JP2021153848A - Treatment device - Google Patents

Abstract

To provide a treatment device capable of delivering oxygen and/or a medicine to a cerebrospinal fluid and a brain tissue in a low invasive manner.SOLUTION: A treatment device 10 includes a long-sized shaft part 20 having a proximal part and a distal part, in which the distal part can be inserted into the nasal cavity 101; and a holding part 40 disposed in the distal part of the shaft part 20, which is formed with a recessed part 41 capable of holding an oxygen supply medium containing oxygen. The shaft part 20 includes at least one lumen that is communicated with the recessed part 41 and can circulate the oxygen supply medium, supplies the oxygen supply medium to the recessed part 41 through the lumen, and can deliver oxygen to a cerebrospinal fluid and a brain tissue 106 from an epithelial tissue 104 of the nasal cavity 101 through a sieve plate 102.SELECTED DRAWING: Figure 5

Description

The present invention relates to therapeutic devices that deliver oxygen and agents to cerebrospinal fluid and brain tissue.

Intravenous t-PA therapy and thrombus recovery therapy have been established as methods for treating cerebral infarction (see, for example, Patent Document 1). Intravenous t-PA therapy is a method in which t-PA (alteplase), which dissolves a thrombus, is intravenously injected to dissolve the thrombus that caused the cerebral infarction and open the obstruction. Thrombus recovery therapy is a method in which a stent-like or spiral device is transvascularly reached to the occlusion, and the device physically removes the thrombus to open the occlusion.

Special Table 2018-534105

Intravenous t-PA therapy increases the risk of bleeding. Also, thrombus recovery therapy cannot be performed if the device is inaccessible to the obstruction. Therefore, the prevalence of intravenous t-PA therapy and thrombus recovery therapy is not as high as about 10% of the total. Therefore, a treatment method and a treatment device for cerebral infarction different from the intravenous t-PA therapy and the thrombus recovery therapy are desired.

Further, in the treatment of cerebral infarction and diseases other than cerebral infarction (for example, Parkinson's disease, Alzheimer's disease, brain tumor, etc.), a therapeutic method capable of delivering a drug into cerebrospinal fluid and brain tissue in a minimally invasive and effective manner is desired.

The present invention has been made to solve the above-mentioned problems, and an object of the present invention is to provide a therapeutic device capable of delivering oxygen and / or a drug to cerebrospinal fluid and brain tissue in a minimally invasive and effective manner. ..

The treatment device according to the present invention that achieves the above object is arranged in a long shaft portion having a proximal portion and a distal portion and capable of inserting the distal portion into the nasal cavity, and a distal portion of the shaft portion. The shaft portion has a holding portion formed with a recess capable of holding a supply medium containing oxygen and / or a drug, and the shaft portion communicates with the recess and at least one capable of flowing the supply medium. Being capable of delivering oxygen and / or drug from the epithelial tissue of the nasal cavity into the cerebrospinal fluid and brain tissue via the lamina cribrosa by supplying the feed medium through the lumen to the recess. It is characterized by.

The therapeutic device configured as described above can deliver oxygen and / or the drug from the epithelial tissue of the nasal cavity into the cerebrospinal fluid and brain tissue via the cribriform plate by the supply medium supplied to the recess.

The supply medium may be an oxygen supply medium containing oxygen. This allows the therapeutic device to deliver oxygen from the epithelial tissue of the nasal cavity into the cerebrospinal fluid and brain tissue via the lamina cribrosa by means of an oxygen supply medium supplied to the recess. Therefore, the therapeutic device can approach from the nasal cavity and treat cerebral infarction with minimal invasiveness.

At least one lumen is provided, and two or more lumens may be provided. This allows the therapeutic device to supply a supply medium with a high concentration of oxygen and / or drug through at least one of the lumens to the recess and expel the supply medium in the recess through at least one of the lumens. Therefore, it is possible to appropriately maintain the concentration of oxygen and / or the drug in the recess and suppress a decrease in the amount of oxygen and / or the drug that can be delivered into the cerebrospinal fluid and the brain tissue. Alternatively, the feed medium can be supplied to the recess via at least one of the lumens and the gaseous oxygen / or drug can be fed to the feed medium in the recess via at least one of the lumens. Therefore, it is possible to appropriately maintain the concentration of oxygen / or drug in the recess and suppress a decrease in the amount of oxygen and / or drug that can be delivered into cerebrospinal fluid and brain tissue.

At least a part of the holding portion may be elastically deformable. As a result, the holding portion can be restored to its original shape by elastic force after being contracted and inserted into the nasal cavity. This allows the operator to insert a retainer large enough to deliver oxygen and / or drug into the cerebrospinal fluid and brain tissue through the lamina cribrosa through the nostrils into the nasal cavity. ..

The holding portion may have a frame body formed in a net shape with a gap and a film covering the gap. As a result, the holding portion can be easily deformed to a small size.

The treatment device may have a long outer sheath that slidably accommodates the shaft portion along the longitudinal direction of the shaft portion. As a result, the outer sheath can be accommodated by slightly deforming the holding portion by moving to the distal side with respect to the shaft portion. Therefore, it is easy to insert the distal portion of the therapeutic device through the nostril into the nasal cavity. Further, the outer sheath can be expanded by releasing the holding portion by moving to the proximal side with respect to the shaft portion. This allows the retainer to expand into the desired size within the nasal cavity to hold the feed medium.

The treatment device may have an oxygen concentration measuring unit. This allows the operator to measure the oxygen concentration in the cerebrospinal fluid and brain tissue to suppress an excessive increase or decrease in the oxygen concentration in the cerebrospinal fluid and brain tissue.

The holding portion is an expandable balloon having a structure capable of supplying the fluid inside and holding the supply medium, and one of the lumens may supply the expanding fluid to the balloon. good. As a result, the operator can expand the holding portion by inserting the holding portion, which is a balloon, into the nasal cavity in a contracted state and supplying a fluid for expansion into the holding portion in the nasal cavity. This allows easy insertion of a retainer large enough to deliver oxygen and / or drug into the cerebrospinal fluid and brain tissue through the lamina cribrosa into the nasal cavity through the nostrils.

It is a figure which shows the treatment device which concerns on 1st Embodiment, (A) is a plan view, (B) is a side view. It is sectional drawing which follows the AA line of FIG. 1A. It is a side view which shows the state which held the holding part of the treatment device which concerns on 1st Embodiment is housed in the outer sheath. It is the schematic which shows the state which inserted the distal part of the treatment device into the nasal cavity. It is the schematic which shows the state which expanded the holding part and brought it into contact with the epithelial tissue of the nasal cavity. It is a figure which shows the state which the holding part of the treatment device which concerns on 2nd Embodiment is contracted, (A) is a plan view, (B) is a cross-sectional view along line BB of (A). It is a figure which shows the state which the holding part of the treatment device which concerns on 2nd Embodiment is expanded, (A) is a plan view, (B) is a cross-sectional view along line CC of (A). It is the schematic which shows the state which expanded the holding part of the therapeutic device which concerns on 2nd Embodiment, and was in contact with the epithelial tissue of a nasal cavity.

Hereinafter, embodiments of the present invention will be described with reference to the drawings. The dimensions of the drawings may be exaggerated and differ from the actual dimensions for convenience of explanation. Further, in the present specification and the drawings, components having substantially the same function are designated by the same reference numerals, so that duplicate description will be omitted. In the present specification, the side of the device to be inserted into the nasal cavity is referred to as the "distal side", and the side of operation is referred to as the "proximal side".

<First Embodiment>
As shown in FIG. 5, the treatment device 10 according to the first embodiment is inserted into the nasal cavity 101 from the external nostril 100 for the treatment of cerebral infarction, and a large number of small holes 103 through which the olfactory nerve passes are formed. A device that delivers oxygen and / or drug into cerebrospinal fluid and brain tissue 106 via a cribriform plate 102. In the present embodiment, the case where oxygen is delivered into the cerebrospinal fluid and the brain tissue 106 by the therapeutic device 10 will be described. The treatment device 10 brings the oxygen supply medium (supply medium) containing a large amount of the substance to be delivered (oxygen in the present embodiment) into contact with the epithelial tissue 104 covering the sieve plate 102 in the nasal cavity 101, thereby causing the epithelial tissue 104 and the sieve. Oxygen is delivered into the cerebrospinal fluid and brain tissue 106 via the plate 102.

As shown in FIGS. 1 and 2, the treatment device 10 includes a long shaft portion 20 having a distal portion and a proximal portion, a hub 30 fixed to the proximal portion of the shaft portion 20, and a shaft portion. It has a holding portion 40 fixed to a distal portion of 20, an oxygen concentration measuring portion 50, and an outer sheath 60.

The shaft portion 20 is an elongated tubular body and has a first lumen 21, a second lumen 22, and a third lumen 23 extending from the proximal portion to the distal portion. The first lumen 21 can circulate an oxygen supply medium for supplying oxygen toward the distal side. The first lumen 21 is opened by a first opening 21A provided at the distal end of the shaft portion 20. The second lumen 22 allows the oxygen supply medium to circulate towards the proximal side. The second lumen 22 is opened by a second opening 22A provided at the distal end of the shaft portion 20. A long oxygen concentration measuring unit 50 penetrates the third lumen 23. The first lumen 23, the second lumen 22, and the third lumen 23 are formed to have substantially the same diameter in FIG. 2, but they do not have to have substantially the same diameter, and are preferably set as appropriate. For example, by setting the cross-sectional area of the second lumen 22 (the cross-sectional area in the cross section orthogonal to the major axis direction X) to be larger than the cross-sectional area of the first lumen 23 and the third lumen 23, the oxygen supply medium It is possible to improve the safety by improving the certainty of the discharge of. Further, by setting the cross-sectional area of the first lumen 23 to be larger than the cross-sectional area of the second lumen 22 and the third lumen 23, the efficiency of oxygen supply can be improved.

The oxygen supply medium is, for example, a liquid such as physiological saline solution, artificial spinal fluid, or water having an increased oxygen concentration, but a high-viscosity gel-like medium containing oxygen, a gas containing oxygen, or oxygen is used more than water. It may be a medium or a solvent in which a large amount of soluble fluorocarbons and peroxide are mixed. When the oxygen supply medium is other than a gas, the oxygen concentration of the oxygen supply medium is, for example, 100 to 200 mmHg, preferably 200 to 500 mmHg, and more preferably 500 to 760 mmHg. When the oxygen supply medium is a gas, the oxygen concentration of the oxygen supply medium is, for example, 20 to 50%, preferably 50 to 70%, and more preferably 70 to 100%.

The hub 30 is fixed to the proximal portion of the shaft portion 20. The hub 30 indicates that the first port 31 communicating with the first lumen 21, the second port 32 communicating with the second lumen 22, and the third port 33 communicating with the third lumen 23. It has a unit 34. A syringe, a pump, or the like is connected to the first port 31, and an oxygen supply medium is supplied from these. A syringe, a pump, or the like is connected to the second port 32, and the oxygen supply medium is discharged from these. The oxygen concentration measuring unit 50 is inserted into the third port 33. The instruction unit 34 is a portion that can be visually or tactilely identified with respect to an adjacent portion. The indicator 34 is formed, for example, in a color different from that of the adjacent portion. The indicator 34 is arranged in the circumferential direction on the side where the recess 41 of the holding portion 40, which will be described later, opens. The indicator 34 is used to grasp the direction Y in which the cup-shaped recess 41 of the holding portion 40 inserted into the nasal cavity 101 opens from outside the body. The indicator 34 may be arranged on the shaft 20 instead of the hub 30.

The holding portion 40 is a cup-shaped portion having the recess 41, and is fixed to the distal portion of the shaft portion 20. The recess 41 has an annular edge 42 formed on the opening side of the recess 41. The outer diameter of the annular edge portion 42 is larger than the outer diameter of the shaft portion 20. The holding portion 40 has a frame body 43 formed in a mesh pattern so as to form a recess 41, and a film 44 covering a gap between the frame bodies 43. Since the frame body 43 has a net shape, it can be deformed while maintaining the shape having the recess 41. It is preferable that the frame body 43 can be restored to its original shape after being deformed. The direction Y in which the recess 41 opens is not particularly limited, but is preferably a direction that intersects the major axis direction X of the shaft portion 20 (a direction that tilts at an angle). In the present embodiment, the direction Y in which the recess 41 opens is a direction substantially orthogonal to the major axis direction X of the shaft portion 20. The first lumen 21, the second lumen 22, and the third lumen 23 of the shaft portion 20 are opened inside the recess 41 (the inner surface of the recess 41).

The constituent material of the frame body 43 is preferably, for example, a shape memory alloy to which a shape memory effect and superelasticity are imparted by heat treatment. As the shape memory alloy, Ni-Ti-based, Cu-Al-Ni-based, Cu-Zn-Al-based, and the like can be preferably used. The constituent material of the frame body 43 is not particularly limited as long as the shape can be elastically restored, and may be, for example, other metals (including alloys) such as stainless steel, resin, or the like. The constituent material of the film 44 is not particularly limited, but a flexible resin material can be preferably used.

The structure and material of the holding portion 40 are not particularly limited as long as they can be deformed, contracted and expanded, and can hold the oxygen supply medium. Further, the frame body 43 may also be composed of a tube-shaped member communicating with the holding portion 40. By doing so, when the holding portion 40 is inflated with air, the frame body 43 can be integrated to develop the same shape.

The oxygen concentration measuring unit 50 is a site for measuring the oxygen concentration in the cerebrospinal fluid and the brain tissue 106. The oxygen concentration measuring unit 50 may be used to measure the oxygen concentration of the oxygen supply medium in the recess 41. The oxygen concentration measuring unit 50 is long and penetrates the third lumen 23, and protrudes from the third opening 23A to substantially the center of the recess 41. At the distal portion of the oxygen concentration measuring unit 50, an oxygen concentration measuring sensor 51 is arranged at the substantially center of the recess 41 in the direction Y in which the recess 41 opens. The oxygen concentration measuring sensor 51 is, for example, a reflection type pulse oximeter, without limitation. Alternatively, it may be an optical fiber type oxygen sensor in which a fluorescent dye that quenches by reacting with oxygen is supported at the tip. The connector 52 located at the base end of the oxygen concentration measuring unit 50 can be connected to the main body (not shown) of the pulse oxyometer. The position where the oxygen concentration measurement sensor 51 is arranged is not limited as long as the oxygen concentration in the cerebrospinal fluid and the brain tissue 106 can be measured. For example, the oxygen concentration measurement sensor 51 may be fixed to the shaft portion 20 or the holding portion 40. Further, the oxygen concentration measurement sensor 51 may be provided with two or more measurement points in a straight line. By doing so, there are variations in the measurement points such as the difference between the tissue and the perfusate liquid and the distribution of the perfusate liquid. In this case, the two sensors do not have to be of the same type. For example, it may be a combination selected from a reflection type pulse oximeter, an electrode type oxygen sensor, a fluorescence type oxygen sensor, and the like. Further, the treatment device 10 does not have to include the oxygen concentration measuring unit 50. In this case, the third lumen 23 may not be provided.

The outer sheath 60 is a tubular body that covers the shaft portion 20, and is movable in the major axis direction X with respect to the shaft portion 20. As shown in FIG. 3, the outer sheath 60 can be accommodated by contracting the holding portion 40 by moving to the distal side with respect to the shaft portion 20.

The constituent materials of the shaft portion 20 and the outer sheath 60 are preferably flexible to some extent, for example, polyethylene, polypropylene, polybutene, ethylene-propylene copolymer, ethylene-vinyl acetate copolymer, ionomer, or these. Polyolefins such as a mixture of two or more kinds, thermoplastic resins such as soft polyvinyl chloride resin, polyamide, polyamide elastomer, polyester, polyester elastomer, polyurethane and fluororesin, silicone rubber, latex rubber and the like. Alternatively, the constituent materials of the shaft portion 20 and the outer sheath 60 may be metal. Desirably, it is preferable to use a material having low oxygen permeability because it perfuse a liquid to which oxygen is added inside. The shaft portion 20 and the outer sheath 60 may be devised by combining two or more materials to prevent the diffusion of oxygen from the perfused liquid. For example, the outside of the silicone rubber may be coated with a metal or another resin.

Next, a method of treating a cerebral infarction using the treatment device 10 according to the first embodiment will be described.

First, as shown in FIG. 3, the operator prepares the treatment device 10 in which the holding portion 40 is housed in the outer sheath 60. Next, as shown in FIG. 4, the operator grasps the proximal portion of the shaft portion 20 or the hub 30, and the treatment device 10 is distant from the external nostril 100 of the patient who has developed a cerebral infarction into the nasal cavity 101. Insert the position. The posture of the patient is not particularly limited, but it is preferable that the top of the head faces upward.

The surgeon then directs the indicator 34 of the hub 30 upwards or in front of the patient. After this, the operator moves the outer sheath 60 to the proximal side. As a result, as shown in FIG. 5, the holding portion 40 is released from the outer sheath 60 and expanded. Therefore, the recess 41 of the holding portion 40 is in a state of facing upward in the nasal cavity 101.

Next, the operator contacts and presses the annular edge 42 of the recess 41 of the holding portion 40 against the epithelial tissue 104 covering the sieve plate 102. At this time, the shaft portion 20 and the outer sheath 60 can be bent, and the edge portion 42 can be pressed against the epithelial tissue 104 by the restoring force of the shaft portion 20 and the outer sheath 60 to be brought into close contact with the epithelial tissue 104. The recess 41 covers at least a part of the olfactory epithelium 105 of the epithelial tissue 104. The annular edge 42 of the recess 41 is deformable and therefore adheres to the epithelial tissue 104. Since the operator can confirm the opening direction Y of the recess 41 by the indicator 34 of the hub 30, the annular edge 42 of the recess 41 can be satisfactorily adhered to the epithelial tissue 104.

Next, the operator connects the syringe or pump that supplies the oxygen supply medium to the first port 31, and connects the syringe or pump that sucks the oxygen supply medium to the second port 32. Since the edge 42 of the recess 41 is in close contact with the epithelial tissue 104, it is possible to prevent the oxygen supply medium from leaking from the recess 41. Further, if the open surface of the recess 41 is substantially horizontal, it is possible to prevent the oxygen supply medium from leaking from the recess 41 due to gravity.

Next, the operator supplies the oxygen supply medium to the recess 41 of the holding portion 40 via the first lumen 21 by a syringe or the like connected to the first port 31. When the recess 41 is filled, the oxygen supply medium is held in the recess 41 and comes into contact with the epithelial tissue 104. As a result, the oxygen contained in the oxygen supply medium reaches the cerebrospinal fluid and the brain tissue 106 through the epithelial tissue 104 including the olfactory epithelium 105 and the numerous small holes 103 of the sieve plate 102. This makes it possible to increase the oxygen concentration in the cerebrospinal fluid and brain tissue 106 that has decreased due to cerebral infarction. If the osmotic pressure of the oxygen supply medium is high, the osmotic pressure can also move the oxygen-containing oxygen supply medium through the epithelial tissue 104 and the lamina cribrosa 102 into the cerebrospinal fluid and brain tissue 106. The operator can measure the oxygen concentration in the cerebrospinal fluid and the brain tissue 106 by the oxygen concentration measuring unit 50. Therefore, the operator can appropriately maintain the oxygen concentration in the cerebrospinal fluid and the brain tissue 106, and suppress an excessive increase or decrease in the oxygen concentration in the cerebrospinal fluid and the brain tissue 106. If the edge 42 of the recess 41 is in close contact with the epithelial tissue 104, it is possible to prevent the oxygen supply medium from leaking from the recess 41. The oxygen supply medium in the recess 41 may leak slightly from the recess 41.

If necessary, the operator supplies oxygen in the recess 41 through the second opening 22A, the second lumen 22, and the second port 32 by a syringe or the like connected to the second port 32. The medium can be ejected. The operator discharges the oxygen supply medium in the recess 41 through the second lumen 22, or after discharging the oxygen supply medium, from the first port 31 through the first lumen 21 and the first opening 21A. A new oxygen supply medium having a high oxygen concentration can be supplied into the recess 41. As a result, the oxygen concentration in the recess 41 can be maintained high.

If the edge 42 of the recess 41 is in close contact with the epithelial tissue 104 and the inside of the recess 41 is sealed, the internal pressure of the recess 41 is increased by supplying the oxygen supply medium from the first lumen 21 to the recess 41. To rise. Therefore, the oxygen supply medium in the recess 41 may be automatically discharged from the second lumen 22 by the internal pressure. In this case, a syringe or the like for suction may not be connected to the second port 32.

After a lapse of a predetermined time, the operator stops the supply of the oxygen supply medium by the first lumen 21 into the recess 41. The time for supplying the oxygen supply medium is not particularly limited, and may be, for example, until the thrombus disappears. Further, the operator discharges the oxygen supply medium in the recess 41 from the second lumen 22. After this, the operator moves the outer sheath 60 to the distal side relative to the shaft portion 20. As a result, the holding portion 40 contracts while being deformed, and is housed in the outer sheath 60 as shown in FIG. After this, the surgeon pulls out the treatment device 10 from the external nostril 100 to complete the procedure.

The treatment method using the treatment device 10 is not limited to the above-mentioned method. For example, the operator brings the annular edge 42 of the recess 41 into close contact with the epithelial tissue 104 and enters the recess 41 via the first lumen 21 and / or the second lumen 22 with saline, artificial cerebrospinal fluid. Alternatively, after supplying an oxygen supply medium that is a liquid such as water, the supply of the oxygen supply medium is stopped. Next, the gas containing oxygen continues to be supplied via the first lumen 21 and / or the second lumen 22. The oxygen-containing gas is released from the first opening 21A and / or the second opening 22A into the oxygen supply medium of the recess 41 and dissolves in the oxygen supply medium. The oxygen-containing gas can be effectively dissolved in the oxygen supply medium by being released into the oxygen supply medium in the form of bubbles, for example. If the gas can escape from the gap between the edge 42 of the recess 41 and the epithelial tissue 104, the oxygen concentration of the oxygen supply medium is appropriate only by supplying the gas containing oxygen to the oxygen supply medium that fills the recess 41. Can be maintained. That is, in order to maintain the oxygen concentration contained in the liquid oxygen supply medium, the oxygen supply medium may be supplied as a gas instead of replacing the oxygen supply medium, which facilitates the operation. After a predetermined time has elapsed, the operator discharges the oxygen supply medium in the recess 41 from the first lumen 21 and / or the second lumen 22. After this, the operator accommodates the holding portion 40 in the outer sheath 60 and pulls out the treatment device 10 from the outer nostril 100 to complete the procedure.

As described above, the treatment device 10 according to the first embodiment has a long shaft portion 20 having a proximal portion and a distal portion and capable of inserting the distal portion into the nasal cavity 101, and a remote portion of the shaft portion 20. It has a holding portion 40, which is arranged at a position and has a recess 41 formed to hold an oxygen supply medium containing oxygen, and the shaft portion 20 communicates with the recess 41 to allow the oxygen supply medium to flow. It has at least one lumen and is capable of supplying an oxygen supply medium through the lumen to the recess 41 to deliver oxygen from the epithelial tissue 104 of the nasal cavity 101 to the cerebrospinal fluid and brain tissue 106 via the sieve plate 102. be.

The treatment device 10 configured as described above can deliver oxygen from the epithelial tissue 104 of the nasal cavity 101 into the cerebrospinal fluid and the brain tissue 106 via the sieve plate 102 by the oxygen supply medium supplied to the recess 41. Therefore, the treatment device 10 can approach from the nasal cavity 101 to treat cerebral infarction with minimal invasiveness. The treatment device 10 enables the treatment of new cerebral infarctions with minimal invasiveness from a non-transvascular approach. Further, since the oxygen supply medium having a high oxygen concentration does not easily leak from the recess 41 and comes into contact with only a predetermined range, the influence on the body due to the high oxygen concentration of the oxygen supply medium can be reduced.

Further, at least two lumens of the shaft portion 20 are provided. As a result, the treatment device 10 supplies the oxygen supply medium having a high oxygen concentration to the recess 41 via the first lumen 21 which is one of the lumens, and the second lumen 22 which is the other one of the lumens. The oxygen supply medium in the recess 41 can be discharged through the recess 41. Therefore, the oxygen concentration in the recess 41 can be appropriately maintained, and the decrease in the amount of oxygen that can be delivered into the cerebrospinal fluid and the brain tissue 106 can be suppressed. Alternatively, the oxygen supply medium is supplied to the recess 41 via at least one of the lumens (first lumen 21 and / or second lumen 22) and at least one of the lumens (first lumen 21 and / or second). Oxygen, which is a gas, may be supplied to the oxygen supply medium in the recess 41 via the lumen 22) of 2. Therefore, the oxygen concentration in the recess 41 can be appropriately maintained, and the decrease in the amount of oxygen that can be delivered into the cerebrospinal fluid and the brain tissue 106 can be suppressed.

Further, at least a part of the holding portion 40 (for example, the frame body 42) is elastically deformable. As a result, the holding portion 40 can be restored to its original shape by elastic force after being contracted and inserted into the nasal cavity 101. Therefore, the operator can insert a holding portion 40 large enough to deliver oxygen into the cerebrospinal fluid and the brain tissue 106 via the cribriform plate 102 from the external nostril 100 into the nasal cavity 101. can.

Further, the holding portion 40 has a frame body 42 formed in a mesh shape with a gap and a film 44 covering the gap. As a result, the holding portion 40 can be easily deformed to a small size.

Further, the treatment device 10 has a long outer sheath 60 that slidably accommodates the shaft portion 20 along the long axis direction X of the shaft portion 20. As a result, the outer sheath 60 can be accommodated by slightly deforming the holding portion 40 by moving to the distal side with respect to the shaft portion 20. Therefore, it is easy to insert the distal portion of the treatment device 10 from the external nostril 100 into the nasal cavity 101. Further, the outer sheath 60 can be expanded by releasing the holding portion 40 by moving to the proximal side with respect to the shaft portion 20. Therefore, the holding portion 40 can be expanded to a size desired for holding the oxygen supply medium in the nasal cavity 101.

Further, the treatment device 10 has an oxygen concentration measuring unit 50. This allows the operator to measure the oxygen concentration in the cerebrospinal fluid and the brain tissue 106 to suppress an excessive increase or decrease in the oxygen concentration in the cerebrospinal fluid and the brain tissue 106.

The present invention also provides a method for treating cerebral infarction. The method for treating cerebral infarction in the present embodiment is a step of inserting a cerebral infarction treatment device 10 having a holding portion 40 formed in a recess 41 capable of holding an oxygen supply medium containing oxygen in the distal portion from the external nasal cavity 100. And the step of bringing the recess 41 into contact with the epithelial tissue 104 of the nasal cavity 101, and supplying an oxygen supply medium to the recess 41 to supply the oxygen contained in the oxygen supply medium from the epithelial tissue 104 through the cerebrospinal fluid and the cerebrospinal fluid 102. It has a step of delivering into the brain tissue 106. The cerebral infarction treatment method configured as described above can treat cerebral infarction with minimal invasiveness by approaching from the nasal cavity 101. Further, since the oxygen supply medium having a high oxygen concentration does not easily leak from the recess 41 and comes into contact with only a predetermined range, the influence on the body due to the high oxygen concentration of the oxygen supply medium can be reduced.

Further, in the step of delivering oxygen from the epithelial tissue 104 to the cerebrospinal fluid and the brain tissue 106 via the cribriform plate 102, the oxygen supply medium is supplied into the recess 41 and the oxygen supply medium is discharged from the recess 41. May be good. Thereby, the oxygen supply medium in the recess 41 can be replaced to appropriately maintain the oxygen concentration of the oxygen supply medium, and the decrease in the amount of oxygen that can be delivered into the cerebrospinal fluid and the brain tissue 106 can be suppressed.

Further, in the step of delivering oxygen from the epithelial tissue 104 to the cerebrospinal fluid and the brain tissue 106 via the sieve plate 102, a gas containing oxygen may be supplied to the oxygen supply medium which is the liquid in the recess 41. As a result, the oxygen concentration of the oxygen supply medium in the recess 41 can be appropriately maintained, and a decrease in the amount of oxygen that can be delivered into the cerebrospinal fluid and the brain tissue 106 can be suppressed.

<Second Embodiment>
The treatment device 70 according to the second embodiment is different from the first embodiment in that the holding portion 90 is a balloon. As shown in FIG. 6, the treatment device 70 has a shaft portion 80, a hub 30 provided at a proximal portion of the shaft portion 80, and a holding portion 90 provided at a distal portion of the shaft portion 80. ..

The shaft portion 80 is an elongated tubular body and has a first lumen 81, a second lumen 82, and a third lumen 83 extending from the proximal portion to the distal portion. The first lumen 81 is opened by a first opening 81A provided on the outer peripheral surface of the distal portion of the shaft portion 80. The second lumen 82 is opened by a second opening 82A provided on the outer peripheral surface of the distal portion of the shaft portion 80. The third lumen 83 is opened by a third opening 83A provided on the outer peripheral surface of the distal portion of the shaft portion 80.

The hub 30 is fixed to the proximal portion of the shaft portion 80. The hub 30 indicates that the first port 31 communicating with the first lumen 81, the second port 32 communicating with the second lumen 82, and the third port 33 communicating with the third lumen 83. It has a unit 34. A syringe, a pump, or the like is connected to the first port 31, and an oxygen supply medium for sharing oxygen is supplied from these. A syringe, a pump, or the like is connected to the second port 32, and the oxygen supply medium is discharged from these. The third port 33 is connected to an indeflator, a syringe, a pump, or the like, and can supply an expansion fluid to the holding portion 90, which is a balloon, via the third lumen 83 and the third opening 83A. , The expansion fluid can be discharged from the holding portion 90. The indicator 34 is arranged on the side where the recess 94 of the holding portion 90 opens. The indicator 34 is used to grasp the direction in which the recess 94 of the holding portion 90 inserted into the nasal cavity 101 opens from outside the body.

As shown in FIG. 7, the holding portion 90 is a balloon that expands when the expanding fluid flows into the inside. The holding portion 90 is substantially tubular and surrounds the distal portion of the shaft portion 80. The holding portion 90 has a first fixing portion 91, a second fixing portion 92, and a third fixing portion 93 that are fixed to the outer peripheral surface of the shaft portion 80. The first fixing portion 91 is located at the distal end of the holding portion 90, surrounds the outer peripheral surface of the shaft portion 80 all around, and is fixed to the shaft portion 80. The second fixing portion 92 is located at the proximal end of the holding portion 90, surrounds the outer peripheral surface of the shaft portion 80 all around, and is fixed to the shaft portion 80. The third fixing portion 93 is located between the first fixing portion 91 and the second fixing portion 92, and is formed in an annular shape on a part of the outer peripheral surface of the shaft portion 80 in the circumferential direction to form the shaft portion 80. It is fixed. The first opening 81A and the second opening 82A of the shaft portion 80 are opened in a range surrounded by the annular third fixing portion 93. That is, the first opening 81A and the second opening 82A are opened in a range not covered by the holding portion 90. The third opening 83A of the shaft portion 80 is opened between the first fixing portion 91 and the second fixing portion 92 and outside the range surrounded by the annular third fixing portion 93. .. That is, the third opening 83A is opened in a range covered by the holding portion 90. The holding portion 90, which is a balloon, can be expanded by the expanding fluid flowing in from the third opening 83A. Since the expanded holding portion 90 is fixed to the shaft portion 80 at the third fixing portion 93, a recess 94 is formed around the third fixing portion 93. The recess 94 is formed by the outer peripheral surface of the shaft portion 80 surrounded by the holding portion 90 and the third fixing portion 93.

Next, a method of treating cerebral infarction using the treatment device 70 according to the second embodiment will be described.

First, as shown in FIG. 6, the operator prepares the treatment device 70 in a state in which the holding portion 90, which is a balloon, is contracted. Next, the operator grasps the proximal portion of the shaft portion 80 or the hub 30, and inserts the distal portion of the treatment device 70 from the external nostril 100 of the patient who has developed a cerebral infarction into the nasal cavity 101.

The surgeon then directs the indicator 34 of the hub 30 upwards or in front of the patient. After that, the operator supplies the fluid for expansion from the third port 33 by an indeflator, a syringe, or the like. As a result, as shown in FIG. 8, an expansion fluid flows into the holding portion 90, which is a balloon, from the third lumen 83 and the third opening 83A, and the holding portion 90 expands. The recess 94 of the holding portion 90 is in a state of facing upward in the nasal cavity 101.

Next, the operator contacts and presses the annular edge 95 (see FIG. 7B) of the recess 94 of the holding portion 90 against the epithelial tissue 104 covering the cribriform plate 102. Since the holding portion 90 is a flexible balloon, the recess 94 is in close contact with the epithelial tissue 104. Since the surgeon can confirm the opening direction of the recess 94 by the indicator 34 of the hub 30, the edge 95 of the recess 94 can be satisfactorily adhered to the epithelial tissue 104.

Next, the operator connects the syringe or pump that supplies the oxygen supply medium to the first port 31, and connects the syringe or pump that sucks the oxygen supply medium to the second port 32. After that, the operator supplies the oxygen supply medium to the recess 94 of the holding portion 90 via the first lumen 81 by a syringe or the like connected to the first port 31. The oxygen supply medium held in the recess 94 comes into contact with the epithelial tissue 104. As a result, the oxygen contained in the oxygen supply medium reaches the cerebrospinal fluid and the brain tissue 106 through the epithelial tissue 104 including the olfactory epithelium 105 and the numerous small holes 103 of the sieve plate 102. This makes it possible to increase the oxygen concentration in the cerebrospinal fluid and brain tissue 106 that has decreased due to cerebral infarction. Further, the operator can discharge the oxygen supply medium in the recess 94 through the second lumen 82 by a syringe or the like connected to the second port 32. As a result, the oxygen concentration in the recess 94 can be maintained high. Since the procedure after this is substantially the same as that of the first embodiment, the description thereof will be omitted.

The holding portion 90 of the treatment device 70 according to the second embodiment is a balloon that can be expanded by supplying a fluid to the inside, and the third lumen 83, which is one of the lumens, expands to the holding portion 90 that is a balloon. Can supply the fluid for. As a result, the operator inserts the holding portion 90, which is a balloon, into the nasal cavity 101 in a contracted state, and expands the holding portion 90 by supplying a fluid for expansion into the holding portion 90 in the nasal cavity 101. Can be made to. Therefore, a holding portion 90 having a size sufficient for delivering oxygen into the cerebrospinal fluid and the brain tissue 106 via the cribriform plate 102 can be easily inserted from the external nostril 100 into the nasal cavity 101.

The present invention is not limited to the above-described embodiment, and various modifications can be made by those skilled in the art within the technical idea of the present invention. For example, in the first embodiment, the number of lumens formed on the shaft portion 10 may be one. Even if there is only one lumen, after supplying a liquid oxygen supply medium from the lumen to the recess 41, the lumen can be used to supply a gas containing oxygen to the oxygen supply medium in the recess 41. can. If the oxygen supply medium itself is a gas containing oxygen (for example, a gas having an oxygen concentration higher than that of the atmosphere), only the oxygen supply medium is supplied from the lumen, and the cerebrospinal fluid and the brain pass through the sieve plate 102. Oxygen can be delivered into tissue 106.

Further, in the holding portions 40 and 90, a flexible sponge-like porous member may be arranged in the recesses 41 and 94 so as to easily hold the oxygen supply medium. Further, the holding portion itself may be a flexible sponge-like porous member. In this case, the fine pores of the porous member correspond to the recesses capable of holding the oxygen supply medium.

Further, the therapeutic device 10 may deliver the drug into the cerebrospinal fluid and the brain tissue 106 instead of oxygen. The drug may be a drug for cerebral infarction or a drug for diseases other than cerebral infarction. The agent can be, for example, a compound, a peptide, an antibody, a protein, a cell. The drug is, for example, a thrombolytic drug, an edaravon that suppresses active oxygen in the brain, an anti-inflammatory drug that suppresses inflammation, an antibody against a causative substance of Parkinson's disease / Alzheimer, an antibacterial drug, an anticancer drug against a brain tumor, and the like. The therapeutic device 10 may deliver at least one selected from the group consisting of oxygen and the agents described above.

10, 70 Treatment device 20, 80 Shaft portion 21, 81 First lumen 22, 82 Second lumen 23, 83 Third lumen 21A, 81A First opening 22A, 82A Second opening 23A, 83A Third opening 40, 90 Reservoir 41, 94 Recess 42 Edge 43 Frame 44 Film 50 Oxygen concentration measuring part 60 Outer sheath 100 Outer nostril 101 Nasal cavity 102 Sibling plate 103 Small hole 104 Epithelial tissue 105 Olfactory epithelium 106 Cerebral spinal cord Fluid and brain tissue X Long axis direction Y Direction of opening of the recess

Claims (8)

A long shaft portion having a proximal portion and a distal portion and capable of inserting the distal portion into the nasal cavity,
It has a holding portion, which is arranged at the distal portion of the shaft portion and has a recess formed in which a supply medium containing oxygen and / or a drug can be held.
The shaft portion has at least one lumen in which the supply medium can flow through the recess so as to communicate with the recess.
A treatment characterized in that oxygen and / or a drug can be delivered from the epithelial tissue of the nasal cavity into cerebrospinal fluid and brain tissue via a lamina cribrosa by supplying the supply medium to the recess via the lumen. device. The therapeutic device according to claim 1, wherein the supply medium is an oxygen supply medium containing oxygen. The therapeutic device according to claim 1 or 2, wherein at least two lumens are provided. The therapeutic device according to any one of claims 1 to 3, wherein at least a part of the holding portion is elastically deformable. The treatment device according to any one of claims 1 to 4, wherein the holding portion has a frame body formed in a net shape having a gap and a film covering the gap. The treatment device according to claim 5, further comprising a long outer sheath that slidably accommodates the shaft portion along the long axis direction of the shaft portion. The therapeutic device according to any one of claims 1 to 6, further comprising an oxygen concentration measuring unit at a distal portion. The holding portion is an expandable balloon to which a fluid is supplied to the inside.
The therapeutic device according to any one of claims 1 to 7, wherein one of the lumens can supply a fluid for expansion to the balloon.

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