 6, and is preferably smaller than 0.4 mm. In order to suppress the bending rigidity of the tube 8, it is also effective to arrange the tube 8 in a spiral shape inside the lumen 6a of the catheter tube 6.

  In the present embodiment, the catheter tube 6 is preferably flexible, and may be made of a soft plastic material such as polyurethane, polyamide, polyester, silicone rubber, soft polyvinyl chloride, polyptadiene resin, or fluorine resin. In addition, the catheter tube 6 may be one in which a metal blade, wire, or fiber having a high tensile strength is wound around a soft plastic material so as to suppress blockage of the duct inner hole due to buckling deformation. Further, the catheter tube 6 is a shaft obtained by corrugating a metal material having a high tensile strength, a metal material having a high tensile strength, and a coil tube in which a coil tube wrapped with a blade, a wire, and a fiber having a high tensile strength is coated so as to be airtight. You may be comprised by what made the bending rigidity of the direction small, or what formed the multilayer molding of 2 or more types of plastic materials.

  Materials with high tensile strength include carbon materials such as carbon steel, stainless steel and nickel titanium alloys, carbon fiber materials such as carbon fibers and carbon nanotubes, fibers such as polyimide, polyimide amide, PEEK, polyester and ultra-high molecular weight polyethylene. Depending on the purpose of use, high molecular weight materials can be used.

  The catheter tube 6 may be made of the same material or different materials from the distal end to the proximal end, but electrically insulates the first electrode 11 and the second electrode 13 from each other. The outer diameter of the catheter tube 6 is preferably 2 mm or less. When this outer diameter is too large, damage to the puncture site tissue at the time of puncture increases, and the followability to body movement tends to decrease.

  The inner diameter of the catheter tube 6 is preferably 0.5 mm or more. If the inner diameter is too small, the stylet must be thinned, and a sufficient pushing force cannot be applied to the catheter 6. Further, the pressure loss to the flow of the cooling fluid flowing from the distal end to the proximal end in the lumen 6 a of the catheter tube tends to increase, and cooling is performed at the opening 8 b of the distal end 8 a of the supply tube 8. It tends to be difficult for the fluid to vaporize. The inner and outer diameters of the catheter tube 6 may be gradually decreased from the proximal end to the distal end, or may be changed over a plurality of times.

  In the catheter of the percutaneous approach, the length in the longitudinal direction of the catheter tube 6 is not particularly limited, but is preferably 70 to 700 mm. In the catheter of the endoscopic approach, the length of the catheter tube 6 in the longitudinal direction is not particularly limited, but is preferably 700 to 2500 mm.

  Next, the usage method of the electrode catheter apparatus 1 which concerns on embodiment shown in FIGS. 1-3 is demonstrated.

  In this embodiment, with the distal end 7b of the stylet 7 screwed to the first electrode 11, the distal end of the catheter 2 is passed through the affected area so that the first electrode 11 and the second electrode 13 penetrate the affected area. Insert a puncture. In that state, the male connector 3a and the female connector 3b of the connector 3 in FIG. 3 may be removed, but are preferably fitted. Further, the cartridge 40 may be connected to the cartridge connection port 26 of the connector 3.

  Thereafter, the handle 7 a attached to the proximal end of the handle 4 is operated to pull out the stylet 7 from the proximal end of the handle 4 through the lumen 6 a of the catheter tube 6. Then, the lumen 6a of the catheter tube 6 communicates with the hollow portion 11a, and the liquefied gas blows out from the distal end opening 8b of the supply tube 8 to the hollow portion 11a and is vaporized to cool the inside of the first electrode 11. Thereafter, when the vaporized gas passes through the lumen 6 a of the catheter tube 6, the inside of the second electrode 13 is also cooled, returns to the proximal end side along the lumen 6 a, and passes through the attachment / detachment hole 4 b of the handle 4 to the outside. To be discharged. Of course, an opening / closing device (not shown) such as a valve can be provided in the connector device 3 to control the timing of blowing out the liquefied gas and the amount of blowout.

  When it is not desired to directly release the vaporized gas to the atmosphere, a connector for a discharge tube is connected to the attachment / detachment hole 4b after the stylet 7 is taken out, and the tank or container is connected through the discharge tube. You may make it return gas.

  After the stylet 7 is pulled out from the proximal end of the handle 4, high frequency power is supplied from the high frequency power supply device 30 shown in FIG. 1 to the first electrode 11 and the second electrode 13 to perform cauterization of the affected area. At that time, as described above, the liquefied gas blows out from the distal end opening 8b of the supply tube 8 to the hollow portion 11a and is vaporized to cool the inside of the first electrode 11 and the second electrode 13. The connection of the cartridge 40 to the cartridge connection port 26 may be performed immediately before the supply of the high frequency power or after the supply, when the electrode needs to be cooled.

  When high frequency power is supplied from the high frequency power supply device 30 shown in FIG. 1 to the first electrode 11 and the second electrode 13 and the voltage between these electrodes 11 and 13 reaches the upper limit and the amount of power decreases, the cauterization is completed. is there. Even if the voltage and the electric energy are not displayed, an end point setting circuit may be provided in the electric circuit, and the completion of cauterization may be notified by a buzzer, lamp lighting or extinction.

  After the stylet 7 is pulled out, the catheter 2 can be flexible enough to follow the body movement. Thereafter, liquefied gas is blown into the hollow portion 11a of the first electrode 11 to cool the first electrode 11 and the second electrode 13, and high peripheral power is supplied to the electrodes 11 and 13, thereby cauterizing the affected part. Since the catheter 2 is flexible, the electrodes 11 and 13 during the cauterization can easily follow the body movement, and thus allow some patient body movement. In addition, since the catheter 2 can be bent and attached to the body surface near the puncture site with an adhesive tape or the like, the practitioner is released from the burden of pressing both the catheter 2 and the patient, and the patient presses the patient. Free from the burden of

  When the cauterization is completed, the stylet 7 is reinserted into the catheter 6 from the proximal end side of the handle 4, and the distal end 7 b is reconnected to the proximal end opening 11 d of the first electrode 11, so that the handle 4 To remove the catheter 2 from the body. By reinserting the stylet 7, the catheter tube 6 of the catheter 2 becomes straight and can be easily removed. Moreover, even if the force pulling the handle 4 is directly transmitted to the first electrode 11 and the first electrode 11 is fixed to the tissue, the first electrode 11 is separated from the catheter 2 when the catheter is removed and remains in the body. The risk of doing so can be avoided.

  As described above, in the present embodiment, in order to vaporize the liquefied gas in the vicinity where the liquefied gas blows out from the distal end opening 8b of the supply tube 8 to the hollow portion 11a, the proximal end of the supply tube 8 is used. It is preferable to design so that a flow rate of 0.3 to 30.0 Nml / min can be obtained when dry air of 0.5 MPa is supplied to 8c. By designing in this way, the liquefied gas can be blown out from the distal end opening 8b of the supply tube 8 to be continuously vaporized in the hollow portion 11a of the first electrode 11, and limited. Cooling for a long time is possible with an amount of liquefied gas.

  When a liquefied gas of 0.5 MPa is supplied to the proximal end of the supply tube 8, in a pipeline that can only flow at a flow rate of less than 0.3 Nml / min, there is a tendency that cooling is insufficient or the risk of blockage increases. . In addition, in a pipeline with a flow rate larger than 30.0 Nml / min, the supply amount of the liquefied gas tends to exceed the vaporization rate in the inner space of the electrode, the cooling becomes unstable, and the use amount of the liquefied gas increases and the cooling efficiency increases. Tend to get worse.

  As the liquefied gas, a substance having a boiling point under atmospheric pressure lower than 10 ° C. and higher than −100 ° C. is preferably selected. When the boiling point exceeds 10 ° C., the vaporization rate is slowed down and the cooling capacity is reduced. When the boiling point is lower than −100 ° C., the liquefied gas container becomes heavy to withstand high pressure. It is possible to adjust the pressure of the container and the vaporization state by using a substance having a boiling point exceeding 10 ° C under atmospheric pressure, but if the amount is not limited to 45 parts by weight, the vaporization rate will be slow. Tend to be unable to demonstrate sufficient cooling capacity.

  In the present embodiment, as the liquefied gas supplied from the cartridge 40 to the hollow portion 11a of the first electrode 11 through the supply tube 8, for example, carbon dioxide, nitrous oxide, propane, butane, and hydrofluorocarbon are used. Carbon dioxide. Carbon dioxide has no boiling point under atmospheric pressure, has a sublimation point of -78 ° C, and when liquefied carbon dioxide is released under atmospheric pressure, solid dry ice is generated simultaneously with vaporization. As a result of repeating the blockage due to the accumulation of dry ice and the opening due to sublimation, the temperature inside the electrode can be autonomously stabilized at a low level. In addition, carbon dioxide is safe because it is nonflammable.

  Since the electrode catheter device 1 according to the present embodiment is a bipolar electrode catheter capable of applying a high-frequency voltage between the first electrode 11 and the second electrode 13, the power required for cauterization can be small. The living tissue located in contact with 11 and 13 can be cauterized efficiently.

  In other words, by using bipolar energization, there is no need for a conductive plate that connects the counter electrode plate and the counter electrode plate to the power supply device, so pre-treatment preparation and wiring during treatment are reduced, and high-frequency power can flow only between the integrated electrodes. The expansion of the ablation area is stable, and the risk of complications due to unexpected ablation can be reduced. In addition, since the energized region is limited between the pair of electrodes, the power density in the energized tissue can be increased. As a result, when the same region is cauterized, it requires only 1/3 to 1/10 the electric power of monopolar energization.

  As a result, it is possible to prevent excessive energization with only the voltage upper limit circuit of the high-frequency power, helping that the increase in electric resistance accompanying cauterization is steep. As a result, the temperature of the electrode part and the impedance accompanying energization are measured, thereby avoiding the risk of over-burning without using a conventional complicated system for controlling the high-frequency voltage and the electric energy, and a predetermined region can be cauterized. This enables the high-frequency power supply device to have a simple configuration with a small output, and enables the realization of a small, lightweight, and inexpensive device.

  The electrode catheter device 1 according to the present embodiment improves the high-frequency ablation treatment of the percutaneous approach or the direct approach by incision, but can also be applied to the high-frequency ablation treatment of the endoscopic approach of the transgastrointestinal tract and the transbronchi. .

  In the electrode catheter device 1 according to this embodiment, a high-frequency voltage is supplied to the first electrode 11 through the supply tube 8, and the high-frequency voltage is applied to the second electrode 13 by the conduction path 13 a embedded in the tube wall of the catheter tube 6. Supply. With this configuration, it is not necessary to provide wiring separately from the catheter tube 6 and the supply tube 8, which contributes to reducing the diameter of the catheter 2 and reducing the number of parts.

  Furthermore, in the electrode catheter device 1 according to the present embodiment, the cartridge 40 is connected to the connector 3 and is separate from the handle 4, so that the catheter 2 including the handle 4 becomes light and easy to operate. It is easy to temporarily fix the catheter 2 near the puncture site of the patient. The electrical wiring connected from the catheter 2 to the high-frequency power supply device 30 and the supply tube 8 serving as a cooling fluid channel communicating with the inside of the cartridge 40 are bundled and integrated with the cable 20. The line connection before the treatment and the cleanup after the treatment can be simplified, and there are few connection lines during the treatment, and it becomes easy to follow the body movement.

  In the present embodiment, the connector 3 to which the cartridge 40 is detachably connected also serves as a connector for the conductive path from the high-frequency power supply device 30 to the first electrode 11 and the second electrode 13, so The connection of the liquefied gas flow path and the preparation for energization can be completed in one operation.

When the supply port (portion connected to the cartridge connection port 26 shown in FIG. 3) of the cartridge 40 which is a container holder for the liquefied gas is directed downward in the gravity direction, the liquid portion of the liquefied gas is supplied into the supply tube 8. Conversely, when the supply port of the cartridge 40 is directed upward, the gas portion of the liquefied gas inside the cartridge 40 is supplied into the supply tube 8. When the first electrode 11 and the second electrode 13 in the catheter 2 are cooled to a lower temperature, the supply port of the cartridge 40 is connected to the supply tube 8 so that the liquefied gas flows into the supply tube 8 as shown in FIG. It is preferable to face downward.
Second embodiment

  As shown in FIGS. 4 to 6, in the electrode catheter device 1 </ b> A according to the present embodiment, the first embodiment described above except that the arrangement relationship between the stylet 7 and the supply tube 8 is changed from the first embodiment. In the following description, parts different from those in the first embodiment will be described in detail, and overlapping descriptions will be omitted.

  In the present embodiment, a through hole 9 continuous along the axis is formed inside the stylet 7A, and a supply tube 8 is inserted into the through hole 9 so as to be relatively movable. As shown in FIG. 5, the distal end 8 a of the supply tube 8 is fixed so as to be connected to the first electrode 11 inside the first electrode 11, and can be conducted. Further, the distal end opening 8 b of the supply tube 8 is open to the hollow portion 11 a inside the first electrode 11.

  The supply tube 8 passes through the through-hole 9 of the stylet 7A, is led out of the stylet 7 from the knob 7a, and is introduced into the cable 20 after extending by a length equal to or longer than the stylet 7A. . Inside the cable 20, the supply tube 8 is insulated from the conductive wire 12 connected to the second electrode 13 </ b> A and grouped into a single cable. The connector 3 and the high frequency power supply device 30 to which the proximal end of the cable 20 is connected are the same as in the first embodiment.

  As shown in FIG. 5, the second electrode 13 </ b> A is exposed not only on the outer peripheral side of the catheter tube 6 but also on the inner peripheral side. With this configuration, the second electrode 13A can be directly cooled from the inside by the liquefied gas and / or the vaporized gas passing through the lumen 6a.

  In the present embodiment, the stylet 7A is inserted and removed along the supply tube 8 that supplies the cooling fluid. With this configuration, the risk of damage to the catheter tube 6 can be reduced when the stylet 7A is inserted and removed, particularly when the stylet 7A is inserted.

In this embodiment, the length until the supply tube 8 exposed to the outside from the knob 7a of the handle 4 is integrated with the cable 20 is kept longer than at least the length of the stylet 7A. During the treatment, the stylet 7A pulled out from the catheter 2A is located along the supply tube 8 extending to the proximal end side from the catheter 2A, and there is no risk of losing the stylet 7A during the treatment.
Third embodiment

  As shown in FIGS. 7 and 8, in the electrode catheter device 1B according to this embodiment, the cartridge 40 can be detachably mounted inside the handle 4B, and the connector 3 in the embodiment shown in FIGS. Except for the above, the configuration and the operational effects are the same as those of the above-described first embodiment. In the following description, portions different from the first embodiment will be described in detail, and overlapping descriptions will be omitted.

  That is, an accommodation space 42 for accommodating the cartridge 40 is provided inside the handle 4B according to this embodiment, and the accommodation space 42 is covered with the cartridge knob 44. By operating the knob 44, the cartridge 40 is pushed in the direction of the opener 28B, and the supply port 46 of the cartridge 40 is opened by the opener 28B so as to communicate with the hollow portion 48.

  The hollow portion 48 formed inside the handle 4 communicates with an opening formed at the proximal end 8 c of the supply tube 8, and liquefied gas can be supplied from the hollow portion 48 to the inside of the supply tube 8. ing. Inside the handle 4, the supply tube 8 is insulated from the conductive path 13 a, the ring-shaped terminal 13 b, and the conductive wire 12. A conductive wire 15 insulated from the conductive wire 12 is connected to the supply tube 8, and these conductive wires 12 and 15 are integrated with the cable 20B in an insulated state, and the high frequency power supply device shown in FIG. 30.

  In this embodiment, the handle 4B becomes large, but it is possible to attach the handle 4B to the patient's body surface with an adhesive tape or the like during the treatment after the stylet 7 is pulled out.

  Since the amount of liquefied gas required for cooling the first electrode 11 and the second electrode 13 of the electrode catheter device 1B according to the present embodiment is small, the cartridge 40 that is the reservoir can be housed in the handle 4B. Since the liquefied gas cartridge 40 or other container can be accommodated in the handle, it is not necessary to connect a cooling line before the treatment, and the post-treatment clean up is easy.

  The present invention is not limited to the above-described embodiment, and can be variously modified within the scope of the present invention.

  For example, the fluid that can be used as the cooling fluid is not limited to the above-described liquefied gas such as carbon dioxide gas, but is usually air piped in medical facilities, as well as inorganic gases such as argon, helium, and nitrogen, methane, and ethane. Liquid gas such as organic gas such as propane can be used. In particular, liquefied gases such as propane, butane, and chlorofluorocarbon have a large cooling effect. Of course, it may be a liquid such as cold water or ice-cold physiological saline, but a liquefied gas is preferred.

  In the present invention, the shape of the first electrode 11 is not particularly limited, and may be a hemispherical shape or a round shape.

1, 1A, 1B ... Electrode catheter device 2, 2A, 2B ... Catheter 4, 4B ... Handle 6 ... Catheter tube 6a ... Lumen 7, 7A ... Stylet 7a ... Knob 7b ... Distal end 8 ... Supply tube 8a ... Distal End 8b ... Opening 8c ... Proximal end 11 ... First electrode 11a ... Hollow part 12 ... Conducting wire 13 ... Second electrode 13a ... Conducting path

Claims (5)

A catheter tube having a lumen formed therein;
A first electrode attached to the distal end of the catheter tube;
A second electrode disposed at a predetermined interval along the longitudinal direction of the catheter tube with respect to the first electrode;
A handle to which the proximal end of the catheter tube is connected;
A stylet that is removably inserted along the lumen of the catheter tube over a length from the first electrode to the handle, and is detached from the proximal end of the handle;
A supply path for flowing a cooling fluid therein is formed, and a distal end opening of the supply path has a supply tube that opens into the internal space of the first electrode, and
An electrode catheter device in which a distal end of the stylet is detachably attached to an attachment portion communicating with the internal space of the first electrode.   The electrode catheter device according to claim 1, wherein the supply tube has conductivity and is also used as a voltage supply conductive line to the first electrode.   The electrode catheter device according to claim 1 or 2, wherein a conductive wire embedded in the catheter tube is connected to the second electrode, and a voltage is supplied to the second electrode through the conductive wire.   The ablation catheter according to claim 1, wherein the cooling fluid introduced into the supply tube is a liquefied gas.   A through hole that is continuous along the axis of the stylet is formed inside the stylet, and the supply tube is inserted into the through hole, and the stylet is connected to the supply tube. The cautery catheter according to any one of claims 1 to 4, wherein the catheter is relatively movable in the axial direction.

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