JP2020512082A - ブラシ生検装置、キット及び方法 - Google Patents
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Abstract
Description
2.患者を砕石位にする。
3.ブラシ試料採取器を外側挿管内に完全に後退させる。(図2)
4.装置を基底部のレベルまで徐々に挿入する。(図3A)
5.外側挿管を取っ手まで完全に引き戻す。ブラシ試料採集器を十分に回転させる。(図3B)
2つの方法が推奨されている。
1)ブラシ試料採集器を、取っ手上の基準マークが360°回転の完了を示すまで時計回りに回転させ、次に、取っ手上の基準マークが360°回転の完了を示すまで反時計回り(反対方向)に回転させる。
2)ブラシ試料採集器を、一方向にのみ4回又は5回、360°完全に回転させることによって回転する。注:取っ手上の基準マークが360°回転の完了を示す。
6.子宮内膜試料を原位置で捕捉するために、外側挿管をブラシ上で先端まで押し、装置を取り出す(図3C)。通常の子宮内膜腔は収縮状態にあり、従って、ブラシは子宮内膜表面全体と直接接触することになる。
7.装置を直ちに8mlのCytoRich(R)Brush Cytology Preservative内に浸漬する。
8.挿管を後退させてブラシを保存液にさらす。
9.挿管をしっかりと保持し、ブラシを挿管に出し入れして、付着した細胞及び組織を洗い出す。(図3C)注:収集物は保存液中で最大数週間まで安定である。
10.ブラシアセンブリを試験管から取り出し、ねじ蓋を元に戻し、試験管を処理のために検査所に提出する。
1.無菌の潤滑剤なしの膣鏡の挿入後、綿棒によりポビドンヨード溶液で子宮頸膣部及び子宮頸管を消毒する。注:ポビドンによる子宮頸膣部の十分な消毒を確実にするために、綿棒を子宮頸管内に約1.5cm挿入する。
2.この使用説明の前項のステップ3からステップ6に従って子宮内膜腔にブラシを挿入する。取っ手上の基準マークが360°回転の完了を示す。
3.試料採集器を取り出す。
4.ブラシの丸い先端を95%アルコールガーゼで拭う。
5.挿管を引き戻す。無菌スライドガラス上に直接塗抹を引くことによって形態評価(必要な場合)の準備をし、直ちにスプレー凝固する。
6.培養検査のために、ブラシを無菌Stuarts Transportation Medium中に入れ、5秒間攪拌する。
Yang GC, Wan LS, Del Priore G. Factors influencing the detection of uterine cancer by suction curettage and endometrial brushing. J Reprod Med 2002;47:1005−10.
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McCluggage WG. My approach to the interpretation of endometrial biopsies and curettings. J Clin Pathol. 2006;59:801−12.
Dijkhuizen FP, Mol BW, Brolmann HA, Heintz AP. The accuracy of endometrial sampling in the diagnosis of the patients with endometrial carcinoma and hyperplasia: a meta-analysis. Cancer 2000; 89(8):1765−72.
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Grimes DA. Diagnostic dilation and curettage: A reappraisal. Am J Obstet Gynecol 1982; 142:1−6.
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Tahir MM, Bigrigg MA, Browning JJ, Brookes ST, Smith PA. A randomized controlled trial comparing transvaginal ultrasound, outpatient hysteroscopy and endometrial biopsy with inpatient hysteroscopy and curettage. Br J Obstet Gynecol 1999; 106(12):1259−64.
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本発明の好ましい一実施形態は、外径約2.25mm、内径1.2mmの薄壁管を有し、長さが20cmと50cmの間、例えば22cmの子宮内生検装置からなる。この管は、例えばナイロン製の、透明で、曲げられるが自己支持型であるプラスチック管とすることができる。ガイドワイヤは、好ましくは、直径約0.1mm〜0.2mmで、使用中にブラシの延伸と後退のための力を伝達するのに十分な機械的特性を有する、ねじりステンレススチールワイヤである。ガイドワイヤの末端には、先端に無外傷球状部を備える図8及び図11に示す生検ブラシがある。ブラシは、長さ約4cmで、延伸時には挿管の端部を約2cm越えて延びる。Oリングは、好ましくは、挿管の端部を再係合する問題を回避するために、全移動範囲にわたって挿管内に留まる。例えば、Oリング(又はより一般的には、ワイヤに取り付けられたプランジャ)は、例えば、延伸時に挿管の端部から2mm〜5mmの位置にある。
第2実施形態によると、1回に採取される複数の生検試料を取得し、分離することができる、複数試料生検装置が提供される。従って、これは複数の生検ブラシ又は器具と、器具をその中で延伸及び後退させる複数の挿管とを必要とする。
複数試料生検装置の第2設計によると、単一のマニピュレータがハウジングから延び、それ自体が複数の生検器具を収容する。
Claims (20)
- 組織試料採取装置であって、
内部真空を維持するように構成された末端部を少なくとも有する可撓性挿管と、
前記挿管を人間又は動物の開口部を通して固定挿入深度に維持するように構成されたスカートストッパと、
同軸構造体を形成する、前記挿管内の移動可能構造体と、を含み、
前記移動可能構造体は、前記挿管の近接端から延びる第1端部と、第1状態では前記挿管の末端から延び、第2状態では前記挿管の前記末端内に後退させられるように構成された第2端部と、を有し、
前記移動可能構造体の前記第2端部は、先に吸引要素がある細胞試料採取構造体を有し、
前記同軸構造体は、前記挿管の前記近接端における前記移動可能構造体の前記第1端部上の張力の結果として、前記移動可能構造体が前記第1状態から前記第2状態に後退して、前記挿管外部の媒体をピストンより末端側の前記挿管内に移動させる吸引を生じさせるように構成された、組織試料採取装置。 - 前記移動可能構造体は前記第2端部において無外傷球状部で終端する、請求項1に記載の組織試料採取装置。
- 前記細胞試料採取構造体はブラシを含む、請求項1に記載の組織試料採取装置。
- 前記ブラシは、前記移動可能構造体から半径方向に延びる複数のブラシ毛を含む、請求項3に記載の組織試料採取装置。
- 前記ブラシは、前記第2端部からの距離に対して相対的に次第に小さくなる断面を有する、請求項3に記載の組織試料採取装置。
- 前記ブラシが、らせん状断面輪郭を有する、請求項3に記載の組織試料採取装置。
- 前記同軸構造体が、子宮内膜生検試料を取り出すために人間の子宮の頸管口内に所定の深度まで挿入され、前記子宮の前記頸管口から引き出されるように構成された、請求項1に記載の組織試料採取装置。
- 前記同軸構造体が、
前記移動可能構造体が前記第2状態にある状態で、前記頸管口内に所定の深度まで挿入され、
前記細胞試料採取構造体が前記子宮内にある状態で、前記第1状態に延伸され、
前記子宮内の細胞を取り去るために、ユーザによって前記移動可能構造体の前記第1端部の移動により操作され、
前記挿管の前記末端内に前記細胞試料採取構造体の周囲の液体試料を引き込むように真空を生じさせるために、前記子宮内で前記第2状態に後退させられ、
前記移動可能構造体が前記第2状態にある状態で前記頸管口から後退させられるようにさらに構成された、請求項7に記載の組織試料採取装置。 - 前記移動可能構造体がスパイラル状にねじれた可撓性ガイドワイヤを含む、請求項1に記載の組織試料採取装置。
- 前記挿管が1mmと3mmの間の外径と、20cmと50cmの間の長さと、を有する、請求項1に記載の組織試料採取装置。
- 前記スカートストッパが前記可撓性挿管の外面上のフランジ状要素を含み、前記可撓性挿管は、前記子宮内部から子宮内膜生検試料を取り出すために人間の子宮の頸管口内に前記所定の深度まで挿入され、前記子宮内膜生検試料が得られた後で前記子宮の頸管口から引き出されるように構成され、
前記可撓性挿管は、
前記移動可能ワイヤが前記第2状態にある状態で、前記頸管口内に前記所定の深度まで挿入され、
前記細胞試料採取装置が前記子宮内にある状態で前記第1状態に延伸され、
子宮内膜細胞を取り去るように前記移動可能ワイヤの前記第1端部の移動により操作され、
前記細胞試料採取装置の周囲の液体試料を前記管状挿管の前記末端に引き込むために真空を引くように、前記子宮内で前記第2状態に後退させられ、
前記移動可能ワイヤが前記第2状態にある状態で、前記頸管口から後退させられるようにさらに構成された、請求項1に記載の組織試料採取装置。 - 前記移動可能ワイヤが前記管状挿管内に引き込まれると前記管状挿管内に負圧を生じさせる要素をさらに含む、請求項11に記載の組織試料採取装置。
- それぞれが内部真空を維持するように構成された末端部を少なくとも有する複数の可撓性挿管と、
1組の同軸構造体を形成する、各可撓性挿管内の移動可能構造体のそれぞれと、
係合させるとユーザインターフェースから前記移動可能構造体に張力と圧迫とが伝えられて前記移動可能構造体を前記第1状態と前記第2状態との間で遷移させ、係合解除されると前記ユーザインターフェースから前記移動可能構造体に張力と圧迫とが伝えられないように、それぞれの移動可能構造体を前記ユーザインターフェースに選択的に取り付けるように構成されたハウジングと、を含む、請求項1に記載の組織試料採取装置。 - 複数試料生検装置であって、
複数の可撓性挿管と、
同軸構造体を形成する、各挿管内の移動可能構造体であって、
各移動可能構造体が、前記挿管の近接端から延びる第1端部と、第1状態では前記挿管の末端から延び、第2状態では前記挿管の前記末端内に後退させられるように構成された第2端部とを有し、
前記移動可能構造体の前記第2端部が細胞試料採取構造体を有する前記移動可能構造体と、
係合されるとユーザインターフェースから前記移動可能構造体に張力と圧迫とが伝えられて前記移動可能構造体を前記第1状態と前記第2状態との間で遷移させ、係合解除されると前記ユーザインターフェースから前記移動可能構造体に張力と圧迫とが伝えられないように、それぞれの移動可能構造体を前記ユーザインターフェースに選択的に取り付けるように構成されたハウジングと、を含む、複数試料生検装置。 - 組織試料採取方法であって、
内部真空を維持するように構成された末端部と、人間の頸部への可撓性挿管の挿入深度を制限するように構成された前記可撓性挿管の周囲のスカートと、同軸構造体を形成する、前記挿管内の移動可能構造体とを少なくとも有する前記可撓性挿管を含む同軸構造体であって、前記移動可能構造体が、前記挿管の近接端から延びる第1端部と、第1状態においては前記挿管の末端から延び、第2状態においては前記挿管の前記末端内に後退させられるように構成された第2端部とを有し、前記移動可能構造体の前記第2端部が、先にピストンがある細胞試料採取構造体を有する、前記同軸構造体を設けることと、
前記移動可能構造体を前記第1状態から前記第2状態に後退させて真空を生じさせるように、前記挿管の前記近接端における前記移動可能構造体の第1端部に張力を加えることと、を含む、組織試料採取方法。 - 前記同軸構造体が、子宮内膜生検試料を取り出すために人間の子宮の頸管口内に所定の挿入深度まで挿入され、前記子宮の頸管口から引き出されるように構成される、請求項15に記載の方法。
- 前記移動可能構造体が第2状態にある状態で、前記同軸構造体の前記末端部を子宮の頸管口内に所定の深度まで挿入することと、
前記細胞試料採取構造体が前記子宮内にある状態で前記同軸構造体の前記末端部を前記第1状態に延伸させることと、
前記子宮内の細胞を取り去るように前記移動可能構造体の前記第1端部を操作することと、
前記細胞試料採取構造体の周囲の液体試料を前記挿管の前記末端内に引き込むように真空を生じさせるために、前記子宮内で前記同軸構造体を前記第2状態に後退させることと、
前記移動可能構造体が前記第2状態にある状態で、前記同軸構造体の前記末端部を前記頸管口から後退させることと、をさらに含む、請求項16に記載の方法。 - 前記細胞試料採取構造体が、前記移動可能構造体から半径方向に延びる複数のブラシ毛を有するとともに無外傷球状部で終端するブラシを含む、請求項15に記載の方法。
- 前記移動可能構造体がスパイラル状にねじれた可撓性ガイドワイヤを含み、前記方法は、前記細胞試料採取構造体を回転させるように前記ガイドワイヤをひねることをさらに含む、請求項15に記載の方法。
- 共通ユーザインターフェースと、前記共通ユーザインターフェースが任意のそれぞれの時点において単一の同軸構造体のみの前記第1状態と前記第2状態との間の遷移を制御するように保証する機構とを備えた、複数の独立して制御可能な同軸構造体が設けられる、請求項15に記載の方法。
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2017
- 2017-12-11 US US15/838,153 patent/US11364020B2/en active Active
- 2017-12-11 BR BR112019011766-0A patent/BR112019011766A2/pt active IP Right Grant
- 2017-12-11 KR KR1020197019577A patent/KR20190104148A/ko active IP Right Grant
- 2017-12-11 AU AU2017371495A patent/AU2017371495A1/en not_active Abandoned
- 2017-12-11 WO PCT/US2017/065646 patent/WO2018107175A1/en unknown
- 2017-12-11 EP EP17877816.3A patent/EP3551084A4/en not_active Withdrawn
- 2017-12-11 JP JP2019551912A patent/JP7303748B2/ja active Active
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- 2017-12-11 CA CA3046632A patent/CA3046632A1/en active Pending
- 2017-12-11 MX MX2019006793A patent/MX2019006793A/es unknown
- 2017-12-11 CN CN201780085786.3A patent/CN110248609A/zh active Pending
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2019
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2022
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MX2019006793A (es) | 2019-11-18 |
KR20190104148A (ko) | 2019-09-06 |
IL267194A (en) | 2019-08-29 |
IL267194B2 (en) | 2023-08-01 |
WO2018107175A1 (en) | 2018-06-14 |
US20230022536A1 (en) | 2023-01-26 |
US11364020B2 (en) | 2022-06-21 |
JP7303748B2 (ja) | 2023-07-05 |
AU2017371495A1 (en) | 2019-07-25 |
CA3046632A1 (en) | 2018-06-14 |
BR112019011766A2 (pt) | 2019-10-29 |
IL267194B1 (en) | 2023-04-01 |
EP3551084A1 (en) | 2019-10-16 |
US20180161021A1 (en) | 2018-06-14 |
CN110248609A (zh) | 2019-09-17 |
EP3551084A4 (en) | 2020-12-30 |
EA201991362A1 (ru) | 2019-11-29 |
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