JP2010273805A - Catheter - Google Patents

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JP2010273805A
JP2010273805A JP2009128104A JP2009128104A JP2010273805A JP 2010273805 A JP2010273805 A JP 2010273805A JP 2009128104 A JP2009128104 A JP 2009128104A JP 2009128104 A JP2009128104 A JP 2009128104A JP 2010273805 A JP2010273805 A JP 2010273805A
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sheath
distal end
electrodes
end surface
target tissue
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Masayuki Kobayashi
雅之 小林
Michihiro Sugawara
理裕 菅原
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Olympus Corp
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Olympus Corp
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Abstract

<P>PROBLEM TO BE SOLVED: To easily settle cells for treatment and medical solution on the surface of a tissue to be treated, such as the heart. <P>SOLUTION: A catheter 1 includes: a tubular sheath 2 with a distal end opening 8; two electrodes 3 and 4 disposed at the distal end of the sheath 2 and electrically insulated from each other; a fixing means 6 for fixing the electrodes 3 and 4 in contact with a treatment region of the target tissue in such a state as positioned to the target tissue; a treatment material feeding part 14 for feeding a treatment material between the electrodes 3 and 4 and the target tissue via the sheath 2 from the distal end opening 8; and a current feeding means 5 for feeding a high-frequency current between the electrodes 3 and 4. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

本発明は、カテーテルに関するものである。   The present invention relates to a catheter.

従来、シースの先端に一対の処置片が個別に回動可能に支持されてシースの基端側からの遠隔操作によって嘴状に開閉する処置具が知られている。この処置具には一対の処置片の間の領域に水を噴出させる送水開口が設けられており、処置対象部位が血液等で汚れている場合に、送水開口から水を噴出して血液等を洗い流すことができる。   Conventionally, a treatment tool is known in which a pair of treatment pieces are individually pivotally supported at the distal end of a sheath and opened and closed in a hook shape by remote operation from the proximal end side of the sheath. This treatment tool is provided with a water supply opening for ejecting water in a region between a pair of treatment pieces. When the treatment target site is contaminated with blood or the like, water is ejected from the water supply opening to remove blood or the like. Can be washed away.

特許第４１３１０１４号公報Japanese Patent No. 4131014

しかしながら、治療用細胞や薬液を治療組織の表面に固定する場合、特に治療組織が心臓である場合には、治療組織の表面に存在する油分によって治療用細胞や薬液がはじかれてしまい、効果的に固定することができないという不都合がある。   However, when fixing therapeutic cells and chemicals on the surface of the treated tissue, especially when the treated tissue is the heart, the therapeutic cells and chemicals are repelled by the oil present on the surface of the treated tissue, which is effective. There is an inconvenience that it cannot be fixed to.

本発明は上述した事情に鑑みてなされたものであって、心臓等の治療組織の表面に治療用細胞や薬液を定着し易くすることができるカテーテルを提供することを目的としている。   This invention is made | formed in view of the situation mentioned above, Comprising: It aims at providing the catheter which can make a treatment cell and a chemical | medical solution fix easily on the surface of treatment tissues, such as a heart.

上記目的を達成するために、本発明は以下の手段を提供する。
本発明は、先端開口を有するチューブ状のシースと、該シースの先端に配置され、相互に電気的に絶縁された２つの電極と、該電極を対象組織の治療部位に接触させた状態で、前記電極を前記対象組織に対して位置決め状態に固定する固定手段と、前記電極と前記対象組織との間に、前記シースを介して治療材を前記先端開口から供給する治療材供給部と、前記電極間に高周波電流を供給する電流供給手段とを備えるカテーテルを提供する。 In order to achieve the above object, the present invention provides the following means.
The present invention comprises a tubular sheath having a tip opening, two electrodes disposed at the tip of the sheath and electrically insulated from each other, and the electrodes in contact with a treatment site of a target tissue. A fixing means for fixing the electrode in a positioning state with respect to the target tissue, a therapeutic material supply unit for supplying a therapeutic material from the distal end opening via the sheath between the electrode and the target tissue, There is provided a catheter comprising current supply means for supplying a high-frequency current between electrodes.

本発明によれば、体内に挿入した内視鏡挿入部のチャネル等を介してシースを挿入し、該シースの先端を内視鏡の先端面から突出させて、その先端に設けられた２つの電極を対象組織の表面に密着させると、固定手段によって電極が対象組織の表面に固定される。この状態で電流供給手段によって電極間に高周波電流を供給することにより、電極間に配置される対象組織の表面を焼灼し、対象組織の表面に軽い炎症を起こさせることで組織を活性化することができる。そして、この状態で、治療材供給部によってシースを介して先端開口から治療材を供給することにより、活性化した組織表面に供給された液体または薬液がその場所に定着し易くなる。これにより、対象組織の所望の表面に治療材を定着させて治療効果を高めることができる。   According to the present invention, the sheath is inserted through the channel or the like of the endoscope insertion portion inserted into the body, the distal end of the sheath is projected from the distal end surface of the endoscope, and the two provided at the distal end are inserted. When the electrode is brought into close contact with the surface of the target tissue, the electrode is fixed to the surface of the target tissue by the fixing means. In this state, by supplying a high-frequency current between the electrodes by the current supply means, the surface of the target tissue disposed between the electrodes is cauterized, and the tissue is activated by causing mild inflammation on the surface of the target tissue. Can do. In this state, the therapeutic material is supplied from the distal end opening through the sheath by the therapeutic material supply unit, so that the liquid or the chemical solution supplied to the activated tissue surface is easily fixed at the place. Thereby, the therapeutic material can be fixed on the desired surface of the target tissue and the therapeutic effect can be enhanced.

上記発明においては、前記２つの電極が、前記シースの先端面に、前記先端開口を挟む位置に配置されていてもよい。
このようにすることで、シースの先端面を対象組織に接触させたままの状態で、電極間に高周波電流を供給して電極間に配される対象組織の表面を焼灼し、治療材を供給することで、活性化した対象組織表面に治療材を固定することができる。 In the above invention, the two electrodes may be disposed at a position sandwiching the distal end opening on the distal end surface of the sheath.
In this way, the surface of the target tissue disposed between the electrodes is cauterized by supplying a high-frequency current between the electrodes while the distal end surface of the sheath is in contact with the target tissue, and the therapeutic material is supplied. By doing so, the treatment material can be fixed to the activated target tissue surface.

また、上記発明においては、前記シースの前記先端面の表面に電解液を供給する電解液供給手段を備えていてもよい。
このようにすることで、電解液を通じて対象組織の表面近傍に高周波電流を流しやすくすることができ、さらに効率的に対象組織の表面近傍を焼灼することができる。 Moreover, in the said invention, you may provide the electrolyte solution supply means which supplies electrolyte solution to the surface of the said front end surface of the said sheath.
By doing so, it is possible to easily flow a high-frequency current near the surface of the target tissue through the electrolytic solution, and it is possible to cauterize the vicinity of the surface of the target tissue more efficiently.

また、上記発明においては、前記シースの前記先端面が、該シースの長手方向に対して一方向に傾斜していてもよい。
このようにすることで、シースの先端面を対象組織の表面に直交する方向に対して傾斜した方向から近接させることができ、体内の狭隘な空間においてもシースの先端面を対象組織の表面に密着させることができる。 Moreover, in the said invention, the said front end surface of the said sheath may incline in one direction with respect to the longitudinal direction of this sheath.
In this way, the distal end surface of the sheath can be brought closer from a direction inclined with respect to the direction orthogonal to the surface of the target tissue, and the distal end surface of the sheath can be brought to the surface of the target tissue even in a narrow space in the body. It can be adhered.

また、上記発明においては、前記固定手段が、前記先端面から突出する尖端を有する突起であってもよい。
このようにすることで、シースの先端面を対象組織の表面に押し付けるだけで、突起の尖端を対象組織に刺して、シースを簡易に位置決め固定することができる。 In the above invention, the fixing means may be a protrusion having a sharp tip protruding from the tip surface.
By doing so, the sheath can be easily positioned and fixed by simply pushing the distal end surface of the sheath against the surface of the target tissue and inserting the tip of the protrusion into the target tissue.

また、上記発明においては、前記固定手段が、前記先端面に開口する吸着口を有する吸着手段であってもよい。
このようにすることで、シースの先端面を対象組織の表面に押し付けて吸着手段を作動させることにより、吸着口を負圧に吸引して対象組織の表面に先端面を吸着させ、シースを位置決め状態に固定することができる。 Moreover, in the said invention, the adsorption | suction means which has the adsorption opening opened to the said front end surface may be sufficient as the said fixing means.
By doing so, the tip surface of the sheath is pressed against the surface of the target tissue and the suction means is operated, so that the suction port is sucked to a negative pressure to adsorb the tip surface to the surface of the target tissue, and the sheath is positioned. Can be fixed to the state.

本発明によれば、心臓等の治療組織の表面に治療用細胞や薬液を定着し易くすることができるという効果を奏する。   According to the present invention, there is an effect that it is possible to easily fix therapeutic cells or a chemical solution on the surface of a treatment tissue such as the heart.

本発明の一実施形態に係るカテーテルを示す縦断面図である。It is a longitudinal section showing a catheter concerning one embodiment of the present invention. 図１のカテーテルのシースの先端面を示す、カテーテルの先端部の部分的な側面図である。FIG. 2 is a partial side view of the distal end portion of the catheter, showing the distal end surface of the catheter sheath of FIG. 1. 図１のカテーテルのシースの先端面を心筋に固定した状態を示す部分的な縦断面図である。FIG. 2 is a partial longitudinal sectional view showing a state where the distal end surface of the sheath of the catheter of FIG. 1 is fixed to the myocardium. 図１のカテーテルのシースの先端面から生理食塩水を心筋に向けて吐出した状態を示す部分的な縦断面図である。FIG. 2 is a partial longitudinal sectional view showing a state in which physiological saline is discharged from the distal end surface of the catheter sheath of FIG. 1 toward the myocardium. 図１のカテーテルのシースの先端面に設けられた電極間に高周波電流を供給した状態を示す部分的な縦断面図である。FIG. 2 is a partial longitudinal sectional view showing a state in which high-frequency current is supplied between electrodes provided on the distal end surface of the sheath of the catheter of FIG. 1. 図１のカテーテルのシースの先端面から細胞や薬液を心筋に向けて吐出した状態を示す部分的な縦断面図である。FIG. 2 is a partial longitudinal sectional view showing a state in which cells and chemicals are discharged from the distal end surface of the sheath of the catheter of FIG. 1 toward the myocardium. 図１のカテーテルのシースの先端面の変形例であって、（ａ）電極に貫通孔を設ける場合、（ｂ）絶縁部材に単一の貫通孔を設ける場合をそれぞれ示すカテーテルの先端部の部分的な側面図である。FIG. 3 is a modification of the distal end face of the sheath of the catheter of FIG. 1, wherein (a) a case where a through hole is provided in an electrode, and (b) a portion of a distal end portion of a catheter showing a case where a single through hole is provided in an insulating member FIG.

本発明の一実施形態に係るカテーテル１について、図面を参照して以下に説明する。
本実施形態に係るカテーテル１は、図１に示されるように、細長く柔軟な筒状のシース２と、シース２の先端面２ａに配置された電極３，４と、該電極３，４に対して高周波電流を供給する電流供給手段５と、シース２の先端面２ａに設けられた固定手段６とを備えている。 A catheter 1 according to an embodiment of the present invention will be described below with reference to the drawings.
As shown in FIG. 1, the catheter 1 according to the present embodiment includes an elongated and flexible tubular sheath 2, electrodes 3 and 4 disposed on the distal end surface 2 a of the sheath 2, and the electrodes 3 and 4. Current supply means 5 for supplying high-frequency current and fixing means 6 provided on the distal end surface 2a of the sheath 2.

シース２の先端面２ａは、シース２の長手方向に対して９０°より小さい角度、例えば、４５°の角度で傾斜している。その傾斜した先端面２ａの略中央には、図２に示されるように、電極３，４を電気的に絶縁する絶縁部材７が配置されている。絶縁部材７には、シース２の内孔２ｂに連絡する貫通孔（先端開口）８が複数設けられている。   The distal end surface 2a of the sheath 2 is inclined with respect to the longitudinal direction of the sheath 2 at an angle smaller than 90 °, for example, an angle of 45 °. As shown in FIG. 2, an insulating member 7 that electrically insulates the electrodes 3 and 4 is disposed in the approximate center of the inclined front end surface 2 a. The insulating member 7 is provided with a plurality of through holes (tip openings) 8 that communicate with the inner hole 2 b of the sheath 2.

電極３，４は、図２に示されるように、シース２の先端面２ａに、絶縁部材７を挟んで２箇所に配置されている。これらの電極３，４には、シース２の内部を介して配線９，１０が相互に電気的に絶縁された状態で接続されている。
シース２の基端側には、手元操作部１１が固定されている。 As shown in FIG. 2, the electrodes 3 and 4 are disposed at two positions on the distal end surface 2 a of the sheath 2 with the insulating member 7 interposed therebetween. The wires 9 and 10 are connected to these electrodes 3 and 4 through the inside of the sheath 2 in a state where they are electrically insulated from each other.
A hand operating portion 11 is fixed to the proximal end side of the sheath 2.

手元操作部１１には、シース２内に配された２本の配線９，１０にそれぞれ接続される接続端子１２，１３が設けられている。接続端子１２，１３どうしは相互に電気的に絶縁されている。   The hand operation unit 11 is provided with connection terminals 12 and 13 connected to two wires 9 and 10 arranged in the sheath 2, respectively. The connection terminals 12 and 13 are electrically insulated from each other.

また、手元操作部１１には、シース２の内孔２ｂに連絡する貫通部（液体供給部）１４が設けられている。該貫通部１４を貫通して手元操作部１１の後端から、図示しないシリンジ等によって生理食塩水Ｂのような電解液と治療用の細胞を含む液体（以下、細胞含有液という。）Ｃ等とを交互に供給することができるようになっている。   Further, the hand operating section 11 is provided with a penetrating section (liquid supply section) 14 that communicates with the inner hole 2 b of the sheath 2. From the rear end of the hand operating section 11 through the penetrating section 14, a liquid (hereinafter referred to as a cell-containing liquid) C or the like containing an electrolytic solution such as physiological saline B and therapeutic cells by a syringe (not shown) or the like. Can be supplied alternately.

固定手段６は、シース２の先端面２ａに、電極３，４を対象組織である心筋Ａ等に対して位置決め状態に固定する微小突起により構成されている。微小突起としては、先端面２ａから突出する尖端を有するものを挙げることができる。シース２の先端面２ａを心筋Ａ等の表面に押し付けると、微小突起の尖端が心筋Ａに刺さり、先端面２ａの電極３，４を心筋Ａの表面に沿う方向に相対的に移動しないように固定することができる。   The fixing means 6 is constituted by a minute projection that fixes the electrodes 3 and 4 to the distal end surface 2a of the sheath 2 in a positioning state with respect to the myocardium A or the like as a target tissue. Examples of the minute protrusion include one having a pointed protrusion protruding from the tip surface 2a. When the distal end surface 2a of the sheath 2 is pressed against the surface of the myocardium A or the like, the tip of the microprojection is stuck in the myocardium A so that the electrodes 3 and 4 on the distal end surface 2a do not move relatively in the direction along the surface of the myocardium A. Can be fixed.

このように構成された本実施形態に係るカテーテル１の作用について、以下に説明する。
本実施形態に係るカテーテル１を用いて、対象組織、例えば、心臓の心筋Ａに、幹細胞や薬液等を定着させるには、図３に示されるように、手元操作部１１の貫通部１４から生理食塩水Ｂと細胞含有液Ｃとを交互に供給してシース２内に配置しておき、例えば、内視鏡の鉗子チャネル等を介して心筋Ａの表面まで導入する。 The operation of the catheter 1 according to this embodiment configured as described above will be described below.
In order to fix a stem cell, a chemical solution, or the like on a target tissue, for example, the myocardium A of the heart, using the catheter 1 according to the present embodiment, as shown in FIG. Saline B and cell-containing liquid C are alternately supplied and placed in the sheath 2 and introduced into the surface of the myocardium A through, for example, a forceps channel of an endoscope.

そして、図３に示されるように、シース２の先端面２ａを心筋Ａの表面に密着させ、先端面２ａに設けられている固定手段６を心筋Ａの表面に刺すことにより、シース２の先端面２ａを心筋Ａに対して動かないように固定する。
この状態で、手元操作部１１の貫通部１４から内孔２ｂ内を加圧することにより、内孔２ｂ内の生理食塩水Ｂを貫通孔８から押し出す。これにより、図４に示されるように電極３，４と心筋Ａとの隙間に生理食塩水Ｂが塗布されるので、図５に示されるように、手元操作部１１に設けられた接続端子１２，１３間に、電流供給手段５から高周波電流Ｄを供給する。 Then, as shown in FIG. 3, the distal end surface 2a of the sheath 2 is brought into close contact with the surface of the myocardium A, and the fixing means 6 provided on the distal end surface 2a is pierced into the surface of the myocardium A. The surface 2a is fixed so as not to move with respect to the myocardium A.
In this state, the inside of the inner hole 2 b is pressurized from the through part 14 of the hand operating part 11, thereby pushing out the physiological saline B in the inner hole 2 b from the through hole 8. As a result, the physiological saline B is applied to the gap between the electrodes 3 and 4 and the myocardium A as shown in FIG. 4, and as shown in FIG. 5, the connection terminal 12 provided in the hand operation unit 11 is provided. , 13, a high-frequency current D is supplied from the current supply means 5.

電極３，４間に高周波電流Ｄが流れることにより、その間に配置されている心筋Ａの表面が軽く焼灼されることで、局所的に組織透過性の亢進や組織の変性などを誘発させた軽い炎症を起こした状態となって、心筋Ａの組織が活性化される。その結果、活性化された心筋Ａの表面には細胞が定着し易くなる。そして、この状態で、図６に示されるように、さらに貫通部１４側から加圧してシース２内の細胞含有液Ｃを貫通孔８から押し出すことにより、活性化された心筋Ａの組織表面に細胞含有液Ｃが塗布され、細胞がそこに定着させられる。   When the high-frequency current D flows between the electrodes 3 and 4, the surface of the myocardium A disposed between the electrodes 3 and 4 is lightly cauterized, so that the tissue permeability is locally increased or the tissue is degenerated. Inflamed, the tissue of the myocardium A is activated. As a result, cells are likely to settle on the surface of the activated myocardium A. In this state, as shown in FIG. 6, the cell-containing liquid C in the sheath 2 is further pushed out from the through-hole 8 by applying pressure from the penetrating portion 14 side, thereby bringing the activated myocardial A to the tissue surface. The cell-containing liquid C is applied and the cells are fixed there.

このように、本実施形態に係るカテーテル１によれば、対象組織の所望の表面に細胞や薬液を簡易に定着させて治療効果を高めることができる。この場合において、シース２の先端面２ａに設けられた固定手段６によってシース２の先端面２ａを心筋Ａの表面に固定するので、心筋Ａが拍動していても、細胞や薬液を定着させたい部位に精度よく位置決めした状態で、生理食塩水Ｂの塗布や高周波電流Ｄによる焼灼を位置ずれを起こすことなく行うことができる。さらに、高周波電流Ｄによる焼灼によって活性化された組織に、より確実に細胞含有液Ｃを付与して細胞や薬液等を定着させることができる。   Thus, according to the catheter 1 which concerns on this embodiment, a cell and a chemical | medical solution can be simply fixed to the desired surface of object tissue, and a therapeutic effect can be heightened. In this case, since the distal end surface 2a of the sheath 2 is fixed to the surface of the myocardium A by the fixing means 6 provided on the distal end surface 2a of the sheath 2, cells and drug solutions are fixed even if the myocardium A is beating. Application of the physiological saline B and cauterization by the high-frequency current D can be performed without causing a position shift in a state where the position is accurately positioned at the desired site. Furthermore, the cell-containing liquid C can be more reliably applied to the tissue activated by cauterization by the high-frequency current D to fix the cells, chemicals, and the like.

なお、本実施形態においては、シース２の先端面２ａの２つの電極３，４を電気的に絶縁する絶縁部材７に、生理食塩水Ｂや細胞含有液Ｃを吐出させるための貫通孔８を設けることとしたが、これに代えて、図７（ａ）に示されるように、電極３，４に貫通孔８を設けることにしてもよい。また、絶縁部材７に複数の貫通孔８を設けることに代えて、図７（ｂ）に示されるように、単一の貫通孔８を設けることにしてもよい。   In the present embodiment, the through-hole 8 for discharging the physiological saline B and the cell-containing liquid C is formed on the insulating member 7 that electrically insulates the two electrodes 3 and 4 on the distal end surface 2a of the sheath 2. However, instead of this, as shown in FIG. 7A, the electrodes 3 and 4 may be provided with through holes 8. Further, instead of providing a plurality of through holes 8 in the insulating member 7, as shown in FIG. 7B, a single through hole 8 may be provided.

また、固定手段としては、微小突起に代えて、シース２の先端面２ａに開口する吸着口を負圧に吸引する吸着手段を採用することにしてもよい。このようにすることで、シース２の先端面２ａを心筋Ａの表面に吸着させて、微小突起の場合と同様に、正確な生理食塩水Ｂの塗布、組織表面の焼灼および細胞含有液Ｃの塗布を行うことができる。
治療材としては、治療用細胞を含んだ液体や薬液の他、治療用細胞を含んだゲルなどを用いることができる。 Further, as the fixing means, instead of the minute protrusions, suction means that sucks the suction port opened in the distal end surface 2a of the sheath 2 to a negative pressure may be employed. In this way, the distal end surface 2a of the sheath 2 is adsorbed to the surface of the myocardium A, and as in the case of the microprotrusions, the accurate application of the physiological saline B, the cauterization of the tissue surface, and the cell-containing liquid C Application can be performed.
As a therapeutic material, a gel or the like containing therapeutic cells can be used in addition to a liquid or drug solution containing therapeutic cells.

１ カテーテル
２ シース
２ａ 先端面
３，４ 電極
５ 電流供給手段
６ 固定手段
７ 絶縁部材
８ 貫通孔（先端開口）
１４ 貫通部（治療材供給部） DESCRIPTION OF SYMBOLS 1 Catheter 2 Sheath 2a Tip surface 3, 4 Electrode 5 Current supply means 6 Fixing means 7 Insulating member 8 Through hole (tip opening)
14 Penetration part (treatment material supply part)

Claims (6)

先端開口を有するチューブ状のシースと、
該シースの先端に配置され、相互に電気的に絶縁された２つの電極と、
該電極を対象組織の治療部位に接触させた状態で、前記電極を前記対象組織に対して位置決め状態に固定する固定手段と、
前記電極と前記対象組織との間に、前記シースを介して治療材を前記先端開口から供給する治療材供給部と、
前記電極間に高周波電流を供給する電流供給手段とを備えるカテーテル。 A tubular sheath having a tip opening;
Two electrodes disposed at the tip of the sheath and electrically insulated from each other;
Fixing means for fixing the electrode in a positioning state with respect to the target tissue in a state where the electrode is in contact with a treatment site of the target tissue;
A therapeutic material supply unit that supplies a therapeutic material from the distal end opening via the sheath between the electrode and the target tissue;
A catheter comprising a current supply means for supplying a high-frequency current between the electrodes; 前記２つの電極が、前記シースの先端面に、前記先端開口を挟む位置に配置されている請求項１に記載のカテーテル。   The catheter according to claim 1, wherein the two electrodes are disposed at a position sandwiching the distal end opening on a distal end surface of the sheath. 前記シースの前記先端面の表面に電解液を供給する電解液供給手段を備える請求項１に記載のカテーテル。   The catheter of Claim 1 provided with the electrolyte solution supply means which supplies electrolyte solution to the surface of the said front end surface of the said sheath. 前記シースの前記先端面が、該シースの長手方向に対して一方向に傾斜している請求項１に記載のカテーテル。   The catheter according to claim 1, wherein the distal end surface of the sheath is inclined in one direction with respect to a longitudinal direction of the sheath. 前記固定手段が、前記先端面から突出する尖端を有する突起である請求項１に記載のカテーテル。   The catheter according to claim 1, wherein the fixing means is a protrusion having a tip protruding from the distal end surface. 前記固定手段が、前記先端面に開口する吸着口を有する吸着手段である請求項１に記載のカテーテル。   The catheter according to claim 1, wherein the fixing unit is a suction unit having a suction port opened in the distal end surface.
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