JP2013540504A5 - - Google Patents

Description

catheter

  The present invention relates to an apparatus and method for transporting liquid to or from a treatment site on a patient's body.

  Transporting fluid to or from a treatment site on a patient's body is effective for many medical procedures. Instruments that transport liquids in medical procedures are commonly referred to as catheters. A catheter can be used to provide drainage or to administer treatment fluid. For example, when a catheter is used, it is possible to drain the liquid from an organ or region where the liquid has abnormally accumulated in a surgical wound or the like accompanying a surgical operation. In addition, it is possible to perform a wide range of treatments from cancer treatment to nutritional supplementation by delivering a liquid to the treatment site using a catheter. Some examples of treatment include promotion of tissue growth, administration of antibiotics, excretion of impurities, destruction of regenerative cancer cells or prevention of cancer cell regeneration, pain relief, and the like.

  The catheter can be used in a configuration using gravity, for example, with a collection container placed under the treatment site or a drug container placed over the treatment site. Similarly, the catheter may be used in a configuration that uses pressure. For example, if suction is performed with a drainage catheter, the liquid can be extracted from the treatment site. Aspirators include elastomeric valves, spring bellows, electromechanical vacuum pumps, and other well-known medical aspirators. Pressurized liquid can be delivered through the catheter to the treatment site. For example, liquid injectors include manual syringes, elastic injectors, spring injectors, electromechanical injectors, and other well known injectors.

  A typical conventional catheter is a linear device that forms one or more openings along a portion of the length of fluid passage. They usually have poor performance because they are unable to drain or deliver liquid from a large area that encompasses all of the treatment site. Furthermore, the presence of pleats and joints in the tissue has a further adverse effect on fluid movement and collection, and conventional catheters are difficult to adequately address the treatment site.

  For example, if the treatment site spans a two-dimensional or three-dimensional treatment range, the liquid can be drained with a conventional drainage catheter only in a relatively small linear part of the treatment area, so that some liquid remains. Often occurs.

  Similarly, treatment liquid can be supplied by a conventional infusion catheter only to a relatively small linear treatment site, and thus, many treatment sites cannot be treated. Conventional infusion catheters may deliver an excessive amount of treatment liquid to a relatively small area, and the retention of the treatment liquid or non-target tissue may come into contact with the treatment liquid. For example, an analgesic may be delivered directly to the surgical site using an infusion catheter to reduce post-operative pain due to a surgical procedure. If the drug does not reach the destroyed tissue during the surgical procedure, the pain may not be relieved. Alternatively, an indiscriminate supply of drugs can cause undesirable effects on local structures such as spinal nerves or critical organs.

  Each aspect of the present invention provides an apparatus and method for draining liquid from or delivering liquid to a treatment site region of a patient's body. The liquid delivered to the treatment site is referred to as the treatment liquid, but this may be any material that is delivered to the treatment site to achieve the desired effect. For example, the treatment fluid can be water, saline, antibiotics, antiviral drugs, hormones, growth factors, anti-inflammatory drugs, analgesics, anesthetics, and / or any other substance useful for treating a patient. . For example, the anesthetic may include marker in, ropivacaine, bupivacaine, and / or any other anesthetic or combination thereof.

  Embodiments of the invention can be used in any procedure where it is desirable to deliver liquid to or drain liquid from the treatment site. The use of such an instrument and method will be described with some specific examples showing delivery of anesthetic to the surgical site and / or drainage of fluid from the surgical site to treat post-surgical pain. Examples of such surgery include head, neck, chest, back, abdomen, and limb surgery. Examples of these include general surgery, cosmetic surgery, joint surgery, and spinal surgery. However, one of ordinary skill in the art will be able to treat a variety of other conditions by using the devices and methods disclosed herein to drain liquid from the treatment site and deliver liquid to the treatment site. Will be clear.

  In one aspect of the invention, the catheter includes a first end or connection end and an opposite second end or end. A liquid conduit through which liquid passes extends between the connection end and the end portion. The distal end includes an elongate hollow body having a wall defining the distal end of the liquid conduit, the wall passing liquid between the liquid conduit and its exterior. One or more openings are formed. It is possible to deliver liquid to a region in a substantially plane or discharge liquid from a region at the end portion that describes a non-linear path. At the end, which describes a non-linear path, it is possible to deliver liquid to a three-dimensional area or to discharge liquid from the three-dimensional area. The distal end may be flexible to adjust the coverage area of the catheter. Such adjustments can be made in a plane by moving the end portions relative to each other so as to change the area to be coated. Such adjustment can be performed in a three-dimensional manner by moving the portions of the end portion relative to each other so as to change the non-planar region to be coated. By configuring the end portion in a non-linear manner, each portion of the end portion separates the tissue layers in the treatment site, and the flow of liquid between the tissue layers in the two-dimensional or three-dimensional treatment site Maintained and effective treatment area will be expanded. Further, the non-linearly configured end portions are extended into tissue folds and irregularities so that the tissue layers are separated from each other and between the tissue layers and adjacent to the end portions. Improved liquid transport. If liquid transport is improved, the number of catheters required for liquid transport to and / or from the treatment site is reduced. One or more of the openings in the wall of the conduit may be located at any location around the wall. In order to prevent the opening from overlapping and closing on the tissue, the opening is arranged parallel to the plane of the nonlinear path at the end so that the opening opens in the space between the tissue layers. Is possible. The non-linear path at the end may be pre-formed to fit the edge of a particular surgical site. The shape may be an arbitrary shape such as a polygon, an egg shape, or a spiral shape.

  The end portion may include more than one conduit. A plurality of conduits can be adjusted to each other two-dimensionally and / or three-dimensionally to change the liquid dispersion pattern at the end portion. It is possible to provide multiple conduits for various functions. For example, liquid can be drained from the treatment site using one or more other conduits while liquid is injected into the treatment site using one or more conduits.

  The distal end of the catheter may have a first non-linear configuration and a second configuration modified from it. For example, the end portion may have a non-linearly deployed configuration for transporting liquid to or from a two-dimensional or three-dimensional region and a configuration for delivering or removing. The delivery or removal configuration can be smaller than the deployed configuration so that the distal portion can be easily placed or removed at a desired anatomical location of the patient. For example, the delivery or removal configuration may be folded, rolled, straightened, stretched, compressed, twisted, contracted, and / or other configuration operable to the deployed configuration.

  In another aspect of the invention, the catheter includes a first end or connection end and an opposite second end or end. A liquid conduit through which liquid passes extends between the connection end and the end portion. The end portion includes a liquid exchange portion. The liquid exchanger includes an elongate hollow body, the hollow body may have a wall defining the end of the liquid conduit, and the wall has a liquid between the liquid conduit and its exterior. One or more openings through which may pass may be formed. The end can include more than one conduit. A plurality of conduits can be adjusted to each other two-dimensionally and / or three-dimensionally to change the liquid dispersion pattern at the end. The plurality of conduits can be attached while being spaced apart from each other at a predetermined interval.

  The distal end may include a member attached to the one or more conduits. The member may connect portions of the one or more conduits to each other and place the portions in a desired configuration. The member may be flexible so that the parts can be rearranged from the original position to another position.

  The member may include a barrier to liquid flow so as to prevent liquid flow in a particular predetermined direction. The barrier can be connected to the one or more conduits to energize liquid flow in a preferred direction and prevent liquid flow in a non-preferred direction. The barrier may function as a connecting member that separates portions of the one or more conduits. The barrier may be permanently fixed to the end portion or removably fixed to the end portion. The barrier may be positioned spaced from the distal end so as to shield the patient's anatomical selection from the delivered fluid. For example, the barrier can impede liquid flow by juxtaposing liquid-impermeable structures and / or by absorbing liquid. The barrier may be resorbable or durable. The barrier can be made of polymer, ceramic, metal, plant tissue, animal tissue, and / or other suitable materials. The barrier may be in the form of a block, sheet, film, layer, sponge, and / or any other suitable form adapted or adaptable to an anatomical site that requires the barrier function. The barriers that are pre-shaped and sized to suit a particular application may be used and / or the user may be able to mold and size during the operation. For example, the barrier can be made of a thin polymer film. In another example, the barrier may be made of collagen that forms a relatively liquid impermeable thin film.

  By separating the tissue layer at the treatment site with the barrier and maintaining the fluid flow between the tissue layers over the two-dimensional or three-dimensional treatment site, an effective treatment region can be expanded. Furthermore, the distal portion of the barrier can be extended into tissue folds and irregularities to separate tissue layers, improving liquid transport between tissue layers and to portions adjacent to the barrier. Improved liquid transport reduces the number of catheters required to transport liquid to and / or from the treatment site.

  The one or more openings in the wall of the conduit may be located at any location around the wall. In order to prevent the opening from overlapping and closing on the tissue, the opening is arranged parallel to the plane of the nonlinear path at the end so that the opening opens in the space between the tissue layers. Is possible.

  The barrier may be pre-formed to fit the edge of a particular surgical site. The shape may be an arbitrary shape such as a polygon, an egg shape, or a spiral shape.

  The distal end of the catheter may have a first configuration and a second configuration modified from it. For example, the distal end may have a configuration deployed to transport liquid to or from the treatment site and a configuration for delivery or removal. The delivery or removal configuration can be smaller than the deployed configuration so that the catheter can be easily placed or removed at a desired anatomical location of the patient. For example, the delivery or removal configuration may be folded, rolled, stretched, compressed, twisted, contracted, straightened, and / or other possible configurations that can be manipulated to the deployed configuration.

  In another aspect of the invention, the catheter includes a first end or connection end and an opposite second end or end. A liquid conduit through which liquid passes extends between the connection end and the end portion. The end portion includes a liquid exchange portion. The liquid exchange part includes a hollow body, the hollow body having a wall defining the end of the liquid conduit, the wall having an opening through which liquid passes between the liquid conduit and the exterior thereof. More than one can be formed. The catheter may include more than one liquid conduit. Multiple liquid conduits may provide the same function or different functions. For example, the catheter may include one or more infusion conduits that deliver treatment fluid to the treatment site and one or more suction conduits that drain fluid from the treatment site. The infusion conduit and suction conduit may be on the same catheter or on separate catheters that are placed independently at the treatment site.

  The end portion may include a diffuser having an outer surface. The diffuser may include a plurality of independent channels capable of transporting liquid between the conduit and a discontinuous portion of the outer surface. The diffuser may include interconnected hole tissue that can disperse liquid throughout the diffuser and the outer surface. The diffuser may be permanently fixed to the end portion or detachably fixed to the end portion. The diffuser may be placed separately at the treatment site independent of the distal end. A separately disposed diffuser can cause liquid to ooze or wick liquid from a defined area of the outer surface of the diffuser. The diffuser may be resorbable or durable. The diffuser may be made from polymers, ceramics, metals, plant tissue, animal tissue, and / or other suitable materials. The diffuser may include fibers, knitted fabrics, sponges, fabrics, and / or other suitable diffusion structures. For example, the diffuser may include a textured surface. The surface can be textured by stamping, knurling, roughening, and / or other suitable means. The surface can be textured by forming line ridges, depressions, undulations, and / or other suitable features. The fabric can include fibers. The diffuser may include a fibrous structure that can conduct liquid within, along, or between the fibers. The fibers may be attached to the surface or stand unsupported. For example, the fibrous structure may be created by weaving, knitting, braiding, felting, gluing, and / or other suitable fiber processing. For example, the diffuser includes a cloth made of synthetic fibers having a substantially planar configuration, and is disposed between opposing tissues so that a liquid is produced along the fibers and between the fibers by capillary action. By bleeding, the liquid can be transported to a wide area. The diffuser can be created.

  The end portion may include a barrier to liquid flow that prevents liquid flow in a particular predetermined direction. The barrier may be connected to one or more conduits to energize liquid flow in a preferential direction and prevent liquid flow in a non-preferential direction. The barrier may be fixed permanently to the end or removably fixed to the end. The barrier may be spaced apart from the distal end to isolate the patient's anatomical selection from fluid flow. The barrier can impede liquid flow, for example by juxtaposing the liquid-impermeable structure and / or by absorbing liquid. The barrier may be resorbable or durable. The barrier can be made from polymers, ceramics, metals, plant tissue, animal tissue, and / or other suitable materials. The barrier may be in the form of a block, sheet, thin film, layer, and / or other suitable form adapted or adaptable to an anatomical site that requires the barrier function. The barriers that are pre-shaped and sized to suit a particular application may be used and / or the user may be able to mold and size during the operation. For example, the barrier can be made of a thin polymer film. In another example, the barrier may be made of collagen that forms a relatively liquid impermeable thin film. The barrier may be coupled to the diffuser so as to provide a liquid flow through a portion of the diffuser and prevent liquid flow in the other portion of the diffuser.

  Separating the tissue layer of the treatment site with the barrier and / or the diffuser and expanding the effective treatment area by maintaining fluid flow between the tissue layers over the two-dimensional or three-dimensional treatment site be able to. Further, the distal portion of the barrier and / or diffuser extends into tissue folds and textures to separate the tissue layers, between the tissue layers, and adjacent to the barrier and / or the diffuser. The liquid transportation to the part can be improved. Improved liquid transport reduces the number of catheters required for liquid transport to and / or from the treatment site.

The one or more openings in the wall of the conduit may be located at any location around the wall. Order before Symbol opening to avoid clogging overlying tissue, to open said opening into the space between the tissue layers to each other, to place the parallel said opening to the surface of the non-linear path of the distal portion It is possible to

  The shape of the barrier and / or diffuser that fits the edge of a particular surgical site may be predetermined. The shape may be an arbitrary shape such as a polygon, an egg shape, or a spiral shape.

  The distal end of the catheter may have a first configuration and a second configuration modified from it. For example, the distal end may have a deployed configuration for transporting liquid to or from the treatment site and a configuration for delivery or removal. The delivery or removal configuration can be smaller than the deployed configuration to facilitate placement or removal of the distal end at the desired anatomical location of the patient. For example, the delivery or withdrawal configuration can be folded, rolled, deflated, stretched, compressed, twisted, contracted, straightened, and / or otherwise manipulated into the deployed configuration It may be the composition of.

  The catheter is placed on the treatment site by placing it on the treatment site by placing it on an open wound and passing the connecting end outside the patient's body, leaving the distal end at the treatment site. can do. Alternatively, the catheter can be placed at the treatment site in a way that it is placed from outside the body into the body, introducing the distal end from outside the patient's body to the treatment site. If a surgical incision site is present near the treatment site, the catheter can be extended through the incision site. Alternatively, the catheter may be extended to the treatment site through another opening, such as a puncture incision, formed to pass a portion of the catheter.

  The catheter is placed on the treatment site by placing it on an open wound, passing the connecting end out of the patient's body and leaving the distal end at the treatment site, from inside the body to outside the body. can do. Alternatively, the catheter can be placed at the treatment site in a way that it is placed from outside the body into the body, introducing the distal end from outside the patient's body to the treatment site. If the surgical incision site is near the treatment site, the catheter can be extended through the incision. Alternatively, the catheter may be extended to the treatment site through another opening, such as a puncture incision, formed to pass a portion of the catheter.

  The conduit may be made of any suitable biocompatible material. For example, the conduit may be made of a biocompatible polymer. For example, the conduit may be made of a heat-settable elastic polymer. For example, the conduit is made of or includes a thermoplastic elastomer such as a styrene block copolymer, a polyolefin, a thermoplastic polyurethane, a thermoplastic copolyester, a thermoplastic polyamide resin, and / or various mixtures thereof. May be. For example, the conduit may comprise or be made of a polyether block amide or PEBA. PEBA is available from Arkema under the trade name PEBAX (registered trademark).

  Various examples of the present invention will be described with reference to the accompanying drawings. These drawings are merely illustrative of the invention and are not intended to limit the scope of the invention.

It is a perspective view of one embodiment of the present invention. FIG. 1B is a top view of the embodiment of FIG. 1A. 1B is a cross-sectional view of the embodiment of FIG. 1A taken along line CC in FIG. 1B. FIG. 1B is a perspective view of the embodiment of FIG. 1A illustrating one method of installation. FIG. 1B is a perspective view of the embodiment of FIG. 1A illustrating one method of installation. FIG. 1B is a perspective view of the embodiment of FIG. 1A illustrating one method of installation. FIG. 1B is a perspective view of the embodiment of FIG. 1A illustrating one method of installation. FIG. 1B is a perspective view of the embodiment of FIG. 1A illustrating one method of installation. 1B is a perspective view of an embodiment of the present invention similar to FIG. 1B is a top view of an embodiment of the present invention similar to FIG. 1B is a top view of an embodiment of the present invention similar to FIG. 1A, including a second liquid conduit. FIG. FIG. 1B is a top view of an embodiment of the invention similar to FIG. 1A that encloses a second liquid conduit. 1B is a partial perspective view of an embodiment of the present invention similar to FIG. 1A that encloses a second liquid conduit. FIG. 1B is a perspective view of an embodiment of the present invention similar to FIG. FIG. 5B is a perspective view of the embodiment of FIG. 5A showing the deployed state of the embodiment of FIG. 5A. 1B is a perspective view of an embodiment of the present invention similar to FIG. 1B is a perspective view of an embodiment of the present invention similar to FIG. It is a bottom perspective view of one embodiment of the present invention. FIG. 7B is a top perspective view of the embodiment of FIG. 7A. It is sectional drawing which followed the CC line of FIG. 7B. It is sectional drawing along CC line of FIG. 7B, and is a figure which further shows the state which has arrange | positioned embodiment of FIG. 7A in the treatment site | part. FIG. 7B is a perspective view of one embodiment of the present invention similar to FIG. 7A showing another surface texture. It is a top perspective view of one embodiment of the present invention. FIG. 8B is a bottom perspective view of the embodiment of FIG. 8A. It is a perspective view of one embodiment of the present invention. FIG. 9B is a perspective view of an embodiment that differs in size from the embodiment of FIG. 9A. FIG. 9B is a perspective view of the embodiment of FIG. 9A positioned at a treatment site. It is a perspective view of one embodiment of the present invention. FIG. 10B is a partial cross-sectional view of one embodiment of FIG. 10A. It is sectional drawing of the modification of embodiment of FIG. 10A. It is a bottom perspective view of one embodiment of the present invention. FIG. 11B is a top perspective view of the embodiment of FIG. 11A. It is sectional drawing which followed the CC line of FIG. 11B. FIG. 11B is a cross-sectional view of the embodiment of FIG. 11A positioned at a treatment site. It is a disassembled perspective view of one Embodiment of this invention. FIG. 12B is a top perspective view of the embodiment of FIG. 12A. FIG. 12B is a bottom perspective view of the embodiment of FIG. 12A. It is a side view of one embodiment of the present invention. It is sectional drawing along the BB line of FIG. 13A. It is a perspective view of one embodiment of the present invention. It is a perspective view of one embodiment of the present invention. It is a detail view of a portion of the embodiment of FIG. 15 A. It is a perspective view of one embodiment of the present invention.

  FIGS. 1A-1C show a catheter 100 having a connecting end 101 and a distal end 102. The end portion 102 is in the form of an elongate liquid conduit 104 having a side wall 106 and an opening 108 leading from the inside to the outside. The liquid conduit 104 is a non-linear original or free state shape that injects liquid into or aspirates liquid from the treatment site. By making the liquid conduit 104 contain an elastic shape memory material, or making the conduit 104 of an elastic shape memory material, the conduit 104 will tend to return to its original free-state nonlinear shape, but may be inserted or It can be linear or compressed for drawing. For example, if the liquid conduit 104 is made of a heat-settable elastic polymer, it will tend to return to the heat-set shape by heating and cooling after it is formed into the original non-linear free-form shape. Can do. For example, the liquid conduit may be made of or include a thermoplastic elastomer such as a styrene block copolymer, a polyolefin, a thermoplastic polyurethane, a thermoplastic copolyester, a thermoplastic polyamide, and / or various mixtures thereof. It may be good. For example, the liquid conduit may comprise a polyether block amide, ie PEBA, or made of PEBA. PEBA is available from Arkema under the trade name PEBAX (registered trademark). In the example shown in FIG. 1, a liquid conduit 104 is manufactured from PEBA, and a two-dimensional pattern repeated in the front-rear direction has a first direction axis 110 corresponding to the pattern length 111 and a second direction axis 112 corresponding to the pattern width 113. It has a non-linear original shape. In the example shown in FIG. 1, the substantially straight first portion 114 of the liquid conduit intersects the longitudinal axis 110 substantially perpendicularly. The first bent portion 116 connects the first portion 114 to a substantially straight second portion 118 that is substantially parallel to the first portion 114, and the second portion 118 also intersects the longitudinal axis 110 substantially perpendicularly. The second bent portion 120 connects the second portion 118 to a substantially linear third portion 122 substantially parallel to the second portion 118, and the third portion 122 also intersects the longitudinal axis 110 substantially perpendicularly. Any number of each portion can be joined in this manner to create the end portion 102 of the desired size. The pattern shown in FIG. 1 can be drawn as a serpentine or zigzag shape that includes two or more typical repeating patterns of curved segments. Specifically, the pattern shown in FIG. 1 forms a continuous path that includes different curved segments that are bounded by a perimeter defined by a length 111 and a width 113 that are substantially equal. They are separated by a distance.

  In the example shown in FIG. 1, the sidewall 106 has a first dimension 124 that is substantially parallel to the length dimension. Since the liquid conduit 104 is tubular, the first dimension corresponds to the diameter of the liquid tube. The spacing 126 between adjacent portions of the non-linear original shape can vary between 1 and 100 times the first sidewall dimension. More specifically, this spacing can vary between 1 and 20 times the first sidewall dimension. More specifically, this spacing can vary between 2 and 5 times the first sidewall dimension.

  The opening 108 is arranged in a substantially straight portion and not in the bent portion, thereby preventing the twisting of the conduit 104 that may occur when the opening 108 is arranged in the bent portion.

  As shown in FIGS. 1B-1C, the illustrated end 102 may be placed at the treatment site. The surgical incision 130 provides access to the treatment site 140 between the overlying tissue layers 142 and 144. The end portion 102 is disposed between the tissue layers 142 and 144 to discharge the liquid from the treatment site and to inject the liquid into the treatment site. The fluid conduit 104 creates and / or maintains a fold or split 146 between the tissue layers 142 and 144 to facilitate fluid flow through the opening 108 along the length 132 and width 134 of the treatment site. The segment-to-segment spacing 126, the diameter of the liquid conduit 104, and the end length 111 and width 113 all contribute to the coverage area of the end 102. The opening 108 can be located at any location around the liquid conduit 104. In the example shown in FIG. 1, by arranging the openings in parallel to the plane of the two-dimensional pattern, the openings are opened in the space between the tissue layers, and the obstruction of the openings by the tissues that are on the top is avoided. The orientation of the opening 108 is best shown in FIG. 1C.

  The incision portion 130 can be temporarily or permanently closed with the closing means 136. The closure means may be any suitable closure means such as staples, sutures, surgical adhesives, butterfly bandages and the like. One or more closure means may be placed on the skin surface, subcutaneously, at the interface, intramuscularly, and the like.

  FIG. 2 shows an instrument and method for introducing the catheter 100 of FIG. 1 to a treatment site. FIG. 2A shows an introducer in the form of a trocar 200 that can be connected to the connecting end 101 of the catheter 100 to pass the connecting end 101 out of the patient's body in a manner that is placed from inside the body to outside the body. For example, during surgery, the surgical site can be accessed by the incision 202 and the catheter 100 can be placed before closing the incision. For example, the trocar is connected to the connection end 101 by inserting the connection end 101 into the hole of the trocar 200 or by inserting a barb extending from the trocar into the conduit of the connection end 101. The trocar 200 includes a sharp puncture end 204 that passes from the surgical site through the adjacent tissue and through the puncture portion 206 subcutaneously. The connecting end 101 of the catheter 100 is pulled out through the puncture portion 206, and the catheter 100 is placed at a desired treatment site in the surgical wound. One or more tissue layers including the incision 202 are closed. For example, the connection end 101 is connected to a liquid inhaler or a liquid delivery device, and treatment is started.

  2B-2C illustrate an introducer 210 that passes the distal end 102 of the catheter 100 through the patient's body and delivers the distal end 102 to the treatment site 222 in a manner that is placed from outside the body into the body. The example introducer 210 shown in FIGS. 2B-2C is in the form of a hollow tube or needle having a side wall 212 that defines a lumen 214 from the proximal end 216 to the distal end 218. In use, a puncture 220 is created that communicates from outside the patient's body through the patient's tissue to the treatment site 222. If necessary, it is also possible to create a space by separating the tissue layers of the treatment site by inserting and aspirating the probe into the treatment site. Insert the distal end 218 of the introducer 210 through the puncture 220 and into the treatment site 222. In the example shown in FIG. 2B, the distal end 218 of the introducer 210 is inserted into the distal portion 224 of the treatment site 222. An introducer 210 is inserted through the distal end 102 of the catheter 100 and the bends 116, 120 are straightened and passed through the lumen 214 as necessary. When the end portion 102 is delivered to the treatment site 222, the introducer is pulled up, so that the end portion 102 is spread over the entire treatment site 222, and the end portion returns to its original free state. FIG. 2B shows the catheter 100 partially inserted into the treatment site with the introducer pulled up midway through the distal portion 224 of the treatment site to the proximal portion 226 of the treatment site 222.

FIGS. 2D-2E illustrate another introducer 250 that passes the distal end 102 of the catheter 100 through the patient's body and delivers the distal end 102 to the treatment site in a manner that is placed from outside the body into the body. . Like introducer of Figure 2C from FIG. 2B, the introducer 250 in the example shown in FIG. 2 E from FIG. 2 D, the hollow having a side wall 252 defining a lumen 254 from the proximal end 256 to distal end 258 It is in the form of a tube or a needle. The lumen 254 is sized to receive the distal end 102 of the catheter 100 in a collapsed or collapsed state, as shown in FIG. 2D, which shows the segments compressed in close contact with each other. The compressed end 102 may be pre-inserted into the introducer 250 prior to inserting the introducer distal end 258 into the treatment site, or the introducer 250 may be inserted first and then the catheter end. 102 may be inserted into the introducer 250. With the introducer 250 inserted into the treatment site, the distal end 102 of the catheter 100 can be removed from the distal end 258 of the introducer 250 to return the distal end 102 to its original free state.

  The pattern shown in FIG. 1 of the end portion 102 has a generally rectangular boundary and fits within the rectangular treatment site in its original or free state. The shape of the distal end 102 can be tailored within the desired treatment site during surgery by compressing, expanding, bending, stretching, and / or otherwise manipulating the conduit 104, where the conduit 104 surrounds It will not be returned to its original free state by being bound by the organization. For example, to accommodate longer or shorter treatment sites, the distal end 102 can be stretched or compressed along the longitudinal axis while maintaining its generally serpentine or zigzag shape. The shape of the end portion 102 can be three-dimensionally deformed by moving the segments away from each other in a direction perpendicular to the first direction axis 110 and the second direction axis 112.

  For example, making the connecting bent part smaller or larger, making the connected part longer or shorter, angle the connected part so that it is not normally perpendicular to the longitudinal axis, and / or the connected part It is possible to change the original non-linear shape by making the shape of the non-linear shape. In this way, it is possible to form the end 102 such that the size and shape of the original free state matches the shape of the particular wound. The length and width of the end portion 102 can be variously configured, and a canonical size suitable for a specific treatment site can be selected from these.

FIG. 3A shows a catheter 300 with a distal end 302 having another shape generated by varying the length of the generally linear portions 304 of the pattern interconnected by bends 306. In the first portion 305 of the pattern, the length of each of the substantially linear portions 304 is increased from the side closer to the connection end 308 toward the center 310 of the pattern, and in the second portion 311 of the pattern, as people toward the distal end 30 2 of the front end 312 from near the center 310, by steadily reducing the length of the portion 304, respectively, are producing end pattern having a boundary substantially elliptical. FIG. 3B shows a non-linear shape in which a pattern in which long curved segments 324 are connected to each other by a bent portion 326 is two-dimensionally repeated by replacing a substantially linear portion with a generally curved portion 324. FIG. 3 shows a catheter 320 with an alternative shaped distal end 322 that produces This pattern has a length 330 and a width 332. The bend has an arc 326 that is typically shorter than the segment 324, and in the illustrated embodiment, the arc is more than 90 degrees so that the segment 324 repeatedly traverses the longitudinal axis 328. By varying the size, shape, and spacing of the segments that form the end 322 , an end pattern contoured to any desired shape can be generated.

  4A to 4C show a variation of the end portion of FIG. FIG. 4A shows a catheter end 400 comprising a dual conduit 401 that includes a first infusion conduit 402 and a second suction conduit 404. In the example shown in FIG. 4, the injection conduit 402 and the suction conduit 404 are coaxially arranged with the suction conduit inside the injection conduit. Alternatively, for example, conduits 402 and 404 may be side by side. The double conduit includes a straight portion 406 and a bend 408 as in FIG. 1, the straight portion being substantially perpendicular to the longitudinal axis 410. Treatment fluid 412 is supplied to the treatment site via an opening 414 in the outer wall of the infusion conduit 402. The suction conduit 404 extends beyond the end 416 of the injection conduit and forms a liquid receiving portion 418. The liquid receiving portion 418 is bent in a direction substantially perpendicular to the linear portion 406 and is in a state of lying under the injection portion of the end portion 400. The liquid receiver 418 includes an opening 420 for receiving a treatment liquid that is removed by the suction conduit 404. In use, the liquid receiving portion 418 is arranged at a treatment site where the treatment liquid tends to stay and / or adjacent to a portion where the liquid at the treatment site should be discharged. For example, the distal end of the catheter is placed at a surgical wound by regenerative surgery such as breast regenerative surgery or knee joint regenerative surgery, and a therapeutic solution such as an anesthetic is administered over a wide area of a segmented tissue having a length and width. And has the advantage of being easy to drain from the wound to the lower part of the treatment site. In another example, a liquid receiving portion 418 is placed adjacent to the nerve root, and the anesthetic is collected and transported to shield the nerve root.

FIG. 4B shows a distal end 430 similar to FIG. 4A except that the straight portion 432 is substantially parallel to the longitudinal axis 434. The treatment liquid 436 is supplied to the treatment site through an opening 438 in the outer wall of the infusion conduit 440. The suction conduit 442 extends beyond the end 444 of the injection conduit and forms a liquid receiving portion 446. The liquid receiving portion 446 extends from the pattern including the bent portion and the straight portion, extends substantially parallel to the straight portion 432, and lies under the injection portion of the end portion 430 .

  FIG. 4C shows a suction conduit 452 and an infusion conduit 454 with a portion of the length of the infusion conduit located within the lumen 456 of the suction conduit 452. Aspiration conduit 452 includes an opening 458 for aspirating fluid from the treatment site. The infusion conduit 454 exits from the suction conduit lumen 456 through one of the openings 458 and has a repeating pattern of segments with openings 462 for injecting liquid into the treatment site. To form an end 460 similar to that of FIG.

  5A-5B show a liquid delivery device in the form of a catheter distal end 500. The distal portion 500 includes one or more conduits 502, 504, 506, 508 having a non-linear original or free deployment configuration such as a curl or “pig tail”. By forming the conduits 502-508 from shape memory type tubes, they can curl when deployed to cover a wide area, and the tubes can be straightened when deployed and / or removed. . Liquid opening 510 communicates liquid between the interior of the conduit and the treatment site. A plurality of conduits can be connected to a common supply line (not shown) by a branch pipe or a connecting pipe at the connection end 512. Although shown here as a pre-curled shape, the conduits 502-508 may be formed in any shape suitable for transporting liquid into and out of the treatment area. For example, the conduits 502-508 are formed in an arc, spiral, serpentine pattern, polygon with any number of sides, and / or any other two-dimensional or three-dimensional regular, irregular, or random shape. You can do it. Any number of conduits can be used to form the desired coating pattern.

  Introducer 514 may be used to assist in placing conduits 502-508 at the treatment site. The introducer 514 has a relatively narrow hollow interior 516 defined by walls 518 that constrain the conduits 502-508 to a compact delivery configuration. Upon exiting the conduits 502-508 from the introducer 514, they return to their original, unfolded, expanded configuration. In the example shown in FIG. 5, the tubular introducer is arranged to slide around conduits 502-508. A fixture 520 may be coupled to the conduits 502 to 508 to bundle together the distal ends of the conduits 502 and 508 in a relatively spaced apart manner in both the axial and radial directions. Alternatively, the fixture 520 may cause the conduits 502-508 to slide relative to the fixture 520 so that the relative position of these conduits can be adjusted. The introducer 514 includes a connector 522 and the fixture 520 includes a connector 524 that cooperatively engages the connector of the introducer.

  In use, the introducer 514 is placed in a first or delivery position, as shown in FIG. 5A, constrained to a shape that compactly conveys the shaped portion of the conduits 502-508 within the introducer. In this example, conduits 502-508 are in a straight line inside introducer 514. By placing the delivery end 526 of the introducer 514 in a desired position relative to the treatment site, for example, by sliding the fixture 520 toward the introducer 514, the conduits 502-508 exit the introducer 514 and FIG. In the second or unfolded position shown in FIG. 2, the conduit is in its original unfolded configuration when unfolded. Conduits 502-508 may be secured to the fixture to provide a constant deployed configuration, or adjustments to the fixture can be made either before or after deployment to adjust the deployed configuration. You may do it. Alternatively, the fasteners may be omitted and the conduits 502-508 may be individually operated within the introducer and the treatment site. The relative positions of the introducer 514 and the fixture 520 may be fixed by engaging the connectors 522 and 524 with a clamp or the like. Introducer 514 and / or fixture 520 may remain in the patient's body or may be removed leaving only conduits 502-508. The introducer can also be used as a guide to straighten the conduits as they are removed from the conduits 502.

  The end portion 500 illustrated in FIG. 5 spreads to suck or inject liquid over a wide area, while the conduits 502 to 508 have a linear shape when removed from the treatment site, so the shape and force required for removal are as follows. Has the advantage of being relatively small. In addition, the ability to fix the relative position of one conduit relative to another conduit allows the coverage area to be selected.

  6A to 6B show a variation of the shape of the distal end. FIG. 6A shows a liquid supply device in the form of a distal end 600 of the catheter 602. The distal end 600 includes an elongated liquid conduit 604 formed in a coil having an opening 610 that allows fluid to flow out of the conduit 604, with which the tissue pleats are separated and a fluid supply area within the tissue. To produce. By forming the conduit 604 from a shape memory material, it can have a linear shape upon delivery and / or withdrawal, but can maintain a coiled configuration upon deployment. FIG. 6B shows a liquid supply device similar to the device of FIG. 6A, except that the device of FIG. 6B has a groove 606 formed on the first side of the conduit 604 and on the opposite side of the first side. And a projection 608 corresponding to. The conduit 604 is formed in a coil shape by the protrusion 608 engaging with the groove 606. The configuration composed of the protrusion and the groove forms a barrier against the liquid in the deployed state, and when extracting the liquid, the conduit 604 is made non-coiled and can be easily extracted.

FIGS. 7A- 7E illustrate a distal end 700 of a catheter 702 having a front or “wet” side 704 and a back or barrier side 706. The distal end 700 includes an elongate body 714 having an outer surface 718 and a wall 716 that defines one or more elongate lumens. In the example shown in FIG. 7, wall 716 defines a single centrally located lumen 720 that is in fluid communication with a corresponding conduit 722 of catheter 702. A plurality of wall openings 724 leading from the lumen 720 through the wall 716 to the outer surface 718 are spaced along the length of the elongate body 714. Wall 716 has a width 717.

A barrier 726 is attached to the outer surface of the elongated body 714 adjacent to the opening 724. In the example shown in FIG. 7, the elongated body 714 has a planar “D” shape on one side, and a barrier 726 is attached to the planar side along the length of the elongated body 714. Is configured to project outward on the same surface as the elongated body 714. The barrier 726 has a length 708, a width 710, and a depth 712. The barrier 726 has a barrier hole 728 that is in fluid communication with the wall opening 724 so that liquid can flow from around the barrier surface into the lumen 720. The barrier 726 is fluid resistant and separates the front side 704 of the end 700 from the back side 706. In the example shown in FIG. 7, the barrier is a liquid-impermeable polyurethane film.

The end 700 of FIG. 7 can be used to selectively deliver treatment fluid to the treatment site. For example, the front side 704 is placed adjacent to the treatment site and treatment liquid is contacted from the lumen 720 through the wall opening 724 to the treatment site. The barrier 726 blocks the treatment liquid flowing to the back side 706 of the end portion 700 and shields the tissue adjacent to the back side 706 from the treatment liquid.

In another example, the distal end 700 of FIG. 7 may be used to selectively aspirate fluid from the treatment site. For example, the front side 704 can be positioned adjacent to the treatment site, and the liquid aspirated through the wall opening 724 can flow into the lumen 720 and drain out through the conduit 722. Barrier 726 blocks backside 706 of end 700 from liquid flow and shields tissue adjacent to backside 706 from the low pressure associated with aspiration.

In the example shown in FIG. 7D, the distal end 700 of FIG. 7 may be used as an aspiration catheter in combination with another therapeutic fluid source. For example, the distal end 700 is placed at the treatment site with the front side 704 adjacent to the nerve root 742 and the back side 706 facing the anesthetic source. When the anesthetic is injected into the treatment site, the barrier 726 blocks the flow of the anesthetic toward the nerve root, and any bodily fluid and excess anesthetic is carried from the periphery of the nerve root 742 through the opening 724 and into the lumen 720. , And discharged out through conduit 722.

In the example shown in FIG. 7E, the front side 704 further includes a protrusion 750 that creates an uneven surface to improve the flow of liquid through the opening 724. The protrusions prevent the adjacent tissue from being compressed or retracted and prevent the opening 724 from becoming occluded. In the example shown here, the protrusions are a plurality of protrusions arranged alternately with the openings 724. However, the protrusions 750 may be distributed on the front surface of the end portion 700 or at other locations to improve the liquid flow. Projections be formed integrally with the front side 704 may be attached to the front side 704, to deform the front side 704 is deposited, casting, and / or may be molded by other methods. For example, the protrusions 750 may be formed by depositing a liquid component and curing to a solid polymer such as a UV curable adhesive.

  In the example shown in FIG. 7, the diameter of the catheter 702 is made larger than the diameter of the elongated body 714, and a step 734 is defined between the catheter 702 and the elongated body 714. If the diameter is changed in this way and the size of the opening in the patient's body is adjusted to the size of the catheter 702, the distal end portion 700 is also pulled out through the opening, so that the extraction can be performed more easily. As the catheter 702 is pulled to remove the distal end 700 from the treatment site, the distal end 700 is deflated behind the step 734, making it easier to pass through the tissue opening.

  In the example shown in FIG. 7, the barrier width 710 may be 1 to 100 times the wall width 717. More specifically, the barrier width 710 may be 2 to 20 times the wall width 717. More specifically, the barrier width may be 2 to 5 times the wall width.

Figure 8B Figures 8A illustrates a distal portion 800 of catheter 801, similar to that from Figure 7A of Figure 7 E. The end 800 includes a network of conduits 802 in which the conduits 804, 806, 808, 810, 812, 814, 816 extend in a palm-like manner, and these conduits 804-816 are openings that allow liquid to pass between the interior and exterior 821 is included. In this example, the peripheral conduits 804 to 814 extend in a pattern that gradually diverges from the central conduit 816, much like the leaf vein pattern. For example, the member 820 having a rear surface 824 which is a second surface opposite to the surface 822 is a first surface on one side of the pipeline network 802, attached in a state placed under the pipeline network. The conduits 804 to 816 are likely to be deployed immediately upon opening, and the desired spatial configuration is maintained by interconnecting the member 820 with the conduits 804 to 816. Member 820 may also form a barrier as in the example of FIG. In the infusion configuration, liquid exiting conduit 804 is supplied to first surface 822 and dispensed from the first surface to the area of the treatment site. During aspiration, liquid is collected on surface 822 and drained through opening 821 and conduits 804-816. The conduits 804 to 816 in the present example have a relatively thick polygonal structure, and the folds of adjacent tissues at the treatment site are separated from each other to facilitate the flow of liquid in a region within the treatment site. Conduits 804 to 816 may be semi-rigid to facilitate tissue separation. Also, making the conduit semi-rigid facilitates maintaining fluid flow, for example, by resisting being crushed or twisted as the patient moves. The member 820 can be a sheet-like film. In the example shown in FIG. 8, the member is a liquid-impermeable polyurethane thin film.

  Each of the various examples of end portions described herein have a length, a width, and a depth. The length of the distal end can vary over a wide range to accommodate a variety of treatment sites. For example, the length may be in the range of several millimeters to several tens of centimeters. In particular, the length can range from 1 to 30 cm. More specifically, the length can range from 5 to 20 cm. The width of the end can vary over a wide range to accommodate a variety of treatment sites. For example, the width may be in the range of several millimeters to several tens of centimeters. Specifically, the width can range from 0.5 to 30 cm. More specifically, the width can range from 1 to 15 cm. The depth of the end can vary over a wide range to accommodate a variety of treatment sites. For example, the depth may be in the range of several mm to several tens of mm. Specifically, the depth can range from 0.05 to 20 mm. More specifically, the depth can range from 0.5 to 10 mm.

  FIG. 9 shows an example of a liquid supply device in the form of a distal end 900 of a catheter for placement at a patient treatment site. The distal end 900 includes a diffuser body 902 having a depth 904, a width 906, and a length 908. A first conduit 910 is disposed near the first portion 912 in the diffuser body 902. In use, liquid is transported between the first conduit 910 and the diffuser body 902. For example, exudate from a wound is absorbed by a diffuser and sent to the first conduit 910 through a small opening 913 that penetrates the conduit wall and removed from the treatment site. Alternatively, the first conduit 910 supplies treatment liquid to the diffuser body 902 and passes through the diffuser body 902 to uniformly wet the surface 918 of the diffuser body 902 and transfer to tissue adjacent to the surface 918 at the treatment site. Let Optionally, a second conduit 914 is disposed near the second portion 916 of the diffuser body 902. By detachably placing the conduits 910, 914, the conduits can be removed from the diffuser after treatment is complete, leaving the diffuser. In the example shown in FIG. 9A, the first conduit 910 is an infusion conduit and the second conduit is a suction conduit 914. The first conduit or infusion conduit 910 supplies treatment liquid to the diffuser body. Aspiration conduit 914 collects body fluid and expels body fluid and excess treatment fluid from the treatment site.

  A liquid impervious barrier 920 may optionally be disposed on one or more surfaces of the diffuser body 902 to prevent liquid transport through the portion of the diffuser body 902 covered by the barrier. The shape of the diffuser, the location and flow rate of the infusion conduit, the location and flow rate of the suction conduit, and / or the location of the liquid barrier can be selected to adjust the therapeutic fluid delivery characteristics of the end piece 900. In the example shown in FIG. 9, the extending range of the injection conduit 910 and the suction conduit 914 is only the portion along the length of the diffuser body 902 except for the non-trimmable portion 922. The size of the trimable portion 922 is short enough that the liquid supply to this portion is not significantly less than the liquid supply to the remaining portion of the diffuser body 902. Trimmable portion 922 can be trimmed to adapt the length of end 900 to the treatment site without severing the fluid conduit and without significantly changing the liquid supply characteristics of end 900. is there.

  FIG. 9B illustrates a method of providing a second end 930 having a length 932 that is different from the first end 900 of FIG. 9A. The length 908 of the first end 900 is approximately equal to the length 934 of the fully trimmed second end 930. By determining the length in this manner, the length can be adjusted infinitely within a length range from the length 936 obtained by completely trimming the first end portion 900 to the length 932 of the second end portion 930. It becomes possible. Any number of ends can be provided to cover a desired length range. Similarly, a trimming portion may be provided so that the depth and width of the diffuser body 902 can be adjusted.

  FIG. 9C shows a distal end 900 positioned at the depth of the surgical scar to deliver anesthetic to the tissue to be severed when operating on the patient's spine. Infusion conduit 910 and diffuser body 902 disperse the anesthetic on the surface of the diffuser body to treat adjacent tissue. A barrier 920 is disposed near the nerve root 942 of the diffuser body 902 to shield the nerve root 942 from the anesthetic. A suction conduit 914 is placed under the barrier 920 to aspirate body fluid and excess anesthetic.

FIG. 10 shows a distal end 1000 of a catheter 1002 having a length 1001 and a width 1003 and a depth in a direction perpendicular thereto. The distal end 1000 may be formed integrally with the catheter 1002 or may be formed separately from the catheter 1002 and connected as shown. End portion 1000 includes a plurality of liquid conduits 1004, 1006, 1008, 1010. Adjacent conduits are connected by intermediate sections 1012, 1014, 1016 that help guide conduits 1004 to 1010 apart and place them in the desired relative position. If the intermediate parts 1012 to 1016 are in the form of a flexible sheet and the conduits 1004 to 1010 are formed of a shape memory tube having a first shape or a static shape, the tube will be released after being constrained to another shape and then released. It can return to the first shape. In the example shown in FIG. 10A, conduits 1004 to 1010 connect to a common line 1020 at junction 1018. When forming the conduits 1004 to 1010, they are formed so that they separate from each other as they move away from the joint 1018. Intermediate sections 1012 to 1016 constrain conduits 1004 to 1010 to a generally parallel palm-like configuration. The conduits 1004 to 1010 include openings 1022 formed through the conduit walls that allow liquid to flow between the interior and exterior thereof. In the infusion configuration, the intermediate portions 1012 to 1016 receive liquid exiting the opening 1022 and disperse the liquid on the surface of the end portion 1000. In the suction configuration, the intermediate portions 1012 to 1016 collect and drain liquid from the treatment site via the opening 1022. When placing the intermediate portions 1012 to 1016 and the opening 1022, the end portion 1000 can be used to form part of the treatment site or by allowing the opening 1022 to communicate with only one side of the intermediate portions 1012 to 1016. The liquid can be preferentially transported from a part. Alternatively, when placing the intermediate portion 1012 1016 and the opening 1022, communicating with the opening 1022 in communication with one side of the middle portion 1 012 1016, an opening 1022 in communication with the other side of the middle portion 1 012 1016 It is also possible to transport liquid to or from both sides of the end piece 1000. Alternatively, as shown in FIG. 10B, it leads such as by placing an aperture 1022 so as to be connected with both sides of the middle portion 1 012 1016, and both sides of the opening 1022 from the intermediate portion 1 012 1016 simultaneously It is also possible to do so. If the intermediate parts 1012 to 1016 have a liquid-impermeable surface, the liquid can be dispersed in a thin plate shape on the surface. If the intermediate parts 1012 to 1016 have a permeable surface, the liquid can be allowed to bleed over the region. By making the intermediate portions 1012 to 1016 permeable and permeable, liquid can flow between the opposing sides of the intermediate portions 1012 to 1016. As shown in FIG. 10C, the intermediate portions 1012 to 1016 may include a laminated structure that includes a permeable layer 1024 that oozes liquid on one side and a liquid impermeable layer 1026 on the other side. Good.

  Although four liquid conduits 1004 to 1010 are shown, it should be understood that any number of conduits may be used. Furthermore, although a tubular conduit is shown, a conduit having a cross-sectional shape such as polygonal, curved, or annular may be used.

During delivery, the distal end 1000 can be folded and / or rolled into a small delivery shape (not shown) and placed at the treatment site. When the distal end is subsequently released, the delivered conduit will revert to the shape shown in FIG. 10A, while allowing the surrounding tissue. In the example shown in FIG. 10, since the common line 1020 has an outer diameter smaller than that of the catheter 1002, a stepped portion 1030 is formed between them. By changing the diameter in this way, removal of the distal end 1000 is facilitated by removal through an opening sized to the catheter 1002 in the patient's body. As the catheter 1002 or common line 1020 is pulled to remove the distal end 1000 from the treatment site, pressure from surrounding patient tissue moves the conduits 1004 to 1010 toward each other. The distal end portion 1000 is folded behind the stepped portion 1030 and has a shape constrained to a size approximately the same as the diameter of the catheter 1002.

FIG. 11 shows a distal end 1100 of a catheter 1102 having a liquid injection side 1104 and a liquid suction side 1106 and including a length 1101, a width 1103, and a depth 1105. The distal portion 1100 includes an elongate body 1108 having an outer surface 1112 and a wall 1110 (FIG. 11C) that defines one or more elongate suction lumens. In the example shown in FIG. 11, the wall 1110 defines a single centrally located aspiration lumen 1114 that is in fluid communication with the corresponding aspiration conduit 1116 (FIG. 11A) of the catheter 1102 . A plurality of suction openings 1118 spaced apart along the length of the elongate body 1108 communicate through the wall 1110 from the suction lumen 1114 to the outer surface 1112. Wall 1110 further defines one or more elongated injection lumens. In the example shown in FIG. 11, the walls are two infusion lumens 1120 that extend parallel to the corresponding infusion conduit 1122 (shown one in FIG. 11A) of catheter 1102 and in parallel with aspiration lumen 1114. Is defined. A plurality of injection openings 1124 leading from the injection lumen 1120 through the wall 1110 to the outer surface 1112 are spaced along the length of the elongate body 1108. In the example shown in FIG. 11, the injection opening 1124 has a directivity of about 90 degrees with respect to the suction opening 1118.

  A barrier 1126 is attached to the outer surface 1112 of the elongate body 1108 adjacent to the suction opening 1118. In the example shown in FIG. 11, the elongated main body 1108 has a “D shape” whose one side is flat. A barrier 1126 is attached to a flat side along the length of the elongated body 1108 so that the barrier 1126 protrudes outward on the same plane as the elongated body 1108. The barrier 1126 has an opening 1128 that is in fluid communication with the suction opening 1118 and allows liquid to flow from around the barrier surface into the suction lumen. The barrier 1126 is fluid resistant and separates the liquid suction side 1106 from the liquid injection side 1104 of the end 1100. In the example shown in FIG. 11, the barrier is a liquid-impermeable polyurethane film.

  A diffuser 1130 is attached to the outer surface 1112 opposite to the barrier 1126 of the elongated body 1108. In the example shown in FIG. 11, the diffuser 1130 conforms to the curved surface of the elongated body 1108 and is attached to the barrier 1126. The injection opening 1124 leads to the diffuser 1130. In the example shown in FIG. 11, the diffuser is a polyester cloth that oozes the treatment liquid throughout the diffuser by a capillary phenomenon.

  The injection side 1104 of the distal end 1100 injects treatment liquid into the treatment site, while the suction side 1106 draws liquid from the treatment site. Barrier 1126 prevents liquid from flowing directly from injection opening 1124 to suction opening 1118. The barrier 1126 also isolates the patient's tissue on the suction side 1106 from the treatment fluid supplied by the injection side 1104.

  In the example shown in FIG. 11, the catheter 1102 has a larger diameter than the elongate body 1108 and defines a step 1134 therebetween. By changing the diameter in this manner, the distal end 1100 can be easily removed by removing the distal end 1100 through an opening in the patient's body that is sized to the catheter 1102. When the catheter 1102 is pulled to remove the distal end 1100 from the treatment site, the distal end is deflated behind the step 1134, making it easier to pass through the tissue opening.

FIG. 11D shows a distal end 1100 placed on tissue 1140 that was disrupted during surgery. The injection side 1104 is arranged toward the tissue to be treated with the treatment liquid, and the suction side 1106 is arranged toward the area for draining and / or the area for isolating the nerve root 1142 and the like from the treatment liquid. In use, for example, the catheter infusion conduit 1122 is attached to the treatment fluid source and the suction conduit 1116 is attached to the vacuum source. The treatment fluid flows along the infusion lumen 1120 and enters the diffuser through the infusion opening 1124 and oozes throughout the diffuser and contacts tissue adjacent to the infusion side 1104 at the distal end of the catheter. Body fluid and excess treatment fluid enter the suction lumen 1114 through the suction opening 1118 and exit through the suction conduit 1116. The tissue 1140 is treated while the nerve root 1142 is shielded from the treatment solution and discharged from the surgical wound.

  12A-12C show a distal end 1200 of a catheter 1202 that is similar to FIG. 11 but with the addition of a member 1204 that covers the diffuser 1130. In the embodiment shown in FIGS. 12A-12C, the member 1204 is in intimate contact with the diffuser 1130 to isolate the diffuser from surrounding tissue and prevent the tissue from contacting the diffuser. Member 1204 can be in the form of a tissue growth inhibitory membrane. For example, member 1204 may be a liquid impermeable polyurethane film. The member 1204 is provided with a plurality of holes 1206 so that liquid dispersed through the diffuser can exit the end portion 1200.

  The embodiment of FIGS. 12A-12C further includes a protrusion 1208 to improve liquid flow through adjacent openings by creating an uneven surface. The protrusions are pushed against adjacent tissue to prevent the opening from closing. In the example shown here, the protrusions are a plurality of ridges that alternate with the suction openings 1128 to improve drainage from the surgical site. However, the protrusion 1208 may be distributed over the surface in a two-dimensional pattern or in other parts of the end portion 1200 to improve the liquid flow. In forming the protrusion, the protrusion can be formed integrally with the surface, attached to the surface, deformed, deposited, and / or formed by other methods. For example, the protrusion 1208 can be formed by depositing a liquid component and curing it to a solid polymer such as a UV curable adhesive.

FIG. 13 illustrates an example of a method for configuring an infusion conduit 1122 and an aspiration conduit 1116 for insertion through tissue adjacent to a treatment site in a method of placement from inside the body to outside the body. The trocar 1300 includes a sharp tip 1302 for puncturing tissue and a hollow back end 1304 that receives a catheter 1102. The rear end 1304 includes a tubular outer wall 1306 that defines an opening 1308 at the opposite end of the tip 1302. Suction conduit 1116 and infusion conduit 1122 are placed through opening 1308 and into the rear end. The trocar 1300 and the catheter 1102 maintain the connection state by friction until a force large enough to overcome friction is applied or the end of the catheter 1102 is cut.

FIG. 14 shows a separate configuration for passing the catheter 1102. Trocar 1400 includes a tip having a sharp tip 1402 that pierces tissue and a rear end 1404 that includes a first barb 1406 and a second barb 1408. The first barb 1406 is sized to be inserted into the suction conduit 1116 in a friction-tight relationship. Second barb 1408 is a hollow body having an internal hole 1410 sized to receive injection conduit 1122 .

FIG. 15 shows a passage shape similar to the catheter 1102 and the previous example. However, in the example of FIG. 15, the infusion conduit 1122 is inserted into an infusion common line 1520 that is in fluid communication with the common line 1520 using, for example, a UV curable potting adhesive as commonly used in medical liquid tubes. Glued to. This configuration reduces the number of injection conduits 1122 that need to be connected to the injection mechanism by providing a single common line 1520 that can be connected, and eliminates the need for a separate Y connector. Trocar 1510 includes a sharp tip 1512 that punctures tissue and a hollow back end 1514 that receives a suction conduit 1116 and a common line 1520.

  FIG. 16 shows the distal portion 1600 of the catheter 1602. The liquid conduits 1604 and 1606 included in the end 1600 are curved and have an elliptical path, and transport liquid to or from the opening 1608 within the elliptical path. The barrier 1610 receives the liquid and disperses the liquid along the uneven surface. In the example shown in FIG. 16, the unevenness is formed by a groove 1612 formed in the barrier 1610. The presence of the groove 1612 facilitates liquid flow by allowing liquid to bleed across the surface of the liquid impermeable barrier 1610. Without this, the liquid may be blocked by the patient's tissues coming into contact. The surface of the barrier 1610 can be textured by stamping, engraving, roughening, and / or other suitable means. The surface of the barrier can be textured by forming line ridges, depressions, undulations, and / or other suitable characteristics. You may make it give an unevenness | corrugation by making a cloth adhere to a barrier surface. For example, by attaching a fiber network to the surface, the liquid can be allowed to bleed over the surface. Each of the various examples of distal ends described has a length, width, and depth. The length of the distal end can vary over a wide range to suit a variety of treatment sites. For example, the length may be in the range of several millimeters to several tens of centimeters. In particular, the length may range from 1 cm to 30 cm. More specifically, the length may range from 5 cm to 20 cm. The width of the end can vary over a wide range to accommodate a variety of treatment sites. For example, the width can range from a few mm to a few tens of centimeters. Specifically, the width may be in the range of 0.5 cm to 30 cm. More specifically, the width may range from 1 cm to 15 cm. The depth of the end can vary over a wide range to suit a variety of treatment sites. For example, the depth can range from a few mm to a few tens of mm. In particular, the depth can range from 0.5 to 20 mm. More specifically, the depth can range from 0.5 to 10 mm.

  A treatment kit comprising one or more catheters according to various aspects of the present invention may be provided. Optionally, the treatment kit may include an introducer. Optionally, the treatment kit may include an infusion source. Optionally, the medical kit may include a container for discharge.

DESCRIPTION OF SYMBOLS 100 Catheter 101 Connection end 102 End part 104 Liquid conduit 106 Side wall 108 Opening 114 Straight part 116 Bending part 140 Treatment site 142, 144 Tissue layer 200 Trocar (Introducer)

Claims (12)

A catheter for transporting liquid between a patient's treatment site and a position outside the patient's body,
An elongated first liquid conduit;
An elongated second liquid conduit;
A distal end positionable at the treatment site,
The first liquid conduit defines a liquid path to the end, the second liquid conduit defines a liquid path from the end;
The end portion is
A first liquid exchanger defining a first outer surface and a first lumen in fluid communication with the first liquid conduit, at least one communicating between the first lumen and the first outer surface The first liquid exchange part having two openings;
A second liquid exchange section defining a second outer surface and a second lumen in fluid communication with the second liquid conduit, at least one communicating between the second lumen and the second outer surface The second liquid exchange part having two openings;
A flexible sheet-like liquid impervious barrier connected to the end portion and extending from the end portion, comprising a flat first barrier surface and a flat second barrier surface that are spaced apart from each other. A barrier defining and wherein the first lumen is in liquid communication with the first barrier surface and the second lumen is in liquid communication with the second barrier surface;
A diffuser adjacent to the first barrier surface and in fluid communication with the first lumen;
A member covering the diffuser,
The member covering the diffuser includes a barrier extending in the tissue, and the member is penetrated by a plurality of openings so that liquid is dispersed through the diffuser and discharged from the end portion.
catheter. The catheter of claim 1, wherein the diffuser has a surface and a channel network in fluid communication with the first liquid exchanger and the surface of the diffuser . The catheter of claim 2, wherein the diffuser includes a fibrous structure that defines the channel . The catheter of claim 3, wherein the diffuser comprises a cloth . The catheter of claim 2 , wherein the diffuser includes a sponge that defines the channel . Member for covering the diffuser, the barrier and close contact with the barrier around the said member, the liquid only through the opening and the through is discharged from the distal end, the catheter according to claim 1. The barrier comprises a polymer film, catheter according to claim 1. The catheter according to claim 1 , wherein the barrier is configured such that a planar shape of the barrier changes . The at least one opening leading to the second lumen includes a plurality of openings spaced along the length of the second lumen, and the barrier includes the lumen through the plurality of openings. The catheter of claim 1 , comprising a hole juxtaposed with the plurality of apertures for fluid communication with the two barrier surfaces and in fluid communication . The catheter according to claim 1 , further comprising a plurality of protrusions extending from the second barrier surface and adjacent to the plurality of openings . The end portion has a length substantially parallel to the first barrier surface and the second barrier surface, a width substantially perpendicular to the length and substantially parallel to the first barrier surface and the second barrier surface, A depth substantially perpendicular to the first barrier surface and the second barrier surface, wherein the length is in the range of 3 to 10 cm, the width is in the range of 1 to 5 cm, and the depth is from 0.05 The catheter of claim 1 , which may be in the range of 2 mm . The elongate first liquid conduit and the elongate second liquid conduit are accommodated in a multi-lumen type conduit, and the barrier is foldable around the conduit so that the end portion is The catheter of claim 1, wherein the catheter is facilitated to be inserted into or removed from the treatment site .

Images