JP6110343B2 - 頭部および頸部の電気外科治療用のシステムおよび方法 - Google Patents
頭部および頸部の電気外科治療用のシステムおよび方法 Download PDFInfo
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Description
本発明は、一般的に言って電気外科の分野に関するものであり、もっと明確に言うと耳、鼻および喉など頭部および頸部の組織を治療するために高周波電気エネルギーを採用する外科装置および方法に関するものである。本発明は、特に、副鼻腔手術および閉塞性睡眠障害の治療に適している。
非剥離モードのとき、電源28は、導電性流体の気化およびその後の組織の分子解離を避けるのに充分に低い電圧を電極端子に加える。外科医は、フット・ペダル37、38を交互に踏むことによって、剥離と非剥離モードの間を自動的に切り替えることができる。一部の実施態様においては、これにより外科医は、手術部位から集中力をそらすことなくまたは助手に電源を切り替えるよう要請することなく、その場で凝結と剥離の間を迅速に移行できる。例として、外科医が剥離モードで軟組織を削っているとき、プローブは、一般に、組織内の小さい切断された血管を同時に封止し(または)凝結する。しかし、大き目の血管または流体圧力の高い血管(例えば、動脈)は、剥離モードでは封止できない場合がある。したがって、外科医は、単にフット・ペダル38を踏むだけで、自動的に剥離の閾値より下に電圧レベルを下げて、血管を封止および(または)凝結するために充分な長さの時間切断された血管に充分な圧力を加えることができる。これが完了した後、外科医は、フット・ペダル37を踏んで、素早く剥離モードに戻ることができる。本発明に使用するのに適した電源の固有の設計については、以前に参照により本出願に組み込まれた1997年10月23日に提出された仮特許出願第60/062997号(弁理士整理番号第16238−007400号)に示されている。
代表的な実施態様においては、電圧降下素子は、帰還電極ワイヤ258に結合される第一の脚264およびコネクタ・ブロック256に結合される第二の脚266を持つ電圧降下キャパシタ262である。当然、キャパシタは、システム内の他の位置、例えば、ケーブル、発電機、コネクタなどの中に配置するかまたはその長さに沿って配分することができる。さらに、ダイオード、トランジスタ、インダクタ、抵抗器、キャパシタまたはその組み合わせなど、他の電圧降下素子を本発明にと共に使用できることが分かるだろう。例えば、プローブ90は、帰還電極112と電極端子104の間の電圧を組織の収縮に適したレベルに下げるように構成されるコード化抵抗器(図には示されていない)を含むことができる。さらに、この目的のために電気回路を採用することができる。
図7Aから7Cは、本発明に基づくプローブ90の3つの異なる実施態様の遠位部を略図的に示している。図7Aに示されるとおり、電極端子104は、特定の処置の要件に応じて製造時に平面、半球形またはその他の形状で形成できる適切な絶縁材(例えば、セラミックまたはアルミナ、ジルコニアなどのガラス材)の支持基質102に固定される。望ましい支持基質の材料は、その高い熱伝導率、優れた絶縁特性、高い曲げ係数、カーボン・トラッキング抵抗、生体適合性および高い融点を持つことから、イリノイ州エルクグルーブのKyocera Industrial Ceramics Corporationから入手できるアルミナである。支持基質102は、基質102とプローブ90の近位端の間の距離のほとんどまたは全てに伸びる管状支持材78に接着接合される。管状支持材78は、エポキシまたはシリコンを主原料とする材料など電気絶縁材から成ることが望ましい。
図16および17は、本発明の原理に従って構成される電気外科用カテーテルの作業端464を示している。図16に示されるとおり、カテーテル460は、一般的に言って、たわみ性または剛性の細長いシャフト462、およびシャフト462の遠位端に連結される電極支持材620を含んでいる。電極支持材620は、シャフト462の遠位端から(通常1から20mm)伸びて、電気的に隔離された複数の電極端子463を支える。電極支持材620および電極端子462は、接着剤630によりシャフト460内の管状支持材626に固定されることが望ましい。
気管狭窄も本発明に従って治療できる。気管の壁の急性および慢性の狭窄は、咳、チアノーゼおよび窒息を引き起こす場合がある。
100 シャフト
102 電極支持材
104 電極端子
Claims (13)
- 近位端部および遠位端部を持つシャフトを有する電気外科用プローブと、
シャフトの遠位端部近くに配置される電極アセンブリと、
電極アセンブリを高周波電源に電気結合するためにシャフトの近位端部近くにあるコネクタと、
絶縁材により電極アセンブリから近位方向に間隔を置いて配置され高周波電源に結合された帰還電極であって、シャフトの一部分を形成する帰還電極と、
帰還電極と電極アセンブリの間の電流の流路を作るために帰還電極および電極アセンブリに電気接触する流体経路を形成する流体供給エレメントと、
を備え、
電極アセンブリは、組織治療面を形成する電気絶縁電極支持材により支持され、
電極アセンブリは複数の活性電極を有し、該複数の活性電極のそれぞれの活性電極は独立して高周波電源の第1ポールに結合され、該複数の活性電極の各活性電極はループ部分を有するループ電極であり、該各ループ部分は、遠位部にて互いに対して実質的に平行に配置され、該各ループ電極のそれぞれが、組織を切断し、同時に切断された組織の止血を行いうるように、該各ループ電極のそれぞれが、鋭い遠位エッジを形成し、
該複数の活性電極のそれぞれの活性電極は、組織治療面から遠位方向に約1mm〜5mm 延在し、
高周波電源によって流体経路内の電極アセンブリに加えられた高周波電圧が、電極アセンブリと標的部位の組織との間の流体の少なくとも一部を気化するのに充分に高く、イオン化されたプラズマが気化した流体内に形成され、荷電粒子が標的部位の組織に向かって加速されて、標的部位の組織の分子破壊または分子崩壊を生じさせるようにした、標的部位の組織に電気エネルギーを与えるための装置。 - 電極アセンブリが体構造のごく近くにまたはこれに一部接触して置かれるとき帰還電極と標的部位の体構造との間の直接接触を最小限に抑えるために、帰還電極が電極アセンブリから充分に間隔を置いて配置される、請求項1に記載の装置。
- 複数のループ電極は3つのループ電極から構成される、請求項1に記載の装置。
- 複数のループ電極は、線形の切断経路を形成するように互いに整列される、請求項1に記載の装置。
- 帰還電極が管状材であり、流体供給エレメントが帰還電極に連結される軸方向のルーメンから成り、軸方向のルーメンが流体経路の少なくとも一部を形成して、電極アセンブルと流体連絡する出口を持つ、請求項1に記載の装置。
- 流体供給エレメントが、シャフトの外面に沿って伸びる流体チューブから成る、請求項1に記載の装置。
- 流体供給エレメントが、電気外科用プローブとは別個の流体供給器具から成る、請求項1に記載の装置。
- さらに、標的部位から流体を吸引するための流体吸引エレメントを含む、請求項1に記載の装置。
- 流体吸引エレメントが、シャフトの中を伸びる吸込みルーメンから成り、吸込みルーメンが、電極アセンブリに隣接するシャフトの遠位先端に入口を持つ、請求項8に記載の装置。
- 組織が扁桃である、請求項1に記載の装置。
- 組織治療面は、シャフトの縦軸に対して鋭角に配設される、請求項1に記載の装置。
- 前記鋭角は、10°から90°である、請求項11に記載の装置。
- 帰還電極は、約0.1mmから2mmの組織治療面から近位方向に間隔を置いて配置された流体接触面を有する、請求項1に記載の装置。
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1998
- 1998-12-14 JP JP2000538642A patent/JP2002508214A/ja not_active Withdrawn
- 1998-12-14 DE DE69839526T patent/DE69839526D1/de not_active Expired - Lifetime
- 1998-12-14 AT AT98964730T patent/ATE395873T1/de not_active IP Right Cessation
- 1998-12-14 AU AU19990/99A patent/AU1999099A/en not_active Abandoned
- 1998-12-14 EP EP98964730A patent/EP1039862B1/en not_active Expired - Lifetime
- 1998-12-14 WO PCT/US1998/026624 patent/WO1999030655A1/en active Application Filing
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JP2014217780A (ja) | 2014-11-20 |
JP2011045756A (ja) | 2011-03-10 |
EP1039862A1 (en) | 2000-10-04 |
DE69839526D1 (de) | 2008-07-03 |
EP1039862A4 (en) | 2001-01-03 |
JP2002508214A (ja) | 2002-03-19 |
JP2016195852A (ja) | 2016-11-24 |
ATE395873T1 (de) | 2008-06-15 |
AU1999099A (en) | 1999-07-05 |
WO1999030655A1 (en) | 1999-06-24 |
EP1039862B1 (en) | 2008-05-21 |
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