JP4959550B2 - 副鼻腔炎および耳、鼻、および/または、喉の各種疾病を診断および治療する装置、システム、および、その方法 - Google Patents
副鼻腔炎および耳、鼻、および/または、喉の各種疾病を診断および治療する装置、システム、および、その方法 Download PDFInfo
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Description
鼻ポリープは、鼻または副鼻腔の内層から成長する良性腫塊である。鼻ポリープは慢性アレルギー性鼻炎、または、鼻粘膜のアレルギー性鼻炎以外の慢性的炎症が原因で生じることが多い。鼻ポリープはまた、膵嚢胞性線維症に罹患している子供にはよく見られる。鼻ポリープが発達して、副鼻腔からの正常な排液を遮るまでになった場合には、副鼻腔炎を引き起こす恐れがある。
「副鼻腔炎」という語は、一般に、副鼻腔の炎症または感染症を意味する。副鼻腔炎はバクテリア、ウイルス、菌類(カビ)、アレルギー、または、これらの組合せが原因で起こることがある。慢性副鼻腔炎(例えば、3ヶ月程度以上も継続する)の結果として、米国では年間の病医院診療件数が1800万ないし2200万件と推定されている。
・ 頭痛または顔面痛
・ 鼻腔鬱血または後鼻漏
・ 一方または両方の鼻孔の呼吸困難
・ 口臭
・ 上顎の歯痛
鼻洞は、一連の空洞が通路でつながり、最終的には鼻腔へと通じているものから構成されている。前述のとおり、このような通路と空洞は骨でできているが、粘膜で被覆されている。このような通路のうちの1つの粘膜が何らかの理由で炎症を起こすと、通路を通して排液をしている空洞は遮断状態となる。粘液がこのように滞留するのは周期的である場合もあれば(その結果、痛みの症状が発現する)、慢性的である場合もある。慢性的に遮断された通路は感染症の治療対象となる。最終的に、鼻洞の諸症候の持続期間と酷さを物語るのは、骨性通路の広がりと、その上に位置する粘膜の厚みと、その慢性状態である。従って、鼻洞治療の主たる目標は通路であり、主たる達成目標点は排液を再開することである。CTではこのような空間的問題を明らかにすることができないことが多く、とりわけ、患者が目下のところ酷い症候を見せていない場合には、そのことが言える。よって、興味のある刺激に反応して、正常な状態にある鼻洞通路をダイナミックに評価する必要がある。本件で提案されているように、鼻洞疾患およびそのダイナミックな成分を査定することができるのであれば、副鼻腔炎の治療を目標に決めて、より集中的かつ観血を最小限に押さえた様式で患者治療にあたることができるかもしれない。このように通路に注目して、可撓性に富む器具を使用することで、鼻洞介在処置に全く新しい取組みを提案することができるが、すなわち、可撓性に富むカテーテルおよびガイド器具を利用し、それらを、周囲組織に対して最小限の損傷で搬送することのできる通路および空洞の修正装置と併用するという取組みである。
鼻中隔は、鼻の一方側を他方側と分割する軟骨性の解剖学的構造である。通例、この鼻中隔は比較的真っ直ぐである。偏向鼻中隔は、隔壁を形成している軟骨が以上に湾曲または屈曲している状態である。偏向した鼻中隔は鼻をかむと発生することがあり、或いは、場合によっては、鼻に外傷が生じた結果として発生することがある。偏向鼻中隔は適切な呼吸を妨害し、鼻汁の正常な排液の障害となることがあり、特に、アレルギー、鬱血緩和剤の濫用などが原因で鼻介骨が膨張または拡張している患者についてはありがちである。鼻洞の排液がこのように阻害されることで、患者は鼻洞感染症に罹りやすくなる。
内視鏡外科手術を含む多様な外科手術技術を利用して、下位鼻介骨が慢性的に拡張しているせいで正常な呼吸や副鼻腔からの正常な排液が阻害されている患者の下位鼻介骨の削減および/または除去をすることは既に実施されている。通例、下位鼻介骨の慢性的拡張はアレルギーや慢性的炎症の結果である。下位鼻介骨の肥大は、鼻介骨の柔組織を押しやり、または、そこに衝突する偏向鼻中隔を患っている患者にとっては特に問題となる。従って、偏向鼻中隔を真っ直ぐにするための鼻中隔形成術は、しばしば、下位鼻介骨の削減と同時に実施される。
大抵のポリープは良性であるが、転位乳頭腫として周知の鼻ポリープの一形態は悪性腫瘍として発生することがある。鼻の両側に発生するのが通例である大抵の良性ポリープとは異なり、転位乳頭腫は一方側だけに見られるのが普通である。従って、片側のみのポリープが見られるような場合は、生検に付して悪性であるか否かを判定するのが普通である。転位乳頭腫は、悪性になる前に見つかって完全に除去されてしまえば、通例は再発することがない。しかし、これまでのところ利用できた技術を利用した場合、長期に亘る術後追跡調査でポリープの再生が見られない限り、また、ポリープ再生が見つかるまでは、乳頭腫が完全に除去されたか否かを判定することが難しい場合があった。
顔面の骨折の最もありふれた原因は自動車事故であるが、顔面骨折はまた、スポーツ傷害、産業事故、落下、暴行、銃撃による負傷などを原因とすることが多い。顔面骨折の或るものは、鼻腔または副鼻腔の内部から接近できる骨に関与している。注目すべきことに、鼻は顔の中で突出した位置にあるため、顔面構造部の中でも最も負傷しやすい部位である。従って、鼻の骨折は(その結果として偏向鼻中隔を伴う場合も、伴わない場合も)稀有なことではない。眼窩床および/または篩骨洞や前頭洞の骨折などの、上記以外の顔面骨折も鼻または鼻洞の内側から接近できる。よくあるタイプの眼窩床骨折が「破裂」骨折であり、これは通例、目に加えられた鈍い外傷が原因であり、力が下向きに伝達されて、眼窩床を形成している比較的薄い骨が下方向に砕けるというものである。これにより、眼窩周辺組織は上顎洞の中に脱漏し、しばしば、下方向に延びて上顎洞に入り込む、骨の「捕獲穴」を作ってしまうこともある。
<<機能的内視鏡鼻洞外科手術>>
慢性副鼻腔炎のもっともありふれた矯正外科手術は機能的内視鏡鼻腔外科手術(FESS)である。FESSでは、内視鏡が鼻に挿入され、内視鏡を介して視認しながら、医者は罹患組織または罹患骨、または、肥大組織または肥厚骨を除去し、鼻腔の小口を拡大して、鼻腔の正常な排液を回復させる。FESS処置は副鼻腔炎の治療と腫瘍除去、ポリープ除去、および、それ以外の異常増殖の除去に効果を有する。上記以外の内視鏡による鼻腔内処置を採用して、脳下垂体腫瘍を除去し、グレーヴズ病(すなわち、甲状腺亢進症の合併症で、眼球の突出を生じる)の治療、および、鼻に脳脊髄液が漏出する(すなわち、脳脊髄液鼻漏)稀有な症状の外科手術による修復を図っている。
前頭洞の炎症は、同部位の狭い解剖学的形状のせいで、それ以外の副鼻腔各部の炎症を外科手術および/または医学的治療が解消した後ですら、特に持続する恐れがある。前頭洞の炎症が宿存する場合、中隔横断前頭洞切開術として周知の外科手術、または、修正ロスロップ処置がしばしば実施される。この処置では、医者は鼻中隔の一部や洞と洞の間の骨隔壁を除去し、1つの大きな共通排液路を形成することで、前頭洞の排液を鼻に流すよう図る。この複雑な処置は、何か他の、耳、鼻、喉の外科手術処置と同様に、頭蓋を刺し通して脳脊髄液(CSF)を漏出させてしまう危険を担う恐れがある。また、或る鼻腔外科手術は、それ以外の耳、鼻、喉の処置手順と同様に、視神経、眼球、脳に近接して実施されるため、そのような構造体に損傷を生じる恐れがある。そのような厄介な合併症や損傷の潜在的可能性を最小限に抑えるために、画像支援外科手術システムを利用して、複雑な頭部および頚部の処置を実施してきた。画像支援外科手術では、統合的解剖学情報が術前に取得されたCTスキャン画像またはそれ以外の解剖学的マッピングデータにより供給される。術前CTスキャンまたはそれ以外の解剖学的マッピング処置に由来するデータはコンピュータに読み込まれ、ローカライザとして周知の特殊センサーが外科手術器具に装着される。斯様にして、コンピュータを使用し、ローカライザ装備の外科手術器具の各々がどの点にあっても、その厳密な位置を適時に医者は確認することができる。この情報は、標準内視鏡により行われた目視観察記録と連動させられて、医者が外科手術器具を注意深く設置して、CSF漏出を生じるのを防止し、神経またはその他の重要な構造体に損傷を与えるのを回避するのを助ける。
FESSは今も尚、酷い副鼻腔炎の一等級治療であるが、いくつかの欠点がある。患者が処置に付随する術後の痛みや出血を訴えることが多く、多数の外科手術を受けた後でさえ、相当な患者集団が依然として症候が残ったままである。FESSは極めて深刻な事例(CTスキャンで異常が確認されているもの等のような)についてのみの選択肢であると考えられているので、処方された治療薬に我慢ができずに外科手術を志願したいと考えるている患者はかなり大勢存在する。更に、副鼻腔炎を査定する方法論が主として静止測定(CT、MRI)であるため、症候が慢性的ではない患者は、実際に潜伏する瑣末要因が重要な役割を演じる場合には、クスリ治療を提供されるだけである場合が多い。これまで、このような患者に提供される瑣末治療というものは存在せず、薬剤治療を見限っても、それ以外に取るべき道は明確ではない。これにより、救済を必要とするかなりの数の患者がステロイド服用を望まない、または、その服用に懸念を抱いたままであるが、外科手術を施すのに適格といえるほどの重病でもない。
鼻介骨の下に位置する骨を改造する必要が無い場合には、医者は鼻介骨内(または、その上)の凝血異常部を生じさせるように、延いては、鼻介骨の柔組織を収縮させるように設計されたレーザ処置または高周波処置を実施することを選ぶことがある。また、場合によっては、プラズマ発生装置ワンドを利用して、鼻介骨に隣接して高エネルギープラズマを生じさせ、鼻介骨の寸法を削減させることもある。
鼻腔 NC
鼻咽頭 NP
上位鼻介骨 ST
中位鼻介骨 MT
下位鼻介骨 IT
前頭洞 FS
篩骨洞 ES
蝶形骨洞 SS
蝶形骨洞小口 SSO
上顎洞 MS
本発明の処置の大半は、鼻、鼻咽頭、中耳、または、副鼻腔の内部に1本以上の可撓性カテーテルまたはそれ以外の可撓性の細長い作業装置(その具体例は、図5Aから図5Y'''''に例示されており、後段で説明される)を挿入して設置することを要件としている。このようなカテーテルおよび/またはそれ以外の細長い作業装置を容易に挿入できるようにして適切に設置するために、また、血液または堆積物が手術部位から排出されるという望ましくない出来事を防止するために、本発明は、多数の異なる閉塞部材および/または接近ポート装置を含んでいるが、それらの具体例が図2Aから図2Rに例示されており、これらは、鼻および/または口腔を通して挿入されて、a)液体(例えば、ガスまたは液体など)が排出されたり漏出するという望ましくない出来事を防止し、b)ガイドや作業装置の挿入と設置を容易にするが、ガイドおよび作業装置の具体例は図5Aから図5Y'''''と図6Aから図6Eに例示されている。
閉塞接近装置10、12、300、400の上述の具体例は本質的に膨張可能なバルーンである閉塞部材を例示しているが、このような閉塞部材はバルーンに限定されず、また、これ以外の多様な設計や種類であってもよいことが分かる。更に、接近吸引管、接近吸引ポートの多様な構成を利用して、血液、それ以外の流体、または、堆積物を閉塞部材(単数または複数)に隣接している領域から、かつ/または、術場のどこか他の部位から完全に除去するのを容易にすることができるとともに、術場の内部に作業装置を最適設置するのを容易にすることができるものと理解することができる。事実、或る閉塞部材設計および/または吸引接近管設計や吸引接近ポート設計は、外科手術中に患者の頭部の位置決め処理や、患者が全身麻酔を受けるのか否か、気管内管材が挿入されるのか否かなどを含む多数の要因次第で、或る処置については他の処置よりは望ましいことがある。或る事例では、後閉塞部材が鼻中隔の後ろの後鼻孔、鼻咽頭、または、咽頭の内部に設置されている場合は、後閉塞部材に隣接している領域から外へ血液、それ以外の流体、または、堆積物が吸引される完璧さの度合いは、閉塞部材そのものの形状および/または設計で決まるほかに、血液、流体、または、堆積物が中を通って吸引されることになる吸引管腔(単数または複数)やポート(単数または複数)の形状および位置で決まる。最適化された流体制御のほかにも、後閉塞部材および/または付随する接近管材も装置の不可欠な案内部材として機能し、特殊な構造体に接近するには代替の形状および軌跡が特に有用となることがある。図3Aないし図3Kは、多様な閉塞部材の種類の変形例と、閉塞部材に隣接している領域から、または、術場内のどこか他の部位から血液、流体、または、堆積物が中を通って吸引される吸引管腔(単数または複数)および吸引ポート(単数または複数)の配置の変形例の具体例を例示している。図3Aおよび図3Kに例示されている具体例は、適当ならば、図2Aないし図2Rに例示されている閉塞接近装置に組み込むことができる。
本発明は、鼻腔、副鼻腔、鼻咽頭、または、中耳に挿入されて診断書地または治療処置を施すことができる多様な装置を提供する。このような装置は可撓性カテーテルまたは可撓性の棒状シャフトを通して搬送され、或いは、それらカテーテルやシャフトに組み込むことができる。このような可撓性の構造のおかげで、装置を搬送および設置して所望の診断処置または治療処置を施しながら、同時に、先行技術の方法論によれば剛性の視認用機器および剛性の器具類が原因で生じる恐れのあった他の組織への外傷を最小限に抑えることができる。このような装置が部分的に可撓性に富んでいる、或いは、装置に剛性部分と可撓性部分が設けられて、適切な領域まで制御および案内するのを容易にすることは、この取組みの範囲に入る。更に、処置の或る部分で、所望に応じて、このような装置を他の標準的な剛性装置(例えば、視認用機器など)と関連して、または、結合させて使用してもよい。
図6Aないし図6Eは、本発明の方法で使用することができる多様なガイドカテーテルを例示している。
図7Aから図7Gは、副鼻腔内で診断処置または治療処置を実施する装置および方法の具体例を提示している。先行技術の方法では、剛性または可撓性の視認用機器を使って副鼻腔の小口を視認化することがあるが、通例、現実にはそのような視認用機器を副鼻腔の内部に進入させていた訳ではない。上述のように、本発明は副鼻腔の内側に内視鏡を設置する装置および方法を提供するものではないが、副鼻腔の内側に内視鏡を設置する方法を利用するのに、図7Aないし図7Gに例示されている診断装置または治療装置および診断方法または治療方法のいずれかと関連づけてもよいし、また、そうでなくてもよい。
図8Aないし図8Dは、図2Aおよび図2Bの閉塞接近装置10、12および/または図5Aないし図5Y''''に例示されているもののような多様な作業装置が使用されて鼻、鼻咽頭、または、副鼻腔の内部で診断処置および/または治療処置を実施しているのを例示している。
副鼻腔の1個以上の洞に接近する手段として、興味の対象である洞(単数または複数)にカテーテルを進入させる方法がある。まず、ガイドワイヤを副鼻腔に挿入してから、ガイドワイヤ上を伝ってカテーテルを前進させて、洞に入る。或る事例では、図6Aないし図6Eに例示されている類の洞口ガイドカテーテルは副鼻腔の小口に挿入され、より小型のカテーテルがガイドカテーテルを通しえ前進させられる。1個以上の視認用危機を使って副鼻腔の小口を視認するとともに、ガイドワイヤおよび/またはカテーテルを洞口の中へ誘導することができる。或る事例では、操舵自在なガイドワイヤ、カテーテル、および/または、視認用機器を使って、副鼻腔へ入ることができる。或る事例では、図2Aから図2Rに例示されているもののような閉塞接近装置が挿入され、副鼻腔に接近するために使用されたガイドワイヤ(単数または複数)、カテーテル(単数または複数)、および/または、視認用機器(単数または複数)が閉塞接近装置に設けられた装置挿入ポートを通して挿入される。
任意で、副鼻腔へのカテーテル接近を達成した後で、マイクロビーズまたは流動性造影媒体(例えば、ヨウ素標識造影溶液に濃化剤を添加したり、添加せずに済ましたりして、対粘液の粘度を調節したものなど)のような、粘稠度が粘液のものに類似している、画像化できる造影物質または放射性物質を副鼻腔に注入する。次に、画像化技術または走査技術(例えば、X線、放射線透視法、CTスキャン、超音波、MRI、放射線検出装置、ガンマカメラなど)を使って、副鼻腔を通ってからその外へ出る造影媒体の流れを観察することができる。或る事例では、冠動脈カテーテル挿入処置や血管形成処置で採用されるのとよく似た様式で、C字型アームを備えている放射線透視装置を使い、異なる複数の視点または角度から造影媒体の運動を視認することができる。副鼻腔から造影媒体が容易に流出することができるようにするために、先に挿入されたカテーテル(単数または複数)および/またはガイドワイヤ(単数または複数)および/または視認用機器(単数または複数)を副鼻腔とその洞口から外へ逆戻りさせ、或いは、完全に取り出して、正常な流れが生じるようにしてもよい。患者の頭部および/またはそれ以外の肉体部分の位置を整えて、異なる姿勢の排出効果を観察するようにしてもよい。この態様で臨床医は、解剖学的構造が副鼻腔から流出する正常な粘液の流れを閉塞している、または、妨害している位置を探して特定し、識別することができる。
任意で、上述の項目1に記載されているように副鼻腔への接近を果たした後、例えば、放射性標識ガス、放射線不透過性ガス、または、画像化マイクロビーズまたは放射性マイクロビーズを含有する気体などのような画像化ガスすなわち追跡標識ガスをカテーテルを通して注入し、副鼻腔の中に入れる。次に、画像化装置または追跡装置(後江波、放射線検出装置、ガンマカメラ、X線、放射線透視装置、CTスキャン、超音波、MRIなど)を使って、その後、気体が副鼻腔から外に出て、かつ/または、副鼻腔の他の洞との平衡を保つようになった時の気体の運動または散逸を観察する。この態様で、副鼻腔の洞で正常な気体交換が行われているか否かを臨床医は判断できるうえに、正常な気体流および/または正常な気体交換を遮断している、または、妨害している解剖学的構造または不整の部位を探して同定することができる。
副鼻腔、それ以外の解剖学的通路、または、解剖学的構造の全体を画像化物質で充満させ、或いは、それ以外の方法で測定することにより、実際の寸法および/または形状を判定する。そのような調査の或る事例では、上の項目1に記載されているように副鼻腔への接近を果たして、副鼻腔の洞を画像化物質(例えば、造影媒体など)で充満させることができる。次に、好適な画像化技術(例えば、X線、放射線透視装置、CTスキャン、超音波、MRI、放射線検出装置、ガンマカメラなど)を利用して、洞の寸法と形状を判定する。ここでもまた、そのような処置では、C字型アームを使って、それぞれ異なる複数の視点または角度から、造影剤を充満させた副鼻腔の洞を視認して測定することができる。そのような処置の一例は図7Bに例示されているとともに、前段で説明されている。
上述のように、可撓性の内視鏡および/または操舵自在な内視鏡を鼻、副鼻腔、鼻腔、鼻咽頭、エウスタキオ管、内耳または中耳などに挿入し、そのような内視鏡を使って、解剖学的構造を目で精査し、かつ/または、治療を観察し、かつ/または、先に施した治療の効能または完全さを査定することができる。副鼻腔の内部を視認するのが望ましい事例では、上段の項目1に記載されているように副鼻腔に接近して、直接またはガイドワイヤ上を伝わせて内視鏡を副鼻腔の内部に進入させる。
可撓性の発光器具(例えば、遠位端に強力発光装置を搭載したカテーテルなど)を鼻、副鼻腔、鼻腔、鼻咽頭、エウスタキオ管、内耳または中耳などに進入させ、そのような発光器具を使って解剖学的構造を照射する。体外から、かつ/または、それ以外の、鼻、副鼻腔、鼻腔、鼻咽頭、エウスタキオ管、内耳または中耳、眼窩、頭蓋冠などの内部の位置から直接観察または内視鏡観察を行い、解剖学的構造を観察し、かつ/または、光が入る迷入口または異常漏出口を検出することができる。発光装置および/または視認用機器(例えば、内視鏡)が副鼻腔の洞(単数または複数)の内部に設置される場合は、前段の項目1に記載されているような副鼻腔の洞(単数または複数)へ接近して、発光装置および/または視認用器具を直接またはガイドワイヤ上を伝わせて副鼻腔の洞(単数または複数)の中に進入させることができる。
上記以外の、MRIやCTなどの画像化技術を前段の項目1から項目6に明示されている様相のいずれかと組合わせたものを実施して、そのような技術を修正することで、副鼻腔解剖学またはそれ以外の病理学ごとに調整を行うことができる。
図9Aから図9Cは、本発明による移植蝸牛刺激装置の取付け処置を例示している。この処置では、エウスタキオ管ETに導通する鼻咽喉口の位置を探査し、初期的にガイドワイヤをエウスタキオ管ETに進入させる。ガイドワイヤ上を伝わせてカテーテル900を前進させて、カテーテル900の遠位端が中耳の鼓室TCまたはその付近に達している位置まで進入させる。その後、必要と思われるのであれば、カテーテル900を通して鉗子装置および/またはそれ以外の装置を前進させて、それら装置を使って、図9Aに例示されているように、耳の小型の骨(すなわち、槌骨、砧骨、鐙骨)を取り除く。中耳の骨をこのように任意で除去する処置は、図5Tに例示されているとともに前段に記載されている内視鏡を装備した鉗子装置790のような内視鏡装備装置を使った内視鏡視認下で遂行される。図9Bに例示されているように、J字型の遠位先端部905を設けた蝸牛ガイドカテーテル904をカテーテル900を通して前進させて、蝸牛ガイドカテーテル904の先端部905の蝸牛C内での目標地点、すなわち、蝸牛C内の挿入位置まで進入させる。或る応用例では、蝸牛ガイドカテーテル904は、蝸牛の丸窓の中に丸窓を覆っている二次鼓膜を通して進入することができるような構成になっていてもよい。必要ならば、ニードル、ドリル、または、カッターのような刺し通し装置が蝸牛ガイドカテーテル904の遠位端を通して前進させられ、整列させられ、または、位置決めされてから、刺し通しにより二次鼓膜を貫くことができる。また別な応用例では、蝸牛ガイドカテーテルを蝸牛に隣接させて置くようにしてもよいし、蝸牛瘻造設装置(例えば、ドリル、ニードル、カッターなどの刺し通し装置)が蝸牛ガイドカテーテル904の遠位端を通して前進させられ、整列させられ、または、位置決めされてから、その装置を使うことで、蝸牛Cの内部に進入させるのにガイドカテーテル904の遠位端を通す蝸牛瘻を形成することができる。その後、蝸牛ガイドカテーテル904を通して蝸牛電極配列906を前進させ、図9Bで分かるように、蝸牛に進入させる。購入可能な蝸牛電極配列の一例は、コウクリア・コーポレーション(Cochlear Corporation)が製造しているニュークレウス24カウントゥアー(Nucleus 24 Countour)装置である。
Claims (12)
- 副鼻腔の小口を拡大するためのシステムにおいて、該システムは、
副鼻腔の小口へ鼻腔を通って前進するように形成された少なくとも一つのガイドカテーテル(120、128、136または144)を備えるポート装置であって、この挿入ポートを通して作業装置を挿入することができるポート装置と、
前記の前もって形成されたガイドカテーテルを通して挿入することができ、前記副鼻腔の小口を拡大するために使用し得る少なくとも1個の作業装置(70、82、98、104、160、208、218、224、744、820、840、850、860、870、880、1040、1052)とを備え、
前記作業装置は、可撓性のカテーテル本体部(100、106、162、746、1042、1054)および、前記副鼻腔の小口を拡張させるように前記副鼻腔の小口中で膨張可能であるバルーン(102、104、164、750、1044、1056)を有しているバルーンカテーテル装置(98,104、160、744、1062、1080)を備え、
前記バルーンは、当該バルーンが中で膨張する前記副鼻腔の小口に隣接しまたは前記副鼻腔の小口の周囲にある骨に骨破砕圧を及ぼし、これによって、前記骨を破砕し、前記小口を拡大することのできる強靱なポリマー素材から構成され、
前記の前もって形成された少なくとも一つのガイドカテーテルは、異なる副鼻腔の小口に前進する場合にはその前進を容易にするようにそれぞれが異なる形状をとる複数のガイドカテーテル(120、128、136、144)を有する、
システム。 - 請求項1に記載のシステムにおいて、前記バルーンは、バルーンから溶離して隣接組織に浸透する薬剤または物質で皮膜され、含浸され、または、それ以外の態様で該薬剤または物質を備えている、システム。
- 請求項1または2に記載のシステムにおいて、前記バルーンには穴または開口が設けられており、そこを通して物質が搬送され、時には圧力下で搬送されるようにすることで、バルーンに隣接している組織に物質を浴びせ、または、組織の中に物質を拡散させることができるようにした、システム。
- 請求項1〜3のいずれか1項に記載のシステムにおいて、鼻中隔の後ろの声門より上の位置で後鼻孔、鼻咽頭、または、咽頭を閉塞することで、患者の食道または気管に流体が排出されるのを阻止するような形状に設定されている後閉塞装置(18、304、305、406、446、450、460、471、504、510、546、570、600、610、626、1006、1024)を更に備えている、システム。
- 請求項1〜4のいずれか1項に記載のシステムにおいて、前記システムは、鼻および/または副鼻腔の内部の構造を視認するために使用される視認用機器(246、740、804、826)を更に備えている、システム。
- 請求項5に記載のシステムにおいて、前記視認用機器は前記ガイドカテーテルの設置を支援し、容易にし、または、検証するために使用される、システム。
- 請求項1〜6のいずれか1項に記載のシステムにおいて、前記少なくとも1個の作業装置は、前記副鼻腔の小口にステント(748、754、768、1046、1058)を移植するために使うことができる装置を備えている、システム。
- 請求項7に記載のシステムにおいて、前記ステントは少なくとも一部を前記副鼻腔の小口内に移植することができる、システム。
- 請求項7または8に記載のシステムにおいて、前記ステントは物質溶離ステントを備えている、システム。
- 請求項9に記載のシステムにおいて、前記物質溶離ステントは治療有効量の少なくとも1種類の、次のグループから選択された物質を溶離し、該グループは、
抗生物質、
抗菌剤、
アンチパラサイト剤、
抗真菌剤、
ステロイド、
血管収縮神経剤、
ロイコトリエン阻害剤、
免疫グロブリンE(IgE)阻害剤、
抗炎症剤、
肥満細胞安定化薬、
抗ヒスタミン薬、
免疫変調剤、
化学治療薬、
抗腫瘍薬、
ムコ多糖類加水分解薬、
粘液の粘性を薄めまたは別様に変化させる薬剤、
柔組織および/または硬骨および/または軟骨の改造を促進する物質
から構成されている、システム。 - 請求項1〜10のいずれか1項に記載のシステムにおいて、前記少なくとも1個の作業装置は、柔組織、硬骨、または軟骨の、寸法、形状、輪郭または位置を変化させる移植可能な装置(166、224)を備えている、システム。
- 請求項11に記載のシステムにおいて、前記移植可能な装置は、移植後に1回以上、調節することができる、システム。
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US10/829,917 | 2004-04-21 | ||
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