JP2011526820A - 体管腔内の閉塞部を治療する装置および方法 - Google Patents
体管腔内の閉塞部を治療する装置および方法 Download PDFInfo
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- A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
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Abstract
【選択図】図7
Description
Claims (30)
- 体管腔を治療する装置において、当該装置が:
近位端部と、体管腔内に導入するサイズの遠位端部と、前記近位端部と前記遠位端部との間に延在する第1の管腔とを具える伸長管状部材と;
前記管状部材の遠位端部に固定された近位端部と、出口を有する遠位端部とを具える膨張性バルーンであって、前記第1の管腔および前記バルーンの出口と連通している内側を具えるバルーンと;
前記第1の管腔内に摺動可能に配置される伸長部材であって、前記管状部材の近位端部に近接する近位端部と、前記バルーンの出口から延在している遠位端部とを具える伸長部材と;
前記伸長部材の遠位端部における密封部材とを具えており、前記伸長部材は、前記第1の管腔を介して導入された流体が前記バルーンの内側を通って前記バルーンの出口の外へ出るように前記密封部材が前記バルーンの出口から離れて配置された第1の位置と、前記第1の管腔を介して導入された流体が前記バルーンの内側に入り前記バルーンを膨脹させるように前記密封部材が前記バルーンの出口を実質的に密封している第2の位置との間を移動することができることを特徴とする装置。 - 請求項1に記載の装置において、前記密封部材が、前記バルーンの出口よりも大きい断面を有することを特徴とする装置。
- 請求項2に記載の装置において、前記伸長部材が前記第1の位置にある場合に、前記バルーンの内側から前記バルーンの出口を通って流体を送達する環状管腔が前記伸長部材と前記バルーンの出口との間に規定されるように、前記伸長部材の遠位端部が前記バルーンの出口よりも小さい断面を有することを特徴とする装置。
- 請求項1に記載の装置において、前記管状部材の近位端部から前記バルーンの内側に流体を送達する環状管腔が前記伸長部材と前記管状部材との間に規定されるように、前記伸長部材が前記第1の管腔よりも小さい断面を有することを特徴とする装置。
- 請求項1に記載の装置において、前記バルーンが、弾性材料を含むことを特徴とする装置。
- 請求項1に記載の装置において、前記バルーンが、実質的に非弾性の材料を含むことを特徴とする装置。
- 請求項1に記載の装置がさらに、前記管状部材の近位端部におけるハンドルと、前記第1および第2の位置の間で前記伸長部材を振り分ける、前記ハンドルにおけるアクチュエータとを具えることを特徴とする装置。
- 請求項1に記載の装置において、前記伸長部材が、前記第1および第2の位置の一方へと付勢されることを特徴とする装置。
- 請求項1に記載の装置がさらに、前記管状部材の遠位端部に連結された第1の端部と、前記伸長部材の遠位端部に連結された第2の端部とを有するらせん形部材を具えており、当該らせん形部材は前記バルーンの内側で前記伸長部材の周りにらせん状に延在し、前記伸長部材は、前記伸長部材の遠位端部が前記管状部材の遠位端部へと誘導されて前記らせん形部材を放射状に外側へ拡張らせん形状へと拡張させ、その結果、前記バルーンを前記拡張らせん形状に拡張させる第3の位置に移動できることを特徴とする装置。
- 請求項9に記載の装置において、前記らせん形部材の第2の端部が前記伸長部材の遠位端部に固定されたストッパに連結されており、前記伸長部材が前記第2および第3の位置の間で振り分けられたときに前記伸長部材の遠位端部に対する前記バルーンの遠位端部の相対的な運動を前記ストッパが制限するように、当該ストッパは前記バルーンの出口よりも大きい断面を有することを特徴とする装置。
- 請求項9に記載の装置がさらに、前記第1の管腔と接続している真空源を具えており、前記伸長部材が前記第3の位置に誘導される前に、前記バルーンが前記らせん形部材の拡張したらせん形状とほぼ一致するように前記バルーンを収縮させることを特徴とする装置。
- 請求項9に記載の装置において、前記伸長部材が前記第3の位置に移動した場合に前記バルーンの遠位端部が前記バルーンの近位端部へと誘導され、その結果、前記バルーンを軸方向に収縮させることを特徴とする装置。
- 請求項12に記載の装置がさらに、前記バルーンの遠位端部に近い前記伸長部材の遠位端部にストッパを具えており、前記伸長部材は前記第3の位置から前記第2の位置に戻るように移動し、それにより前記らせん形部材を伸長させて収縮させることができ、前記伸長部材が前記第3の位置から前記第2の位置へと戻るように移動したときに前記ストッパが前記バルーンの遠位端部と係合して前記バルーンの遠位端部を遠位に誘導し、その結果、前記バルーンを軸方向に伸長させて収縮させることを特徴とする装置。
- 体管腔を治療する装置において、当該装置が:
近位端部と、体管腔内に導入するサイズの遠位端部と、前記近位端部と前記遠位端部との間に延在している第1の管腔とを具える外側管状部材と;
前記外側部材の遠位端部に固定された近位端部と、出口を有する遠位端部とを具える膨張性バルーンであって、前記第1の管腔および前記バルーンの出口と連通している内側を具えるバルーンと;
前記第1の管腔内に摺動可能に配置される内側部材であって、前記外側部材の前記近位端部と前記遠位端部との間において環状管腔が前記外側部材と前記内側部材との間に規定されるように前記第1の管腔よりも小さい断面を有しており、前記外側部材の近位端部と近接する近位端部と前記バルーンの出口から延在している遠位端部とを具える内側部材と;
前記内側部材の遠位端部における密封部材であって、前記内側部材が、前記第1の管腔を介して導入された流体が前記バルーンの内側を通り前記バルーンの出口の外へ出るように前記密封部材が前記バルーンの出口から離れて配置される第1の位置と、前記第1の管腔を介して導入された流体が前記バルーンの内側に入り前記バルーンを膨脹させるように前記密封部材が前記バルーンの出口を実質的に密封する第2の位置との間を移動することができる密封部材と;
前記外側部材の遠位端部に連結された第1の端部と、前記内側部材の遠位端部に連結された第2の端部とを具えるらせん形部材であって、前記バルーンの内側で前記内側部材の周りにらせん状に延在するらせん形部材とを具えており、前記内側部材は、当該内側部材の遠位端部が前記外側部材の遠位端部へと誘導され、前記らせん形部材を放射状に外側へ拡張させ、その結果前記バルーンを拡張らせん形状に拡張させる第3の位置に移動できることを特徴とする装置。 - 請求項14に記載の装置において、前記バルーンが、実質的に非弾性の材料を含むことを特徴とする装置。
- 請求項14に記載の装置において、前記らせん形部材の第2の端部が前記内側部材の遠位端部に固定されたストッパに連結されており、前記伸長部材が前記第2および第3の位置の間で振り分けられたときに前記内側部材の遠位端部に対する前記バルーンの遠位端部の相対的な運動を前記ストッパが制限するように、当該ストッパは前記バルーンの出口よりも大きい断面を有することを特徴とする装置。
- 請求項14に記載の装置がさらに、前記第1の管腔と接続している真空源を具えており、前記内側部材が前記第3の位置に誘導される前に、前記バルーンが拡張したらせん形状に拡張されたときに前記バルーンが前記らせん形部材の形状とほぼ一致するように前記バルーンを収縮させることを特徴とする装置。
- 体管腔を治療する装置において、当該装置が:
近位端部と、体管腔内に導入するサイズの遠位端部と、前記近位端部と前記遠位端部との間に延在している第1の管腔とを具える外側管状部材と;
前記第1の管腔内に摺動可能に配置された内側部材であって、前記外側部材の前記近位端部と前記遠位端部との間において環状管腔が前記外側部材と前記内側部材との間に規定されるように前記第1の管腔よりも小さい断面を有しており、前記外側部材の近位端部に近接する近位端部と、前記外側部材の遠位端部を越えて延在する遠位端部とを具える内側部材と;
前記外側部材の遠位端部に固定された近位端部と、前記内側部材の遠位端部に連結された遠位端部とを具える膨張性バルーンであって、前記第1の管腔および前記バルーンの出口と連通している内側を具えるバルーンと;
前記第1の管腔を介して前記バルーンの内側に膨脹媒体を送達すべく前記第1の管腔と接続しており、収縮状態から円筒形の膨脹状態に前記バルーンを放射状に外側へ拡張させる膨脹媒体の供給源と;
前記外側部材の遠位端部に連結された第1の端部と、前記内側部材の遠位端部に連結された第2の端部とを具えるらせん形部材であって、前記バルーンの内側で前記内側部材の周りにらせん状に延在するらせん形部材とを具えており、前記内側部材は、前記らせん形部材が前記内側部材と近接して配置され前記バルーンが収縮した状態にある第1の遠位位置から、前記らせん形部材を軸方向に収縮させて放射状に外側へ拡張させ、その結果、前記バルーンを軸方向に収縮させて拡張らせん形状へと放射状に拡張させる第2の近位位置に移動できることを特徴とする装置。 - 請求項18に記載の装置において、前記らせん形部材が前記第1の端部と前記第2の端部との間に第1および第2の領域を具えており、前記第1の領域は、前記バルーンが前記拡張らせん形状における第1および第2のらせん領域を規定するように前記第2の領域よりも大きい直径まで拡張することができ、ここで前記第1のらせん領域は前記第2のらせん領域よりも大きい直径を有することを特徴とする装置。
- 請求項18に記載の装置がさらに、前記第1の管腔と接続している真空源を具えており、前記内側部材が前記第2の位置に誘導される前に、前記バルーンが前記拡張らせん形状における前記らせん形部材の形状とほぼ一致するように前記収縮状態へと前記バルーンを収縮させることを特徴とする装置。
- 体管腔を治療する装置において、当該装置が:
近位端部と、体管腔内に導入するサイズの遠位端部と、前記近位端部と前記遠位端部との間に延在している第1の管腔とを具える外側管状部材と;
前記第1の管腔内に摺動可能に配置され、前記外側部材の近位端部と近接する近位端部と、前記外側部材の遠位端部を超えて延在する遠位端部とを具える内側部材と;
前記外側部材の遠位端部に固定された近位端部と、前記内側部材の遠位端部に連結された遠位端部とを具える膨張性バルーンであって、前記第1の管腔および前記バルーンの出口と連通している内側を具えるバルーンと;
前記外側部材の遠位端部に連結された第1の端部と、前記内側部材の遠位端部に連結された第2の端部とを具えるらせん形部材であって、前記バルーンの内側で前記内側部材の周りにらせん状に延在するらせん形部材とを具えており、前記内側部材は、前記らせん形部材が前記内側部材と近接して配置され前記バルーンが前記収縮状態にある第1の近位位置から、前記らせん形部材を軸方向に収縮させて放射状に外側へ拡張させ、その結果、前記バルーンが拡張らせん形状へと軸方向に収縮して放射状に拡張する第2の近位位置に移動することができ、前記らせん形部材は前記第1の端部と前記第2の端部との間に第1および第2の領域を具え、前記第1の領域は前記バルーンが前記拡張らせん形状における第1および第2のらせん領域を規定するように前記第2の領域よりも大きい直径まで拡張することができ、前記第1のらせん領域は前記第2のらせん領域よりも大きい直径を有することを特徴とする装置。 - 体管腔内の物質を除去する装置において、当該装置が:
近位端部と、体管腔内に導入するサイズの遠位端部と、前記近位端部と前記遠位端部との間に延在している吸引管腔とを具える伸長管状部材と;
前記遠位端部から延在し、遠位先端部で終端する細長い誘導部材であって、前記遠位先端部が前記管状部材の遠位端部の方へおよびそこから離れる方に移動するように前記管状部材に対して往復運動しうる誘導部材と;
互いに連続的に連結された複数のループを具えるフラグメント装置であって、前記誘導部材が往復運動する際に、前記ループが概ね前記誘導部材に沿って延在しているロープロファイルと、前記ループが前記誘導部材に対して横方向に延在するラージプロファイルとの間に振り分けられるように、第1のループが前記管状部材の遠位端部に連結され、最後のループが前記誘導部材に連結されているフラグメント装置とを具えることを特徴とする装置。 - 請求項22に記載の装置において、前記フラグメント装置がさらに、前記誘導部材の遠位端部の周りにらせん状に配置されたフラグメントコイルを具えており、前記ループが前記ロープロファイルに誘導されるときに前記フラグメントコイルが伸長して半径方向に収縮され、前記ループが前記ラージプロファイルに誘導されるときに前記フラグメントコイルが軸方向に収縮されて半径方向に拡張するように、前記フラグメントコイルが前記誘導部材に連結されていることを特徴とする装置。
- 請求項22または23に記載の装置において、前記誘導部材が前記管状部材の遠位端部に対して遠位に誘導された場合に前記ループは前記ロープロファイルに誘導され、前記誘導部材が前記管状部材の遠位端部に対して近位に誘導された場合に前記ループは前記ラージプロファイルに誘導されることを特徴とする装置。
- 請求項22乃至24の何れか一項に記載の装置がさらに、前記管状部材の近位端部にハンドルを具えており、当該ハンドルは前記誘導部材を往復運動させるべく前記誘導部材に連結されたアクチュエータを具えていることを特徴とする装置。
- 請求項25に記載の装置がさらに、前記ハンドルによって保持され、前記管状部材の管腔内に真空を生成するように構成された真空源を具えており、前記フラグメント装置によって係合または分離された閉鎖性物質を吸引することを特徴とする装置。
- 近位端部と遠位端部との間に延在している第1の管腔を含む外側部材と、前記第1の管腔内を摺動可能な内側部材と、前記外側および内側部材によって保持されるバルーンであって、出口と前記第1の管腔および前記出口と連通している内側とを具えているバルーンとを具えるバルーン装置を用いて患者の体管腔を治療する方法において、当該方法が:
前記バルーンが収縮した状態で前記バルーン装置の遠位端部を体管腔内に導入するステップと;
前記収縮状態から拡張らせん形状に前記バルーンを拡張させるべく、前記バルーンの近位端部および遠位端部を互いの方に誘導させるステップと;
前記体管腔の壁から閉鎖性物質を除去すべく、前記バルーンが前記拡張らせん形状にある状態で前記体管腔の壁に沿って前記装置の前記遠位端部を誘導するステップと;
前記収縮状態からほぼ円筒の形状に前記バルーンを膨脹させて前記体管腔の壁を拡張させるべく、前記第1の管腔を介して前記バルーンの内側に膨脹媒体を導入するステップと;
前記バルーンが前記収縮状態に戻るよう収縮させるべく、前記第1の管腔を介して前記バルーンの内側から前記膨脹媒体を取り除くステップと;
前記バルーンが前記収縮した状態で、前記体管腔から前記装置の遠位端部を除去するステップとを具えることを特徴とする方法。 - 患者の体管腔を治療する方法において、当該方法が:
装置の遠位端部を体管腔内に導入するステップであって、前記装置が前記遠位端部において収縮状態の膨脹性部材を保持しているステップと;
前記膨脹性部材を前記収縮状態から拡張らせん形状に拡張させるべく、前記膨脹性部材の近位端部および遠位端部を互いの方へと誘導するステップと;
前記体管腔の壁から閉鎖性物質を除去すべく、前記膨脹性部材が前記拡張らせん形状にある状態で前記体管腔の壁に沿って前記装置の前記遠位端部を誘導するステップと;
前記膨脹性部材を前記収縮状態からほぼ円筒の形状および球形の一方を具える拡張形状に拡張させるべく、前記シャフトを介して前記膨脹性部材の内側に膨脹媒体を導入するステップとを具えることを特徴とする方法。 - 体管腔を治療する方法において、当該方法が:
装置の遠位端部を体管腔内に導入するステップであって、前記装置が前記遠位端部において収縮状態の膨脹性部材を保持しているステップと;
前記流体が前記バルーンの内側を通って前記バルーンと近接する開放バルブを出るように、前記装置の第1の管腔を介して流体を送達するステップと;
前記バルブを密封するステップと;
前記バルブが密封された状態で前記第1の管腔を介して流体を送達するステップであって、その結果、前記バルーンを前記収縮状態から膨脹状態に拡張させるステップとを具えることを特徴とする方法。 - 請求項29に記載の方法において、前記バルーンが弾性材料を含んでおり、前記方法がさらに:
前記バルブを密封した状態で前記膨脹状態における前記バルーンを軸方向に収縮するステップであって、それにより前記バルーンの形状およびサイズの少なくとも一方を変更するステップを具えることを特徴とする方法。
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EP2307086B1 (en) | 2015-04-15 |
CN102159277A (zh) | 2011-08-17 |
AU2009266808A1 (en) | 2010-01-07 |
CN102159277B (zh) | 2013-08-21 |
WO2010003135A2 (en) | 2010-01-07 |
JP5571074B2 (ja) | 2014-08-13 |
JP6054916B2 (ja) | 2016-12-27 |
WO2010003135A3 (en) | 2010-04-01 |
HK1211253A1 (en) | 2016-05-20 |
US20100036410A1 (en) | 2010-02-11 |
EP2307086A2 (en) | 2011-04-13 |
EP2902070B1 (en) | 2016-10-05 |
CA2729750C (en) | 2017-06-06 |
CA2729750A1 (en) | 2010-01-07 |
EP2902070A1 (en) | 2015-08-05 |
US8043313B2 (en) | 2011-10-25 |
JP2014236994A (ja) | 2014-12-18 |
AU2009266808B2 (en) | 2014-07-10 |
EP2307086A4 (en) | 2013-11-20 |
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