JP7009459B2 - 偏心性の結節組織を採取する為のシステム - Google Patents
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- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
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- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
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- A—HUMAN NECESSITIES
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Description
図5A~5Fを参照する。使用時において、例示であるが、気管支鏡(図示略)は、気管を貫通して標的組織部位(例えば、肺結節)の近傍の気管支経路内に前進させられる。図3Aの搬送装置330(例えば、カテーテル)は、気管支経路の超音波画像を撮影する為に、気管支鏡の作業チャネルを貫通して遠位方向に前進させられる。搬送装置が、標的組織部位に接近すると、超音波トランスデューサー340は、偏心性結節8(図5A)の超音波画像を取得し得る。図5Bに示すように、超音波トランスデューサー340が、超音波画像の中央に暗い円として視認し得るのに対比して、偏心性結節8は、超音波画像の左上の4分円内の暗い病変として視認し得る。超音波トランスデューサー340が、偏心性結節8の近傍に配置されると、医療従事者は、肺経路の壁の中にエンドキャップ310の第2の開口部318aを貫通して組織サンプリング要素350を移動する(例えば、遠位方向に前進させ得る)(図5C)。図5Dに示すように、組織サンプリング要素350は、超音波トランスデューサー340を超えて移動させられると(例えば、遠位方向に前進させられる)、超音波画像に現れる。組織サンプリング要素を前進させて組織サンプリング要素が偏心性結節を貫通しない場合には、医療従事者は、組織サンプリング要素350をエンドキャップ310の中に後退させて、組織サンプリング要素350と偏心性結節8の相対的な位置(図5C,5D)に基づいて、搬送装置330全体を回転させて第2の開口部318aの位置を偏心性結節8(図5E)に合わせた後、組織サンプリング要素350をエンドキャップ310の第2の開口部318aを貫通して偏心性の結節の中に改めて移動させる(図5F)。組織サンプリング要素350は、その後、エンドキャップ310の中に後退させられて、搬送装置330は、気管支鏡の中を近位方向に後退させられて、患者の体内から除去される。偏心性結節の生検サンプルは、その後、細胞学的な評価を行う為に、組織サンプリング要素350の管腔内部から除去される。図5Cの組織サンプリング要素350は、偏心性結節8(例えば、標的結節が「見失われている」)に入らない部位で気管支経路の壁を貫通するものとして示されているが、様々な実施形態では、組織サンプリング要素350は、組織サンプリング要素350の端部(例えば、鋭利な部分)が超音波画像に表示されるものの気管支経路の壁の中には延びないように超音波トランスデューサー340を超えて遠位方向に移動される。医療従事者は、搬送装置330全体を回転して、組織サンプリング要素350の位置を偏心性結節8に一致させた後、組織サンプリング要素350を偏心性結節8の中へ完全に、即ち全体的に移動させる。図3Aに係る搬送システムは、従来の針吸引システムよりも優れていると同時に、医療従事者にとっては、生検針が、エンドキャップや搬送装置の内部に収容されている時に(例えば、最初に前進させる前に)、標的の肺結節に対して生検針の位置と方向とを判断できる為、有用である。
Claims (15)
- 第1の作業チャネルと第2の作業チャネルとを備える搬送装置と、
第1の開口部と第2の開口部とをそれぞれ形成する第1の管腔と第2の管腔とを備えるエンドキャップと、
前記エンドキャップの遠位端を越えて遠位方向に延びるシースと、
ラジアル超音波画像で視認可能なマーカーであって、前記シースに配置され、組織サンプリング要素が前記エンドキャップの第2の管腔の第2の開口部よりさらに遠位方向に前進された時、前記組織サンプリング要素の一部が配置された部位に対して予め定められた偏倚された角度を有する、前記マーカーと、
前記シース内に配置された超音波トランスデューサーと
からなるシステムであって、
前記エンドキャップの近位端は、前記第1の作業チャネルが前記第1の管腔に連続し、且つ前記第2の作業チャネルが前記第2の管腔に連続するように、前記搬送装置の遠位端に取り付けられる、システム。 - 前記第1の管腔と前記第2の管腔とは、多様な厚みを有する内壁で分離され、前記内壁の厚みは、前記遠位端から前記近位端に向かって減少されて前記第2の管腔の内部に傾斜表面を形成する、請求項1に記載のシステム。
- 前記超音波トランスデューサは、前記第1の作業チャネルと第1の管腔の内部に配置される、請求項1又は2に記載のシステム。
- 前記超音波トランスデューサーは、前記エンドキャップの遠位端を超えて遠位方向に延びる、請求項1~3のいずれか一項に記載のシステム。
- 前記超音波トランスデューサーは、前記第1の作業チャネルと前記第1の管腔の内部に回転可能に配置される、請求項1~4のいずれか一項に記載のシステム。
- 前記第2の作業チャネルと前記第2の管腔の内部に摺動可能に配置される、組織サンプリング要素をさらに備える、請求項1~5のいずれか一項に記載のシステム。
- 前記エンドキャップの近位端は、はんだ、のり、接着剤、エポキシ、又は樹脂のうちの少なくともいずれか1つで前記搬送装置の近位端に取り付けられる、請求項1~6のいずれか一項に記載のシステム。
- 前記エンドキャップの近位端は、前記エンドキャップの近位部の外表面と前記搬送装置の遠位部の外表面との周囲に配置された熱収縮スリーブで前記搬送装置の遠位端に取り付けられる、請求項1~6のいずれか一項に記載のシステム。
- 前記熱収縮スリーブは、前記第2の開口部を覆っていない、請求項8に記載のシステム。
- 前記搬送装置の遠位部は、ポケットを備え、前記エンドキャップは、前記ポケットの内部に適合する、請求項1~6のいずれか一項に記載のシステム。
- 前記ポケットは、前記第2の開口部に一致する切削開口部を備える、請求項10に記載のシステム。
- 前記シースの一部は、放射線不透過性材料を備える、請求項3に記載のシステム。
- 前記放射線不透過性材料は、前記シースの一定の長さに沿って延びる放射線不透過性材料のストリップである、請求項12に記載のシステム。
- 前記シースの一部は、前記超音波トランスデューサーを超えて遠位方向に延びる、請求項12に記載のシステム。
- 前記放射線不透過性材料のストリップと前記エンドキャップの外表面にある第2の開口部とは、180度の角度で偏倚されている、請求項13に記載のシステム。
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JP2021177469A JP2022016459A (ja) | 2016-12-07 | 2021-10-29 | 偏心性の結節組織を採取する為のシステム |
JP2023177196A JP2023184568A (ja) | 2016-12-07 | 2023-10-13 | 偏心性の結節組織を採取する為のシステム |
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PCT/US2017/064879 WO2018106787A1 (en) | 2016-12-07 | 2017-12-06 | Systems for eccentric nodule tissue acquisition |
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CN110292403A (zh) * | 2019-07-04 | 2019-10-01 | 南京市胸科医院 | 一种支气管超声探测与活检同步取样的装置及方法 |
WO2022144695A2 (en) * | 2020-12-31 | 2022-07-07 | Ethicon, Inc. | Systems and methods for liquid flooding of lung to enhance endobronchial energy transfer for use in imaging, diagnosis and/or treatment |
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