WO2019187238A1 - Dispositif d'ablation - Google Patents

Dispositif d'ablation Download PDF

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Publication number
WO2019187238A1
WO2019187238A1 PCT/JP2018/036227 JP2018036227W WO2019187238A1 WO 2019187238 A1 WO2019187238 A1 WO 2019187238A1 JP 2018036227 W JP2018036227 W JP 2018036227W WO 2019187238 A1 WO2019187238 A1 WO 2019187238A1
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WO
WIPO (PCT)
Prior art keywords
electrode needle
ablation
temperature
region
temperature measuring
Prior art date
Application number
PCT/JP2018/036227
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English (en)
Japanese (ja)
Inventor
謙二 森
祐貴 児玉
Original Assignee
日本ライフライン株式会社
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by 日本ライフライン株式会社 filed Critical 日本ライフライン株式会社
Priority to KR1020207018381A priority Critical patent/KR20200092356A/ko
Priority to CN201880083251.7A priority patent/CN111511304A/zh
Publication of WO2019187238A1 publication Critical patent/WO2019187238A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1477—Needle-like probes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01K—MEASURING TEMPERATURE; MEASURING QUANTITY OF HEAT; THERMALLY-SENSITIVE ELEMENTS NOT OTHERWISE PROVIDED FOR
    • G01K1/00—Details of thermometers not specially adapted for particular types of thermometer
    • G01K1/16—Special arrangements for conducting heat from the object to the sensitive element
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00059—Material properties
    • A61B2018/00089—Thermal conductivity
    • A61B2018/00095—Thermal conductivity high, i.e. heat conducting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00595—Cauterization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00636—Sensing and controlling the application of energy
    • A61B2018/00773—Sensed parameters
    • A61B2018/00791—Temperature
    • A61B2018/00797—Temperature measured by multiple temperature sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical 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
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1425—Needle

Definitions

  • the present invention relates to an ablation device provided with an electrode needle that is percutaneously punctured to an affected part in the body.
  • An ablation system that performs ablation (cauterization) on such an affected part has been proposed as one of medical devices for treating an affected part in a patient (for example, an affected part having a tumor such as cancer) (for example, Patent Document 1).
  • This ablation system includes an ablation device having an electrode needle that is punctured percutaneously into an affected part in the body, and a power supply device that supplies electric power for performing the ablation on the affected part.
  • the above-described ablation devices are generally required to improve convenience when used, for example. Therefore, it is desirable to provide an ablation device that can improve convenience.
  • An ablation device includes an electrode needle that is punctured percutaneously into an affected part of the body and that is supplied with electric power for ablation, and is formed inside the electrode needle.
  • a handle attached to the proximal end side of the electrode needle.
  • the first temperature measurement element disposed in the flow path through which the cooling liquid flows and the vicinity of the tip of the electrode needle are disposed inside the electrode needle.
  • a second temperature measuring element Accordingly, when the ablation is performed with the electrode needle percutaneously punctured on the affected part, the temperature of the cooling liquid is measured by the first temperature measuring element, and the first The temperature of the affected area is measured by the two temperature measuring elements. That is, during the ablation, both the temperature of the cooling liquid and the temperature of the affected part can be measured simultaneously (in parallel).
  • a sealing member may be further provided to separate the arrangement region of the second temperature measurement element and the flow path inside the electrode needle.
  • the second temperature measurement element is disposed in a region formed near the tip in the electrode needle, and at least the above-described region is formed in the region.
  • a heat conductive material is embedded and sealed in the vicinity of the arrangement region of the second temperature measurement element, and the vicinity of the tip inside the electrode needle and the arrangement region of the second temperature measurement element above are arranged in the heat You may make it join by a conductive material. In such a case, the temperature difference between the vicinity of the affected area and the second temperature measuring element is reduced, so that the temperature measurement accuracy of the affected area by the second temperature measuring element is improved. As a result, the convenience when using the ablation device is further improved.
  • the region may communicate with the outside of the electrode needle.
  • the temperature measurement accuracy of the affected part by the second temperature measurement element is further improved. As a result, the convenience when using the ablation device is further improved.
  • the first temperature measurement element and the second temperature measurement element are provided inside the electrode needle. Both the temperature of the cooling liquid and the temperature of the affected area can be measured simultaneously. Therefore, convenience when using the ablation device can be improved.
  • FIG. 3 is a schematic cross-sectional view illustrating an example of an internal configuration on a distal end side of the electrode needle illustrated in FIG. 2. It is a schematic diagram showing an example of the cauterization condition in the affected part by ablation. It is a model side view showing an example of the slide operation
  • FIG. 1 schematically shows a block diagram of an overall configuration example of an ablation system 5 including an ablation device (ablation device 1) according to an embodiment of the present invention.
  • the ablation system 5 is a system used when treating an affected part 90 in the body of a patient 9, and performs predetermined ablation (cauterization) on the affected part 90. It has become.
  • the above-mentioned affected part 90 includes, for example, an affected part having a tumor such as cancer (liver cancer, lung cancer, breast cancer, kidney cancer, thyroid cancer, etc.).
  • a tumor such as cancer (liver cancer, lung cancer, breast cancer, kidney cancer, thyroid cancer, etc.).
  • the ablation system 5 includes an ablation device 1, a liquid supply device 2, and a power supply device 3 as shown in FIG.
  • the counter electrode plate 4 shown in FIG. 1 is also used as appropriate.
  • the ablation device 1 is a device used in the above-described ablation, and includes an electrode needle 11 and an insulating tube 12 as will be described in detail later.
  • the electrode needle 11 is a needle that is punctured percutaneously into the affected part 90 in the body of the patient 9, for example, as indicated by an arrow P1 in FIG.
  • the liquid L supplied from the liquid supply apparatus 2 to be described later circulates in the electrode needle 11 (see FIG. 1).
  • the insulating tube 12 is a member that covers the periphery of the electrode needle 11 along the axial direction of the electrode needle 11 while exposing an electrode region (exposed region Ae described later) located on the distal end side of the electrode needle 11. .
  • the liquid supply apparatus 2 is an apparatus that supplies the cooling liquid L to the ablation device 1 (inside the electrode needle 11), and has a liquid supply section 21, for example, as shown in FIG.
  • Examples of the cooling liquid L include sterilized water and sterilized physiological saline.
  • the liquid supply unit 21 supplies the liquid L to the ablation device 1 as needed according to control by a control signal CTL2 described later. Specifically, for example, as shown in FIG. 1, the liquid supply unit 21 circulates the liquid L between the inside of the liquid supply device 2 and the inside of the electrode needle 11 (in a predetermined flow path 110 described later). In this way, the liquid L supply operation is performed. Further, according to the control by the control signal CTL2, the liquid L supply operation is executed or stopped.
  • a liquid supply part 21 is comprised including the liquid pump etc., for example.
  • the power supply device 3 supplies power Pout (for example, power of radio frequency (RF)) for performing ablation between the electrode needle 11 and the counter electrode plate 4 and the liquid L in the liquid supply device 2 described above. It is a device for controlling the supply operation. As shown in FIG. 1, the power supply device 3 includes an input unit 31, a power supply unit 32, a control unit 33, and a display unit 34.
  • Pout for example, power of radio frequency (RF)
  • RF radio frequency
  • the input unit 31 is a part for inputting various set values and an instruction signal (operation signal Sm) for instructing a predetermined operation to be described later.
  • Such an operation signal Sm is input from the input unit 31 in response to an operation by an operator (for example, an engineer) of the power supply device 3.
  • these various setting values are not input in response to an operation by the operator, but may be set in the power supply device 3 in advance, for example, when the product is shipped.
  • the set value input by the input unit 31 is supplied to the control unit 33 described later.
  • Such an input unit 31 is configured using, for example, a predetermined dial, button, touch panel, or the like.
  • the power supply unit 32 is a part that supplies the power Pout described above between the electrode needle 11 and the counter electrode plate 4 in accordance with a control signal CTL1 described later.
  • a power supply part 32 is comprised using the predetermined power supply circuit (for example, switching regulator etc.).
  • the predetermined power supply circuit for example, switching regulator etc.
  • the frequency is, for example, about 450 kHz to 550 kHz (for example, 500 kHz).
  • the control unit 33 is a part that controls the entire power supply device 3 and performs predetermined arithmetic processing, and is configured using, for example, a microcomputer. Specifically, the control unit 33 first has a function (power supply control function) of controlling the supply operation of the power Pout in the power supply unit 32 using the control signal CTL1. In addition, the control unit 33 has a function (liquid supply control function) for controlling the supply operation of the liquid L in the liquid supply device 2 (liquid supply unit 21) using the control signal CTL2.
  • temperature information It1, It2 measured by the ablation device 1 is supplied to the control unit 33 as needed. It has become.
  • the measurement value of the impedance value Zm is supplied to the control unit 33 from the power supply unit 32 as needed.
  • the display unit 34 is a part (monitor) that displays various types of information and outputs the information to the outside. Examples of information to be displayed include the above-described various set values input from the input unit 31, various parameters supplied from the control unit 33, temperature information It1, It2 supplied from the ablation device 1, and the like. . However, the information to be displayed is not limited to these information, and other information may be displayed instead of or in addition to other information.
  • a display part 34 is comprised using the display (For example, a liquid crystal display, a CRT (Cathode * Ray * Tube) display, an organic EL (Electro * Luminescence) display, etc.) by various systems.
  • the counter electrode plate 4 is used while being attached to the body surface of the patient 9 during ablation. Although details will be described later, during ablation, high-frequency energization is performed (electric power Pout is supplied) between the electrode needle 11 (the electrode region described above) and the counter electrode plate 4 in the ablation device 1. ing. Although details will be described later, during such ablation, as shown in FIG. 1, the impedance value Zm between the electrode needle 11 and the counter electrode plate 4 is measured as needed, and the measured impedance value Zm is In the power supply device 3, power is supplied from the power supply unit 32 to the control unit 33.
  • FIG. 2 schematically shows a detailed configuration example of the ablation device 1 shown in FIG. 1 in a side view (YZ side view).
  • FIG. 3 is a schematic cross-sectional view (YZ cross-sectional view) showing an example of the internal configuration of the distal end side of the electrode needle 11 shown in FIG.
  • the portion indicated by the symbol P ⁇ b> 2 is enlarged and shown below in FIG. 2 as indicated by arrows.
  • the electrode needle 11 is provided along the Z-axis direction as shown in FIGS. 2 and 3, and the length (axial length) along the Z-axis direction is, for example, about 30 mm to 350 mm. .
  • the electrode needle 11 has, along its axial direction (Z-axis direction), an exposed region Ae (electrode region that functions as an electrode during ablation) that is not covered with the insulating tube 12, and an insulating tube. 12 and the area
  • the electric power Pout for ablation is supplied between the exposed area Ae of the electrode needle 11 and the counter electrode plate 4.
  • hook 11 is comprised by metal materials, such as stainless steel, nickel titanium alloy, a titanium alloy, platinum, for example.
  • the internal configuration on the tip side of the electrode needle 11 is as follows. That is, the channel 110, the inner tube 111, the regions (holes) 112a and 112b, the heat conductive material 113, the sealing member 114, and the temperature measuring elements 115a and 115b are provided inside the electrode needle 11.
  • the flow path 110 is formed inside the electrode needle 11 along the axial direction (Z-axis direction) of the electrode needle, and is a flow path through which the cooling liquid L described above flows. Specifically, for example, as indicated by the dashed arrows in FIG. 3, the cooling liquid L circulates inside the electrode needle 11 in the channel 110.
  • the flow path 110 includes a flow path serving as a forward path for the cooling liquid L (flow path when flowing from the proximal end side to the distal end side of the electrode needle 11) and a flow path serving as a return path (electrodes). A flow path when flowing from the distal end side of the needle 11 to the proximal end side).
  • the inner tube 111 is provided in the flow path 110 along the axial direction of the electrode needle (Z-axis direction).
  • the inner pipe 111 constitutes a flow path serving as the above-described forward path for the cooling liquid L.
  • Each of the regions 112a and 112b is formed in the vicinity of the tip inside the electrode needle 11, and extends along the axial direction (Z-axis direction) of the electrode needle. As shown in FIG. 3, the region 112b is formed in the vicinity of the most distal end inside the electrode needle 11, and communicates with the outside on the tip side of the electrode needle 11 and the region 112a. The region 112a is formed on the proximal end side of the electrode needle 11 with respect to the region 112b, and communicates with the region 112b as described above.
  • the heat conductive material 113 is embedded in the above-described regions 112a and 112b at least in the vicinity of a region where a temperature measuring element 115b described later is disposed. Specifically, in this example, as shown in FIG. 3, among these regions 112 a and 112 b, the heat conductive material 113 is embedded in the region 112 b (nearest tip in the electrode needle 11). . As a result, the region 112b is sealed (the hole corresponding to the region 112b is closed), and the vicinity of the tip inside the electrode needle 11 and the region where the temperature measuring element 115b described later is disposed are thermally conductive. It will be joined by the material 113.
  • the heat conductive material 113 may be embedded in both the regions 112a and 112b.
  • a heat conductive material 113 is made of a material having high heat conductivity, such as solder (solder) or brazing material.
  • the sealing member 114 includes an arrangement region of a temperature measurement element 115 b described later (in this example, a region on the side of the regions 112 a and 112 b) and the flow channel 110 inside the electrode needle 11. It is a separating member. In other words, the sealing member 114 seals (prevents) the cooling liquid L flowing through the flow path 110 from flowing into the regions 112a and 112b.
  • a sealing member 114 is disposed in the vicinity of the tip of the flow path 110.
  • a thermosetting resin such as an epoxy resin, a urethane resin, a silicone resin, or a phenol resin, or a metal such as solder or brazing material. It is composed of materials.
  • the temperature measuring element 115a is disposed in the flow path 110 as shown in FIG. Specifically, in this example, the temperature measuring element 115a is disposed in the inner tube 111 that constitutes the above-described forward flow path.
  • the temperature measuring element 115a is an element for measuring the temperature of the cooling liquid L flowing in the flow path 110. In this example, the temperature at the time of flowing in the electrode needle 11 from the proximal end side to the distal end side is measured. It is supposed to be.
  • the temperature measuring element 115b is disposed in the vicinity of the tip of the electrode needle 11 inside the electrode needle 11, as shown in FIG. Specifically, in this example, the temperature measuring element 115b is disposed in the above-described region 112b (near the forefront in the electrode needle 11).
  • the temperature measuring element 115b is an element that measures the temperature (tissue temperature) of the affected area 90 during the ablation described above.
  • the distance from the flow path 110 to the temperature measuring element 115b is too short, the temperature measuring element 115b is cooled by the cooling liquid L, and the temperature measuring element 115b There is a possibility that the temperature measurement accuracy of the affected part 90 may be lowered.
  • the distance from the flow path 110 to the temperature measuring element 115b is too long, the cooling effect by the liquid L becomes insufficient during ablation, resulting in rapid carbonization of the affected area 90. As a result, the ablation range may be reduced.
  • the distance from the flow path 110 to the temperature measurement element 115b is, for example, about 0 mm to 10 mm, and preferably about 0.2 mm to 1.0 mm.
  • each of such temperature measuring elements 115a and 115b is configured using, for example, a thermocouple.
  • the temperature information It1 (information indicating the temperature of the cooling liquid L) is output from the temperature measuring element 115a
  • the temperature information It2 (information indicating the temperature of the affected area 90) is output from the temperature measuring element 115b. ) Is output.
  • the temperature measuring element 115a corresponds to a specific example of “first temperature measuring element” in the present invention.
  • the temperature measuring element 115b corresponds to a specific example of “second temperature measuring element” in the present invention.
  • the insulating tube 12 is a member that covers the periphery of the electrode needle 11 along the Z-axis direction while partially exposing the distal end side (exposed region Ae) of the electrode needle 11.
  • the insulating tube 12 is attached to the electrode needle 11 along its axial direction (Z-axis direction), for example, as indicated by an arrow d2 in FIG.
  • Z-axis direction Z-axis direction
  • it is configured to be relatively slidable. Thereby, the length (axial direction length) along the Z-axis direction in the exposed region Ae of the electrode needle 11 can be adjusted.
  • the length (axial direction length) along the Z-axis direction in the exposed region Ae of the electrode needle 11 that can be adjusted by such an insulating tube 12 is, for example, about 3 mm to 50 mm.
  • the insulating tube 12 is made of, for example, a synthetic resin such as PEEK (polyether ether ketone), PI (polyimide), fluorine resin, or polyether block amide.
  • the handle 13 is a portion that is gripped (gripped) by an operator (doctor) when the ablation device 1 is used.
  • the handle 13 mainly includes a handle main body (handle member) 130 attached to the proximal end side of the electrode needle 11 and an operation unit 131.
  • the handle body 130 corresponds to a portion (gripping portion) that is actually gripped by the operator, and is a portion that also functions as an exterior of the handle 13.
  • the handle body 130 is made of synthetic resin such as polycarbonate, acrylonitrile-butadiene-styrene copolymer (ABS), acrylic, polyolefin, polyoxymethylene, and the like.
  • the operation part 131 is a part used for a predetermined operation (slide operation) for causing the insulating tube 12 to slide relative to the electrode needle 11 along the axial direction (Z-axis direction). Yes, and protrudes outside the handle body 130 (in the Y-axis direction).
  • the operation unit 131 is made of, for example, the same material (synthetic resin or the like) as the handle body 130 described above.
  • the operation unit 131 is configured to be slidable relative to the handle main body 130 along the axial direction (Z-axis direction) of the handle 13.
  • the insulating tube 12 moves along the Z-axis direction with respect to the electrode needle 11.
  • the sliding movement is relatively performed (see, for example, the arrow d2 in FIG. 2).
  • the length (axial direction length) along the Z-axis direction in the exposed region Ae of the electrode needle 11 can be adjusted.
  • the liquid supply device 2 is circulated so that the cooling liquid L circulates between the inside of the liquid supply device 2 and the inside of the electrode needle 11 (inside the flow path 110 described above).
  • the liquid L is supplied from the (liquid supply part 21) to the electrode needle 11 (see FIG. 1).
  • a cooling operation (cooling) is performed on the electrode needle 11 during ablation, and as a result, an excessive increase in the temperature (tissue temperature) of the affected area 90 is suppressed, and the impedance described above due to tissue carbonization. A sudden increase in the value Zm is prevented.
  • the temperature of the affected area 90 (cauterization temperature) during the execution of such ablation is usually 40 to 100 ° C., preferably 50 to 80 ° C.
  • the ablation temperature is usually 40 to 100 ° C., preferably 50 to 80 ° C.
  • the ablation temperature is too low, the affected part 90 cannot be reliably heat-coagulated.
  • the ablation temperature is too high, tissue carbonization occurs in the affected area 90, and the impedance value Zm rapidly increases, making it difficult for current to flow. As a result, the ablation range may be reduced.
  • FIG. 4 schematically shows an example of the condition of cauterization in the affected area 90 due to such ablation.
  • the initial rugby ball-shaped (elliptical spherical) thermal coagulation region Ah1 gradually expands.
  • a substantially spherical thermocoagulation region Ah2 is obtained (see the broken arrow in FIG. 3).
  • isotropic ablation of the entire affected area 90 is performed, and as a result, effective treatment of the affected area 90 is performed.
  • the above-described slide operation on the operation unit 131 is performed on the handle 13 of the ablation device 1. Done in advance. Specifically, when a slide operation along the Z-axis direction is performed on the operation unit 131 (see, for example, the arrow d1 in FIGS. 2 and 5B), the operation unit 131 is interlocked with the slide operation of the operation unit 131. Thus, the slide mechanism 132 in the handle main body 130 performs a slide operation along the Z-axis direction (see FIGS. 5A and 5B).
  • the insulating tube 12 In conjunction with the slide operation of the slide mechanism 132, the insulating tube 12 also performs a slide operation along the Z-axis direction (see, for example, the arrow d2 in FIGS. 2 and 5B).
  • the size (length along the Z-axis direction) of the exposed area Ae on the distal end side of the electrode needle 11 is arbitrarily adjusted,
  • the ablation range at the time of ablation is also arbitrarily adjusted.
  • the exposed area Ae (ablation range) is set small, and the tip of the electrode needle 11 is inserted to the affected area 90 to perform ablation.
  • the exposed area Ae cauterized selectively. That is, parts other than the affected part 90 are not cauterized, and the original function can be maintained.
  • the exposed area Ae cauterized together (collectively).
  • the slide operation on the operation unit 131 and the slide operation of the slide mechanism 132 and the insulating tube 12 in conjunction with the slide operation are stepwise along the axial direction (Z-axis direction) of the electrode needle 11. It may be adjustable (intermittently). In other words, the position when the operation unit 131, the slide mechanism 132, and the insulating tube 12 slide may be slightly fixed for each predetermined distance along the Z-axis direction.
  • the ablation device according to the comparative example for example, the following configuration can be considered. That is, the ablation device of this comparative example is the same as the ablation device 1 of the present embodiment shown in FIGS. 2 and 3, but one (one type) temperature measuring element (cooling liquid) is provided inside the electrode needle 11. This corresponds to a device in which only an element for measuring the temperature of L) is provided.
  • the ablation device of this comparative example at the time of ablation, only the temperature of the cooling liquid L is measured as described above, and the temperature (tissue temperature) of the affected part 90 is not measured.
  • the temperature of the cooling liquid L at the time of ablation of this comparative example, it is impossible to measure both the temperature of the cooling liquid L and the temperature of the affected part 90 simultaneously (in parallel). Therefore, it is difficult to perform effective ablation because the tissue temperature cannot be grasped during the ablation.
  • the ablation device of the comparative example when used, it is difficult to effectively perform the ablation. As a result, the convenience in using the ablation device may be impaired.
  • the ablation device 1 of the present embodiment as shown in FIG. 3, unlike the ablation device of the comparative example, the following two types of temperature measuring elements 115a and 115b are placed inside the electrode needle 11. Is provided. That is, inside the electrode needle 11 in the ablation device 1, there are a temperature measuring element 115 a disposed in the flow path 110 through which the cooling liquid L flows, and a temperature measuring element 115 b disposed near the tip of the electrode needle 11. And are provided.
  • the ablation device 1 of the present embodiment is as follows, unlike the ablation device of the comparative example described above.
  • the temperature of the cooling liquid L is measured by the temperature measuring element 115a, and the temperature measuring element 115b.
  • the temperature (tissue temperature) of the affected area 90 is measured. That is, unlike the ablation of the comparative example described above, both the temperature of the cooling liquid L and the temperature of the affected part 90 can be measured simultaneously (in parallel) during the ablation of the present embodiment. It becomes like this.
  • the temperature of the affected part 90 can be measured simultaneously in addition to the temperature of the cooling liquid L, for example, effective ablation can be performed as follows. That is, first, based on the temperature information It1 measured by the temperature measuring element 115a, it can be noticed, for example, when the temperature of the cooling liquid L rises. Therefore, in such a case, for example, by cooling the cooling liquid L, it is possible to prevent the cooling operation (cooling) for the electrode needle 11 from becoming insufficient. At the same time, based on the temperature information It2 measured by the temperature measuring element 115b, whether the tissue temperature of the affected part 90 has risen sufficiently or has not increased excessively, such as whether the affected part 90 has been cauterized. Can also be confirmed.
  • ablation can be performed while maintaining a suitable cauterization temperature.
  • an abrupt increase in the impedance value Zm due to carbonization of the affected area 90 is prevented, and a sufficient ablation range for the affected area 90 can be secured.
  • the two types of temperature measuring elements 115a and 115b are provided inside the electrode needle 11, so that cooling is performed during ablation using the electrode needle 11. Both the temperature of the liquid L for use and the temperature of the affected part 90 can be measured simultaneously. Therefore, in this ablation device 1, compared with the ablation device of the comparative example, for example, effective ablation can be performed. As a result, convenience in use can be improved.
  • the sealing member 114 is provided in the electrode needle 11 so as to separate the arrangement region of the temperature measuring element 115b from the flow path 110. It becomes like this. That is, since the cooling liquid L is prevented from flowing near the arrangement region of the temperature measurement element 115b (regions 112a and 112b side), the temperature measurement accuracy of the affected part 90 by the temperature measurement element 115b is improved. . As a result, the convenience when using the ablation device 1 can be further improved.
  • the temperature measuring element 115 b is disposed in the region 112 b inside the electrode needle 11. Further, in this region 112b, at least in the vicinity of the arrangement region of the temperature measuring element 115b (in the region 112b), the thermal conductive material 113 is embedded and sealed, and the vicinity of the tip inside the electrode needle 11 and the temperature The arrangement region of the measuring element 115b is joined by the heat conductive material 113. As a result, the temperature difference between the vicinity of the affected part 90 and the temperature measuring element 115b is reduced, so that the temperature measurement accuracy of the affected part 90 by the temperature measuring element 115b is improved. As a result, the convenience when using the ablation device 1 can be further improved.
  • the above-described region 112 b (region where the temperature measuring element 115 b is disposed) communicates with the outside of the electrode needle 11.
  • the possibility that air or the like is accumulated in the region 112b (occurrence of air accumulation) is avoided, so that the temperature measurement accuracy of the affected part 90 by the temperature measurement element 115b is further improved.
  • the convenience when using the ablation device 1 can be further improved.
  • FIG. 6 is a schematic cross-sectional view (YZ side view) showing an example of the internal configuration of the distal end side of the electrode needle 11A of the ablation device (ablation device 1A) according to the modification.
  • the ablation device 1A of this modification corresponds to the ablation device 1 of the embodiment provided with the electrode needle 11A instead of the electrode needle 11, and the other configurations are the same.
  • the region (region 112 b) where the temperature measuring element 115 b is disposed communicates with the outside of the electrode needle 11.
  • the region (region 112a) where the temperature measuring element 115b is disposed does not communicate with the outside of the electrode needle 11A. That is, in this electrode needle 11A, the region 112b communicating with the outside is not formed, and the temperature measuring element 115b is disposed in the region 112a as a cavity closed in the electrode needle 11A.
  • the temperature measuring element 115b is near the tip of the electrode needle 11A (in the example shown in FIG. 6, near the forefront in the region 112a) so that the temperature of the affected part 90 can be measured with high accuracy.
  • the heat conducting material 113 is embedded at least near the region where the temperature measuring element 115b is disposed (in the example shown in FIG. 6, the entire region in the region 112a).
  • a sealing member 114 is provided in the electrode needle 11A to separate the arrangement area (inside the area 112a) of the temperature measuring element 115b from the flow path 110.
  • the following can be said similarly to the ablation device 1 (electrode needle 11) of the embodiment. That is, for example, if the distance from the flow path 110 to the temperature measuring element 115b (Z-axis length of the region 112a) is too short, the temperature measuring element 115b is cooled by the cooling liquid L, and the affected part by the temperature measuring element 115b There is a possibility that the temperature measurement accuracy of 90 is lowered.
  • the ablation range may be reduced.
  • the ablation device 1A of this modified example having such a configuration since the two types of temperature measuring elements 115a and 115b are provided inside the electrode needle 11A, basically, by the same operation as the embodiment, Similar effects can be obtained. That is, also in this ablation device 1A, as compared with the ablation device of the comparative example described above, for example, effective ablation can be performed. As a result, convenience in use can be improved.
  • each member described in the above embodiment and the like are not limited and may be other materials.
  • the heat conductive material may be made of a thermosetting resin such as an epoxy resin, a urethane resin, a silicone resin, or a phenol resin.
  • the configuration of the ablation device and the like has been specifically described, but it is not always necessary to include all members, and other members may be further included.
  • the values, ranges, magnitude relationships, etc. of the various parameters described in the above embodiments are not limited to those described in the above embodiments, etc., and other values, ranges, magnitude relationships, etc. Good.
  • the configuration of the electrode needle, the insulating tube, the handle, etc. in the ablation device has been specifically described, but the configuration of each of these members has been described in the above-described embodiment, etc. It is not restricted to, It is good also as another structure.
  • the electrode needle may be a bipolar type instead of the monopolar type described in the above embodiments and the like.
  • the insulating tube may not be slidable along the axial direction of the electrode needle.
  • the number, type, arrangement position, and the like of the temperature measuring elements are not limited to those described in the above embodiment, and other configurations may be employed. Further, in some cases, for example, a sealing member and a heat conductive material may not be provided.
  • the block configurations of the liquid supply device 2 and the power supply device 3 have been specifically described, but it is not always necessary to include all the blocks described in the above-described embodiment and the like. Other blocks may be further provided.
  • the ablation system 5 as a whole may further include other devices in addition to the devices described in the above embodiments and the like.
  • the ablation device in which high-frequency conduction is performed between the electrode needle 11 and the counter electrode plate 4 at the time of ablation has been specifically described, but is not limited to the above-described embodiment and the like. Absent. Specifically, for example, an ablation device that performs ablation using other electromagnetic waves such as radio waves and microwaves may be used.
  • control operation (ablation method) in the control unit 33 including the power supply control function and the liquid supply control function has been specifically described.
  • the control method (ablation method) in the power supply control function and the liquid supply control function is not limited to the method described in the above embodiment.
  • the series of processing described in the above-described embodiment and the like may be performed by hardware (circuit) or may be performed by software (program).
  • the software is composed of a group of programs for causing each function to be executed by a computer.
  • Each program may be used by being incorporated in advance in the computer, for example, or may be used by being installed in the computer from a network or a recording medium.

Abstract

L'invention concerne un dispositif d'ablation permettant d'améliorer la commodité. Un dispositif d'ablation 1 est inséré par voie percutanée dans une zone affectée 90 dans le corps et comprend : une aiguille d'électrode 11 à partir de laquelle une puissance électrique Pout pour effectuer une ablation est fournie ; un trajet d'écoulement 110 à travers lequel un liquide L pour le refroidissement s'écoule, ledit trajet d'écoulement étant formé à l'intérieur de l'aiguille d'électrode 11 ; un premier élément de mesure de température (élément de mesure de température 115a) disposé à l'intérieur du chemin d'écoulement 110 ; un second élément de mesure de température (élément de mesure de température 115b) à l'intérieur de l'aiguille d'électrode 11 et disposé à proximité de la pointe de celle-ci ; et une poignée 13 fixée au côté extrémité de base de l'aiguille d'électrode 11.
PCT/JP2018/036227 2018-03-27 2018-09-28 Dispositif d'ablation WO2019187238A1 (fr)

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CN201880083251.7A CN111511304A (zh) 2018-03-27 2018-09-28 消融器件

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JP2018-059920 2018-03-27

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Citations (4)

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Publication number Priority date Publication date Assignee Title
JPH0779991A (ja) * 1993-08-20 1995-03-28 Ep Technol Inc 組織のインピーダンスをモニタしながら組織を切除する装置及び方法
JPH11504539A (ja) * 1995-05-01 1999-04-27 イーピー テクノロジーズ，インコーポレイテッド 予測最高組織温度を使用して生体組織を切除するためのシステムおよび方法
WO2012074296A2 (fr) * 2010-12-03 2012-06-07 주식회사 태웅메디칼 Dispositif d'électrode pour ablation par radiofréquence
JP5907545B2 (ja) * 2011-05-12 2016-04-26 スターメド カンパニー リミテッド フレキシブル管が備えられる高周波熱治療用電極装置

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Publication number Priority date Publication date Assignee Title
JPS597545B2 (ja) 1979-03-22 1984-02-18 新日本製鐵株式会社 鋼の消耗電極式ア−ク溶接方法
WO1995005212A2 (fr) * 1993-08-11 1995-02-23 Electro-Catheter Corporation Electrode d'ablation amelioree
US5907545A (en) * 1996-01-16 1999-05-25 Canon Kk Wireless communication apparatus and method

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JPH0779991A (ja) * 1993-08-20 1995-03-28 Ep Technol Inc 組織のインピーダンスをモニタしながら組織を切除する装置及び方法
JPH11504539A (ja) * 1995-05-01 1999-04-27 イーピー テクノロジーズ，インコーポレイテッド 予測最高組織温度を使用して生体組織を切除するためのシステムおよび方法
WO2012074296A2 (fr) * 2010-12-03 2012-06-07 주식회사 태웅메디칼 Dispositif d'électrode pour ablation par radiofréquence
JP5907545B2 (ja) * 2011-05-12 2016-04-26 スターメド カンパニー リミテッド フレキシブル管が備えられる高周波熱治療用電極装置

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CN111511304A (zh) 2020-08-07
JP2019170466A (ja) 2019-10-10

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