WO2013105528A1 - Body tissue cauterizing system - Google Patents

Body tissue cauterizing system Download PDF

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Publication number
WO2013105528A1
WO2013105528A1 PCT/JP2013/050035 JP2013050035W WO2013105528A1 WO 2013105528 A1 WO2013105528 A1 WO 2013105528A1 JP 2013050035 W JP2013050035 W JP 2013050035W WO 2013105528 A1 WO2013105528 A1 WO 2013105528A1
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WO
WIPO (PCT)
Prior art keywords
body tissue
deformed
end side
ablation system
tissue ablation
Prior art date
Application number
PCT/JP2013/050035
Other languages
French (fr)
Japanese (ja)
Inventor
知紀 八田
狩野 渉
裕一 多田
泰佳 中野
Original Assignee
テルモ株式会社
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Publication of WO2013105528A1 publication Critical patent/WO2013105528A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B18/1492Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32Surgical cutting instruments
    • A61B2017/320004Surgical cutting instruments abrasive
    • A61B2017/320008Scrapers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00541Lung or bronchi
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00595Cauterization
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B2018/1405Electrodes having a specific shape
    • A61B2018/1435Spiral
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14Probes or electrodes therefor
    • A61B2018/1495Electrodes being detachable from a support structure

Definitions

  • the present invention relates to a body tissue ablation system that cauterizes a lesioned part generated in a body tissue.
  • the body tissue when the lesion is spread, the body tissue must be cauterized over a wide area, which increases the treatment time and increases the burden on the patient and the operator.
  • the lung parenchyma since the lung parenchyma is emphysematous and swells, the lesion is spread.
  • the treatment time tends to be long, and the burden on the patient and the practitioner is likely to increase.
  • the high temperature condensable vapor has a high risk of damaging the normal part due to the presence of the secondary airway, etc., so it is necessary to selectively cauterize the target site.
  • the present invention has been made to solve such a problem, and an object thereof is to provide a body tissue ablation system that can efficiently cauterize a body tissue.
  • a body tissue ablation system for achieving the above-mentioned object is a long member having a deformed part that deforms into a shape preliminarily shaped on the distal end side and a cauterization part for cauterizing the body tissue. And a covering portion made of a non-conductive member that covers the entire circumference of the base end side of the main body portion, and a power supply portion that is connected to the main body portion and supplies energy to the cauterizing portion, and the deformation portion is deformed Thus, the body tissue is collected, and the cauterization unit cauterizes the collected body tissue.
  • a wide range of body tissue is cauterized at once by collecting and cauterizing the body tissue, so that the body tissue can be cauterized efficiently.
  • the deforming portion is formed of a shape memory alloy
  • the deforming portion is deformed depending on the properties of the shape memory alloy to be restored to a pre-shaped shape. Therefore, the motor is used to deform the deforming portion. It is not necessary to provide mechanical elements such as. Therefore, the apparatus can be reduced in size.
  • the ablation part is made of a coiled metal member and is fixed to the tip of the main body part, the ablation part is attached to the tip of the main body part and arranged at a desired location in the body. At the same time, it receives heat from the power source and generates heat. Therefore, the desired part in the body can be cauterized well.
  • the cautery part covers the deformed part, the cautery part is deformed into the shape of the deformed part, so that the body tissue is easily cauterized according to the shape of the deformed part.
  • the main body portion has a distal end side wire and a proximal end side wire having higher rigidity than the distal end side wire, and has a separating means for separating the distal end side wire, the proximal end side wire becomes By separating from the distal end side wire and recovering from the inside of the body, the base end side wire having high rigidity does not remain in the body, so that the burden on the patient can be reduced.
  • the deformable portion is deformed by supplying energy from the power supply unit to the cauterized portion and the cauterized portion is heated, a structure for heating to deform the deformable portion is separated from the cauterized portion. There is no need to provide it, and thus the apparatus configuration can be simplified.
  • the deforming portion is arranged on the proximal end side of the cauterizing portion, the deformation of the deforming portion is not easily disturbed by the cauterizing portion, so that the deforming portion is easily deformed into a pre-shaped shape.
  • the body tissue ablation system further includes an elongated deforming portion correcting member, and the deforming portion is pushed out of the deforming portion correcting member to deform the deforming portion when starting to deform. Therefore, it is not necessary to use electricity or the like, and therefore the deforming portion can be deformed with a simple configuration.
  • the deformable portion correcting member includes a heating portion and an energizing member for energizing the heating portion and the power supply portion, and the deformable portion is pulled into the deformable portion correcting member in a state where the heating portion is heated. If it becomes straight by being embedded, since the habit of the deformed portion is removed, the main body portion can be smoothly drawn into the deformed portion correcting member.
  • the body tissue ablation system reduces the volume of the lung emphysematous region and further cauterizes, a large area in the lung emphysematous region is cauterized at one time, so It is possible to efficiently cauterize the emphysema area.
  • FIG. 1 It is a schematic block diagram of the body tissue ablation system of 1st Embodiment. It is a figure which shows typically the state by which the main-body part with which the body tissue ablation system of 1st Embodiment was equipped was inserted in the airway and the lung parenchyma. It is a figure which shows typically a mode when the deformation
  • the body tissue ablation system 10 includes an elongated main body part 11, a covering part 14 that covers the entire circumference of the base end side of the main body part 11, and an electrical connection to the main body part 11. And a power supply unit 15 connected to the power supply unit 15.
  • the main body 11 includes a distal end side wire 12 and a proximal end side wire 13 that are aligned in the axial direction and connected to each other.
  • the distal end side wire 12 has a flexible wire 121 and a cautery portion 120 disposed on the wire 121.
  • the wire 121 includes a deformable portion 122 that can be deformed into a pre-shaped shape.
  • the deformable portion 122 is formed by forming the wire 121 with a shape memory alloy such as a Ni—Ti binary alloy, a Ni—Ti—Cu ternary alloy, a Ni—Zn—Al ternary alloy, and the like. It is formed by storing a predetermined shape in a part.
  • the predetermined shape is a shape wound in a spiral shape.
  • the deformed portion 122 has a substantially linear shape or a gently curved shape in a state where no external force and heat are applied, and when heated, due to the property of the shape memory alloy trying to restore the shape memorized. , Deformed into a spirally wound shape.
  • the cautery unit 120 is made of a coiled metal member.
  • the material forming the cauterized portion 120 is, for example, nickel chrome or iron chrome.
  • the cauterization unit 120 can cauterize the body tissue by Joule heat.
  • the cautery unit 120 is disposed in the deforming unit 122.
  • the cautery portion 120 is wound around the deformable portion 122 in a spiral manner to cover the deformable portion 122. Both ends of the cautery part 120 are joined to the wire 121 respectively.
  • the joining of the end portion of the cauterized portion 120 and the wire 121 is, for example, welding.
  • the cautery part 120 and the wire 121 preferably have X-ray contrast properties.
  • the proximal end side wire 13 has a separating means 130 for separating the distal end side wire 12 and an operation unit 131 used for operating the separating means 130.
  • the rigidity of the proximal end side wire 13 is higher than the rigidity of the distal end side wire 12.
  • the separating means 130 is a gripping member that can be opened and closed provided at the distal end of the proximal end side wire 13.
  • the separating means 130 closes and grips the proximal end of the wire 121, thereby connecting the distal end side wire 12 and the proximal end side wire 13.
  • the proximal end of the wire 121 has a spherical shape.
  • the separating means 130 separates the distal end side wire 12 and the proximal end side wire 13 by opening and releasing the proximal end of the wire 121.
  • the operation unit 131 includes a handle 132 that protrudes in the radial direction and a plunger 133 that is provided so as to advance and retract in the axial direction.
  • a handle 132 that protrudes in the radial direction
  • a plunger 133 that is provided so as to advance and retract in the axial direction.
  • the covering portion 14 extends from the proximal end of the cauterizing portion 120 to the operation portion 131 and covers the entire circumference of the main body portion 11.
  • the covering portion 14 has an insulating property.
  • coated part 14 has flexibility.
  • the covering portion 14 bends or bends according to the main body portion 11. Further, when the separating means 130 is opened, the separating means 130 and the covering portion 14 may come into contact with each other, but since the covering portion 14 is flexibly deformed, the opening / closing operation of the separating means 130 is not hindered.
  • Examples of the material for forming the covering portion 14 include polyesters such as polyethylene terephthalate and polybutylene terephthalate, polyester elastomers using these as hard segments, polyolefins such as polyethylene and polypropylene, polyolefin elastomers, and copolymers using a metallocene catalyst.
  • thermoplastic resins such as polyphenylene oxide (PPO) and polyphenylene sulfide (PPS) and polymer derivatives thereof
  • thermosetting or crosslinkable resins such as vulcan
  • the power supply unit 15 is electrically connected to the distal end side wire 12 and the proximal end side wire 13.
  • the power supply unit 15 is electrically connected to the cautery unit 120 via the proximal end side wire 13 and the wire 121.
  • the cautery unit 120 generates heat.
  • the body tissue cauterization method of this embodiment includes an insertion step of inserting the deformable portion 122 and the cauterization portion 120 into the body, and a cauterization step of scraping and cauterizing the body tissue after the insertion step.
  • the cauterization method of the body tissue of this embodiment has the isolation
  • the operator transforms the deformed portion from the opening such as the mouth or nose into the lumen of the lung parenchyma 1 (internal tissue) that is swollen through the airway 2 (internal tissue).
  • the airway 2 includes the trachea, main bronchus, lobe bronchus, bronchi, bronchiole, and terminal bronchiole.
  • Lung parenchyma 1 includes respiratory bronchioles, alveoli, alveolar passages, and alveolar sac.
  • the surgeon identifies the lung parenchyma 1 that has become emphysematous and swollen in advance by a preliminary examination or the like, and confirms the positions of the deformable portion 122 and the cauterized portion 120 that are visible under fluoroscopy, and the target lung Proceed to real one.
  • the surgeon advances the main body part 11 together with the covering part 14 while operating like a guide wire.
  • the deformed portion 122 deforms and collects the lung parenchyma 1, and the cauterized portion 120 cauterizes the collected lung parenchyma 1.
  • the surgeon supplies electric energy from the power supply unit 15 to the cauterization unit 120.
  • the cautery unit 120 generates heat upon receiving energy from the power supply unit 15.
  • the cautery 120 contacts the lung parenchyma 1 and cauterizes by applying heat thereto.
  • the deformation unit 122 starts to be deformed by the heat generated by the cautery unit 120.
  • the deforming part 122 collects the airway 2 and the lung parenchyma 1 while being deformed so as to involve the entire lung parenchyma 1 together with the airway 2. Due to the deformation of the deforming portion 122, the lung parenchyma 1 that has become emphysematous and inflated is compressed, and as a result, the volume decreases. Moreover, when the deformation
  • the cautery unit 120 cauterizes the lung parenchyma 1 having a reduced volume. Since the volume of the lung parenchyma 1 is reduced, heat is easily transmitted from the cauterized portion 120 in the lung parenchyma 1 to the entire lung parenchyma 1. In addition, since the cautery part 120 is drawn out from the inside of the lung parenchyma 1 to the airway 2 and is deformed so as to involve the lung parenchyma 1 together with the airway 2, heat is also generated from outside the lung parenchyma 1 to the lung parenchyma 1. It is transmitted. Therefore, the cautery unit 120 can cauterize the lung parenchyma 1 efficiently.
  • the cautery portion 120 drawn from the lung parenchyma 1 to the airway 2 also cauterizes the airway 2 deformed by the deforming portion 122 around the lung parenchyma 1.
  • the airway 2 deformed around the lung parenchyma 1 undergoes coagulation necrosis in the deformed state.
  • the operator stops supplying energy from the power supply unit 15 to the ablation unit 120.
  • the operator opens the separation means 130 to separate the distal end side wire 12 and the proximal end side wire 13.
  • the surgeon removes the separated proximal wire 13 together with the covering portion 14 from the body.
  • the distal end side wire 12 is left in the lung in a deformed state.
  • the surgeon swells a heating element such as a heating wire as shown in FIG. And the lung parenchyma 1 must be cauterized extensively while moving the heating element.
  • the lung parenchyma 1 is ablated and cauterized, and a wide range of the lung parenchyma 1 is cauterized at a time. Can be cauterized efficiently.
  • the lung parenchyma 1 is cauterized by the high-temperature condensable vapor
  • the high-temperature vapor may flow into the normal lung parenchyma through the collateral airway, so that the normal lung parenchyma is damaged. Risk is great.
  • the cauterization unit 120 because the cauterization unit 120 generates heat, the lung parenchyma 1 is cauterized, so that high-temperature steam does not flow into the normal lung parenchyma through the accessory airway. Therefore, the target site can be selectively cauterized, and therefore the risk of damage to normal lung parenchyma can be suppressed as compared with the case of cauterizing with high-temperature condensable vapor.
  • the lung parenchyma 1 that has been emphysematous and swollen is compressed by being collected, compression on the normal lung parenchyma is suppressed, and as a result, the function of the lung is improved.
  • the lung parenchyma 1 in which the cauterized part 120 is lesioned is cauterized and necrotic, propagation of the lesioned part to the normal part is suppressed. Thus, improved lung function is well maintained.
  • the deformable portion 122 is deformed to block the airway 2, the inflow of gas into the compressed lung parenchyma 1 is prevented, and as a result, the lung parenchyma 1 is difficult to return to the original inflated state. Thus, improved lung function is well maintained.
  • the deformable portion 122 is formed of a shape memory alloy, and the deformable portion 122 is deformed depending on the properties of the shape memory alloy to be restored to the shape previously formed, the motor is used to deform the deformable portion 122. It is not necessary to provide mechanical elements such as. Therefore, the apparatus can be reduced in size.
  • the cautery part 120 is made of a coiled metal member and is fixed to the distal end of the main body part 11, the cautery part 120 is attached to the distal end of the main body part 11 to the desired lumen of the lung parenchyma 1. It is arranged and generates heat upon receiving energy from the power supply unit 15. Therefore, the desired lung parenchyma 1 can be cauterized well.
  • the cautery part 120 covers the deformed part 122 and the cautery part 120 is deformed into the shape of the deformed part 122, the lung parenchyma 1 and the airway 2 are easily cauterized according to the shape of the deformed part 122.
  • the main body 11 has the separating means 130 and the base end side wire 13 having higher rigidity than the front end side wire 12 is separated and collected in the separation step, the base end side wire 13 having high rigidity is separated from the body. Therefore, the burden on the patient can be reduced.
  • the distal end side wire 12 is placed inside the lung while being deformed and holds the lung parenchyma 1 and the airway 2 in a state of being collected, it is difficult for the lung parenchyma 1 to return to the original inflated state. Therefore, the pressure to the normal lung parenchyma is suppressed and the function of the lung is maintained well.
  • the deforming part 122 is deformed by the heat of the cauterizing part 120, it is not necessary to provide a configuration for heating the deforming part 122 separately from the cauterizing part 120, and thus the apparatus configuration can be simplified.
  • the body tissue ablation system 20 of the second embodiment is provided with an elongated main body portion 21, a covering portion 23 that covers the entire circumference of the base end side of the main body portion 21, and the main body portion 21. And a power supply unit 24 connected to the.
  • the body tissue ablation system 20 of the second embodiment further includes a long deformed portion correction member 22.
  • the deformable portion correcting member 22 includes a flexible tube body 220, a heating unit 221 disposed on the inner surface of the tube body 220, and an energizing member 222 that electrically connects the heating unit 221 and the power supply unit 24. Have.
  • the pipe body 220 includes, for example, polyesters such as polyethylene terephthalate and polybutylene terephthalate, polyester elastomers using these as hard segments, polyolefins and polyolefin elastomers such as polyethylene and polypropylene, copolymer polyolefins and polychlorinations using metallocene catalysts.
  • Vinyl-based polymers such as vinyl, PVDC, PVDF, polyamides and polyamide elastomers (PAE) including nylon, polyimide, polystyrene, SEBS resin, polyurethane, polyurethane elastomer, ABS resin, acrylic resin, polyarylate, polycarbonate, polyoxymethylene (POM) ), Polyvinyl alcohol (PVA), fluororesin (ETFE, PFA, PTFE), ethylene-acetic acid Nyl saponified products, ethylene-copoly-vinyl alcohol, ethylene vinyl acetate, carboxymethyl cellulose, methyl cellulose, cellulose acetate, vinyl polysulfone, liquid crystal polymer (LCP), polyethersulfone (PES), polyetheretherketone (PEEK), polyphenylene oxide
  • thermoplastic resins such as (PPO) and polyphenylene sulfide (PPS) and their polymer derivatives
  • thermosetting or crosslinkable resins such as vulcanized rubber, silicone resin, epoxy
  • Tube 220 can be inserted into airway 2 and lung parenchyma 1.
  • the heating unit 221 is preferably arranged at the forefront of the tube body 220. Moreover, the heating part 221 is preferably arranged on the entire inner circumference at the forefront of the tube body 220.
  • the heating unit 221 is fixed to the tube body 220.
  • the heating unit 221 is supplied with electrical energy from the power supply unit 24 and self-heats due to resistance.
  • the heating part 221 is insulated from the main body part 21.
  • the heating unit 221 has a configuration in which, for example, a heating wire is covered with an insulating material.
  • the energizing member 222 is also insulated from the main body 21 and has a configuration in which, for example, a conductive wire is covered with an insulating material.
  • the energizing member 222 is disposed inside the tube body 220.
  • the energizing member 222 is fixed to the tube body 220.
  • the energizing member 222 has flexibility, and can be bent or bent flexibly together with the tube body 220.
  • the main body 21 has a flexible wire 211 and a cautery portion 210 disposed on the wire 211.
  • the wire 211 includes a deformable portion 212 that can be deformed into a pre-shaped shape.
  • the deformation part 212 is arranged on the proximal end side of the cautery part 210.
  • the cautery part 210 is different from the first embodiment in that it is not disposed on the deforming part 212 but on the distal end side of the deforming part 212.
  • the material and other configurations are the same as those in the first embodiment. Since it is the same as that of the part 120, the overlapping description here is abbreviate
  • the power supply unit 24 supplies electric energy to the cauterization unit 210 through the wire 211.
  • the deformable portion 212 is formed by forming the wire 211 from a shape memory alloy such as a Ni—Ti binary alloy, a Ni—Ti—Cu ternary alloy, a Ni—Zn—Al ternary alloy, and the like. It is formed by storing a predetermined shape in a part.
  • the predetermined shape stored in the deformation unit 212 is a substantially linear shape or a gently curved shape.
  • the deforming portion 212 has a spiral shape when no external force and heat are applied.
  • the deforming part 212 having such a shape is arranged in the deforming part correcting member 22 in a state where the shape is corrected so as to follow the deforming part correcting member 22.
  • the deforming portion 212 When the deforming portion 212 is pushed out from within the deforming portion correcting member 22, it is deformed into a pre-shaped shape by elasticity. Specifically, when the deformation portion correction member 22 is pushed out, the external force applied to the deformation portion 212 is removed from the deformation portion correction member 22, and the deformation portion 212 has a shape along the deformation portion correction member 22. To a pre-shaped shape, in this case a spiral shape.
  • the deforming portion 212 when the deforming portion 212 is heated, it is deformed into a pre-shaped shape due to the property of restoring the shape memorized by the shape memory alloy. Specifically, the deformed portion 212 that has been spirally wound by being pushed out of the deformed portion correcting member 22 is heated to be pre-shaped, in this case, It changes to a substantially linear shape or a gently curved shape.
  • the deforming portion 212 is deformed from a substantially linear shape or a gently curved shape to a shape wound in a spiral shape by being heated.
  • the deformed portion 212 is deformed from a spirally wound shape to a substantially linear shape or a gently curved shape by being heated. To do.
  • the covering portion 23 extends from the proximal end of the cauterized portion 210 to the proximal end of the wire 211 and covers the entire circumference of the main body portion 21.
  • the covering portion 23 has an insulating property.
  • coated part 23 has flexibility.
  • the covering portion 23 bends or bends in accordance with the wire 211, and deforms in accordance with the deformation of the deformation portion 212.
  • Examples of the material for forming the covering portion 23 include polyesters such as polyethylene terephthalate and polybutylene terephthalate, polyester elastomers using these as hard segments, polyolefins such as polyethylene and polypropylene, polyolefin elastomers, and copolymers using a metallocene catalyst.
  • thermoplastic resins such as polyphenylene oxide (PPO) and polyphenylene sulfide (PPS) and polymer derivatives thereof
  • thermosetting or crosslinkable resins such as vulcan
  • the body tissue cauterization method of the present embodiment includes an insertion process of inserting the cauterization part 210 and the deforming part 212 into the body, and a cauterization process of collecting and cauterizing the body tissue after the insertion process. Further, the body tissue cauterization method of the present embodiment includes a recovery step of recovering the main body 21, the covering portion 23, and the deformed portion correcting member 22 from the body after the cauterization step.
  • the surgeon converts the body portion 21 into the deformed portion correcting member 22 and emphysemas them through the airway 2 from the opening such as the mouth or nose. Insert into the lumen of the inflated lung parenchyma 1.
  • the surgeon confirms and advances the positions of the deforming portion 212 and the cauterizing portion 210 under fluoroscopy, and places the cauterizing portion 210 on the target lung parenchyma 1.
  • the deformable portion 212 collects the lung parenchyma 1 while being deformed, and the cauterized portion 210 cauterizes the collected lung parenchyma 1.
  • the operator pushes the deformed portion 212 from the deformed portion correcting member 22 by pulling the deformed portion correcting member 22 toward the base end side with respect to the main body portion 21. After the entire deformable portion 212 is pushed out from the deformable portion correcting member 22, the operator stops pulling the deformable portion correcting member 22.
  • the deforming portion 212 When the deforming portion 212 is pushed out from the deforming portion correcting member 22, the deforming portion 212 starts to deform due to elasticity, and deforms from a shape along the deforming portion correcting member 22 into a spiral shape.
  • the deforming portion 212 collects the airway 2 and the lung parenchyma 1 while being deformed so as to involve the entire lung parenchyma 1 together with the airway 2. Due to the deformation of the deforming portion 212, the lung parenchyma 1 that has become emphysematous and inflated is compressed, and as a result, the volume decreases. Moreover, when the deformation
  • the surgeon supplies electric energy from the power source portion 24 to the cauterizing portion 210.
  • the cautery unit 210 receives heat from the power supply unit 24 and generates heat.
  • the cautery unit 210 contacts the reduced volume lung parenchyma 1 and cauterizes it by applying heat thereto. Since the volume of the lung parenchyma 1 is reduced, heat is easily transmitted from the cauterized portion 210 in the lung parenchyma 1 to the entire lung parenchyma 1.
  • the heat of the cautery unit 210 is also transmitted to the airway 2 that is deformed around the lung parenchyma 1 by the deforming unit 212.
  • the deformed airway 2 around the lung parenchyma 1 is also cauterized, resulting in coagulative necrosis in the deformed state.
  • the operator stops supplying energy from the power source unit 24 to the ablation unit 210.
  • the operator covers the heating part 221 so that the deformation part 212 passes through while heating the heating part 221 by supplying electric energy from the power supply part 24.
  • the main body 21 is collected in the deformed portion correcting member 22 together with the portion 23.
  • the surgeon removes the covering portion 23 and the main body portion 21 from the inside of the lungs and collects them in a state where the covering portion 23 and the main body portion 21 are recovered in the deformable portion correcting member 22.
  • the heating part 221 heats the deformation part 212.
  • the deforming portion 212 is corrected to the deformed portion while changing from a spirally wound shape to a substantially linear shape or a gently curved shape due to the property of restoring the shape memorized by the shape memory alloy. It is drawn into the member 22.
  • the lung parenchyma 1 is collected and cauterized, a wide range of the lung parenchyma 1 is cauterized at a time. Can be cauterized efficiently.
  • the lung parenchyma 1 that has been emphysematous and swollen is compressed by being collected, compression on the normal lung parenchyma is suppressed, and as a result, the function of the lung is improved.
  • the lung parenchyma 1 in which the cautery part 210 is lesioned is cauterized and necrotic, the propagation of the lesion part to the normal part is suppressed. Thus, improved lung function is well maintained.
  • the deformed portion 212 is deformed to block the airway 2 and coagulates in a state where the airway 2 is closed by heating by the cautery unit 210, inflow of gas to the compressed lung parenchyma 1 is prevented, and as a result, It is difficult for the lung parenchyma 1 to return to the original inflated state. Thus, improved lung function is well maintained.
  • the overlapping description here is omitted.
  • the effect produced by the cauterized part 210 being made of a coil-shaped metal member and being fixed to the tip of the main body part 21 is the same as that of the first embodiment, the overlapping explanation here is as follows. Omitted.
  • the deforming portion 212 is arranged on the proximal end side of the cauterizing portion 210, and therefore the deformation of the deforming portion 212 is not easily disturbed by the cauterizing portion 210, so that the deforming portion 212 is easily deformed into a pre-shaped shape.
  • the deforming portion 212 when the deforming portion 212 is pushed out from the deforming portion correcting member 22, the deforming portion 212 starts to deform due to its own elasticity, so that it is not necessary to use electricity or the like to deform the deforming portion 212, and thus simple.
  • the deformation unit 212 can be deformed depending on the configuration.
  • transformation part 212 becomes a substantially linear shape or a gently curved shape by being drawn in in the deformation
  • the deforming portion may be deformed in any way as long as it collects the body tissue by being deformed. Therefore, it is not limited to what deform
  • the deforming portion may be deformed into an S shape or a U shape.
  • body tissue ablation systems can be used for gastric vestibular telangiectasia (GAVE), portal hypertension gastric disease (PHG), radiation-induced proctopathies and colon diseases, arteriovenous malformations and vascular dysplasia. It may be applied to the treatment to eradicate chronic bleeding disorders that occur. In this case, the body tissue is the digestive tract.
  • GAVE gastric vestibular telangiectasia
  • PSG portal hypertension gastric disease
  • PEG portal hypertension gastric disease
  • radiation-induced proctopathies and colon diseases arteriovenous malformations and vascular dysplasia. It may be applied to the treatment to eradicate chronic bleeding disorders that occur. In this case, the body tissue is the digestive tract.
  • the cautery part is heated to a high temperature and brought into contact with the body tissue, but the present invention is not limited to this.
  • the cauterization unit may receive the electric energy from the power supply unit and radiate microwaves toward the body tissue to cauterize the body tissue in a non-contact manner.

Abstract

[Problem] To provide a body tissue cauterizing system which can efficiently cauterize body tissue. [Solution] A body tissue cauterizing system (10) has: a body section (11) which is a long member and which has, on the distal end side thereof, a deformable section (122) which deforms into a shape formed in advance and a cauterizing section (120) which cauterizes body tissue; a cover section (14) which covers the entire periphery of the proximal end side of the body section and which comprises an electrically non-conductive member; and an electric power source section (15) which is connected to the body section and which supplies energy to the cauterizing section. The body tissue cauterizing system (10) is characterized in that the deformable section scrapes body tissue by deforming and that the cauterizing section cauterizes the scraped body tissue.

Description

体内組織焼灼システムBody tissue ablation system
 本発明は、体内組織に生じた病変部を焼灼する体内組織焼灼システムに関する。 The present invention relates to a body tissue ablation system that cauterizes a lesioned part generated in a body tissue.
 体内組織に生じた病変部が正常部へと伝搬する肺気腫等の疾患に対する処置として、病変部を焼く焼灼がある。例えば特許文献1のように、気腫化して膨らんだ肺実質を、ワイヤ形状を有するインプラントによって圧縮することによって一時的に肺の機能を回復させたとしても、いずれ病変部が伝搬して正常部が膨らむため、焼灼によって病変部を壊死させることが有効である。 As a treatment for a disease such as emphysema in which a lesion part generated in a body tissue propagates to a normal part, there is cauterization that burns the lesion part. For example, as in Patent Document 1, even if the lung function is temporarily restored by compressing the lung parenchyma that is swollen and swollen with an implant having a wire shape, the lesion part propagates to the normal part. It is effective to necrotize the lesion by cauterization.
国際公開第2007/106495号パンフレットInternational Publication No. 2007/106495 Pamphlet
 しかしながら、病変部が広がっていると広範囲に体内組織を焼灼しなければならず、そのため、施術時間が長くなるとともに患者及び術者への負担増加を招く。特に肺気腫の場合、肺実質が気腫化して膨らんでいるため病変部が広がっており、その結果、施術時間が長くなり易く、また患者及び施術者への負担増加を招き易い。 However, when the lesion is spread, the body tissue must be cauterized over a wide area, which increases the treatment time and increases the burden on the patient and the operator. In particular, in the case of emphysema, since the lung parenchyma is emphysematous and swells, the lesion is spread. As a result, the treatment time tends to be long, and the burden on the patient and the practitioner is likely to increase.
 また、高温の凝縮性蒸気では副側気道の存在等により正常部を損傷することのリスクが大きいことから選択的に対象部位を焼灼する必要がある。 Also, the high temperature condensable vapor has a high risk of damaging the normal part due to the presence of the secondary airway, etc., so it is necessary to selectively cauterize the target site.
 そこで、本発明は、このような課題を解決するためになされたものであり、体内組織を効率良く焼灼し得る体内組織焼灼システムを提供することを目的とする。 Therefore, the present invention has been made to solve such a problem, and an object thereof is to provide a body tissue ablation system that can efficiently cauterize a body tissue.
 上記目的を達成するための体内組織焼灼システムは、長尺状の部材であって、先端側に予め形状付けられた形状に変形する変形部と体内組織を焼灼するための焼灼部とを有する本体部と、本体部の基端側全周を被覆する非導電性部材からなる被覆部と、本体部に接続され焼灼部にエネルギーを供給するための電源部と、を有し、変形部は変形することにより体内組織をかき集め、焼灼部は該かき集められた体内組織を焼灼する、ことを特徴とする。 A body tissue ablation system for achieving the above-mentioned object is a long member having a deformed part that deforms into a shape preliminarily shaped on the distal end side and a cauterization part for cauterizing the body tissue. And a covering portion made of a non-conductive member that covers the entire circumference of the base end side of the main body portion, and a power supply portion that is connected to the main body portion and supplies energy to the cauterizing portion, and the deformation portion is deformed Thus, the body tissue is collected, and the cauterization unit cauterizes the collected body tissue.
 上記のように構成した体内組織焼灼システムによれば、体内組織がかき集められて焼灼されることによって体内組織の広い範囲が一度に焼灼されるため、体内組織を効率良く焼灼できる。 According to the body tissue ablation system configured as described above, a wide range of body tissue is cauterized at once by collecting and cauterizing the body tissue, so that the body tissue can be cauterized efficiently.
 また、前記変形部が形状記憶合金から形成されるようにすれば、予め形状付けられた形状に復元しようとする形状記憶合金の性質によって変形部が変形するため、変形部を変形させるためにモータ等の機械要素を設けなくてもよい。よって装置の小型化を図り得る。 In addition, if the deforming portion is formed of a shape memory alloy, the deforming portion is deformed depending on the properties of the shape memory alloy to be restored to a pre-shaped shape. Therefore, the motor is used to deform the deforming portion. It is not necessary to provide mechanical elements such as. Therefore, the apparatus can be reduced in size.
 また、前記焼灼部がコイル状の金属部材からなり、前記本体部の先端に固着されているようにすれば、焼灼部が本体部の先端にともなわれて体内の所望の箇所へ配置されるとともに電源部からのエネルギーを受けて発熱する。従って体内の所望の箇所を良好に焼灼できる。 Further, if the ablation part is made of a coiled metal member and is fixed to the tip of the main body part, the ablation part is attached to the tip of the main body part and arranged at a desired location in the body. At the same time, it receives heat from the power source and generates heat. Therefore, the desired part in the body can be cauterized well.
 また、前記焼灼部が前記変形部上を被覆しているようにすれば、焼灼部が変形部の形状に変形するため、体内組織を変形部の形状に合わせて焼灼し易い。 Further, if the cautery part covers the deformed part, the cautery part is deformed into the shape of the deformed part, so that the body tissue is easily cauterized according to the shape of the deformed part.
 また、前記本体部が先端側線材と先端側線材よりも剛性の高い基端側線材とを有し、前記先端側線材を分離するための分離手段を有するようにすれば、基端側線材が先端側線材と分離され、そして体内から回収されることによって、剛性の高い基端側線材が体内に残らないため、患者への負担を軽減できる。 Further, if the main body portion has a distal end side wire and a proximal end side wire having higher rigidity than the distal end side wire, and has a separating means for separating the distal end side wire, the proximal end side wire becomes By separating from the distal end side wire and recovering from the inside of the body, the base end side wire having high rigidity does not remain in the body, so that the burden on the patient can be reduced.
 また、前記電源部から前記焼灼部にエネルギーを供給し、前記焼灼部が加熱されることで前記変形部が変形するようにすれば、変形部を変形させるために加熱する構成を焼灼部と別に設ける必要がなく、よって装置構成を簡単にできる。 In addition, if the deformable portion is deformed by supplying energy from the power supply unit to the cauterized portion and the cauterized portion is heated, a structure for heating to deform the deformable portion is separated from the cauterized portion. There is no need to provide it, and thus the apparatus configuration can be simplified.
 また、前記変形部は前記焼灼部の基端側に配置されているようにすれば、変形部の変形が焼灼部によって阻害され難く、そのため変形部が予め形状付けられた形状に変形し易い。 Further, if the deforming portion is arranged on the proximal end side of the cauterizing portion, the deformation of the deforming portion is not easily disturbed by the cauterizing portion, so that the deforming portion is easily deformed into a pre-shaped shape.
 また、前記体内組織焼灼システムは更に長尺状の変形部矯正部材を有し、前記変形部は該変形部矯正部材から押し出されることにより、変形を開始するようにすれば、変形部を変形させるために電気等を使用する必要がなく、従って簡単な構成によって変形部を変形させることができる。 The body tissue ablation system further includes an elongated deforming portion correcting member, and the deforming portion is pushed out of the deforming portion correcting member to deform the deforming portion when starting to deform. Therefore, it is not necessary to use electricity or the like, and therefore the deforming portion can be deformed with a simple configuration.
 また、前記変形部矯正部材は加熱部と、該加熱部と前記電源部とを通電する通電部材とを有し、前記変形部は前記加熱部が加熱した状態で前記変形部矯正部材内に引きこまれることにより直線状になるようにすれば、変形部のくせが除去されるため、本体部を円滑に変形部矯正部材内に引き込める。 The deformable portion correcting member includes a heating portion and an energizing member for energizing the heating portion and the power supply portion, and the deformable portion is pulled into the deformable portion correcting member in a state where the heating portion is heated. If it becomes straight by being embedded, since the habit of the deformed portion is removed, the main body portion can be smoothly drawn into the deformed portion correcting member.
 また、前記体内組織焼灼システムは、肺の気腫化した領域の体積を減少させ、さらに焼灼するようにすれば、肺の気腫化した領域における広い範囲が一度に焼灼されるため、肺の気腫化した領域を効率良く焼灼できる。 In addition, if the body tissue ablation system reduces the volume of the lung emphysematous region and further cauterizes, a large area in the lung emphysematous region is cauterized at one time, so It is possible to efficiently cauterize the emphysema area.
第1実施形態の体内組織焼灼システムの概略構成図である。It is a schematic block diagram of the body tissue ablation system of 1st Embodiment. 第1実施形態の体内組織焼灼システムに備えられた本体部が、気道及び肺実質に挿入された状態を模式的に示す図である。It is a figure which shows typically the state by which the main-body part with which the body tissue ablation system of 1st Embodiment was equipped was inserted in the airway and the lung parenchyma. 第1実施形態の体内組織焼灼システムに備えられた変形部が気道及び肺実質をかき集めるとともに焼灼部がこれらを焼灼するときの様子を模式的に示す図である。It is a figure which shows typically a mode when the deformation | transformation part with which the body tissue cauterization system of 1st Embodiment was equipped collects an airway and lung parenchyma, and an ablation part cauterizes these. 第1実施形態の体内組織焼灼システムに備えられた変形部が気道及び肺実質をかき集めるとともに焼灼部がこれらを焼灼するときの様子を模式的に示す図である。It is a figure which shows typically a mode when the deformation | transformation part with which the body tissue cauterization system of 1st Embodiment was equipped collects an airway and lung parenchyma, and an ablation part cauterizes these. 第1実施形態の体内組織焼灼システムに備えられた先端側線材及び基端側線材が分離された状態を模式的に示す図である。It is a figure which shows typically the state by which the front end side wire and base end side wire with which the body tissue ablation system of 1st Embodiment was equipped were isolate | separated. 第2実施形態の体内組織焼灼システムの概略構成図である。It is a schematic block diagram of the internal tissue ablation system of 2nd Embodiment. 第2実施形態の体内組織焼灼システムに備えられた本体部及び変形部矯正部材が、気道及び肺実質に挿入された状態を模式的に示す図である。It is a figure which shows typically the state by which the main-body part and the deformation | transformation part correction member with which the body tissue ablation system of 2nd Embodiment was equipped were inserted in the airway and lung parenchyma. 第2実施形態の体内組織焼灼システムに備えられた変形部が気道及び肺実質をかき集めるとともに焼灼部がこれらを焼灼するときの様子を模式的に示す図である。It is a figure which shows typically a mode when the deformation | transformation part with which the body tissue ablation system of 2nd Embodiment was equipped collects an airway and lung parenchyma, and an ablation part cauterizes these. 第2実施形態の体内組織焼灼システムに備えられた変形部が気道及び肺実質をかき集めるとともに焼灼部がこれらを焼灼するときの様子を模式的に示す図である。It is a figure which shows typically a mode when the deformation | transformation part with which the body tissue ablation system of 2nd Embodiment was equipped collects an airway and lung parenchyma, and an ablation part cauterizes these. 第2実施形態の体内組織焼灼システムに備えられた変形部矯正部材に、本体部及び被覆部が引き込まれる様子を模式的に示す図である。It is a figure which shows typically a mode that a main-body part and a coating | coated part are drawn in to the deformation | transformation part correction member with which the body tissue ablation system of 2nd Embodiment was equipped.
 以下、図面を参照して本発明の実施形態を説明する。なお、図面の寸法比率は、説明の都合上、誇張されて実際の比率とは異なる場合がある。 Hereinafter, embodiments of the present invention will be described with reference to the drawings. In addition, the dimension ratio of drawing is exaggerated on account of description, and may differ from an actual ratio.
 <第1実施形態>
 図1において概説すると、第1実施形態の体内組織焼灼システム10は、長尺状の本体部11と、本体部11の基端側全周を被覆する被覆部14と、本体部11に電気的に接続した電源部15と、を有する。本体部11は、軸方向に並び且つ互いに連結した先端側線材12及び基端側線材13を有する。
<First Embodiment>
Referring to FIG. 1, the body tissue ablation system 10 according to the first embodiment includes an elongated main body part 11, a covering part 14 that covers the entire circumference of the base end side of the main body part 11, and an electrical connection to the main body part 11. And a power supply unit 15 connected to the power supply unit 15. The main body 11 includes a distal end side wire 12 and a proximal end side wire 13 that are aligned in the axial direction and connected to each other.
 先端側線材12は、可撓性を有する線材121と、線材121に配置された焼灼部120と、を有する。線材121は、予め形状付けられた形状に変形可能な変形部122を備える。変形部122は、例えば、線材121をNi-Ti系2元合金、Ni-Ti-Cu系3元合金、Ni-Zn-Al系3元合金等の形状記憶合金によって形成するとともに、線材121の一部に所定の形状を記憶させることによって形成される。本実施形態において、この所定の形状とは、渦巻き状に巻回された形状である。 The distal end side wire 12 has a flexible wire 121 and a cautery portion 120 disposed on the wire 121. The wire 121 includes a deformable portion 122 that can be deformed into a pre-shaped shape. For example, the deformable portion 122 is formed by forming the wire 121 with a shape memory alloy such as a Ni—Ti binary alloy, a Ni—Ti—Cu ternary alloy, a Ni—Zn—Al ternary alloy, and the like. It is formed by storing a predetermined shape in a part. In the present embodiment, the predetermined shape is a shape wound in a spiral shape.
 変形部122は、外力及び熱が作用していない状態では、略直線形状又は緩やかに湾曲した形状を有しており、加熱されたとき、形状記憶合金が記憶した形状に復元しようとする性質によって、渦巻き状に巻回された形状に変形する。 The deformed portion 122 has a substantially linear shape or a gently curved shape in a state where no external force and heat are applied, and when heated, due to the property of the shape memory alloy trying to restore the shape memorized. , Deformed into a spirally wound shape.
 焼灼部120は、コイル状の金属部材からなる。焼灼部120を形成する材料は、例えばニッケルクロム、鉄クロムである。焼灼部120は、ジュール熱によって体内組織を焼灼し得る。焼灼部120は、変形部122に配置されている。焼灼部120は、変形部122のまわりに螺旋状に巻回されて変形部122上を被覆している。焼灼部120の両端は、それぞれ線材121に接合されている。焼灼部120の端部と線材121との接合は、例えば溶接である。焼灼部120及び線材121はそれぞれX線造影性を有することが好ましい。 The cautery unit 120 is made of a coiled metal member. The material forming the cauterized portion 120 is, for example, nickel chrome or iron chrome. The cauterization unit 120 can cauterize the body tissue by Joule heat. The cautery unit 120 is disposed in the deforming unit 122. The cautery portion 120 is wound around the deformable portion 122 in a spiral manner to cover the deformable portion 122. Both ends of the cautery part 120 are joined to the wire 121 respectively. The joining of the end portion of the cauterized portion 120 and the wire 121 is, for example, welding. The cautery part 120 and the wire 121 preferably have X-ray contrast properties.
 基端側線材13は、先端側線材12を分離する分離手段130と、分離手段130の操作に用いられる操作部131と、を有する。基端側線材13の剛性は、先端側線材12の剛性より高い。分離手段130は、基端側線材13の先端に設けられた開閉可能な把持部材である。分離手段130は、閉じて線材121の基端を把持することによって、先端側線材12と基端側線材13とを連結する。線材121の基端は球形状を有する。また、分離手段130は、開いて線材121の基端を放すことによって、先端側線材12と基端側線材13とを分離する。 The proximal end side wire 13 has a separating means 130 for separating the distal end side wire 12 and an operation unit 131 used for operating the separating means 130. The rigidity of the proximal end side wire 13 is higher than the rigidity of the distal end side wire 12. The separating means 130 is a gripping member that can be opened and closed provided at the distal end of the proximal end side wire 13. The separating means 130 closes and grips the proximal end of the wire 121, thereby connecting the distal end side wire 12 and the proximal end side wire 13. The proximal end of the wire 121 has a spherical shape. Moreover, the separating means 130 separates the distal end side wire 12 and the proximal end side wire 13 by opening and releasing the proximal end of the wire 121.
 操作部131は、径方向に突出したハンドル132と、軸方向に進退可能に設けられたプランジャ133と、を有する。術者がハンドル132に軸まわりのトルクを加えると、トルクは分離手段130及び先端側線材12へ伝わる。また、術者がプランジャ133を押し引きすると、これに連動して分離手段130が開閉する。プランジャ133と分離手段130とは、基端側線材13の内部に設けられたワイヤによって連結されている。 The operation unit 131 includes a handle 132 that protrudes in the radial direction and a plunger 133 that is provided so as to advance and retract in the axial direction. When the operator applies torque about the axis to the handle 132, the torque is transmitted to the separating means 130 and the distal end side wire 12. Further, when the surgeon pushes and pulls the plunger 133, the separating means 130 opens and closes in conjunction with this. The plunger 133 and the separating means 130 are connected by a wire provided inside the proximal end side wire 13.
 被覆部14は、焼灼部120の基端から操作部131まで伸びるとともに本体部11の全周を被覆する。被覆部14は、絶縁性を有する。また、被覆部14は、可撓性を有する。被覆部14は、本体部11に合わせて曲がる又は撓む。また、分離手段130が開いたとき、分離手段130と被覆部14とが接する可能性があるが、被覆部14が柔軟に変形するため、分離手段130の開閉動作が妨げられない。 The covering portion 14 extends from the proximal end of the cauterizing portion 120 to the operation portion 131 and covers the entire circumference of the main body portion 11. The covering portion 14 has an insulating property. Moreover, the coating | coated part 14 has flexibility. The covering portion 14 bends or bends according to the main body portion 11. Further, when the separating means 130 is opened, the separating means 130 and the covering portion 14 may come into contact with each other, but since the covering portion 14 is flexibly deformed, the opening / closing operation of the separating means 130 is not hindered.
 被覆部14を形成する材料は、例えば、ポリエチレンテレフタレート、ポリブチレンテレフタレートのようなポリエステルやそれらをハードセグメントとしたポリエステルエラストマー、ポリエチレン、ポリプロピレンのようなポリオレフィンおよびポリオレフィンエラストマー、メタロセン触媒を用いた共重合体ポリオレフィン、ポリ塩化ビニル、PVDC、PVDFなどのビニル系ポリマー、ナイロンを含むポリアミドおよびポリアミドエラストマー(PAE)、ポリイミド、ポリスチレン、SEBS樹脂、ポリウレタン、ポリウレタンエラストマー、ABS樹脂、アクリル樹脂、ポリアリレート、ポリカーボネート、ポリオキシメチレン(POM)、ポリビニルアルコール(PVA)、フッ素樹脂(ETFE、PFA、PTFE)、エチレン-酢酸ビニルケン化物、エチレン-コポリ-ビニルアルコール、エチレンビニルアセテーテート、カルボキシメチルセルロース、メチルセルロース、セルロースアセテート、ビニルポリスルホン、液晶ポリマー(LCP)、ポリエーテルスルホン(PES)、ポリエーテルエーテルケトン(PEEK)、ポリフェニレンオキサイド(PPO)、ポリフェニレンスルフィド(PPS)等の各種熱可塑性樹脂やその高分子誘導体のほか、加硫ゴム、シリコン樹脂、エポキシ樹脂、二液反応性ポリウレタン樹脂などの熱硬化又は架橋性樹脂が挙げられる。更に、上記の熱可塑性樹脂及び熱硬化・架橋性樹脂のうちいずれかを含むポリマーアロイも利用可能であり、成形材料として溶媒に樹脂を溶解した樹脂溶液を用いても良い。 Examples of the material for forming the covering portion 14 include polyesters such as polyethylene terephthalate and polybutylene terephthalate, polyester elastomers using these as hard segments, polyolefins such as polyethylene and polypropylene, polyolefin elastomers, and copolymers using a metallocene catalyst. Polyolefin, polyvinyl chloride, vinyl polymers such as PVDC, PVDF, polyamide and polyamide elastomer (PAE) including nylon, polyimide, polystyrene, SEBS resin, polyurethane, polyurethane elastomer, ABS resin, acrylic resin, polyarylate, polycarbonate, poly Oxymethylene (POM), polyvinyl alcohol (PVA), fluororesin (ETFE, PFA, PTFE), Tylene-vinyl acetate saponified product, ethylene-copoly-vinyl alcohol, ethylene vinyl acetate, carboxymethylcellulose, methylcellulose, cellulose acetate, vinylpolysulfone, liquid crystal polymer (LCP), polyethersulfone (PES), polyetheretherketone (PEEK) In addition to various thermoplastic resins such as polyphenylene oxide (PPO) and polyphenylene sulfide (PPS) and polymer derivatives thereof, thermosetting or crosslinkable resins such as vulcanized rubber, silicone resin, epoxy resin, two-component reactive polyurethane resin, etc. Is mentioned. Furthermore, a polymer alloy containing any one of the above thermoplastic resins and thermosetting / crosslinkable resins can also be used, and a resin solution in which a resin is dissolved in a solvent may be used as a molding material.
 電源部15は、先端側線材12及び基端側線材13に電気的に接続している。電源部15は、基端側線材13及び線材121を介して焼灼部120と電気的に接続している。電源部15から供給される電気エネルギーが、基端側線材13及び線材121を通り焼灼部120に達することによって、焼灼部120が発熱する。 The power supply unit 15 is electrically connected to the distal end side wire 12 and the proximal end side wire 13. The power supply unit 15 is electrically connected to the cautery unit 120 via the proximal end side wire 13 and the wire 121. When the electric energy supplied from the power supply unit 15 passes through the proximal end side wire 13 and the wire 121 and reaches the cautery unit 120, the cautery unit 120 generates heat.
 次に、肺気腫によって病変した肺実質を焼灼する場合を例に挙げて、本実施形態の体内組織の焼灼方法について述べる。 Next, taking the case of cauterizing the lung parenchyma affected by emphysema as an example, the body tissue cauterization method of this embodiment will be described.
 概説すると、本実施形態の体内組織の焼灼方法は、変形部122及び焼灼部120を体内に挿入する挿入工程と、挿入工程後、体内組織をかき集めるとともに焼灼する焼灼工程と、を有する。また、本実施形態の体内組織の焼灼方法は、焼灼工程後、先端側線材12と基端側線材13とを分離する分離工程を有する。 In general, the body tissue cauterization method of this embodiment includes an insertion step of inserting the deformable portion 122 and the cauterization portion 120 into the body, and a cauterization step of scraping and cauterizing the body tissue after the insertion step. Moreover, the cauterization method of the body tissue of this embodiment has the isolation | separation process which isolate | separates the front end side wire 12 and the base end side wire 13 after the cauterization process.
 図2に示すように、挿入工程において、術者は、口又は鼻等の開口部から気道2(体内組織)を通じ、気腫化して膨らんだ肺実質1(体内組織)の内腔へ変形部122及び焼灼部120を挿入する。気道2は、気管、主気管支、葉気管支、気管支、細気管支、及び終末細気管支を含む。肺実質1は、呼吸細気管支、肺胞、肺胞道、及び肺胞嚢を含む。 As shown in FIG. 2, in the insertion process, the operator transforms the deformed portion from the opening such as the mouth or nose into the lumen of the lung parenchyma 1 (internal tissue) that is swollen through the airway 2 (internal tissue). 122 and the cautery part 120 are inserted. The airway 2 includes the trachea, main bronchus, lobe bronchus, bronchi, bronchiole, and terminal bronchiole. Lung parenchyma 1 includes respiratory bronchioles, alveoli, alveolar passages, and alveolar sac.
 術者は、気腫化して膨らんだ肺実質1を予備検査等によって予め特定しておき、そしてX線透視下で視認可能な変形部122及び焼灼部120の位置を確認しつつ目的とする肺実質1へとこれらを進める。術者は、本体部11を被覆部14ととともにガイドワイヤのように操作しつつ進める。 The surgeon identifies the lung parenchyma 1 that has become emphysematous and swollen in advance by a preliminary examination or the like, and confirms the positions of the deformable portion 122 and the cauterized portion 120 that are visible under fluoroscopy, and the target lung Proceed to real one. The surgeon advances the main body part 11 together with the covering part 14 while operating like a guide wire.
 図3、図4に示すように、焼灼工程では、変形部122が変形しつつ肺実質1をかき集めるとともに、かき集められる肺実質1を焼灼部120が焼灼する。焼灼工程において、術者は、電源部15から焼灼部120へ電気エネルギーを供給する。焼灼部120は、電源部15からのエネルギーを受けて発熱する。焼灼部120は、肺実質1に接触し、そしてこれに熱を加えることによって焼灼する。 As shown in FIGS. 3 and 4, in the cauterization process, the deformed portion 122 deforms and collects the lung parenchyma 1, and the cauterized portion 120 cauterizes the collected lung parenchyma 1. In the cauterization process, the surgeon supplies electric energy from the power supply unit 15 to the cauterization unit 120. The cautery unit 120 generates heat upon receiving energy from the power supply unit 15. The cautery 120 contacts the lung parenchyma 1 and cauterizes by applying heat thereto.
 変形部122は、焼灼部120の発熱によって変形を開始する。変形部122は、気道2とともに肺実質1全体を巻き込むように変形しつつ気道2及び肺実質1をかき集める。変形部122が変形することによって、気腫化して膨らんでいた肺実質1は圧縮され、その結果、体積が減少する。また、変形部122が変形することによって、気道2が押し潰されて閉塞する。 The deformation unit 122 starts to be deformed by the heat generated by the cautery unit 120. The deforming part 122 collects the airway 2 and the lung parenchyma 1 while being deformed so as to involve the entire lung parenchyma 1 together with the airway 2. Due to the deformation of the deforming portion 122, the lung parenchyma 1 that has become emphysematous and inflated is compressed, and as a result, the volume decreases. Moreover, when the deformation | transformation part 122 deform | transforms, the airway 2 is crushed and obstruct | occluded.
 焼灼部120は、体積の減少した肺実質1を焼灼する。肺実質1の体積が減少しているため、肺実質1内の焼灼部120から肺実質1の全体へと熱が伝わり易い。また焼灼部120は、肺実質1の内部から気道2へと引き出され、そして気道2とともに肺実質1を巻き込むように変形しているため、肺実質1の外からも肺実質1へと熱が伝わる。従って、焼灼部120は肺実質1を効率的に焼灼できる。また、肺実質1から気道2へと引き出されている焼灼部120は、肺実質1のまわりで変形部122によって変形させられている気道2も焼灼する。その結果、肺実質1のまわりで変形している気道2は、変形した状態で凝固壊死する。病変部が壊死するのに十分な熱量が焼灼部120から肺実質1へ供給された後、術者は電源部15から焼灼部120へのエネルギーの供給を停止する。 The cautery unit 120 cauterizes the lung parenchyma 1 having a reduced volume. Since the volume of the lung parenchyma 1 is reduced, heat is easily transmitted from the cauterized portion 120 in the lung parenchyma 1 to the entire lung parenchyma 1. In addition, since the cautery part 120 is drawn out from the inside of the lung parenchyma 1 to the airway 2 and is deformed so as to involve the lung parenchyma 1 together with the airway 2, heat is also generated from outside the lung parenchyma 1 to the lung parenchyma 1. It is transmitted. Therefore, the cautery unit 120 can cauterize the lung parenchyma 1 efficiently. In addition, the cautery portion 120 drawn from the lung parenchyma 1 to the airway 2 also cauterizes the airway 2 deformed by the deforming portion 122 around the lung parenchyma 1. As a result, the airway 2 deformed around the lung parenchyma 1 undergoes coagulation necrosis in the deformed state. After a sufficient amount of heat is supplied from the ablation unit 120 to the lung parenchyma 1 for the lesion to be necrotic, the operator stops supplying energy from the power supply unit 15 to the ablation unit 120.
 図5に示すように、分離工程では、術者は分離手段130を開いて先端側線材12と基端側線材13とを分離する。術者は、分離した基端側線材13を被覆部14とともに体内から抜去する。一方、先端側線材12は変形した状態のまま肺の内部に留置される。 As shown in FIG. 5, in the separation step, the operator opens the separation means 130 to separate the distal end side wire 12 and the proximal end side wire 13. The surgeon removes the separated proximal wire 13 together with the covering portion 14 from the body. On the other hand, the distal end side wire 12 is left in the lung in a deformed state.
 本実施形態の作用効果を述べる。 The effect of this embodiment will be described.
 本実施形態と異なり、気腫化した肺実質1がかき集められることなく焼灼される場合、術者は、電熱線等の発熱体を、図2のように膨らんで広がった肺実質1の内腔に挿入し、そして発熱体を動かしながら広範囲に肺実質1を焼灼しなければならない。 Unlike the present embodiment, when the emphysematous lung parenchyma 1 is cauterized without being collected, the surgeon swells a heating element such as a heating wire as shown in FIG. And the lung parenchyma 1 must be cauterized extensively while moving the heating element.
 しかし本実施形態の体内組織焼灼システム10及び体内組織の焼灼方法によれば、肺実質1がかき集められて焼灼されることによって、肺実質1の広い範囲が一度に焼灼されるため、肺実質1を効率良く焼灼できる。 However, according to the body tissue ablation system 10 and body tissue ablation method of the present embodiment, the lung parenchyma 1 is ablated and cauterized, and a wide range of the lung parenchyma 1 is cauterized at a time. Can be cauterized efficiently.
 また、本実施形態と異なり高温の凝縮性蒸気によって肺実質1を焼灼しようとすると、副側気道を通じて高温の蒸気が正常な肺実質へと流入する虞があるため、正常な肺実質が損傷するリスクが大きい。これに対し、本実施形態では焼灼部120が発熱することによって肺実質1を焼灼するため、高温の蒸気が副側気道を通じて正常な肺実質へ流入しない。従って対象部位を選択的に焼灼でき、そのため高温の凝縮性蒸気によって焼灼する場合に比べ正常な肺実質が損傷するリスクを抑えられる。 Further, unlike the present embodiment, if the lung parenchyma 1 is cauterized by the high-temperature condensable vapor, the high-temperature vapor may flow into the normal lung parenchyma through the collateral airway, so that the normal lung parenchyma is damaged. Risk is great. On the other hand, in this embodiment, because the cauterization unit 120 generates heat, the lung parenchyma 1 is cauterized, so that high-temperature steam does not flow into the normal lung parenchyma through the accessory airway. Therefore, the target site can be selectively cauterized, and therefore the risk of damage to normal lung parenchyma can be suppressed as compared with the case of cauterizing with high-temperature condensable vapor.
 また、気腫化して膨らんでいた肺実質1が、かき集められることによって圧縮されるため、正常な肺実質への圧迫が抑制され、その結果、肺の機能が改善する。 Moreover, since the lung parenchyma 1 that has been emphysematous and swollen is compressed by being collected, compression on the normal lung parenchyma is suppressed, and as a result, the function of the lung is improved.
 また、圧縮された肺実質1が焼灼によって凝固するため、肺実質1が元の膨らんだ状態に戻り難い。従って、改善した肺の機能が良好に維持される。 Also, since the compressed lung parenchyma 1 is solidified by cauterization, it is difficult for the lung parenchyma 1 to return to its original swollen state. Thus, improved lung function is well maintained.
 また、焼灼部120が病変した肺実質1を焼灼して壊死させるため、病変部の正常部への伝播が抑制される。従って、改善した肺の機能が良好に維持される。 Further, since the lung parenchyma 1 in which the cauterized part 120 is lesioned is cauterized and necrotic, propagation of the lesioned part to the normal part is suppressed. Thus, improved lung function is well maintained.
 また、変形部122が変形して気道2を閉塞させるため、圧縮した肺実質1へのガスの流入が防止され、その結果、肺実質1が元の膨らんだ状態に戻り難い。従って、改善した肺の機能が良好に維持される。 In addition, since the deformable portion 122 is deformed to block the airway 2, the inflow of gas into the compressed lung parenchyma 1 is prevented, and as a result, the lung parenchyma 1 is difficult to return to the original inflated state. Thus, improved lung function is well maintained.
 また、変形部122が形状記憶合金によって形成されており、そのため予め形状付けられた形状に復元しようとする形状記憶合金の性質によって変形部122が変形するので、変形部122を変形させるためにモータ等の機械要素を設けなくてもよい。よって装置の小型化を図り得る。 In addition, since the deformable portion 122 is formed of a shape memory alloy, and the deformable portion 122 is deformed depending on the properties of the shape memory alloy to be restored to the shape previously formed, the motor is used to deform the deformable portion 122. It is not necessary to provide mechanical elements such as. Therefore, the apparatus can be reduced in size.
 また、焼灼部120がコイル状の金属部材からなり、また本体部11の先端に固着されているため、焼灼部120が本体部11の先端にともなわれて所望の肺実質1の内腔へ配置されるとともに電源部15からのエネルギーを受けて発熱する。従って所望の肺実質1を良好に焼灼できる。 Further, since the cautery part 120 is made of a coiled metal member and is fixed to the distal end of the main body part 11, the cautery part 120 is attached to the distal end of the main body part 11 to the desired lumen of the lung parenchyma 1. It is arranged and generates heat upon receiving energy from the power supply unit 15. Therefore, the desired lung parenchyma 1 can be cauterized well.
 また、焼灼部120が変形部122上を被覆しており、そのため焼灼部120が変形部122の形状に変形するので、肺実質1及び気道2を変形部122の形状に合わせて焼灼し易い。 In addition, since the cautery part 120 covers the deformed part 122 and the cautery part 120 is deformed into the shape of the deformed part 122, the lung parenchyma 1 and the airway 2 are easily cauterized according to the shape of the deformed part 122.
 また、本体部11が分離手段130を有し、そして分離工程において先端側線材12に比べ剛性の高い基端側線材13が分離されて回収されるため、剛性の高い基端側線材13が体内に残らず、従って患者への負担を軽減できる。また、先端側線材12が、変形したまま肺の内部に留置されて肺実質1及び気道2をかき集められた状態で保持するため、肺実質1が元の膨らんだ状態に戻り難い。従って、正常な肺実質への圧迫が抑制されて肺の機能が良好に維持される。 Further, since the main body 11 has the separating means 130 and the base end side wire 13 having higher rigidity than the front end side wire 12 is separated and collected in the separation step, the base end side wire 13 having high rigidity is separated from the body. Therefore, the burden on the patient can be reduced. In addition, since the distal end side wire 12 is placed inside the lung while being deformed and holds the lung parenchyma 1 and the airway 2 in a state of being collected, it is difficult for the lung parenchyma 1 to return to the original inflated state. Therefore, the pressure to the normal lung parenchyma is suppressed and the function of the lung is maintained well.
 また、変形部122が焼灼部120の熱によって変形するため、変形部122を変形させるために加熱する構成を焼灼部120と別に設ける必要がなく、よって装置構成を簡単にできる。 Also, since the deforming part 122 is deformed by the heat of the cauterizing part 120, it is not necessary to provide a configuration for heating the deforming part 122 separately from the cauterizing part 120, and thus the apparatus configuration can be simplified.
 <第2実施形態>
 図6において概説すると、第2実施形態の体内組織焼灼システム20は、長尺状の本体部21と、本体部21の基端側全周を被覆する被覆部23と、本体部21に電気的に接続した電源部24と、を有する。また、第2実施形態の体内組織焼灼システム20は、長尺状の変形部矯正部材22を更に有する。
<Second Embodiment>
Outlined in FIG. 6, the body tissue ablation system 20 of the second embodiment is provided with an elongated main body portion 21, a covering portion 23 that covers the entire circumference of the base end side of the main body portion 21, and the main body portion 21. And a power supply unit 24 connected to the. The body tissue ablation system 20 of the second embodiment further includes a long deformed portion correction member 22.
 変形部矯正部材22は、可撓性を有する管体220と、管体220の内面に配置された加熱部221と、加熱部221及び電源部24を電気的に接続する通電部材222と、を有する。 The deformable portion correcting member 22 includes a flexible tube body 220, a heating unit 221 disposed on the inner surface of the tube body 220, and an energizing member 222 that electrically connects the heating unit 221 and the power supply unit 24. Have.
 管体220は、例えば、ポリエチレンテレフタレート、ポリブチレンテレフタレートのようなポリエステルやそれらをハードセグメントとしたポリエステルエラストマー、ポリエチレン、ポリプロピレンのようなポリオレフィンおよびポリオレフィンエラストマー、メタロセン触媒を用いた共重合体ポリオレフィン、ポリ塩化ビニル、PVDC、PVDFなどのビニル系ポリマー、ナイロンを含むポリアミドおよびポリアミドエラストマー(PAE)、ポリイミド、ポリスチレン、SEBS樹脂、ポリウレタン、ポリウレタンエラストマー、ABS樹脂、アクリル樹脂、ポリアリレート、ポリカーボネート、ポリオキシメチレン(POM)、ポリビニルアルコール(PVA)、フッ素樹脂(ETFE、PFA、PTFE)、エチレン-酢酸ビニルケン化物、エチレン-コポリ-ビニルアルコール、エチレンビニルアセテーテート、カルボキシメチルセルロース、メチルセルロース、セルロースアセテート、ビニルポリスルホン、液晶ポリマー(LCP)、ポリエーテルスルホン(PES)、ポリエーテルエーテルケトン(PEEK)、ポリフェニレンオキサイド(PPO)、ポリフェニレンスルフィド(PPS)等の各種熱可塑性樹脂やその高分子誘導体のほか、加硫ゴム、シリコン樹脂、エポキシ樹脂、二液反応性ポリウレタン樹脂などの熱硬化または架橋性樹脂が挙げられる。更に、上記の熱可塑性樹脂及び熱硬化・架橋性樹脂のうちいずれかを含むポリマーアロイも利用可能であり、成形材料として溶媒に樹脂を溶解した樹脂溶液を用いても良い。 The pipe body 220 includes, for example, polyesters such as polyethylene terephthalate and polybutylene terephthalate, polyester elastomers using these as hard segments, polyolefins and polyolefin elastomers such as polyethylene and polypropylene, copolymer polyolefins and polychlorinations using metallocene catalysts. Vinyl-based polymers such as vinyl, PVDC, PVDF, polyamides and polyamide elastomers (PAE) including nylon, polyimide, polystyrene, SEBS resin, polyurethane, polyurethane elastomer, ABS resin, acrylic resin, polyarylate, polycarbonate, polyoxymethylene (POM) ), Polyvinyl alcohol (PVA), fluororesin (ETFE, PFA, PTFE), ethylene-acetic acid Nyl saponified products, ethylene-copoly-vinyl alcohol, ethylene vinyl acetate, carboxymethyl cellulose, methyl cellulose, cellulose acetate, vinyl polysulfone, liquid crystal polymer (LCP), polyethersulfone (PES), polyetheretherketone (PEEK), polyphenylene oxide In addition to various thermoplastic resins such as (PPO) and polyphenylene sulfide (PPS) and their polymer derivatives, thermosetting or crosslinkable resins such as vulcanized rubber, silicone resin, epoxy resin, and two-component reactive polyurethane resin can be used. . Furthermore, a polymer alloy containing any one of the above thermoplastic resins and thermosetting / crosslinkable resins can also be used, and a resin solution in which a resin is dissolved in a solvent may be used as a molding material.
 管体220は、気道2及び肺実質1に挿入可能である。加熱部221は、好ましくは管体220の最先端に配置される。また、加熱部221は、好ましくは管体220の最先端で内面全周に配置される。加熱部221は管体220に固定されている。加熱部221は、電源部24から電気エネルギーを供給され、抵抗によって自己発熱する。加熱部221は、本体部21と絶縁されている。加熱部221は、例えば電熱線を絶縁材によって被覆した構成を有する。また、通電部材222も本体部21と絶縁されており、例えば導線を絶縁材によって被覆した構成を有する。通電部材222は、管体220の内部に配置される。また、通電部材222は管体220に固定される。通電部材222は可撓性を有し、従って管体220とともに柔軟に曲がる又は撓むことができる。 Tube 220 can be inserted into airway 2 and lung parenchyma 1. The heating unit 221 is preferably arranged at the forefront of the tube body 220. Moreover, the heating part 221 is preferably arranged on the entire inner circumference at the forefront of the tube body 220. The heating unit 221 is fixed to the tube body 220. The heating unit 221 is supplied with electrical energy from the power supply unit 24 and self-heats due to resistance. The heating part 221 is insulated from the main body part 21. The heating unit 221 has a configuration in which, for example, a heating wire is covered with an insulating material. The energizing member 222 is also insulated from the main body 21 and has a configuration in which, for example, a conductive wire is covered with an insulating material. The energizing member 222 is disposed inside the tube body 220. The energizing member 222 is fixed to the tube body 220. The energizing member 222 has flexibility, and can be bent or bent flexibly together with the tube body 220.
 本体部21は、可撓性を有する線材211と、線材211に配置された焼灼部210と、を有する。線材211は、予め形状付けられた形状に変形可能な変形部212を備える。変形部212は、焼灼部210の基端側に配置されている。焼灼部210は、変形部212上に配置されるのではなく、変形部212の先端側に配置される点で第1実施形態と異なるが、材質等その他の構成については第1実施形態の焼灼部120と同様であるため、ここでの重複する説明は省略する。電源部24は、線材211を介して電気エネルギーを焼灼部210に供給する。 The main body 21 has a flexible wire 211 and a cautery portion 210 disposed on the wire 211. The wire 211 includes a deformable portion 212 that can be deformed into a pre-shaped shape. The deformation part 212 is arranged on the proximal end side of the cautery part 210. The cautery part 210 is different from the first embodiment in that it is not disposed on the deforming part 212 but on the distal end side of the deforming part 212. However, the material and other configurations are the same as those in the first embodiment. Since it is the same as that of the part 120, the overlapping description here is abbreviate | omitted. The power supply unit 24 supplies electric energy to the cauterization unit 210 through the wire 211.
 変形部212は、例えば、線材211をNi-Ti系2元合金、Ni-Ti-Cu系3元合金、Ni-Zn-Al系3元合金等の形状記憶合金によって形成するとともに、線材211の一部に所定の形状を記憶させることによって形成される。本実施形態において、変形部212に記憶された所定の形状とは、略直線形状又は緩やかに湾曲した形状である。 For example, the deformable portion 212 is formed by forming the wire 211 from a shape memory alloy such as a Ni—Ti binary alloy, a Ni—Ti—Cu ternary alloy, a Ni—Zn—Al ternary alloy, and the like. It is formed by storing a predetermined shape in a part. In the present embodiment, the predetermined shape stored in the deformation unit 212 is a substantially linear shape or a gently curved shape.
 変形部212は、外力及び熱が作用していない状態では、渦巻き状に巻回された形状を有する。このような形状を有する変形部212は、変形部矯正部材22に沿うように形状を矯正した状態で、変形部矯正部材22内に配置される。 The deforming portion 212 has a spiral shape when no external force and heat are applied. The deforming part 212 having such a shape is arranged in the deforming part correcting member 22 in a state where the shape is corrected so as to follow the deforming part correcting member 22.
 変形部212は、変形部矯正部材22内から押し出されたとき、弾性によって、予め形状付けられた形状に変形する。具体的には、変形部矯正部材22内から押し出されると、変形部矯正部材22から変形部212に加わっていた外力が除かれ、そして、変形部212は、変形部矯正部材22に沿った形状から、予め形状付けられた形状、この場合には渦巻き状に巻回された形状へと変形する。 When the deforming portion 212 is pushed out from within the deforming portion correcting member 22, it is deformed into a pre-shaped shape by elasticity. Specifically, when the deformation portion correction member 22 is pushed out, the external force applied to the deformation portion 212 is removed from the deformation portion correction member 22, and the deformation portion 212 has a shape along the deformation portion correction member 22. To a pre-shaped shape, in this case a spiral shape.
 また、変形部212は、加熱されたとき、形状記憶合金が記憶した形状に復元しようとする性質によって、予め形状付けられた形状に変形する。具体的には、変形部矯正部材22内から押し出されることによって渦巻き状に巻回された形状となっている変形部212は、加熱されることによって、予め形状付けられた形状、この場合には、略直線形状又は緩やかに湾曲した形状へと変化する。第1実施形態では、変形部212は、加熱されることによって、略直線形状又は緩やかに湾曲した形状から、渦巻き状に巻回された形状へと変形する。しかし、第2実施形態では、第1実施形態とは逆に、加熱されることによって、変形部212は、渦巻き状に巻回された形状から、略直線形状又は緩やかに湾曲した形状へと変形する。 Also, when the deforming portion 212 is heated, it is deformed into a pre-shaped shape due to the property of restoring the shape memorized by the shape memory alloy. Specifically, the deformed portion 212 that has been spirally wound by being pushed out of the deformed portion correcting member 22 is heated to be pre-shaped, in this case, It changes to a substantially linear shape or a gently curved shape. In the first embodiment, the deforming portion 212 is deformed from a substantially linear shape or a gently curved shape to a shape wound in a spiral shape by being heated. However, in the second embodiment, contrary to the first embodiment, the deformed portion 212 is deformed from a spirally wound shape to a substantially linear shape or a gently curved shape by being heated. To do.
 被覆部23は、焼灼部210の基端から線材211の基端まで伸びるとともに本体部21の全周を被覆する。被覆部23は、絶縁性を有する。また、被覆部23は、可撓性を有する。被覆部23は、線材211に合わせて曲がる又は撓み、また、変形部212の変形に合わせて変形する。 The covering portion 23 extends from the proximal end of the cauterized portion 210 to the proximal end of the wire 211 and covers the entire circumference of the main body portion 21. The covering portion 23 has an insulating property. Moreover, the coating | coated part 23 has flexibility. The covering portion 23 bends or bends in accordance with the wire 211, and deforms in accordance with the deformation of the deformation portion 212.
 被覆部23を形成する材料は、例えば、ポリエチレンテレフタレート、ポリブチレンテレフタレートのようなポリエステルやそれらをハードセグメントとしたポリエステルエラストマー、ポリエチレン、ポリプロピレンのようなポリオレフィンおよびポリオレフィンエラストマー、メタロセン触媒を用いた共重合体ポリオレフィン、ポリ塩化ビニル、PVDC、PVDFなどのビニル系ポリマー、ナイロンを含むポリアミドおよびポリアミドエラストマー(PAE)、ポリイミド、ポリスチレン、SEBS樹脂、ポリウレタン、ポリウレタンエラストマー、ABS樹脂、アクリル樹脂、ポリアリレート、ポリカーボネート、ポリオキシメチレン(POM)、ポリビニルアルコール(PVA)、フッ素樹脂(ETFE、PFA、PTFE)、エチレン-酢酸ビニルケン化物、エチレン-コポリ-ビニルアルコール、エチレンビニルアセテーテート、カルボキシメチルセルロース、メチルセルロース、セルロースアセテート、ビニルポリスルホン、液晶ポリマー(LCP)、ポリエーテルスルホン(PES)、ポリエーテルエーテルケトン(PEEK)、ポリフェニレンオキサイド(PPO)、ポリフェニレンスルフィド(PPS)等の各種熱可塑性樹脂やその高分子誘導体のほか、加硫ゴム、シリコン樹脂、エポキシ樹脂、二液反応性ポリウレタン樹脂などの熱硬化または架橋性樹脂が挙げられる。更に、上記の熱可塑性樹脂及び熱硬化・架橋性樹脂のうちいずれかを含むポリマーアロイも利用可能であり、成形材料として溶媒に樹脂を溶解した樹脂溶液を用いても良い。 Examples of the material for forming the covering portion 23 include polyesters such as polyethylene terephthalate and polybutylene terephthalate, polyester elastomers using these as hard segments, polyolefins such as polyethylene and polypropylene, polyolefin elastomers, and copolymers using a metallocene catalyst. Polyolefin, polyvinyl chloride, vinyl polymers such as PVDC, PVDF, polyamide and polyamide elastomer (PAE) including nylon, polyimide, polystyrene, SEBS resin, polyurethane, polyurethane elastomer, ABS resin, acrylic resin, polyarylate, polycarbonate, poly Oxymethylene (POM), polyvinyl alcohol (PVA), fluororesin (ETFE, PFA, PTFE), Tylene-vinyl acetate saponified product, ethylene-copoly-vinyl alcohol, ethylene vinyl acetate, carboxymethylcellulose, methylcellulose, cellulose acetate, vinylpolysulfone, liquid crystal polymer (LCP), polyethersulfone (PES), polyetheretherketone (PEEK) In addition to various thermoplastic resins such as polyphenylene oxide (PPO) and polyphenylene sulfide (PPS) and polymer derivatives thereof, thermosetting or crosslinkable resins such as vulcanized rubber, silicone resin, epoxy resin, two-component reactive polyurethane resin, etc. Is mentioned. Furthermore, a polymer alloy containing any one of the above thermoplastic resins and thermosetting / crosslinkable resins can also be used, and a resin solution in which a resin is dissolved in a solvent may be used as a molding material.
 次に、肺気腫によって病変した肺実質を焼灼する場合を例に挙げて、本実施形態の体内組織の焼灼方法について述べる。 Next, taking the case of cauterizing the lung parenchyma affected by emphysema as an example, the body tissue cauterization method of this embodiment will be described.
 概説すると、本実施形態の体内組織の焼灼方法は、焼灼部210及び変形部212を体内に挿入する挿入工程と、挿入工程後、体内組織をかき集めるとともに焼灼する焼灼工程と、を有する。また、本実施形態の体内組織の焼灼方法は、焼灼工程後、本体部21、被覆部23、及び変形部矯正部材22を体内から回収する回収工程を有する。 Briefly, the body tissue cauterization method of the present embodiment includes an insertion process of inserting the cauterization part 210 and the deforming part 212 into the body, and a cauterization process of collecting and cauterizing the body tissue after the insertion process. Further, the body tissue cauterization method of the present embodiment includes a recovery step of recovering the main body 21, the covering portion 23, and the deformed portion correcting member 22 from the body after the cauterization step.
 図7に示すように、挿入工程において、術者は、本体部21を変形部矯正部材22内に挿入した状態で、これらを、口又は鼻等の開口部から気道2を通じて、気腫化して膨らんだ肺実質1の内腔へ挿入する。術者は、X線透視下で変形部212及び焼灼部210の位置を確認して進めるとともに、目的とする肺実質1へ焼灼部210を配置する。 As shown in FIG. 7, in the insertion step, the surgeon converts the body portion 21 into the deformed portion correcting member 22 and emphysemas them through the airway 2 from the opening such as the mouth or nose. Insert into the lumen of the inflated lung parenchyma 1. The surgeon confirms and advances the positions of the deforming portion 212 and the cauterizing portion 210 under fluoroscopy, and places the cauterizing portion 210 on the target lung parenchyma 1.
 図8、図9に示すように、焼灼工程では、変形部212が変形しつつ肺実質1をかき集めるとともに、かき集められた肺実質1を焼灼部210が焼灼する。焼灼工程において、まず、術者は、本体部21に対し変形部矯正部材22を基端側へ引くことによって、変形部212を変形部矯正部材22から押し出す。変形部212の全体が変形部矯正部材22から押し出された後、術者は変形部矯正部材22を引くのを止める。 As shown in FIGS. 8 and 9, in the cauterization process, the deformable portion 212 collects the lung parenchyma 1 while being deformed, and the cauterized portion 210 cauterizes the collected lung parenchyma 1. In the cauterization process, first, the operator pushes the deformed portion 212 from the deformed portion correcting member 22 by pulling the deformed portion correcting member 22 toward the base end side with respect to the main body portion 21. After the entire deformable portion 212 is pushed out from the deformable portion correcting member 22, the operator stops pulling the deformable portion correcting member 22.
 変形部212は、変形部矯正部材22から押し出されると、弾性によって変形を開始し、そして変形部矯正部材22に沿った形状から渦巻き状に巻回された形状へと変形する。変形部212は、気道2とともに肺実質1全体を巻き込むように変形しつつ気道2及び肺実質1をかき集める。変形部212が変形することによって、気腫化して膨らんでいた肺実質1は圧縮され、その結果、体積が減少する。また、変形部212が変形することによって、気道2が押し潰されて閉塞する。 When the deforming portion 212 is pushed out from the deforming portion correcting member 22, the deforming portion 212 starts to deform due to elasticity, and deforms from a shape along the deforming portion correcting member 22 into a spiral shape. The deforming portion 212 collects the airway 2 and the lung parenchyma 1 while being deformed so as to involve the entire lung parenchyma 1 together with the airway 2. Due to the deformation of the deforming portion 212, the lung parenchyma 1 that has become emphysematous and inflated is compressed, and as a result, the volume decreases. Moreover, when the deformation | transformation part 212 deform | transforms, the airway 2 is crushed and obstruct | occluded.
 変形部212の変形が完了した後、術者は、電源部24から焼灼部210へ電気エネルギーを供給する。焼灼部210は、電源部24からのエネルギーを受けて発熱する。焼灼部210は、体積の減少した肺実質1に接触し、そしてこれに熱を加えることによって焼灼する。肺実質1の体積が減少しているため、肺実質1内の焼灼部210から肺実質1の全体へと熱が伝わり易い。また、焼灼部210の熱は、肺実質1のまわりで変形部212によって変形させられている気道2へも伝わる。この熱によって、肺実質1のまわりの変形した気道2も焼灼され、その結果、変形した状態で凝固壊死する。病変部が壊死するのに十分な熱量が焼灼部210から肺実質1へ供給された後、術者は電源部24から焼灼部210へのエネルギーの供給を停止する。 After the deformation of the deforming portion 212 is completed, the surgeon supplies electric energy from the power source portion 24 to the cauterizing portion 210. The cautery unit 210 receives heat from the power supply unit 24 and generates heat. The cautery unit 210 contacts the reduced volume lung parenchyma 1 and cauterizes it by applying heat thereto. Since the volume of the lung parenchyma 1 is reduced, heat is easily transmitted from the cauterized portion 210 in the lung parenchyma 1 to the entire lung parenchyma 1. The heat of the cautery unit 210 is also transmitted to the airway 2 that is deformed around the lung parenchyma 1 by the deforming unit 212. Due to this heat, the deformed airway 2 around the lung parenchyma 1 is also cauterized, resulting in coagulative necrosis in the deformed state. After a sufficient amount of heat is supplied from the ablation unit 210 to the lung parenchyma 1 to cause necrosis of the lesion, the operator stops supplying energy from the power source unit 24 to the ablation unit 210.
 図10に示すように、回収工程では、まず、術者は、電源部24から電気エネルギーを供給することによって加熱部221を加熱しつつ、加熱部221の中を変形部212が通るように被覆部23とともに本体部21を変形部矯正部材22内に回収する。その後、術者は、被覆部23及び本体部21を変形部矯正部材22内に回収した状態で、これらを肺の内部から体外へと抜去して回収する。 As shown in FIG. 10, in the recovery process, first, the operator covers the heating part 221 so that the deformation part 212 passes through while heating the heating part 221 by supplying electric energy from the power supply part 24. The main body 21 is collected in the deformed portion correcting member 22 together with the portion 23. Thereafter, the surgeon removes the covering portion 23 and the main body portion 21 from the inside of the lungs and collects them in a state where the covering portion 23 and the main body portion 21 are recovered in the deformable portion correcting member 22.
 変形部212が加熱部221を通過して変形部矯正部材22内に引き込まれるとき、加熱部221が変形部212を加熱する。このため、変形部212は、形状記憶合金が記憶した形状に復元しようとする性質によって、渦巻き状に巻回された形状から、略直線形状又は緩やかに湾曲した形状へと変化しつつ変形部矯正部材22内に引き込まれる。 When the deformation part 212 passes through the heating part 221 and is drawn into the deformation part correcting member 22, the heating part 221 heats the deformation part 212. For this reason, the deforming portion 212 is corrected to the deformed portion while changing from a spirally wound shape to a substantially linear shape or a gently curved shape due to the property of restoring the shape memorized by the shape memory alloy. It is drawn into the member 22.
 本実施形態の作用効果を述べる。 The effect of this embodiment will be described.
 本実施形態の体内組織焼灼システム20及び体内組織の焼灼方法によれば、肺実質1がかき集められて焼灼されることによって、肺実質1の広い範囲が一度に焼灼されるため、肺実質1を効率良く焼灼できる。 According to the body tissue ablation system 20 and the body tissue ablation method of the present embodiment, since the lung parenchyma 1 is collected and cauterized, a wide range of the lung parenchyma 1 is cauterized at a time. Can be cauterized efficiently.
 また、気腫化して膨らんでいた肺実質1が、かき集められることによって圧縮されるため、正常な肺実質への圧迫が抑制され、その結果、肺の機能が改善する。 Moreover, since the lung parenchyma 1 that has been emphysematous and swollen is compressed by being collected, compression on the normal lung parenchyma is suppressed, and as a result, the function of the lung is improved.
 また、圧縮された肺実質1が焼灼によって凝固するため、肺実質1が元の膨らんだ状態に戻り難い。従って、改善した肺の機能が良好に維持される。 Also, since the compressed lung parenchyma 1 is solidified by cauterization, it is difficult for the lung parenchyma 1 to return to its original swollen state. Thus, improved lung function is well maintained.
 また、焼灼部210が病変した肺実質1を焼灼して壊死させるため、病変部の正常部への伝播が抑制される。従って、改善した肺の機能が良好に維持される。 Moreover, since the lung parenchyma 1 in which the cautery part 210 is lesioned is cauterized and necrotic, the propagation of the lesion part to the normal part is suppressed. Thus, improved lung function is well maintained.
 また、変形部212が変形して気道2を閉塞させるとともに、焼灼部210による加熱によって気道2が閉塞した状態で凝固するため、圧縮した肺実質1へのガスの流入が防止され、その結果、肺実質1が元の膨らんだ状態に戻り難い。従って、改善した肺の機能が良好に維持される。 In addition, since the deformed portion 212 is deformed to block the airway 2 and coagulates in a state where the airway 2 is closed by heating by the cautery unit 210, inflow of gas to the compressed lung parenchyma 1 is prevented, and as a result, It is difficult for the lung parenchyma 1 to return to the original inflated state. Thus, improved lung function is well maintained.
 また、変形部212が形状記憶合金により形成されていることによって奏される効果は、第1実施形態と同様であるため、ここでの重複する説明は省略する。また、焼灼部210がコイル状の金属部材からなり、また本体部21の先端に固着されていることによって奏される効果は、第1実施形態と同様であるため、ここでの重複する説明は省略する。 Further, since the effect exerted by the deformable portion 212 being formed of the shape memory alloy is the same as that of the first embodiment, the overlapping description here is omitted. In addition, since the effect produced by the cauterized part 210 being made of a coil-shaped metal member and being fixed to the tip of the main body part 21 is the same as that of the first embodiment, the overlapping explanation here is as follows. Omitted.
 また、変形部212が焼灼部210の基端側に配置されており、そのため変形部212の変形が焼灼部210によって阻害され難いので、変形部212が予め形状付けられた形状に変形し易い。 Also, the deforming portion 212 is arranged on the proximal end side of the cauterizing portion 210, and therefore the deformation of the deforming portion 212 is not easily disturbed by the cauterizing portion 210, so that the deforming portion 212 is easily deformed into a pre-shaped shape.
 また、変形部212が変形部矯正部材22から押し出されると、変形部212が自身の弾性によって変形を開始するため、変形部212を変形させるために電気等を使用する必要がなく、従って簡単な構成によって変形部212を変形させることができる。 Further, when the deforming portion 212 is pushed out from the deforming portion correcting member 22, the deforming portion 212 starts to deform due to its own elasticity, so that it is not necessary to use electricity or the like to deform the deforming portion 212, and thus simple. The deformation unit 212 can be deformed depending on the configuration.
 また、変形部212は、加熱部221が加熱した状態で変形部矯正部材22内に引きこまれることにより略直線形状又は緩やかに湾曲した形状になるため、渦巻き状に巻回された変形部212のくせが除去され、その結果、本体部21を円滑に変形部矯正部材22内に引き込める。また、変形部212のくせが除去されるので、変形部212が回収されるときの変形部212と肺実質1との摩擦、及び変形部212と気道2との摩擦が抑制される。従って、本体部21の回収によって、変形した肺実質1及び気道2が元の状態に戻り難い。 Moreover, since the deformation | transformation part 212 becomes a substantially linear shape or a gently curved shape by being drawn in in the deformation | transformation part correction member 22 in the state which the heating part 221 heated, the deformation | transformation part 212 wound by the spiral shape is carried out. As a result, the main body 21 is smoothly retracted into the deformed portion correcting member 22. Further, since the habit of the deforming portion 212 is removed, friction between the deforming portion 212 and the lung parenchyma 1 and the friction between the deforming portion 212 and the airway 2 when the deforming portion 212 is recovered are suppressed. Therefore, it is difficult for the deformed lung parenchyma 1 and airway 2 to return to the original state due to the recovery of the main body 21.
 本発明は、上述した実施形態に限定されるものではなく、特許請求の範囲の範囲内で種々改変できる。 The present invention is not limited to the embodiment described above, and can be variously modified within the scope of the claims.
 例えば、変形部は、変形することによって体内組織をかき集めるものであれば、どのように変形してもよい。従って、上記実施形態のように、渦巻き状に巻回されるように変形するものに限定されない。例えば、変形部は、S字状又はU字状に変形するものであってもよい。 For example, the deforming portion may be deformed in any way as long as it collects the body tissue by being deformed. Therefore, it is not limited to what deform | transforms so that it may be wound spirally like the said embodiment. For example, the deforming portion may be deformed into an S shape or a U shape.
 また、上記実施形態では、体内組織焼灼システムを肺気腫の治療に適用した例を説明したが、本発明はこれに限定されない。例えば、体内組織焼灼システムを胃前庭部毛細血管拡張症(GAVE),門脈圧高進症性胃疾患(PHG),放射線誘発性のプロクトパシー及び結腸疾患,動静脈の奇形および血管の異形成で起こるような、慢性的に出血する障害を根絶するための治療に適用してもよい。この場合、体内組織は、消化管である。 In the above embodiment, an example in which the body tissue ablation system is applied to the treatment of emphysema has been described, but the present invention is not limited to this. For example, body tissue ablation systems can be used for gastric vestibular telangiectasia (GAVE), portal hypertension gastric disease (PHG), radiation-induced proctopathies and colon diseases, arteriovenous malformations and vascular dysplasia. It may be applied to the treatment to eradicate chronic bleeding disorders that occur. In this case, the body tissue is the digestive tract.
 また、上記実施形態では、焼灼部が高温に加熱されるとともに体内組織に接触することによってこれを焼灼するが、本発明はこれに限定されない。例えば、焼灼部は、電源部からの電気エネルギーを受けてマイクロ波を体内組織に向かって放射することによって、非接触で体内組織を焼灼するものであってもよい。 In the above-described embodiment, the cautery part is heated to a high temperature and brought into contact with the body tissue, but the present invention is not limited to this. For example, the cauterization unit may receive the electric energy from the power supply unit and radiate microwaves toward the body tissue to cauterize the body tissue in a non-contact manner.
 さらに、本出願は、2012年1月12日に出願された日本特許出願番号2012-004203号に基づいており、それらの開示内容は、参照され、全体として、組み入れられている。 Furthermore, this application is based on Japanese Patent Application No. 2012-004203 filed on January 12, 2012, the disclosures of which are referenced and incorporated as a whole.
1  肺実質(体内組織)、
2  気道(体内組織)、
10、20  体内組織焼灼システム、
11、21  本体部、
12  先端側線材、
13  基端側線材、
14、23  被覆部、
15、24  電源部、
120、210  焼灼部、
122、212  変形部、
130  分離手段、
22  変形部矯正部材、
221  加熱部、
222  通電部材。
1 lung parenchyma (body tissue),
2 airways (tissues),
10, 20 Tissue ablation system,
11, 21 body part,
12 Tip side wire,
13 Base end side wire,
14, 23 Covering part,
15, 24 power supply unit,
120, 210 Shochu part,
122, 212 deformation part,
130 separation means,
22 deformation part correction member,
221 heating section,
222 Current-carrying member.

Claims (10)

  1.  長尺状の部材であって、先端側に予め形状付けられた形状に変形する変形部と体内組織を焼灼するための焼灼部とを有する本体部と、
     前記本体部の基端側全周を被覆する非導電性部材からなる被覆部と、
     前記本体部に接続され前記焼灼部にエネルギーを供給するための電源部と、を有し、
     前記変形部は変形することにより前記体内組織をかき集め、前記焼灼部は該かき集められた体内組織を焼灼する、ことを特徴とした体内組織焼灼システム。
    A main body having an elongated member and having a deformed portion deformed into a shape pre-shaped on the distal end side and a cauterized portion for cauterizing the body tissue;
    A covering portion made of a non-conductive member covering the entire circumference of the base end side of the main body portion;
    A power supply unit connected to the main body unit for supplying energy to the cautery unit,
    A body tissue ablation system, wherein the deformable portion deforms to collect the body tissue and the cauterization portion cauterizes the collected body tissue.
  2.  前記変形部は形状記憶合金からなることを特徴とする請求項1に記載の体内組織焼灼システム。 The body tissue ablation system according to claim 1, wherein the deformable portion is made of a shape memory alloy.
  3.  前記焼灼部はコイル状の金属部材からなり、前記本体部の先端に固着されていることを特徴とする請求項1または2に記載の体内組織焼灼システム。 The body tissue ablation system according to claim 1 or 2, wherein the ablation part is made of a coiled metal member and is fixed to the tip of the main body part.
  4.  前記焼灼部は前記変形部上を被覆していることを特徴とする請求項1ないし3のうちのいずれか1つに記載の体内組織焼灼システム。 4. The body tissue ablation system according to any one of claims 1 to 3, wherein the ablation part covers the deformation part.
  5.  前記本体部は先端側線材と先端側線材よりも剛性の高い基端側線材とを有し、前記先端側線材を分離するための分離手段を有することを特徴とする請求項1ないし4のうちのいずれか1つに記載の体内組織焼灼システム。 The said main-body part has a proximal end side wire with higher rigidity than a front end side wire and a front end side wire, and has the isolation | separation means for isolate | separating the said front end side wire. The body tissue ablation system according to any one of the above.
  6.  前記電源部から前記焼灼部にエネルギーを供給し、前記焼灼部が加熱されることで前記変形部が変形することを特徴とする請求項1ないし5のうちのいずれか1つに記載の体内組織焼灼システム。 The body tissue according to any one of claims 1 to 5, wherein the deformable portion is deformed by supplying energy from the power source to the cauterized portion and heating the cauterized portion. Shochu system.
  7.  前記変形部は前記焼灼部の基端側に配置されていることを特徴とする請求項1ないし3のうちのいずれか1つに記載の体内組織焼灼システム。 The body tissue ablation system according to any one of claims 1 to 3, wherein the deformable portion is disposed on a proximal end side of the ablation portion.
  8.  前記体内組織焼灼システムは更に長尺状の変形部矯正部材を有し、前記変形部は該変形部矯正部材から押し出されることにより、変形を開始することを特徴とする請求項7に記載の体内組織焼灼システム。 The body tissue ablation system further includes an elongated deformed portion correcting member, and the deformed portion starts to be deformed by being pushed out of the deformed portion correcting member. Tissue ablation system.
  9.  前記変形部矯正部材は加熱部と、該加熱部と前記電源部とを通電する通電部材とを有し、前記変形部は前記加熱部が加熱した状態で前記変形部矯正部材内に引きこまれることにより直線状になることを特徴とする請求項7または8に記載の体内組織焼灼システム。 The deformable portion correcting member includes a heating portion and an energizing member that energizes the heating portion and the power supply portion, and the deformable portion is drawn into the deformable portion correcting member while the heating portion is heated. The body tissue ablation system according to claim 7 or 8, wherein the body tissue ablation system is linear.
  10.  前記体内組織焼灼システムは、肺の気腫化した領域の体積を減少させ、さらに焼灼することを特徴とする請求項1ないし9のうちのいずれか1つに記載の肺組織焼灼システム。 The lung tissue ablation system according to any one of claims 1 to 9, wherein the body tissue ablation system reduces the volume of an emphysematous region of the lung and further cauterizes.
PCT/JP2013/050035 2012-01-12 2013-01-07 Body tissue cauterizing system WO2013105528A1 (en)

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