JPS63294852A - Cholangiocarcinoma treatment apparatus - Google Patents

Abstract

PURPOSE:To bring a cancerous cell to deformation necrosis, by providing a heating part by an electric heater and a thermometric body measuring the temp. of the heating part in the vicinity of the leading end part of a drainage tube in the treatment of cholangiocarcinoma and heating the heating part inserted in a cancerous part to specific temp. CONSTITUTION:After percutaneous bile duct drainage through the liver is performed for about one week to reduce jaundice, a drainage tube 1 is further pushed in toward the duodenum D to be allowed to pierce a cancerous part (k) and the position of a heating part 2 is allowed to coincide with the cancerous part (k). Next, the temp. setting of a temp. control means 4 is performed so as to hold the temp. of the heating part 2 to about 41 deg.C and a heating time is set to about 30min-1hr to perform the hyperthermia of the cancerous part (k). About 41 deg.C being the set temp. of the heating part 2 is the temp. bringing an cancerous cell to deformation necrosis and the temp. bringing a normal tissue cell to deformation necrosis is about 43 deg.C higher by 2 deg.C than said temp. and, therefore, by controlling the heating part 2 so as to enter a range of 41-43 deg.C, only the cancerous cell can be directly and effectively subjected to hyperthermia.

Description

DETAILED DESCRIPTION OF THE INVENTION (Field of Industrial Application) The present invention relates to a cholangiocarcinoma treatment device for directly treating cholangiocarcinoma by applying percutaneous transhepatic biliary drainage.

(Conventional techniques and problems) Due to its anatomical peculiarities and the diagnosis of nu duct cancer, which is extremely difficult given the current medical level, many cases are unresectable. Fortunately, it is possible to remove the cancer surgically. Even in cases where it is thought that it can be completely resected, the 5-year survival rate is around 20-30%, making it a disease with a relatively poor prognosis among gastrointestinal cancers.

Generally, cholangiocarcinoma is accompanied by yellow scars, which increases the risk of surgery (serum total bilirubin, /1.
5"/a+ or less 3.9!, 5-'8 or less 9.2$, 5
．． In Japan, percutaneous transhepatic biliary drainage (Pcrcutaneo) is performed first.
US Lranshepatic biliary d
lrainage, PTBD) was performed to reduce the jutea upwardly, and then radical surgery was performed. However, it takes about a month for the yellow scar to be reduced, and the cancer continues to grow and progress during this time, so there has recently been an opinion in Europe and the United States that it is better to have it removed in one stage rather than reducing the cost. The number is increasing.

In this way, for cholangiocarcinoma, there is a choice between reducing the yellowing and reducing surgical mortality, or daringly performing surgery under MU in order to improve the curability, although the risk of surgery is high. It is considered difficult.

Currently, the treatment methods for unresectable cholangiocarcinoma are:
Treatments with anticancer drugs, immunotherapy, radiotherapy, etc. are all indirect treatments and are not sufficiently effective.

(Means for Solving the Problems) The present invention has been made to solve the above-mentioned problems, and its purpose is to treat bile duct cancer while performing percutaneous transhepatic biliary drainage. The purpose of the present invention is to provide a cholangiocarcinoma treatment device that can directly and locally perform thermal treatment.
In order to achieve this objective, the present invention has a hollow part that has a size and flexibility that can be inserted from outside the body to the inside of the bile duct, and that guides bile accumulated in the bile duct to the outside of the body. A hollow pipe-shaped drainage tube comprising: a heating section using an electric heater as a heat source near the distal end of the drainage tube; and a temperature measuring element for measuring the temperature of the heating section. In addition, on the proximal end side of the drainage tube, the temperature of the heating section 21 is measured based on the temperature detected by the thermometer.
! It is equipped with a temperature control stage as close as possible to the J section, and a communication hole is provided in the side wall of the distal end of the drainage tube, at least on the proximal side of the heating part, for communicating between the inside of the hollow part and the outside. The structure is as follows.

(effect) In the cholangiocarcinoma treatment device of the present invention, as described above.

Near the distal end of the drainage tube, there is a heating section using an electric heater and a temperature sensing element that measures the temperature of the heating section, and a temperature sensing element is installed near the proximal end of the drainage tube. Equipped with a temperature adjustment means capable of adjusting the temperature of the heating section based on the temperature, the heating section inserted through the septum is
By heating after 1"CjWj, cancer cells can be caused to undergo degenerative necrosis, and a heating section is provided in the drainage tube, and at least the heating section is heated at the distal end of the drainage tube. The proximal side wall is equipped with a circulation hole that passes between the inside of the hollow part and the outside, and bile released from the liver is guided from the communication hole of the drainage tube to the duodenum via the hollow part. can.

Therefore, it becomes possible to directly and locally heat treat cholangiocarcinoma while performing percutaneous transhepatic biliary drainage.

(Example) Hereinafter, embodiments of the present invention will be described in detail based on the drawings.

First, the configuration of the embodiment will be explained.

As shown in FIGS. 1 and 2, the cholangiocarcinoma treatment device RA of this embodiment includes a drainage tube 1, a heating section 2,
The main components include a temperature measuring body 3 and a temperature adjusting means 4.

The drainage tube I is generally used when performing percutaneous transhepatic drainage, and has a size (length and diameter) that allows it to be inserted from outside the body to the inside of the bile duct B. ) and flexibility, and is formed in the shape of a hollow pipe with a hollow portion IO for guiding bile accumulated in the bile duct B to the outside of the body.

In this embodiment, a fluororesin having excellent heat resistance, acid resistance, and alkali resistance is used as the material for the drainage tube l, and the outer width is 5 mm and the inner diameter of the hollow part 10 is 2.
The drainage tube 1 is formed into a hollow pipe shape with a length of 5,000 mm, and the distal end portion of the drainage tube 1 is formed into a tapered shape.

Furthermore, at the distal end of the drainage tube 1, a plurality of communication holes 11 are provided in the side walls of both ends of the heating section 2 to communicate between the inside of the hollow section 10 and the outside.

The heating unit 2 is provided near the distal end of the drainage tube l, and is brought into direct contact with the bile duct cancer K from the inner surface of the bile duct B to locally heat the cancer cells and degenerate them. This is a part to cause necrosis, and in this embodiment, an electric heater 20 is used as a heat source.

The electric heater 20 includes a coiled nichrome wire 20a buried inside the wall of the vibrator of the heating section 2.
Both ends of the nichrome wire 20a are connected through conducting wires 21 and 21 buried along the inside of the pipe wall.
It is wired externally from the proximal end of the C drainage tube L.

Incidentally, many types of drainage tubes l having different lengths of the heating section 2 are formed so that the length of the heating section 2 can be arbitrarily selected and used depending on the length of the cholangiocarcinoma. .

The temperature measuring element 3 is a stage for directly detecting the temperature of the heating section 2, and in this embodiment, it is a thermocouple type temperature measuring element 3.
0 is used, and its tip temperature measuring contact 30a or the heating section 2
It is provided in a shape IE buried inside the pipe wall of the heating section 2 so as to be located in the center of the pipe wall.

Both ends of the thermocouple temperature sensing element 30 are wired from the proximal end of the drainage tube l to the outside via conductive wires 31 and 31 buried along the inside of the pipe wall.

The temperature adjusting means 4 is a stage for adjusting the temperature of the heating section 2 based on the temperature detected by the temperature measuring element 3, and in this embodiment, as shown in the block diagram of FIG. ,
A temperature measuring circuit 40 outputs a detected temperature signal based on the input signal a from the temperature measuring element 3, and a temperature display section displays the temperature based on the temperature signal from the temperature circuit 40. 4
1, the temperature/time setting circuit 42 which outputs the temperature set value signal C and the set time value signal d to the i'Ij control circuit, and the temperature set value signal C which becomes the feedback signal. A control circuit 43 outputting a control signal e at
and an output circuit 4 that increases or decreases the output type if of the electric heater 20 for the nichrome wire 20a based on the control signal e.
4, and a maximum current -1 limit circuit 45 for setting the maximum value of the output current f from the output circuit 44 and intentionally cutting off the current exceeding this set value; An alarm value detection circuit 46 that outputs an alarm signal when the temperature rises or exceeds the 1 & semi-value, or when the temperature signal exceeds the set value, and a disconnection state on the output circuit side from the output circuit 44 is detected. a disconnection detection circuit 47 that outputs an alarm signal i;
It is comprised of an alarm display section 48 that issues an audible or light alarm based on the re-alarm signal i, and a power supply circuit 49 that supplies power to each section.

The conducting wires 31 and 31 of the temperature measuring body 30 are connected to the temperature measuring circuit 4.
0 input side, and also the lead of the nichrome wire 20a!
ff121.21 is connected to the output side of the output circuit 44.

Next, the effects of the examples will be explained based on a method for treating cholangiocarcinoma.

In addition, in wS3154 to FIG. 5, L indicates the liver, D indicates the duodenum, G indicates the gallbladder, and 1M indicates the stomach.

(B) Percutaneous transhepatic biliary drainage process (Figures 3 and 41A) ■ For a case of single-duct cancer, first perform percutaneous transhepatic biliary drainage under ultrasound imaging.

This percutaneous transhepatic biliary drainage refers to the bile that is blocked by biliary liver cancer and has stopped flowing in the direction of the 12 fingers + 11D, and the jute produced when the bile flows into the blood on the liver side from the blockage into the bile duct B. This is done for the purpose of alleviating pain by draining it out of the body through an inserted drainage tube.

(0) Hyperthermia treatment process for cholangiocarcinoma (Figure 5) As mentioned above, after performing percutaneous transhepatic biliary drainage for about a week to alleviate jaundice, the drainage tube
is further pushed in the direction of the twelfth finger 118D to penetrate the muscle part k so that the position of the heating part 2 coincides with the muscle part.

In this case, the first part and the lower part of the bile duct B are sufficiently contrasted using an ultrasonic echo direct viewing device or an X-ray direct viewing device, and the length of the muscular portion is measured, and heating is performed according to this length. Part 2
Select and use a drainage tube with a

Next, set the temperature of the temperature 7A node 4 so that the temperature of the heating section 2 is maintained at around 41"C, and set the heating time to about 30 minutes to 1 hour to heat the muscle. Perform heat treatment.

The set temperature of heating section 2, which is around 416C, is the temperature at which cancer cells undergo degenerative necrosis, whereas the temperature at which normal tissue cells undergo degenerative necrosis is around 43°C, which is 2°C higher. Therefore, by utilizing the difference in temperature characteristics between the two and controlling the heating section 2 to within this range of 41"C to 43C, only cancer cells can be directly and effectively killed. It can be treated with heat.

In addition, as in 1 or above, drainage and
The bile duct in the septum becomes obstructed by the heating part 2 of the tube l, but the bile accumulated in the bile duct B in the lehy part (liver side) due to the septum flows through the circulation hole 11 and the hollow part lO. Since it can be guided in the direction of the 12 fingers 111D (and in the direction outside the body) via the tube, cancer treatment and jaundice alleviation can proceed at the same time.

Then, during the reduction period (approximately one month) until physical strength has recovered and resection surgery for bile duct cancer is possible, by performing the above-mentioned heat treatment about twice a week, It becomes possible to reduce the possibility of cancer growth and metastasis, or to reduce the size of most cancer cells by causing them to undergo necrosis, thereby improving the therapeutic effect of resection surgery.

Furthermore, the survival of unresectable cholangiocarcinoma can be extended by causing most of the local cancer cells to undergo necrosis.

As explained above, bile duct cancer treatment device A of this embodiment
By configuring as described above, the following effects can be obtained.

■ A heating section 2 is incorporated into the drainage tube 1, making it possible to treat cholangiocarcinoma while reducing MU.

(Resectable cholangiocarcinoma can be treated using a reduction period of about 1 month, and cancer progression can be prevented during this period.
Furthermore, there is a possibility that it is effective against flexible microscopic cancer cells that inevitably remain after resection.

■ Currently, anticancer drugs, immunotherapy, and radiation therapy are being used for unresectable cholangiocarcinoma, but no direct treatment is available, and this device does not directly target local cancer cells. Since it can be treated, it has an extremely high therapeutic effect.

) It does not compete with current treatments such as surgery, anticancer drugs, immunotherapy drugs, and radiation therapy.
Additive or synergistic treatments can be used.

■ It also has the effect of killing cancer cells floating in bile.

■ Compared to microwaves, it can heat the cancer area evenly.

■ High safety because temperature measurement is performed directly in the heating section 2 inside the drainage tube 1.

(Φ The entire book and device can be made at a relatively low price,
It is extremely inexpensive compared to devices that use microwaves or external warming devices.

Although the embodiments of the present invention have been described above in detail with reference to the drawings, the specific configuration is not limited to these embodiments, and the present invention may be modified without departing from the gist of the present invention. included.

For example, in the embodiment, a coiled nichrome wire is used as the electric heater serving as the heat source of the heating section, but the material, shape, etc. thereof may be arbitrary.

Further, in the embodiment, a thermocouple type temperature measuring element is used as an example, but other known temperature measuring elements may be used.

In addition, in the embodiment, the temperature adjustment means is
It is not limited to the specific means, and whether Pa5 is used based on the temperature display.
It may also be one that performs e.

(Effects of the Invention) As explained above, in the cholangiocarcinoma treatment device of the present invention, there is a heating section using an electric heater near the distal end of the drainage tube, and the temperature of the heating section is measured. In addition, the proximal end of the drainage tube is equipped with a temperature adjustment means that can adjust the temperature of the heating section a1 based on the temperature detected by the temperature sensor. Cancer cells can be caused to undergo degenerative necrosis by heating the inserted heating part to around 41"C. Furthermore, if the heating part is provided in the drainage tube and the drainage tube is At the distal end, at least the side wall on the proximal side of the heating section is equipped with a communication hole that passes between the inside of the hollow part and the outside, so that bile released from the liver can be transferred from the communication hole of the drainage tube to the hollow part. It can be guided to the duodenum side via.

Therefore, it is possible to directly and locally heat treat the bile duct muscle while performing C1 percutaneous percutaneous drainage.

[Brief explanation of the drawing]

FIG. 1 is an explanatory diagram showing a cholangiocarcinoma treatment device δ according to an embodiment of the present invention;
No. 2121ff is block 1 showing details of temperature control means
56, FIG. 3 is an explanatory diagram showing the percutaneous transhepatic biliary drainage process, FIG. 4 is an enlarged view of the same essential part, and FIG. 5 is an explanatory diagram showing the bile duct muscle thermal treatment process. 1: Drainage tube 2: Heating part 3 2 Temperature measuring body 4: Temperature adjustment means 1O: Hollow part 11: Distribution hole 20: Electric heater K: Lip tube cancer B: 1ljj tube

Claims (1)

[Claims] 1) A hollow pipe-shaped drainage tube that is large enough and flexible enough to be inserted between the outside of the body and into the bile duct, and that has a hollow part for guiding bile accumulated in the bile duct to the outside of the body. The drainage tube is provided with a heating part using an electric heater as a heat source near the distal end of the drainage tube, and a temperature measuring element for measuring the temperature of the heating part, and a proximal end of the drainage tube. The drainage tube is equipped with a temperature control means that can adjust the temperature of the heating section based on the temperature detected by the thermometer, and a hollow side wall is provided at least on the proximal side of the heating section at the distal end of the drainage tube. A cholangiocarcinoma treatment device characterized by having a communication hole that communicates between the inside and the outside.