JP2016087268A - Electrode support mechanism and electrostimulator - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an electrode support mechanism and an electrostimulator, in which an electrode can be placed stably even in a blood vessel with a small diameter and many curved parts.SOLUTION: An electrode support mechanism (1) comprises: a plurality of long electrode support parts (2) which are made of an elastic body curved in a natural state and provided with electrode parts; a distal end projection part (3) for gathering and fixing the distal ends of the plurality of electrode support parts into one; a base end fastener (4) for gathering and accommodating the base ends of the plurality of electrode support parts into one; and a wiring part (5) which is connected to the base end fastener and energizes the electrode parts. The base end fastener is arranged on an axis line of the wiring part. The distal end projection part is arranged at a position away from the axis line of the wiring part.SELECTED DRAWING: Figure 1

Description

  The present invention relates to an electrode support mechanism placed in the body and an electrical stimulation device including the electrode support mechanism.

  2. Description of the Related Art Conventionally, stimulation generators that perform treatment by applying electrical stimulation to biological tissue such as nerve tissue or muscle are known. Examples of such a stimulus generator include a nerve stimulator, a pain relieving device, an epilepsy treatment device, and a muscle stimulator.

  These stimulation generators are provided in the vicinity of a tissue to be stimulated in a living body, and include electrode leads that transmit electrical stimulation to the tissue to be stimulated.

  In general, an electrode lead applies electrical stimulation to biological tissue, or detects at least one electrode part for detecting electrical excitation generated in the biological tissue, and an electrical connector for electrically connecting to the stimulation generator; A main body for transmitting electrical stimulation is provided between the electrode unit and the stimulation generator. For example, Patent Document 1 discloses a multi-electrode probe used in a mapping technique for specifying the position of a lesion in heart tissue. As shown in FIG. 14, the multi-electrode probe of Patent Document 1 includes an electrode support assembly 203 that is held in a three-dimensional shape by a plurality of spline elements 202 that hold an electrode 201 and spread radially. The multi-electrode probe disclosed in Patent Document 1 is configured to spread in a three-dimensional shape when it is inserted into a heart chamber and to contact a body tissue.

Japanese Patent No. 3423719

  The multi-electrode probe disclosed in Patent Document 1 can be applied when the site to be placed has a relatively wide space such as a heart or a linear space. However, for example, when applied to a narrow and curved organ such as a blood vessel, a portion other than the spline element comes into contact with the wall portion 205 of the organ, so that the contact between the spline element of the electrode support portion and the wall portion is prevented. It becomes non-uniform and it is difficult to maintain the electrode position relative to the organ wall. Further, as shown in FIG. 15, when the spline element 202 is inserted into the organ, the wall portion 205 is pressed by pressing the wall portion of the organ while the tip 204 of the spline element 202 is in contact with the wall portion 205 of the organ. May hurt. Therefore, it is difficult to apply to narrow and curved organs.

  An object of the present invention is to provide an electrode support mechanism and an electrical stimulation device that can stably place an electrode even in a narrow and curved organ.

  The electrode support mechanism according to the first aspect of the present invention is made of an elastic body that is curved in a natural state, and includes a plurality of long electrode support portions on which electrode portions are provided, and one end of the plurality of electrode support portions. A distal end projecting portion that is collected and accommodated, a proximal end fastener that collects and accommodates proximal ends of the plurality of electrode support portions, and an electrical connection to the electrode portion that is connected to the proximal end fastener A wiring portion, wherein the proximal end fastener is disposed on an axis of the wiring portion, and the distal protrusion is disposed at a position spaced from the axis of the wiring portion.

  In the electrode support mechanism according to the second aspect of the present invention, in the natural state, the midpoint and the tip at a length obtained by projecting the distance from the proximal end fastener to the tip protrusion on the axis of the wiring portion The tip protrusion may be arranged such that an offset line connecting the protrusion is inclined at an angle of 30 ° or more and 90 ° or less with respect to the axis of the wiring portion.

  In the electrode support mechanism according to the third aspect of the present invention, at least one of the plurality of electrode support portions may be shorter than the length of the other electrode support portions.

  In the electrode support mechanism according to the fourth aspect of the present invention, the plurality of electrode support portions are all formed to be equal in length, and at least two of the plurality of electrode support portions have shape memory. The electrode support portions made of a wire and made of the shape memory wire may have different curved shapes.

  In the electrode support mechanism according to the fifth aspect of the present invention, the axial line is formed on a plane including the two electrode support portions that are accommodated so that the proximal ends of the proximal end fasteners face each other across the axis. The separation distance between the tip protrusion in the direction perpendicular to the axis and the axis of the wiring part is at least one third of the maximum separation distance in the direction perpendicular to the axis of the two electrode support parts in the natural state. The length may be 2/3 or less.

  In the electrode support mechanism according to a sixth aspect of the present invention, the base end fastener is supported by inserting the base end of at least one of the electrode support portions so as to be able to advance and retract relative to the base end fastener. The at least two electrode support portions of the plurality of electrode support portions are fixed electrode support portions whose base ends are fixed to the base end fastener, At least one of the electrode support portions of the plurality of electrode support portions is a movable electrode support portion whose base end is inserted into the insertion hole and can be advanced and retracted in the base end fastener, When the base end of the movable electrode support part moves to the wiring part side in the insertion hole, the length of the movable electrode support part with respect to the length of the fixed electrode support part is shortened, and the tip protrusion part Is at a position away from the position on the axis of the wiring portion. It may be configured to reduction.

  The electrical stimulation apparatus which concerns on the 7th aspect of this invention is equipped with the electrode support mechanism which concerns on the said aspect.

  According to the present invention, even in a narrow and curved organ such as a blood vessel, the wall of the organ can be prevented from being damaged, and the electrode can be stably disposed at an appropriate position.

It is a schematic diagram which shows the electrode support mechanism which concerns on 1st Embodiment of this invention. It is a schematic diagram which shows the state which inserted the medical treatment tool provided with the electrode support mechanism which concerns on 1st Embodiment of this invention in the organ. It is a schematic diagram which shows the electrode support mechanism which concerns on 2nd Embodiment of this invention. It is a side view which shows the electrode support mechanism which concerns on 3rd Embodiment of this invention. It is sectional drawing in the AA of FIG. In FIG. 5, it is sectional drawing which shows the state which the base end of the movable electrode support part moved to the base end side of the penetration hole. It is sectional drawing in the BB line of FIG. It is sectional drawing in the CC line of FIG. It is sectional drawing which shows the 1st modification of 3rd Embodiment of this invention. It is sectional drawing in the DD line | wire of FIG. It is sectional drawing in the EE line | wire of FIG. It is sectional drawing which shows the 2nd modification of the electrode support mechanism 12 which concerns on 3rd Embodiment. It is a figure which shows the state which moved the operation knob in the base end direction in FIG. It is a figure which shows the example of the conventional multiple electrode probe. It is a figure which shows the example which inserted the conventional multiple electrode probe in the body.

[First Embodiment]
An electrode support mechanism according to a first embodiment of the present invention and an electrical stimulation device including the same will be described. In this embodiment, the nerve stimulation electrode 10 is placed in a blood vessel using the nerve stimulation electrode 10 provided with the electrode support mechanism 1 and the stimulus generation device 63, and the vagus nerve n adjacent to the blood vessel is electrically supplied. An example will be described in which tachycardia and chronic heart failure are treated by stimulation.
The electrode support mechanism 1 according to the present embodiment includes four electrode support portions 2, a distal end fastener (front end protruding portion) 3, a proximal end fastener 4, and a wiring portion 5. FIG. 1 is a schematic view of an electrode support mechanism 1 according to this embodiment, and shows only two electrode support portions 2 out of four electrode support portions 2.

  As shown in FIG. 2, the electrode support portion 2 is provided with an electrode portion 6 at an arbitrary position in the length direction of the electrode support portion 2. The electrode portion 6 is formed by removing the coating resin of the electrode portion 6 so that a polyurethane resin coating or a polyamide resin coating is formed on the surface, and the conductive electrode surface is exposed at a portion in contact with the inner wall of the blood vessel. In the electrode part 6, an exposed part is arranged on the surface of the outer peripheral surface of the electrode support part 2 opposite to the face directed to the axis L <b> 1 side of the wiring part 5. As a material of the electrode part 6, a metal material excellent in biocompatibility is preferable, and examples thereof include a noble metal material such as a platinum iridium alloy. In the present embodiment, two electrodes 61 and 62 are provided apart from each other in the length direction of the electrode support portion 2, the distal electrode 61 is a negative electrode, and the proximal electrode 62 is a positive electrode. The two electrodes 61 and 62 are connected to the stimulus generator 63 by wires (not shown) passing through the inside of the wiring portion 5 and the electrode support portion 2, respectively.

  The electrode support part 2 is a long linear member formed of an elastic body. The electrode support part 2 has a curved shape in a natural state where no external force acts, and has flexibility. The electrode support 2 is made of, for example, a shape memory alloy such as Nitinol that is restored near body temperature (around 37 ° C.). The electrode support 2 is configured to be elastically deformable when an external force is applied and to be restored to a predetermined curved shape. When inserting the electrode support part 2 into the blood vessel, it is necessary to narrow the whole of the plurality of electrode support parts 2, and in this case, when the electrode support part 2 is cooled, insertion into the blood vessel becomes easy. Further, the electrode support portion 2 has a rigidity that can maintain a certain shape against deformation of the indwelling blood vessel wall.

  The wiring unit 5 has a known configuration including an insulating tube 51 and a wiring (not shown) inserted through the insulating tube 51. The wiring part 5 is configured to be long and flexible. The insulating tube 51 is a tube with a blade made of polyurethane or polyamide with a built-in stainless steel net assembly. The wiring passes through the electrode support portion 2 and the insulating tube 51, is connected to the electrode portion 6 and the stimulus generator 63 (see FIG. 2), and energizes the electrode portion 6.

  The proximal end fastener 4 is connected to the distal end of the wiring portion 5. In the base end fastener 4, the base ends 21 of the plurality of electrode support portions 2 are collected and accommodated together. In the present embodiment, the proximal end fastener 4 has a substantially cylindrical shape, and is arranged so that the central axis is positioned coaxially with the axis L <b> 1 of the wiring portion 5.

  The front end fastener 3 has the front ends 22 of the plurality of electrode support portions 2 collected and fixed together. In the present embodiment, the distal end fastener 3 has a substantially cylindrical shape, an opening 31 is formed on the proximal end side, and a bottom 32 is provided on the distal end side.

  In the electrode support mechanism 1 according to the present embodiment, the base ends 21 of the four electrode support portions 2 are respectively arranged at symmetrical positions around the axis L <b> 1 of the wiring portion 5 and fixed to the base end fastener 4. Is done. In FIG. 1, of the four electrode support portions, the two electrode support portions 2 are arranged so that the base ends 21 are symmetrical with respect to the axis L <b> 1 and are fixed to the base end fastener 4. Is shown. The distal ends 22 of all the electrode support portions 2 are inserted into the openings 31 of the distal end fastener 3 and fixed to the distal end fastener 3. In the present embodiment, the four electrode support portions 2 as a whole have a substantially spindle shape in which the intermediate portion is expanded in a substantially spherical shape in a state where no external force is applied to the electrode support portion 2. In the present embodiment, of the four electrode support portions 2, the two electrode support portions 2 are shorter than the other two electrode support portions 2. The base ends 21 of the four electrode support portions 2 having different lengths are fixed to one base end fastener 4, and the respective distal ends 22 are fixed to the one front end fastener 3. Thereby, as shown in FIG. 1, the front-end | tip fastener 3 is arrange | positioned in the position spaced apart from the axis line L1 of the wiring part 5. As shown in FIG. That is, when viewed in the direction of the axis L1 (the direction of the arrow Y shown in FIG. 1) from the base end side of the wiring portion 5, the distal end fastener 3 appears to be at a position separated from the axis L1.

  As shown in FIG. 1, the electrode support mechanism 1 according to this embodiment includes at least two of the four electrode support portions 2 that are accommodated in the proximal end fastener 4 at a position where the proximal end 21 sandwiches the axis L1. On the plane including the electrode support portion 2, the front end fastener 3 is disposed at a position separated from the axis L <b> 1 of the wiring portion 5. Moreover, as shown in FIG. 1, the front-end | tip fastener 3 is arrange | positioned on the offset line L2. The offset line L2 is the midpoint in the line segment Q obtained by projecting the distance of the electrode support portion 2 from the proximal end fastener 4 to the distal end fastener 3 on the axis L1 of the wiring portion 5 in the electrode support portion 2 in a natural state. This is an imaginary line connecting I and the front end fastener 3. More preferably, the offset line L2 is set within a range inclined with respect to the axis L1 of the wiring portion 5 at an angle of 30 ° or more and 90 ° or less.

  Next, as an example of use of the electrode support mechanism 1 according to the present embodiment, an example in which electrical stimulation is applied to the vagus nerve n using the electrical stimulation device 100 including the electrode support mechanism 1 will be described. The electrical stimulation device 100 includes a nerve stimulation electrode 10 including the electrode support mechanism 1 according to the present embodiment and a stimulation generator 63. FIG. 2 shows an example in which the nerve stimulation electrode 10 is placed in the blood vessel V in order to apply electrical stimulation to the vagus nerve n. First, the nerve stimulation electrode 10 is inserted into the blood vessel V. The nerve stimulation electrode 10 is inserted in a state where the electrode support portion 2 is elastically deformed and accommodated inside an insertion tube or the like until reaching a predetermined indwelling position in the blood vessel V. When the insertion tube reaches near the detention position of the electrode portion 6, the insertion tube is retracted or removed, and the distal end fastener 3, the electrode support portion 2, the proximal end fastener 4, and the distal end side of the wiring portion 5 are connected. It is exposed in the blood vessel V. At this time, as shown in FIG. 2, the electrode support portion 2 is restored to a curved shape in the blood vessel V, and the electrode support portion 2 is biased toward the blood vessel wall V1 so that the electrode portion 6 contacts the blood vessel wall V1. Is done.

  The nerve stimulation electrode 10 is pushed in from the proximal end side of the wiring portion 5 in the direction of the axis L1 and advances in the blood vessel V. When the nerve stimulation electrode 10 approaches the portion where the blood vessel V is curved, the blood vessel wall V1 of the blood vessel V that curves forward in the traveling direction of the nerve stimulation electrode 10 (in the direction of the axis L1 of the wiring portion 5) faces the nerve stimulation electrode 10. . When the nerve stimulation electrode 10 is further advanced, the nerve stimulation electrode 10 is continuously pushed in the direction of the axis L <b> 1 of the wiring portion 5. At this time, the electrode support mechanism 1 according to this embodiment is provided at a position where the front end fastener 3 is separated from the axis L <b> 1 of the wiring portion 5. For this reason, in the nerve stimulation electrode 10, the nerve stimulation electrode 10 can be advanced while avoiding the distal end fastener 3 being pressed against the blood vessel wall V1. As a result, even when the electrode support portion 2 passes through the curved portion V2 during placement, the nerve stimulation electrode 10 can be inserted while preventing the distal end fastener 3 from damaging the blood vessel wall V1.

[Second Embodiment]
Next, an electrode support mechanism 11 according to a second embodiment of the present invention will be described. FIG. 3 is a schematic diagram showing an electrode support mechanism 11 according to the second embodiment. This embodiment and 1st Embodiment differ in the structure of an electrode support part. That is, in the present embodiment, the lengths of the electrode support portions 7 are all set equal, and the distal end fastener 3 is disposed at a position separated from the axis L1 of the wiring portion 5 due to the curved shape of the electrode support portions 7. Thus, it is different from the first embodiment. In the following description, the same reference numerals are given to the same components and the like as those in the first embodiment, and duplicate descriptions are omitted.

  The electrode support mechanism 11 according to the present embodiment includes four electrode support portions. FIG. 3 shows only the two first electrode support portions 7 arranged at positions symmetrical with respect to the axis L <b> 1 in the proximal end fastener 4 among the four electrode support portions 7. In addition, the electrode part provided in the 1st electrode support part 7 is abbreviate | omitting illustration. In this embodiment, the 1st electrode support part 7 consists of a shape memory wire, and has the rigidity of the grade which can hold | maintain a fixed shape against a deformation | transformation of the indwelling blood vessel wall. The base ends 71 of the four electrode support portions including the first electrode support portion 7 are all fixed to the base end fastener 4, and the distal ends 72 are all fixed to the distal end fastener 3.

  In the electrode support mechanism 11 according to the present embodiment, as shown in FIG. 3, the curved shapes of the first electrode support portions 7 are different. One of the peaks of the curved portion of the first electrode support portion 7 is on the proximal end side, and the other is on the distal end side. Thereby, even if the first electrode support part 7 having the same length is located on both sides of the axis line L1 of the wiring part 5, the front end fastener 3 is disposed at a position separated from the axis line L1 of the wiring part 5. . In the present embodiment, the front end fastener 3 is separated from the axis L1 so that the axis of the substantially cylindrical front end fastener 3 is parallel to the axis L1 of the wiring portion 5. The two first electrode support portions 7 are inserted into an organ such as a blood vessel, and even if the wall portion of the organ and the first electrode support portion 7 come into contact with each other, the distal end fastener 3 is positioned away from the axis L1. Keep each curved state to keep. The electrode support mechanism 11 according to the present embodiment is a position where the front end fastener 3 is separated from the axis L1 of the wiring portion 5 by a separation distance M in a natural state on a plane including the two first electrode support portions 7. Placed in. The separation distance M is one third or more of the maximum separation distance N in the direction perpendicular to the axis L1 of the two first electrode support portions 7 in the natural state on the plane including the two first electrode support portions 7. The length is preferably less than two-thirds. By setting the separation distance M of the distal end fastener 3 within this range, the distal end fastener 3 is prevented from damaging the organ when the nerve stimulation electrode 10 is placed in an organ having a small diameter and a large curved portion such as a blood vessel. The effect is high, and the electrode support portion can be smoothly brought into contact with the wall portion of the organ even at a branching portion or a curved portion of the organ. In addition, if the maximum separation distance N of the first electrode support part 7 in the direction orthogonal to the axis L1 of the wiring part 5 is set according to the diameter of the organ to be placed, the first electrode support part 7 is reliably attached to the organ wall part. It can be made to contact.

  In addition, in this embodiment, it is the structure which maintains the state by which the front end fastener 3 was arrange | positioned in the position spaced apart with respect to the axis line L1 by the curved shape of the 1st electrode support part 7. FIG. Therefore, electrode support parts (not shown) other than the first electrode support part 7 among the four electrode support parts in the present embodiment have a shape in which the intermediate part in the length direction is curved outward in a natural state. There is no limitation on the curved shape as long as it has wires. In addition, you may comprise all four electrode support parts with the same shape memory wire as the 1st electrode support part 7. FIG.

  In this embodiment, since the lengths of the two first electrode support portions 7 are equal, when the electrode support portions are cooled to be inserted into a blood vessel and the plurality of electrode support portions are narrowed, the entire electrode support portions It is possible to narrow the width narrower. Therefore, the electrode support portion can be easily inserted into the blood vessel, and the load on the blood vessel can be suppressed.

  The electrode support mechanism 11 according to the present embodiment has the same effects as those of the first embodiment. Further, the electrode support mechanism 11 according to the present embodiment maintains the position of the tip fastener 3 at a position spaced from the axis L1 of the wiring part 5 while using the first electrode support part 7 having the same length. By energizing the wall portion of the organ with the first electrode support portion 7, a space can be easily formed in front of the distal end fastener 3 in the organ. Therefore, it can prevent more reliably that the front-end | tip fastener 3 contact | abuts to the wall part of an organ.

[Third Embodiment]
Next, an electrode support mechanism 12 according to a third embodiment of the present invention will be described with reference to FIGS. This embodiment is different from the first and second embodiments in the configurations of the electrode support portion and the proximal end fastener. In the following description, the same reference numerals are given to the same components and the like as those in the first and second embodiments, and redundant description is omitted.

  FIG. 4 is a side view showing the electrode support mechanism 12 according to the third embodiment. FIG. 5 is a cross-sectional view taken along the line AA in FIG. FIG. 6 is a cross-sectional view showing a state in which the base end of the movable electrode support portion has moved to the base end side of the insertion hole. In FIG. 4 to FIG. 6, illustration of electrode portions provided on the electrode support portion 8 is omitted. In the present embodiment, four electrode support portions 8 having the same length are provided, and a part of the electrode support portions (movable electrode support portions 81) is moved back and forth within the proximal end fastener 41 to adjust the length. By having a possible configuration, the front end fastener 3 is disposed at a position separated from the axis L <b> 1 of the wiring portion 5.

  The electrode support mechanism 12 according to this embodiment uses four electrode support portions 8 having the same length, and the tips 83 of all the electrode support portions 8 are accommodated in the tip fasteners 3 and fixed. The base ends 84 of all the electrode support portions 8 are accommodated in the base end fasteners 41. A detailed configuration in which the base end 84 of the electrode support portion 8 is accommodated in the base end fastener 41 will be described later. As shown in FIGS. 3 and 4, the electrode support mechanism 12 according to this embodiment has a substantially ellipsoidal outer shape in a state where it does not receive an external force, and an intermediate portion in the length direction of the electrode support portion 8 is The diameter is expanded. That is, in the electrode support mechanism 12 according to the present embodiment, the tip fastener 3 is disposed on the axis L <b> 1 of the wiring portion 5 in a state where the electrode support portion 8 does not receive external force.

  In the present embodiment, the four electrode support portions 8 include one movable electrode support portion 81 and three fixed electrode support portions 82. The four electrode support portions 8 are formed of a shape memory wire having a curved shape as in the second embodiment, and all the wires have the same rigidity. The fixed electrode support portion 82 has a distal end 83 fixed to the distal end fastener 3 and a proximal end 84 a fixed to the proximal end fastener 41. The movable electrode support portion 81 has a distal end 83 fixed to the distal end fastener 3, a proximal end 84 b inserted into a second insertion hole 41 c (insertion hole) of the proximal end fastener 41, and a proximal end within the proximal end fastener 41. 84b is arranged to be able to advance and retreat.

  7 is a cross-sectional view taken along line BB in FIG. 6, and FIG. 8 is a cross-sectional view taken along line CC in FIG. As shown in FIGS. 5 to 8, the proximal end fastener 41 has an outer tube 41a and four insertion holes 41b and 41c. The outer tube 41 a has a cylindrical shape whose center is coaxial with the axis L <b> 1 of the wiring portion 5. The insertion holes 41b and 41c are formed in the outer tube 41a so as to extend in parallel with the axis L1 of the wiring portion 5.

  As shown in FIG. 7, the three first insertion holes 41b are formed between the axis L1 of the wiring part 5 and the outer tube 41a. As shown in FIG. 5, the three first insertion holes 41 b have positions P (hereinafter referred to as “reference positions P”) where the base ends 84 a of the three fixed electrode support portions 82 abut against the bottom 41 d of the first insertion holes 41 b. Is inserted and fixed.

  As shown in FIGS. 7 and 8, one second insertion hole 41c has a sectional shape that opens in a sector shape with the center of the outer tube 41a (the axis L1 of the wiring portion 5) as the apex, and extends along the axis L1. It is formed as follows. The bottom 41e of the second insertion hole 41c is formed further on the base end side (wiring part 5 side) than the bottom 41d of the first insertion hole 41b. The cross sectional area of the second insertion hole 41 c is larger than the cross section of the movable electrode support portion 81. Therefore, a gap S is formed between the movable electrode support portion 81 and the second insertion hole 41c in a state where the base end 84b of the movable electrode support portion 81 is inserted into the second insertion hole 41c. The movable electrode support portion 81 is inserted so that the base end 84b can advance and retreat in the second insertion hole 41c.

  As shown in FIG. 5, the movable electrode support portion 81 has a base end 84 b of the base end 84 a of the fixed electrode support portion 82 due to the balance with the three fixed electrode support portions 82 that are curved in a state where no external force is received. It remains in the second insertion hole 41c at the same position in the direction of the reference position P and the axis L1. On the other hand, for example, when the electrode support mechanism 12 is placed in the blood vessel, any of the electrode support portions 8 receives an external force due to the electrode support portion 8 coming into contact with the blood vessel wall. In this case, the base end 84b of the movable electrode support part 81 moves to the bottom 41e side (wiring part 5 side) of the second insertion hole 41c. Therefore, the length of the movable electrode support portion 81 relative to the length of the fixed electrode support portion 82 between the distal end fastener 3 and the proximal end fastener 4 is shortened. As a result, the position of the front end fastener 3 is changed to a position away from the axis L <b> 1 of the wiring portion 5.

  When an external force is applied equally to the movable electrode support portion 81 and the fixed electrode support portion 82, the curved shape of the intermediate portion in the length direction of the electrode support portion 8 changes uniformly, so that the base end of the movable electrode support portion 81 84b does not move to the bottom 41e side of the second insertion hole 41c. Therefore, when an external force is equally applied to the movable electrode support portion 81 and the fixed electrode support portion 82, the movable electrode support portion 81 and the fixed electrode support portion 82 between the distal end fastener 3 and the proximal end fastener 41 are used. The length does not change.

  In the present embodiment, the reference position P in the proximal end fastener 41 (the position where the bottom 41d is formed in the first insertion hole 41b) and the distance from the reference position P to the bottom 41e in the second insertion hole 41c are defined as the electrode support portion 8. Is set based on the length, the curved shape and the rigidity. Thereby, the range in which the length of the movable electrode support portion 81 between the distal end fastener 3 and the proximal end fastener 4 changes is defined by the second insertion hole 41c, and the position of the distal end fastener 3 is determined by the wiring portion. The range which changes so that it may leave | separate from 5 axis line L1 can be set. Furthermore, the reference position P is set in consideration of preventing the base end 84b of the movable electrode support portion 81 from coming out of the second insertion hole 41c when the electrode support portion 8 receives an external force.

  The electrode support mechanism 12 according to the present embodiment has a movable electrode support portion corresponding to the length of the fixed electrode support portion 82 between the distal end fastener 3 and the proximal end fastener 41 when an external force is applied to the electrode support portion 8. The length of 81 changes and the position of the front-end | tip fastener 3 can move to the position spaced apart from the axis line L1 of the wiring part 5. FIG. For this reason, the effect similar to 1st Embodiment is acquired. Furthermore, when the base end 84 b of the movable electrode support portion 81 is located at the reference position P, the distal end fastener 3 is located on the axis L <b> 1 of the wiring portion 5. Therefore, for example, when the nerve stimulation electrode is inserted or removed from a portion where the blood vessel is not curved, the protruding amount in the direction intersecting the axis L1 of the curved portion of the electrode support portion 8 is reduced, and the distal end fastener 3 and the proximal end It is possible to change the dimension in the radial direction to be small so that the separation distance from the fastener 4 becomes long. As a result, it becomes easy to insert and remove the nerve stimulation electrode including the electrode support mechanism 12 according to the present embodiment.

[First Modification of Third Embodiment]
Next, a first modification of the electrode support mechanism 12 according to the third embodiment will be described. FIG. 9 is a schematic diagram showing an electrode support mechanism 13 according to this modification. This modification differs from the third embodiment in the number of movable electrode support portions 81 and fixed electrode support portions 82. Furthermore, the present modification is different from the third embodiment in that the base end 84c of the movable electrode support portion 81 has a configuration in which the diameter is larger than the distal end side and prevents the second electrode insertion hole 42a from coming off. In the following description, the same reference numerals are assigned to the same components and the like as those in the third embodiment, and duplicate descriptions are omitted. Further, in FIG. 9, the illustration of the electrode portion provided in the electrode support portion 8 is omitted.

  10 is a cross-sectional view taken along the line DD of FIG. 9, and FIG. 11 is a cross-sectional view taken along the line EE of FIG. As shown in FIGS. 9 to 11, in the electrode support mechanism 13 according to this modification, two movable electrode support portions 81 and two fixed electrode support portions 82 are provided. As shown in FIG. 10, the movable electrode support portion 81 is provided so as to be adjacent to the circumferential direction of the outer tube 41 a of the proximal end fastener 42. That is, in the cross section of the proximal end fastener 42 shown in FIG. 10, the regions divided into two semicircles are defined as a first region 42d and a second region 42e, respectively. The first insertion hole 41b is formed in the first region 42d and the fixed electrode support portion 82 is fixed, the second insertion hole 42a is formed in the second region 42e, and the movable electrode support portion 81 is formed in the second insertion hole 42a. Is inserted. The base ends 84c of the two movable electrode support portions 81 can advance and retract within the second insertion hole 42a. When no external force is applied to the electrode support 8 or when an external force is applied equally to the movable electrode support 81 and the fixed electrode support 82, the base end 84c of the movable electrode support 81 is the same as in the third embodiment. Is located at the reference position P. Further, for example, when the electrode support mechanism 13 is placed in a blood vessel, when any of the electrode support portions 8 receives an external force due to the electrode support portion 8 coming into contact with the blood vessel wall, the same as in the third embodiment. The base end 84c of the movable electrode support part 81 moves to the bottom part 42c side of the second insertion hole 42a. The electrode support mechanism 13 according to this modification has the same effects as those of the third embodiment. Further, since the number of the movable electrode support portions 81 is large, the position of the front end fastener 3 can be moved to a position away from the axis L1 of the wiring portion 5 more smoothly with respect to the external force received by the electrode support portion 8. it can.

  Further, in the present modification, the second insertion hole 42a of the proximal end fastener 42 has a larger cross-sectional area at the bottom 42c than the opening area at the opening 42b on the distal end side, and faces from the opening 42b toward the bottom 42c. The cross-sectional area is formed so as to increase gradually. As shown in FIG. 10, the cross-sectional area of the second insertion hole 42 a is slightly larger than the cross-sectional area of the movable electrode support portion 81 in the vicinity of the opening 42 b (on the tip side from the reference position P). A gap S1 is formed between the portion 81 and the second insertion hole 41c. As shown in FIG. 11, the cross-sectional area of the second insertion hole 42 a is sufficiently larger than the cross-sectional area of the movable electrode support portion 81 on the bottom 42 c side (the base end side of the reference position P) of the second insertion hole 42 a. The gap S2 between the movable electrode support portion 81 and the second insertion hole 41c is formed larger than the gap S1 in the vicinity of the opening 42b.

  Furthermore, the base end 84c of the movable electrode support portion 81 is formed so that the outer diameter is larger than that of other portions. On the base end side with respect to the reference position P, the cross-sectional area of the second insertion hole 42 a is sufficiently larger than the cross-sectional area of the base end 84 c of the movable electrode support portion 81. Therefore, the base end 84c of the movable electrode support portion 81 can be easily advanced and retracted on the base end side with respect to the reference position P. On the other hand, the cross-sectional area of the enlarged diameter portion of the base end 84c of the movable electrode support portion 81 is larger than the opening area of the opening portion 42b. Therefore, it is possible to prevent the base end 84c of the enlarged movable electrode support portion 81 from coming out of the opening portion 42b of the second insertion hole 42a on the tip side of the reference position P. Therefore, it is possible to reliably prevent the movable electrode support portion 81 from coming out of the second insertion hole 42a.

[Second Modification of Third Embodiment]
A second modification of the electrode support mechanism 12 according to the third embodiment will be described. FIG. 12 is a cross-sectional view illustrating a second modification of the electrode support mechanism 12 according to the third embodiment. FIG. 13 is a view showing the electrode support mechanism 14 according to this modification, and is a view showing a state where the operation knob is moved in the proximal direction. This modification is different from the third embodiment in that it is a base end fastener 43 that allows the operator to adjust the protruding length of the movable electrode support portion 81 from the base end fastener 43.

  A base end 84 d of the movable electrode support portion 81 is connected to the operation wire 85. An operation knob 85 a is connected to the proximal end of the operation wire 85. The proximal end of the proximal end fastener 43 is connected to the distal end of the insulating tube 51 of the wiring portion. The insulating tube 51 has a tubular shape communicating from the distal end to the proximal end, and an operation wire insertion passage 51a is formed. The operation wire insertion passage 51a communicates with the second insertion hole 43a of the base end fastener 43 through which the movable electrode support portion 81 is inserted, and the operation wire 85 is inserted therein. An opening 50 communicating with the operation wire insertion passage 51a is formed on the outer peripheral surface on the proximal end side of the insulating tube 51 located outside the patient's body. In FIG. 12 and FIG. 13, wiring inserted through the insulating tube 51 is omitted. Since the operation wire insertion path 51 a communicates with the outside through the opening 50, the wiring is inserted into a communication path (not shown) independent of the insulating tube 51. The configuration of the first insertion hole 41b and the fixed electrode support portion 82 inserted into the first insertion hole 41b is the same as in the third embodiment.

  The operation wire 85 extends from the vicinity of the connection portion between the proximal end fastener 43 and the insulating tube 51 to the opening 50, and is inserted into the operation wire insertion passage 51a so that a part of the operation knob 85a is exposed to the opening 50. ing. The operation wire 85 and the movable electrode support portion 81 are inserted in the second insertion hole 43a of the proximal end fastener 43 and the operation wire insertion passage 51a so as to be able to advance and retreat. In this modification, when the operation knob 85a is positioned at the distal end portion of the opening 50, the operation wire is set so that the protruding lengths of the movable electrode support portion 81 and the fixed electrode support portion 82 from the proximal end fastener 43 are equal. The length of 85, the position of the opening 50, and the position of the operation knob 85a are set. When the operator wants to make the length of the movable electrode support portion 81 shorter than the fixed electrode support portion 82, when the operator pulls the operation knob 85a toward the proximal end side of the opening 50, the operation wire 85 moves to the proximal end side, The protrusion length from the base end fastener 43 of the movable electrode support part 81 becomes short.

  In the electrode support mechanism 14 of the present modification, the operator changes the length of the movable electrode support 81 by sliding the operation knob 85a, and changes the direction in which the distal end fastener 3 extends to an arbitrary direction. be able to.

  According to the electrode support mechanism 14 of the present modification, the surgeon adjusts the direction of the distal end fastener 3 while confirming the curve direction of the blood vessel on a monitor or the like, and finely adjusts the degree of adhesion of the electrode support portion to the blood vessel. Is possible. As a result, the electrode support portion can be moved to a shape corresponding to the shape of the blood vessel and securely locked. In the case of this modification, the amount of pulling of the movable electrode support portion into the proximal end fastener is not affected by the shape of the proximal end fastener, so that the amount of withdrawal can be set large. Therefore, the electrode support mechanism 14 of the present modification can be brought into close contact with a blood vessel having a strong curvature (a blood vessel having a curved portion with a small curvature), and can cope with a wide range of curved shapes of blood vessels.

  If a lock mechanism is further provided between the opening 50 and the operation knob 85a to hold the position of the operation knob 85a in the long axis direction at the opening 50, the operation knob 85a is fixed at a desired position and is movable. The length of the electrode support part 81 can be kept at a desired length.

  In this modification, the operation wire insertion path 51a is formed in the long axis direction of the insulating tube 51 independently of the communication path through which the wiring is inserted. However, the present invention is not limited to this structure. For example, an insertion hole through which only the operation wire 85 can be inserted is formed in the vicinity of the opening on the distal end and the proximal end side of the insulating tube 51, and the wiring and the operation wire 85 are the same in the intermediate portion of the insulating tube 51. The structure arrange | positioned in space may be sufficient.

  In this modification, when the operation knob 85a is located on the distal end side of the opening 50, the movable electrode support portion 81 and the fixed electrode support portion 82 are set to have the same protruding length from the proximal end fastener 43. showed that. In addition, for example, when the operation knob 85a is positioned at a substantially central portion in the long axis direction of the opening 50, the protruding lengths of the movable electrode support portion 81 and the fixed electrode support portion 82 from the proximal end fasteners 43 are equal. When the operation knob 85 a is located on the distal end side of the opening 50, the length of the protrusion of the movable electrode support portion 81 from the proximal end fastener 43 is longer than the fixed electrode support portion 82, and the operation knob 85 a is the base of the opening 50. When located on the end side, the protruding length of the movable electrode support portion 81 from the proximal end fastener 43 may be set to be shorter than the protruding length of the fixed electrode support portion 82 from the proximal end fastener 43.

  Although the example which inserts the nerve stimulation electrode 10 which has an electrode support mechanism in the blood vessel was given in the said embodiment, the organ to which the nerve stimulation electrode provided with the electrode support mechanism which concerns on this invention is applied is not limited to a blood vessel.

  In the first embodiment, the four electrode support portions 2 are provided, and the four electrode support portions 2 have different lengths by two. However, at least one electrode support portion 2 is another electrode support portion. The front end fastener 3 may be disposed at a position separated from the axis L <b> 1 of the wiring portion 5.

  In the said embodiment, although the example provided with four electrode support parts was shown, the number of electrode support parts is not limited to four. From the viewpoint of forming a shape capable of abutting against the wall of the tubular organ and urging and abutting against the inner wall of the organ, it is preferable that there are four or more electrode support portions, for example, six A configuration including an electrode support is conceivable. In the first embodiment, when six electrode support portions are provided, by setting at least one electrode support portion to be shorter than the other five electrode support portions, the position of the tip fastener can be determined from the axis of the wiring portion. It is possible to arrange them at spaced positions. In addition, the length of the electrode support portion is not limited to two types, that is, a long one and a short one, and many combinations are possible in which the front end fastener can be arranged at a position separated from the axis of the wiring portion. is there. In addition, when using two or three electrode support parts shorter than another electrode support part, a short electrode support part is arrange | positioned adjacently.

  The position of the electrode provided in the electrode support portion is not limited to the position described in the above embodiment, and a configuration in which electrodes are provided in all electrode support portions, or a living tissue and an electrical stimulation device that apply electrical stimulation are applied. It can be set as appropriate depending on the positional relationship with the organ.

  In the above-described embodiment, the example in which the tips of the plurality of electrode support portions are housed and fixed in the tip fasteners as an example of the tip protrusion portion is shown. However, the electrode support mechanism according to the present invention includes a plurality of electrode support portions. Any configuration may be used as long as the tips are gathered together and fixed. For example, the structure which the front-end | tip part of the some electrode support part was bundled and fixed may be sufficient.

As mentioned above, although embodiment of this invention was explained in full detail with reference to drawings, the concrete structure is not restricted to this embodiment, The design change etc. of the range which does not deviate from the summary of this invention are included.
In addition, the constituent elements shown in the above-described embodiments and modifications can be combined as appropriate.

1, 12, 13 Electrode support mechanism 2, 7, 8 Electrode support part 3 Tip clamp (tip protrusion)
4, 41, 42, 43 Base end fastener 5 Wiring part 6, 61, 62 Electrode part 22 Front end 21 Base end 41c, 42a, 43a Insertion hole 71 First electrode support part (electrode support part)
81 Movable electrode support part 82 Fixed electrode support part 100 Electrical stimulator L1 Axis line L2 Offset line I Middle point

Claims (7)

A plurality of elongated electrode support portions that are made of an elastic body that is curved in a natural state and provided with electrode portions;
A tip projecting portion that collects and fixes the tips of the plurality of electrode support portions together, and
A base end fastener for collecting and storing base ends of the plurality of electrode support portions;
A wiring portion connected to the proximal end fastener and energizing the electrode portion;
With
The proximal end fastener is disposed on an axis of the wiring portion;
The tip protrusion is an electrode support mechanism arranged at a position spaced from the axis of the wiring part.   In a natural state, an offset line connecting the midpoint of the length obtained by projecting the distance from the proximal end fastener to the tip protruding portion onto the axis of the wiring portion and the tip protruding portion is the wire portion of the wiring portion. The electrode support mechanism according to claim 1, wherein the tip protrusion is disposed so as to be inclined at an angle of 30 ° to 90 ° with respect to the axis.   The electrode support mechanism according to claim 1, wherein at least one of the plurality of electrode support portions is shorter than the length of the other electrode support portion. The plurality of electrode support portions are all formed equal in length,
At least two of the plurality of electrode support portions are made of a shape memory wire.
The electrode support mechanism according to claim 1, wherein the electrode support portions made of the shape memory wires have different curved shapes. On the plane including the two electrode support portions that are accommodated so that the base end faces the base end fastener with the axis line in between.
The separation distance between the tip projecting portion and the axis of the wiring portion in the direction perpendicular to the axis is 3 minutes with respect to the maximum separation distance in the direction perpendicular to the axis of the two electrode support portions in the natural state. The electrode support mechanism according to claim 4, which has a length of 1 to 2/3. The proximal end fastener has an insertion hole in which the proximal end of at least one of the electrode support portions is inserted and supported so as to be able to advance and retract relative to the proximal end fastener,
At least two or more of the electrode support portions of the plurality of electrode support portions are fixed electrode support portions whose base ends are fixed to the base end fastener,
At least one or more of the electrode support portions of the plurality of electrode support portions is a movable electrode support portion whose base end is inserted into the insertion hole and can advance and retreat in the base end fastener. ,
When the base end of the movable electrode support part moves to the wiring part side in the insertion hole, the length of the movable electrode support part with respect to the length of the fixed electrode support part is shortened, and the tip protrusion part The electrode support mechanism according to claim 1, wherein the electrode support mechanism is configured to change from a position on the axis of the wiring portion to a position away from the position.   An electrical stimulation device comprising the electrode support mechanism according to any one of claims 1 to 6.

Images