KR20000010815A - 목젖, 편도선, 선양 및 부비동 조직 치료 장치 및 방법 - Google Patents

목젖, 편도선, 선양 및 부비동 조직 치료 장치 및 방법 Download PDF

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Publication number
KR20000010815A
KR20000010815A KR1019980708951A KR19980708951A KR20000010815A KR 20000010815 A KR20000010815 A KR 20000010815A KR 1019980708951 A KR1019980708951 A KR 1019980708951A KR 19980708951 A KR19980708951 A KR 19980708951A KR 20000010815 A KR20000010815 A KR 20000010815A
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South Korea
Prior art keywords
electrode
coupled
throat
electrode means
milk
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KR1019980708951A
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English (en)
Inventor
스튜어트 디. 에드워드
Original Assignee
스튜어트 디. 에드워즈
솜너스 메디칼 테크놀로지스 인코포레이티드
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Application filed by 스튜어트 디. 에드워즈, 솜너스 메디칼 테크놀로지스 인코포레이티드 filed Critical 스튜어트 디. 에드워즈
Publication of KR20000010815A publication Critical patent/KR20000010815A/ko

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Abstract

목젖의 적어도 일부를 절제하기 위한 장치는, 인접 단부를 구비하고 있는 전극 수단 및 목젖을 지지하는 유지 장치 없이 목젖의 외부를 찌르기 위하여 충분히 날카로운 전극 수단 말단 단부를 포함하고 있다. 상기 전극 수단에 결합되어 있는 진행 및 수축 수단은, 목젖의 외부 표면을 통해서 목젖의 내부 부위 내로 진행할 수 있도록 형성되어 있다. 상기 진행 및 수축 수단은 목젖의 내부로부터 상기 전극 수단 말단 단부를 수축시키기 위하여 형성되어 있다. 손잡이 수단은 전극 수단 인접 단부에 결합되어 있다. 케이블링 수단은 전극 수단에 결합되어 있다. 상기 치료는 RF에너지의 사용에 의해서 이루어진다. 흡출 및 주입 수단은 제공되어 있다.

Description

목젖, 편도선, 선양 및 부비동 조직 치료 장치 및 방법
[동시 계속 출원과의 관계]
본 출원은, 동시 계속 출원된 1992년 8월 12일 출원된 출원 번호 07/929,638, 1993년 2월 2일 출원된 출원 번호 08/012,370(특허 번호 5,370,675), 1993년 5월 13일 출원된 출원 번호 08/062,364, 1993년 5월 13일 출원된 출원 번호 08/061,647, 1993년 5월 14일 출원된 출원 번호 08/061, 072(특허 번호 5,385,544) 및 1994년 5월 9일 출원된 출원 번호 08/239,658의 일부 계속 출원인, 1995년 9월 23일 출원된 출원 번호 08/311,097인, 종래 출원의 계속 출원이다. 상기 각각의 출원의 전체 내용들은 여기에서 참고로 한다.
세포 조직의 치료는, 일반적으로 타깃(Target)을 노출시켜서 실질적인 외상에 조직을 끼우는 수술 절차에 의한, 의료 기구와 타깃 조직과의 직접 접촉을 필요로 한다. 종종, 치료 탐침의 정확한 배치는, 몸체내의 타깃 조직의 위치 또는 쉽게 병변을 입는 타깃 조직의 근접, 위험한 몸체 기관(器官), 신경들 또는 다른 성분들 때문에 어렵다.
원래 위치에서의 세포 조직들의 파괴는, 많은 질병들 및 의료적 신체 이상들의 치료 또는 절제 수술 절차들의 보조로서 사용되어왔다. 그것은 종종 수술 절차들보다는 외상이 적고, 다른 절차들이 안전하지 않은 곳에서의 대안으로만 사용될 수 있다. 절제 치료 장치들은, 빠르게 방산 되어서 순환 유체들의 전도 및 대류력들 및 다른 선천적인 몸체 과정에 의해서 비 파괴 수준까지 줄어드는 파괴 에너지를 사용하는 이점을 가지고 있다.
극초단파, 무선 주파수, 음향(초음파) 및 빛 에너지(레이저) 장치들 및 조직 파괴 물질들은, 넓고 다양한 해부 위치 및 기관들로부터 악성, 양성 및 다양한 타입의 세포들 및 조직들을 파괴하기 위하여 사용되어 왔다. 치료되는 조직들은, 분리된 암종 덩어리들 및 특히, 전립선, 선(腺) 및 양성 전립선 생장의 기질 소결절 특질과 같은 기관들을 포함하고 있다. 상기 장치들은 전형적으로, 관을 통해서 치료 부위로 무선 주파수 전극 또는 고주파 안테나를 이동시켜서 관벽을 통해서 에너지를 주위 조직내의 모든 방향으로 방사 적으로 인가하기 위해서 사용되는 도뇨관 또는 캐뉼러를 포함하고 있다.
상기 동시 계속 출원들은, 의료 목적들 및 광학적 바라봄 특성들을 가지고 있는 무선 주파수 의료 치료를 위해서 몸체 조직들을 관통하기 위한 일반적인 절제 의료 탐침을 개시하고 있다.
상기 RF 절제 기술은, 목젖, 편도선, 선양(腺樣) 및 부비동(副鼻洞)들의 치료로 확장될 수 있다. 많은 사람들은 감염된 편도선 및 선양들로 고통을 겪고 있다. 또한, 많은 사람들은 부비동 문제로 고통을 겪고 있다. 여태까지, 상기 모든 신체 이상들은 외과적 수술로 치료될 수 있었다. 그러나, 그러한 외과적 수술은, 환자를 불편하게 하고 출혈을 야기시켰다. 더욱, 외과적 수술은 꽤 비싼 병원에서 수일 동안의 입원을 필요로 한다.
본 발명은 일반적으로 목젖, 편도선, 선양(腺樣) 및 부비동(副鼻洞) 조직의 치료 장치 및 방법에 관한 것이다. 특히, 본 발명은 목젖, 편도선, 선양(腺樣) 및 부비동(副鼻洞) 조직을 치료하기 위한 RF 절제 장치 및 방법에 관한 것이다.
도 1은 목젖, 편도선, 선양(腺樣) 및 부비동(副鼻洞) 조직들의 위치를 나타내고 있는 사람 두부를 도시한 두개골도(頭蓋骨圖).
도 2는 목젖 및 편도선의 방향을 나타내고 있는 구강을 도시한 정면도.
도 3은 본 발명의 탐침 절제 장치를 도시한 평면도.
도 4는 도 3에 도시된 탐침 절제 장치의 손잡이 상부 판을 도시한 상부도.
도 5는 도 3의 A-A선을 따라서 취한 도 3에 도시된 탐침 절제 장치 손잡이의 수동 제어 부분을 도시한 부분 횡단면도.
도 6은 탐침이 팁내로 들어가 있는 상태에 있는, 도 3에 도시된 것과 같은 탐침 절제 장치의 팁을 도시한 부분 횡단면도.
도 7은 전극 및 슬리브가 팁으로부터 내밀어진 상태에 있는, 도 3에 도시된 탐침 절제 장치의 팁을 도시한 부분 횡단면도.
도 8은 목젖이 본 발명의 절제 방법에 의해서 줄어든 환자의 구강을 도시한 정면도.
도 9는 목젖, 편도선, 선양(腺樣) 및 부비동(副鼻洞) 조직들을 치료하기 위한 본 발명에 의한 장치를 도시한 등각도.
도 10은 들어가 있는 광섬유, 들어가 있는 전극 및 조종 메커니즘을 구비하고 있는 도 9에 도시된 장치의 탐침 단부를 도시한 확대 부분 절개 측면도.
도 11은 내밀어진 광섬유, 내밀어진 전극 및 조종 메커니즘을 구비하고 있는 도 9에 도시된 장치의 탐침 단부를 도시한 확대 부분 절개 측면도.
도 12는 양극 전극 및 광섬유를 구비하고 있는 도 9에 도시된 장치의 탐침 단부를 도시한 확대 부분 절개 측면도.
도 13은 중공 전극 및 상기 전극 내에 수용되어 있는 광섬유를 구비하고 있는 도 9에 도시된 장치의 탐침 단부를 도시한 확대 부분 절개 측면도.
도 14는 본 발명에서 사용되는 단극 전극의 일 실시 예를 도시한 확대 부분 측면도.
도 15는 단극 전극의 또 다른 실시 예를 도시한 확대 부분 측면도.
도 16은 단극 전극의 또 다른 실시 예를 도시한 확대 부분 측면도.
도 17은 A-A선을 따라 취한 도 9에 도시된 장치를 도시한 부분 확대 횡단면도.
도 18은 편도선을 치료하기 위하여 사용되는 단극 핀처 전극을 구비하고 있는 본 발명에 의한 장치를 도시한 사람 두부의 두개골도.
도 19는 하나의 단극 전극으로 한 쌍의 편도선을 치료하기 위하여 사용되는 본 발명의 장치를 나타내고 있는 구강의 정면도.
도 20은 확대된 선양을 치료하기 위하여 사용되는 본 발명의 장치를 나타내고 있는 사람의 두부를 도시한 두개골도.
도 21은 후방 부비동 조직을 치료하기 위하여 사용되는 본 발명의 장치를 나타내고 있는 사람의 두부를 도시한 두개골도.
도 22는 전두골 부비동 조직을 치료하기 위하여 사용되는 본 발명의 장치를 나타내고 있는 사람의 두부를 도시한 두개골도.
도 23은 목젖을 치료하기 위하여 사용되는 본 발명의 장치를 나타내고 있는 사람의 두부를 도시한 두 개골도.
따라서, 본 발명의 목적은 출혈 및 주변 조직으로의 외상을 최소화하는 목젖, 편도선, 선양(腺樣) 및 부비동(副鼻洞) 조직 치료 방법을 제공하는 것이다.
본 발명의 또 다른 목적은 처분성 전극을 가지고 있는 목젖, 편도선, 선양(腺樣) 및 부비동(副鼻洞) 조직 치료용 장치를 제공하는 것이다.
본 발명의 또 다른 목적은, 의료 치료 장치가, 조직들을 치료하기 위하여 코 통로를 통해서 방향이 정해지는 목젖, 편도선, 선양(腺樣) 및 부비동(副鼻洞) 조직 치료 방법을 제공하는 것이다.
본 발명의 상기 및 다른 목적들은, 다음과 같은, a) 몸체 개구부를 통해서, 그 상단에서 축 방향으로 이동할 수 있고 그와 함께 휠 수 있는 절연 슬리브내에서 둘러싸여있는 전극을 구비하고 있는, 탐침을 삽입하여서 조직에 매우 근접하게 탐침을 이동시키는 단계;
b) 상기 탐침의 밖으로 상기 슬리브 및 상기 전극을 연장하여서 상기 조직을 관통하는 단계;
c) 절제를 위한 소정의 전극 부위를 노출시키기 위하여 전극의 말단으로부터 상기 슬리브를 수축시키는 단계; 및
d) 상기 조직의 절제에 영향을 미치는 노출된 전극 부위를 에워싸고 있는 조직에 RF 에너지를 인가하는 단계들을 가지고 있는, 상기 조직의 크기 및 덩어리를 줄이기 위한 조직의 의료적 절제 방법에 의해서 제공되어 있다. 조직 치료 장치 또한 개시되어 있다.
본 발명의 장치 및 방법을 이해하기 위하여, 사람 두부의 해골을 간단히 보는 것이 필요하다. 도 1은 사람 두부(1)의 두개골 도를 도시하고 있다. 코(3)는 외과 의사가 코 통로(13)에 접근할 수 있는 것으로 도시되어 있다. 구강(口腔)(2) 또한 도시되어 있다. 구강(2)을 통해서, 입천장(4)은 위치되어 있다. 상기 입천장(4)의 단부에는, 목젖(6)이 위치되어 있다. 상기 목젖(6)은 구강(2) 또는 코(3)를 통해서 접근될 수 있다. 혀(10)뒤의 구강(2)내에 놓여있는 것은 편도선(8)이다. 단 하나의 편도선이 본 도면에 도시되어 있다. 코 통로(13)들은 전두골 부비동(15) 및 설상골 부비동(17)에 각각 이르는 개구부(16,18)들을 구비하고 있다. 더욱, 선양 조직은 상기 코 통로들을 통해서 접근될 수 있다.
많은 문제점들 및 질병들은 상기 구강 및 코내에서 발생될 수 있다. 예를 들면, 편도선염(즉, 감염된 편도선)으로 알려진 가벼운 병(CONDITION)은 발생될 수 있다. 더욱, 부비강염(즉, 감염된 부비강 조직) 또한 발생될 수 있다. 더욱, 사람들은 감염된 선양을 발병시킨다. 사람들은 감염되거나 코골기를 방지하기 위하여 줄어들 필요가 있는 목젖을 가질 수 있다.
여태까지, 수술 절차들은 모든 상기 문제점들을 다루기 위해서 사용될 수 있었다. 그러나, 수술은 많은 위험부담을 갖고 있고 출혈을 야기한다. 본 발명의 장치 및 방법들은 상기 건강 문제들을 치유할 수 있고, 회복 시간 및 출혈을 줄일 수 있다.
본 발명의 제 1 실시 예는 코골기를 방지하는 목젖 조직을 줄이기 위해서 사용되었다.
도 2는 환자의 구강을 도시한 정면도이다. 구강(2)의 후방에 있는 입천장으로부터 하향으로 매달려있는 조직의 원뿔 형상의 부분은 목젖(6)으로 불린다. 더욱, 참고로, 혓바닥(10) 및 한 쌍의 편도선(8)은 목젖(6)과 관련하여 도시되어 있다.
어떤 환자들은 취침시 반듯이 누워서 어떤 때에는 구강을 통해서 숨쉬어야 할 것이다. 구강을 통한 공기의 폐로의 운동은, 때때로 매우 커질 수 있는 거칠고 신경질적인 소리를 목젖(6)이 진동시켜 발생시킬 수 있도록 한다. 이 같은 소리는 종종 코골기로 불린다. 취침하는 환자는 심지어 다른 사람이 알려주기 전까지 코골기를 인식하지 못한다. 어떤 환자들에게 있어서, 목젖(6)은 목구멍을 넘어서 하향으로 매달릴 수 있도록 충분히 커서, 폐로의 공기의 흐름을 실제로 차단한다. 이때 환자는 공기를 필요로 하여 놀라서 일어나 뒹군다. 따라서, 코골기 및 그러한 문제점들은 환자에게 불편하고 또한 환자의 침대 파트너를 불안하게 한다.
환자를 깨우기 위해서 또는 적어도 코고는 사람을 뒹굴게 하기 위하여 사용되는 물리적 외부 장치들과는 별개로, 실행될 수 있는 수술 절차들이 있다. 목젖 절제술 또는 부분적 목젖 절제술은 환자의 목젖의 전부 또는 일부를 제거하기 위하여 실행될 수 있다. 그러나, 환자에게 적합하고 유익하더라도, 어떤 수술은 그 본래의 위험성을 가지고 있다. 또한, 회복 시간은, 수술 동안에 실행되어야만 하는 출혈 및 봉합 때문에 길다. 더욱, 상당한 고통 및 불편이 환자에 가해진다. 이 같은 전통적인 목젖 절제술은 목젖 조직의 일부 또는 전부를 없애기 위해서 사용되는 정상적인 외과용 메스 절제 또는 강한 레이저 빛의 사용에 의해서 실행될 수 있다.
환자의 통증, 불편함 및 회복 시간을 줄이기 위하여, 무선 주파수(RF) 또는 극초단파 절제 기술들은 사용될 수 있다. RF 절제 기술에 있어서, 목젖 조직 내에 놓여있는 전극으로부터의 RF 신호는 조직을 가열한다. 상기 세포들은, 상기 세포들은 그것들이 터져서 죽는 포인트(POINT)까지 가열된다. 사실, RF 절제 기술은 몸체에 의해서 흡수되는 목젖내의 작은 병변을 야기한다. 따라서, 외부 출혈은 없고, 봉합은 필요 없다. 또한, 목젖 크기는 감소된다.
본 발명에서 사용되는 의료 절제 방법은, 코골기를 줄이기 위하여 목젖내의 원하지 않는 조직 덩어리를 제거하거나 줄이는 국부적인 치료 절제보다 상당히 우위에 있다.
절제를 이용하여 코골기를 줄이는 상기 방법을 완전히 이해하기 위하여, 동시 계속 출원들 내에 개시된 것과 같은, 절제 장치에 대해서 기술하기로 한다.
절제 장치의 특별한 구조를 도 3 및 도 4를 참조하여 기술하기로 한다. 도 3은 절제 장치의 평면도이다. 상기 장치는 일반적으로 손잡이 부분(20) 및 방출 관 부분(22)을 구비하고 있다. 탐침 슬리브 수동 제어 탭(26) 및 탐침 전극 수동 제어 탭(24)들은 손잡이 상부 판(23)의 슬롯(52,54)들 내의 활주 맞물림을 위해서 장착되어 있다(도 4). 표시 점(28)들은 탐침 각 지시기(30)에 대한 탐침의 방향 상대 각을 나타낸다. 상기 각 지시기(30)는 곡선의 투명 관내의 기포, 저울 추(WEIGHTED) 선회 다이얼 지시기 또는 전자 각 지시기 일 수 있다. 각각의 계기 기준 스트립(36,38)을 가지고 있는 탭 슬라이드(24,26)의 말단 가장자리(32,34)의 위치는 도 5 및 도 6에 도시된 탐침 전극(58) 및 슬리브(62)의 상대 위치들을 보여주고 있다. 상기 탭 슬라이드들 및 기준 계기 작동의 상세한 설명은 다음과 같다.
섬유 광학 연결자(42)에 적합한 연결자들, RF 출력 연결자(44) 및 옴 저항 연결자(46)들은 상기 손잡이 부분(20)의 인접 단부로부터 연장되어 있다. 상기 연결자들은 본 발명의 절제 장치를, 광원, 출력원 및 검전기에 각각 연결한다.
도 4는 도 3에 도시된 절제 장치의 손잡이 상부 판(23)을 도시한 상부도이다. 위에서 언급한 바와 같이, 슬롯(52,54)들은 그 내측에서의 활주 맞물림을 위해서 각각의 탭(24,26)들을 수용한다. 슬롯(50)은 탐침 각 지시기(30)를 수용한다. 상기 기준 슬롯(36,38)들은 또한 도시되어 있다.
수동 탭(24,26)의 구조에 대해서 설명하기로 한다. 도 5는, 선 A-A를 따라 취한 도 3에 도시된 탐침 절제 장치의 손잡이의 수동 제어 부분을 도시한 부분 횡단면 측면도이다.
도 5는 측면도이고, 슬리브 수동 제어 탭(26)이 전극 수동 제어 탭(24) 바로 뒤에 있기 때문에, 전극 수동 제어 탭(24)만이 도시되어 있다. 상기 전극 수동 제어 탭(24)은 전극 연결자(56)에 연결되어 있다. 차례로 상기 전극 연결자(56)는 상기 전극(58)에 연결되어 있다. 비록 도시되어 있지 않지만, 상기 전극(58)은 또한 RF 출력 연결자(44) 및 옴 저항 연결자(46)에 전기적으로 연결되어 있다. 상기 전극(58)은 슬리브(62)내로 활주한다. 상기 슬리브(62)는 차례로 슬리브 수동 제어 탭(26)에 연결되어 있는 슬리브 연결자(60)에 연결되어 있다. 따라서, 상기 전극(58) 및 상기 슬리브(62)는 서로에 대해서 활주한다.
상기 전극(58)은, 니켈-티타늄 합금 또는 담금질된 강(tempered steel)과 같은, 신축성 있는 형상 기억 금속으로 바람직하게 제작될 수 있지만, RF 출력을 전도할 수 있는 물질이면 어느 것이나 가능하다. 상기 슬리브(62)는, 폴리아미드와 같은 높은 적합성 절연 플라스틱 재료로 제조되어 있다. 이하, 상기 탭(24,26)의 작동을 기술하기로 한다.
상기 수동 제어 탭(24,26)의 동시적 전방 또는 후방 운동은 상기 전극(58) 및 슬리브(62)의 동시적 진행 및 수축을 야기한다. 만약 전극 수동 제어 탭(24)이 홀로 움직인다면, 상기 전극(58)은 슬리브(62)내에서 활주하고 슬리브의 내로 수축하거나 밖으로 확장한다. 유사하게, 슬리브 수동 제어 탭(26)만이 이동되면, 상기 슬리브는 상기 전극 너머로 활주한다. 상기 기준 스트립(36,38)은 전극 수동 제어 탭(24) 및 슬리브 수동 제어 탭(26)의 제어된 위치 정함에 적합한 기준 포인트들을 제공하는데, 이는 아래에서 상세하게 설명될 목젖의 제어된 절제에 적합한 전극(58) 및 슬리브(62)의 정확하고 독립적인 위치 정함을 허여한다.
도 6은, 직선 바늘과 함께 접근할 수 있는 위치로의 초기 삽입을 위하여 탑침이 바늘(74)내로 수축되어 있는 상태의 도 3에 도시된 바와 같은 절제 장치의 팁을 횡단면으로 도시하고 있다. 상기 전극 팁(70)은 바늘(74)의 선도 예리한 팁(72)뒤에 위치된다. 상기 절연 슬리브 팁(76)은 전극 팁(70)의 선도 가장자리 뒤에 바로 위치된다.
전극(58)이 중공 관일 때, 치료, 액 투여 동안의 흡출에 적합한 도관 또는 실시 예에 도시된 바와 같이, 광섬유 가닥(78)에 적합한 하우징일 수 있다. 윤이나 있는 광섬유 팁(80)은 삽입 동안에 전극 팁을 둘러싸고 있는 조직의 검사를 용이하게 하는 전극 팁(70)의 뒤에 위치된다.
도 7은, 전극 및 슬리브가 바늘(74)의 밖으로 확장되어 있는 도 6에 도시된 탐침 절제 장치의 팁을 횡단면으로 도시하고 있다. 상기 실시 예는 직선 형상을 가지고 있는 바늘(74)을 도시하고 있다. 상기 바늘(74)은 또한 휘어질 수 있다. 상기 슬리브(62)는 그것이 전극을 덮고 있는 점선 위치(84)내에 처음에는 있다. 절제되는 특별한 장소의 몸체 내로 바늘을 삽입한 후, 상기 슬리브(62)는 원하는 크기의 변병을 형성하기 위하여 필요로 하는 특별한 전극 부위를 노출시키기 위하여 전극(58)의 선택된 부위로부터 수축된다. 상기 슬리브(62)의 수축은 위에서 언급한 바와 같이 슬리브 수동 제어 탭(26)에 의해서 제어된다.
도 8은 RF절제 장치가 본 방법에 의해서 목젖(6)을 치료하기 위해서 사용되는 환자의 구강을 도시한 정면도이다. 환자는 그/그녀의 구강(2)을 개방하고 혓바닥은 고정되어 있다. 손잡이 부분(20)을 구비하고 있는 RF 절제 장치는 상기 바늘(74)이 목젖 근처에 있도록 위치되어 있다. 상기 슬리브(62) 및 전극(58)들은 바늘(74)의 밖으로 그리고 목젖(6)내로 확장된다. 그 다음, 전극(58)은, 절제되는 목젖의 양에 따라서, 소정의 거리로 노출된다. 그 다음, RF 또는 극초단파 에너지는 전극을 통하여 보내지고 목젖(6)내에서 내부 병변을 야기한다. 일단 상기 내부 병변이 몸체에 의해서 흡수되면, 목젖(6)의 크기는 감소하고 또한 코골기 문제점들은 제거된다.
편도선 조직, 선양 조직, 부비동 조직 및 심지어 목젖 조직을 치료하기 위하여 사용될 수 있는 본 발명의 다른 실시 예를 기술하기로 한다. 조직 치료를 위한 장치 및 조직 치료 방법들을 기술하기로 한다.
도 9는 목젖, 편도선, 선양 및 부비동 조직을 치료하기 위한 장치의 또 다른 실시 예의 평면도를 도시하고 있다. 본 실시 예는, 제 1 실시 예과 유사한 많은 부분들을 구비하고 있고, 유사한 부분들은 동일한 번호로 표시되어 있다. 상기 손잡이 부분(90)은 탐침(92)에 연결되어 있는데, 이는 손잡이 단부(94) 및 탐침 단부(96)를 구비하고 있다. 상기 장치는 전극(122) 및 슬리브(124)를 제어하는 동일한 탭(24,26)을 구비하고 있다. 따라서, 상기 탭(24,26)의 작동은 아래에서 기술하지 않기로 한다. 본 실시 예의 하나의 다른 점은, 탭(24,26) 및 다른 제어기 구조들이 힌지(110) 상에 개방되어 있는 표면(109)상에 장착될 수 있도록 전극(122)이 처분할 수 있다는 것이다. 상기 제어기는 도 17을 참조하여 아래에서 기술하기로 한다.
본 실시 예의 상기 장치는 상기 손잡이(90)와 결합되는 임피던스 측정기(112) 및 온도 측정기(114)를 또한 구비하고 있다. 상기 측정기(112,114)들은 피드백 데이터를 공급하기 위하여 RF 출력 공급 리드(44)에 전기적으로 연결되어 있다. 상기 측정기들은 외과 의사가 치료를 정확히 제어할 수 있도록 한다.
상기 손잡이(90)는 RF 출력 원의 에너지 공급(ENERGIZATION)을 제어하는 트리거(106) 및 트리거 가드(108)를 또한 구비하고 있다. 상기 손잡이(90)는 관찰 경(98)이 조절될 수 있도록 힌지(100)에 의해서 손잡이(90)에 연결되어 있는 관찰 경(98)을 또한 구비하고 있다. 상기 관찰 경(98)은 외과 의사가 늘 치료 상태를 바라볼 수 있도록 광섬유(78)에 연결되어 있다. 상기 손잡이(90)는 또한 수평 조종 제어 휠(102) 및 수직 조종 제어 휠(104)을 구비하고 있다. 상기 휠 들의 작동을 이하 도 10을 참조하여 기술하기로 한다.
도 10은 도 9에 도시된 장치의 탐침 단부(96)의 확대 절개 측면도이다. 상기 탐침 단부(96)는 어떤 조직도 뚫지 않고서 상기 부비동 통로를 통과하는 루트를 따를 수 있도록 본 실시 예에서는 날카롭지 않다. 본 실시 예에서, 필요한 어떤 조직의 뚫음은 상기 전극(124)의 날카로운 팁(126)에 의해서 실행된다. 탐침 단부(96)의 내측에는, 날카로운 팁(126)을 구비하고 있는 전극, 상기 전극 둘레의 슬리브(122) 및 광섬유(78)를 구비하고 있는 전극(124)이 있다. 상기 슬리브(122)는 상기 전극과 비교하여 얇고, 상기 전극의 날카로운 팁(126)의 뒤에 위치되어 있다. 따라서, 상기 전극(124) 및 슬리브(122)는 함께 조직을 뚫을 수 있다. 이후, 상기 슬리브(122)는 상기 전극(124)을 노출시키기 위하여 수축될 수 있다. 또한 상기 슬리브(122)는 조직의 관통이전에 수축될 수 있다. 더욱, 상기 슬리브(122)는, 상기 전극(124)의 소정 양이 항상 노출될 수 있도록 전극(124)에 단단하게 고정될 수 있다. 상기 슬리브(122)는 치료 동안의 병변으로부터 건강한 조직을 보호한다. 예를 들면, 상기 슬리브(122)는 부비동 조직의 치료 동안에 코 통로들을 보호할 것이다. 조종 와이어들에 의해서 상기 조종 휠(102,104)에 연결되어 있는 조종 부재들이 있다. 단지 수직 제어 와이어(118,120) 및 수직 조절 부재(116)들이 도시되어 있다. 상기 수평 조종 부재 및 조종 와이어들은 동일한 방식으로 작동한다는 것을 알 수 있다. 상기 수직 조종 부재(116)는 상기 핸들 단부(94) 부근에 부착되어 있다. 상기 탐침 단부(96)를 상향으로 조종하기 위하여, 상기 수직 조종 휠(102)은 회전하고, 상기 상부 조종 와이어(120)는, 상기 탐침 단부(96)를 또한 휘게 하는 신축성 조절 부재(116)를 상향으로 휘게 할 수 있도록 뒤로 당겨진다. 유사하게, 상기 탐침 단부(96)는 하향으로 조절될 수 있다. 상기 탐침 단부(96), 상기 전극(124), 상기 슬리브(122) 및 상기 광섬유(78)들은 휠 수 있도록 어느 정도 신축적인 것을 알아야 한다. 조종 메커니즘의 더욱 상세한 기술 내용은 여기에서 참조하고 있는 미국 특허 출원 호 5,195,968 및 5,254,088에서 발견할 수 있다.
도 11은, 광섬유(78), 슬리브(122) 및 상기 탐침 단부밖으로 연장되어 있는 전극(124)을 구비하고 있는 도 10의 탐침 단부(96)를 도시하고 있다. 도 12는 단 하나의 슬리브(132)내의 양극 전극(128,130), 광섬유(78) 및 조종 메커니즘을 구비하고 있는 본 장치의 또 다른 실시 예를 도시하고 있다. 외부 접지 판을 필요로 하는 단극 전극과는 다르게, 양극 전극들은 제 1 전극(128) 및 제 2 전극(130)들이다. 상기 RF 전류는, 치료되는 조직을 통해서 전압 V1에 있는 제 1 전극(128)으로부터 흘러서, V1보다 낮은 전압 V2에 있는 제 2 전극(130)을 통해서 복귀한다. 단극 전극뿐만 아니라 상기 양극 전극은 본 발명과 함께 동일하게 사용될 수 있다.
도 13은 중공 단극 전극(134)을 구비하고 있는 본 발명의 또 다른 실시 예를 도시하고 있다. 상기 중공 단극 전극(134)은 앞에서와 같은 슬리브(135)내에 수용되어 있다. 그러나, 중공 단극 전극 내에는, 광섬유(78)가 위치되어 있다. 앞에서와 같이, 조종 메커니즘은 상기 탐침 단부(96)내에 위치되어 있다.
도 14, 15 및 16은 단극 전극의 세 개의 다른 실시 예를 도시하고 있다. 도 14는 목젖 또는 편도선 조직을 치료하기 위하여 사용되는 핀처(pincher) 전극(138)이다. 상기 핀처 전극(138)이 상기 슬리브내에 있을 때, 그것은 접어진다. 이후, 상기 슬리브가 수축될 때, 상기 핀처 전극(138)은 도시된 형상을 갖는다. 유사하게 도 15는 핀처 전극(140)의 또 다른 실시 예를 도시하고 있다. 도 16은 단 한번의 치료로 두 개의 편도선을 치료하기 위하여 사용되는 두 개의 지선(branch)들을 구비하고 있는 전극(142)을 도시하고 있다.
도 17은 B-B선을 따라서 취한 도 9 장치의 확대 횡단면도이고, 탭(24,26)들을 구비하고 있는 손잡이의 힌지 표면(109)을 도시하고 있다. 앞에서와 같이, 상기 슬리브 탭(26)은 다른 탭의 바로 뒤에 있기 때문에 단 하나의 전극 탭(24)이 도시되어 있다. 상기 전극 탭(24)은 전극 연결자(150)에 연결되어 있다. 상기 전극 연결자(150)는 처분성(disposable) 전극(124)을 연결자(150)에 전기적으로 연결하는 전기 접촉자(144)를 구비하고 있다. 상기 연결자(150)는 처분성 전극(124)을 RF 연결자(44)(미 도시)에 전기적으로 연결하는 전기 트레이스(144)를 구비하고 있다. 상기 연결자(150)는 또한 상기 처분성 전극(124)을 전극 탭(24)에 기구 적으로 연결한다. 유사하게, 상기 슬리브 탭은 상기 슬리브(122)에 연결하는 슬리브 접촉자(148)에 의해서 슬리브 연결자(152)에 연결되어 있다.
수술시, 외과 의사가 타깃 조직 부근으로 탐침 단부(96)를 안내한 후, 처분성 전극(124) 및 슬리브(122)들은 힌지 표면(109)을 통과하는 장치 내에 놓인다. 일단 전극 및 슬리브가 소정의 위치 내에 있으면, 상기 힌지 표면(109)은 폐쇄되어서 걸린다. 상기 힌지 표면(109)이 폐쇄되어 걸릴 때, 상기 처분성 전극(124) 및 슬리브(122)들은 기구 적으로 그리고 전기적으로 상기 장치에 연결된다. 일단 특별한 전극에 의한 치료가 완료되면, 상기 힌지 표면(109)은 개방되고, 상기 처분성 전극(124) 및 슬리브(122)는 제거된다. 이후, 또 다른 전극은 삽입될 수 있거나 상기 장치는 제거될 수 있다.
편도선 조직, 선양 조직, 설상골 부비동 조직, 전두골 부비동 조직 및 목젖 조직의 치료 방법들은, 도 18 내지 도 23을 참조하여 기술하기로 한다. 도 18은 편도선(8)을 치료하기 위하여 구강(2)을 통해서 삽입된 탐침(92)을 나타내고 있는 두부의 두개골 도이다. 상기 탐침 단부(96)는 외과 의사에 의해서 편도선(8) 부근에 위치되고, 광섬유(78), 전극(124) 및 슬리브(122)들은 탐침 단부(96)의 밖으로 확장된다. 이후, 핀처 전극(138)은 슬리브(122)의 밖으로 연장되어서 편도선(8)을 둘러싼다. 이후, RF 전류는 전극(124)을 통해 흘러서 편도선(8)내의 내부 병변을 야기한다. 만약 충분한 출력이 편도선(8)에 제공된다면, 모든 편도선 조직은 제거될 수 있다. 두 경우에 있어서, 상기 조직의 온도는 조직 세포들의 사멸을 야기하는 충분한 시간을 위해서 47℃ 위로 올려져야 한다. 현저한 출혈은 발생하지 않고 편도선(8)은 치료된다.
유사하게, 도 19에서, 상기 탐침은 구강(2)을 통해서 삽입되고, 지선 전극(142)은 편도선을 동시에 치료하기 위하여 사용된다. 상기 지선 전극(142)은, 상기 전극들이 상기 편도선을 관통하여 편도선 내에서 RF 전류를 발생시킬 수 있도록 날카로운 팁들을 구비하고 있다. 다시 한번, 상기 RF 전류는 상기 편도선 내에 병변을 발생시킨다.
도 20은 선양(14)을 치료하기 위하여 코(3) 및 코 통로(13)를 통하여 삽입된 탐침을 도시하고 있다. 본 치료를 위하여, 상기 광섬유(78)는, 필요하다면, 외과 의사가 조종 휠 들을 사용하여 선양(14) 부근의 위치로 탐침 단부(96)를 안내하는 것을 돕는데 사용된다. 일단 선양(14) 부근에 위치하면, 외과 의사는 선양을 향하여 광섬유(78) 및 슬리브(122)를 밖으로 연장한다. 이후, 전극(124)은, 전극의 날카로운 팁(126)이 원하는 깊이로 선양(14)을 뚫을 때까지 상기 슬리브(122)의 밖으로 연장된다. 그러면, 상기 RF전류는 전극에 의해서 조직에 공급되고 병변은 선양 내에 형성된다. 일단 몸체가 병변을 재 흡수하면, 선양(14)은 움츠러들거나 제거된다.
도 21은 설상골 부비동 조직(17)을 치료하기 위하여 코 및 코 통로(13)를 통해서 삽입되어 있는 탐침을 도시하고 있다. 위에서와 같이, 외과 의사는 탐침 단부(96)의 방향을 조절하고 설상골 부비동(17)의 개구부(18)부근에 탐침 단부를 안내하기 위하여 조종 휠(102,104)을 사용한다. 그러면, 광섬유(78) 및 전극을 구비하고 있는 슬리브(122)들은 개구부(18)를 통해서 설상골 부비동내로 연장된다. 그러면, 전극(124)의 날카로운 팁(126)은 부비동 조직 내로 연장되어서 치료는 완료된다. 유사하게, 도 22는 전두골 부비동(15)을 치료하기 위하여 코(3) 및 코 통로(13)를 통해서 삽입된 장치를 도시하고 있다. 다시 한번, 상기 탐침 단부(96)는, 전두골 부비동(15)의 개구부 부근에 수정되어 위치될 수 있도록 조종 휠(102,104)을 사용하여 조절된다. 위에서와 같이, 광섬유(78) 및 슬리브(122)들은 개구부(16)를 통해서 연장되고, 전극(124)의 날카로운 팁(126)들은 조직 내로 연장되어서 RF출력은 조직을 치료하기 위하여 공급된다.
도 23은 목젖(6)을 치료하기 위하여 구강(2)을 통해서 삽입된 탐침을 도시하고 있다. 상기 탐침 단부(96)는 목젖(6) 부근에 위치되어 있고, 광섬유(78) 및 슬리브(122)들은 밖으로 연장된다. 이후, 전극(124)은 슬리브의 밖으로 연장되고 전극의 날카로운 팁(126)은 목젖을 관통하여 치료는 수행된다.
본 발명은 특별한 바람직한 실시 예들을 참조하여 기술되었지만, 당업자는, 본 발명의 기술적 사상 및 범위를 벗어나지 않는 범위 내에서, 다양한 변형 예가 가능하다는 것과 대응 안들이 그 요소들에 대치될 수 있다는 것을 알 수 있을 것이다. 더욱, 많은 수정안들은 본 발명의 본질적인 가르침을 벗어나지 않고 이루어질 수 있다.
본 발명의 바람직한 실시 예의 상기 기술 사항은 예시 및 기술을 목적으로 제공되었다. 본 발명을 개시된 바로 그 예들에 속속들이 규명해 내거나 한정하고자 하는 것은 아니다. 명백하게 많은 수정안들 및 변형 예들은 당업자에게 명백할 것이다. 본 발명의 범위를 아래의 청구 범위 및 그 대응 안들에 한정하고자 한다.

Claims (16)

  1. 인접 단부, 목젖의 외부를 관통하기 위하여 충분히 날카로운 전극 수단 말단 단부 및 전극 수단 에너지 전달 표면을 포함하고 있는 전극 수단으로서, 상기 전극 수단 에너지 전달 표면은, 목젖의 외부 점막 표면을 보호함과 동시에 목젖의 내부 내에 절제 체적을 형성하기 위하여 목젖의 내부에 위치될 때 충분한 길이를 가지는 전극 수단;
    상기 전극 수단에 결합되어서 상기 목젖의 외부 표면을 통해서 상기 목젖의 내부 내로 상기 전극 수단 말단 단부를 진행시킬 수 있도록 형성되어 있는 진행 및 수축 수단으로서, 상기 진행 및 수축 수단은 상기 목젖의 내부로부터 전극 수단 말단 단부를 수축시키기 위해서 형성되어 있는 진행 및 수축 수단;
    상기 전극 수단 인접 단부와 결합되어 있는 손잡이 수단; 및
    상기 전극 수단에 결합되어 있는 케이블링 수단을 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  2. 제 1 항에 있어서,
    상기 전극 수단에 결합되어서 전극 수단 말단 단부에 주입 매체를 공급하기 위해서 형성되어 있는 주입 매체 수단을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  3. 제 1 항에 있어서,
    전극 수단에 결합되어서 목젖의 적어도 일부분의 시각화를 제공하기 위하여 형성되어 있는 시각화 수단을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  4. 제 1 항에 있어서,
    상기 케이블링 수단에 결합되어 있는 에너지원을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  5. 제 1 항에 있어서,
    상기 전극 수단은 RF 에너지 원 수단에 결합될 수 있도록 형성되어 있는 RF 전극 수단인 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  6. 제 1 항에 있어서,
    상기 전극 수단은 RF 에너지 원 수단에 결합될 수 있도록 형성되어 있는 양극 RF 전극 수단인 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  7. 제 1 항에 있어서,
    상기 전극 수단은 RF 에너지 원 수단에 결합될 수 있도록 형성되어 있는 단극 RF 전극 수단이고, 상기 장치는 접지 패드 전극 수단을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  8. 제 5 항에 있어서,
    상기 RF 전극 수단에 결합되어 목젖으로부터 흡출 매체를 제거하기 위하여 형성되어 있는 흡출 수단을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  9. 제 1 항에 있어서,
    상기 전극 수단에 결합되어 있는 절연 수단을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  10. 제 1 항에 있어서,
    상기 전극 수단에 결합되어 목젖 내로 그리고 밖으로의 전극 수단의 진행 거리 또는 수축 거리를 나타내기 위하여 형성되어 있는 탭 제어 수단을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  11. 인접 단부 및 상기 목젖의 외부를 꿰뚫기 위하여 충분히 날카로운 말단 단부 및 전극 에너지 전달 표면을 포함하고 있는 RF 전극으로서, 상기 전극 에너지 전달 표면은, 목젖의 외부 점막 표면을 보호함과 동시에 목젖의 내부내의 절제 체적을 창출하기 위하여 목젖의 내부 내에 위치되어 있을 때 충분한 길이를 가지는 RF 전극;
    전극에 결합되어 그리고 목젖의 내부 부위 내로 그리고 밖으로 전극 말단 단부를 진행하고 수축하기 위하여 형성되어 있는 진행 및 수축 장치로서, 상기 진행 및 수축 장치는 목젖을 통하여 연장하지 않고 목젖의 내부 내로 전극 말단 단부를 진행시키기 위하여 형성되어 있는 진행 및 수축 장치;
    상기 전극에 결합되어 있는 손잡이; 및
    상기 전극에 결합되어 있는 케이블을 포함하고 있는 것을 목젖의 적어도 일부분을 절제하기 위한 장치.
  12. 제 11 항에 있어서,
    상기 전극에 결합되어서 상기 전극 말단 단부에 주입 매체를 공급하기 위하여 형성되어 있는 주입 매체 원을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  13. 제 11 항에 있어서,
    전극에 결합되어서 적어도 목젖의 일부분을 시각화하기 위하여 형성되어 있는 시각화 장치를 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  14. 제 11 항에 있어서,
    전극에 결합되는 RF에너지원을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  15. 제 11 항에 있어서,
    RF 전극에 결합되어 있는 흡출 원을 더 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
  16. 제 11 항에 있어서,
    상기 손잡이는, 적어도 전극의 외부 부분과 둘러쌈 관계로 위치되어 있는 절연체를 포함하고 있는 것을 특징으로 하는 적어도 목젖 부분을 절제하기 위한 장치.
KR1019980708951A 1996-05-06 1997-03-06 목젖, 편도선, 선양 및 부비동 조직 치료 장치 및 방법 KR20000010815A (ko)

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US08/643,203 US5718702A (en) 1992-08-12 1996-05-06 Uvula, tonsil, adenoid and sinus tissue treatment device and method
US08/643,203 1996-05-06

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KR200482235Y1 (ko) 2015-12-28 2017-01-02 이성완 부비동 확장 치료기

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CA2253705A1 (en) 1997-11-13
CN1217639A (zh) 1999-05-26
AU2070897A (en) 1997-11-26
US5514131A (en) 1996-05-07
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