JP2002045370A - Device for treatment - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a device for treatment with which cost for the treatment is lowered and the position of an energy emission part for a treatment site is determined accurately. SOLUTION: An energy emission device 3 having an antenna 27 and a catheter means 2 having a lumen 5 in which the energy emission device 3 is inserted and attachably/detachably connected. A connecting ditch 5b is provided to determine the position of the energy emission device 3 near the end of a lumen 5 for inserting the energy emission device 3 in the catheter means 2.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a treatment apparatus for radiating electromagnetic wave energy such as microwaves to a treatment site in a body cavity of a patient, for example, a prostate, and heating and treating the treatment site.

[0002]

2. Description of the Related Art Generally, an insertion portion which can be inserted into a body cavity of a patient is provided, and in a heating treatment for a malignant tumor or a benign tumor, an electromagnetic wave energy such as an RF wave (high frequency), a microwave, a laser, and an ultrasonic wave is used. Various treatment devices that have been used have been developed. In particular, as a method for treating benign prostatic hyperplasia, the prostate to be treated is treated at a temperature of 45 ° C. or higher for 3 hours.
A treatment method of performing a heating treatment for about 0 minute to 1 hour is known. This is called high temperature therapy (thermotherapy). Among these warming treatments, transurethral treatment using microwaves in particular is becoming an established outpatient treatment at general hospitals and clinics in Japan.

[0003] Usually, in this heating treatment, an applicator for applying a heating treatment to an affected part is used. This applicator
It is composed of an energy radiating means mounted inside thereof and a cover sheath (catheter) which is an outer skin portion which covers the outer periphery and comes into contact with the urethral mucosa of the patient.

An apparatus for performing these heating treatments is disclosed in JP-A-7-116274 and JP-A-9-122260.
No., for example. Here, JP-A-7-11
Japanese Patent No. 6274 discloses a configuration in which a microwave antenna as an energy radiating element for heating treatment is provided at an insertion portion of an applicator for heating treatment that can be inserted into a body cavity of a patient. . A cover sheath, which is an outer sheath, and a microwave antenna disposed inside the cover sheath are integrally assembled with the applicator for heating treatment. In addition, two temperature sensors for controlling heating are mounted on the outer surface of the applicator in contact with the heating treatment section.

In Japanese Patent Application Laid-Open No. 9-122260, a brachytherapy catheter is removably inserted into a warming intraluminal applicator which can be inserted into a patient's body cavity. The device is shown.

[0006]

Generally, in order to reuse an applicator for warming treatment which is used by inserting it into a body cavity of a patient, it is desirable that the applicator be sterilized and then reused. However, in the device disclosed in Japanese Patent Application Laid-Open No. Hei 7-116274, the applicator is configured by integrally assembling the microwave antenna and the cover sheath which is the outer sheath. Therefore, it is difficult to perform a sterilization treatment after one use, and it is often discarded.

The energy radiating element as a component of the applicator is generally an expensive component. For example, as a microwave antenna, a helical antenna, a slot antenna, a diball antenna, or the like obtained by finely processing a coaxial cable is used. Further, microwave connectors for transmitting microwave energy supplied from a microwave oscillator to a microwave antenna generally include relatively expensive components such as an SMA connector, a BNC connector, and an N connector. It is used. Therefore, there is a problem that the cost required for one heating treatment becomes expensive and the economic burden on the patient becomes large.

In the device disclosed in Japanese Patent Application Laid-Open No. 9-122260, a brachytherapy catheter, which is an energy radiating element, can be freely attached to and detached from an intraluminal applicator. It is located at the base end side. Therefore, in the heating section disposed on the distal end side of the insertion section, the brachytherapy source of the brachytherapy catheter inserted into the intraluminal applicator due to expansion and contraction in the longitudinal direction of the applicator and movement of the patient. There is a problem that the positioning of the radiating portion is likely to be unstable, and it is difficult to increase the positioning accuracy with respect to the treatment site.

The present invention has been made in view of the above circumstances, and an object of the present invention is to provide a treatment apparatus which has a low treatment cost and can accurately position an energy radiating portion with respect to a treatment site. is there.

[0010]

According to the present invention, there is provided a treatment apparatus in which an energy radiating element for heating treatment is disposed in an insertion portion which can be inserted into a body cavity of a patient, wherein the energy radiating element is disposed. The internal unit and an exterior unit having an internal unit insertion space into which the internal unit is inserted form the insertion portion, and the exterior unit and the internal unit are detachably connected to each other, and the exterior unit is A therapeutic device, characterized in that a positioning portion for positioning the internal unit is provided at a position near the tip of the internal unit insertion space of the unit. Then, in the present invention, the internal unit is assembled in a state where the internal unit is inserted into the internal unit insertion space of the exterior unit before use. At this time, in a state where the distal end portion of the internal unit is positioned by the positioning portion near the distal end portion of the internal unit insertion space of the exterior unit to prevent relative movement in the long axis direction, the energy radiating element of the internal unit treats the treatment site. Radiates energy to perform warming treatment. Further, after the treatment, the exterior unit and the internal unit are separated, the energy radiating means of the internal unit is reused, and the exterior unit is discarded.

[0011]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Hereinafter, a first embodiment of the present invention will be described with reference to FIGS. 1 to 3 (A) to 3 (C). FIG. 1 shows a urethral applicator 1 of a therapeutic device for heating a prostate according to the present embodiment. The urethral applicator 1 is provided with a catheter means 2 which is an exterior unit shown in FIG. 2A and an energy radiating device 3 which is an internal unit shown in FIG. 2B.

The catheter means 2 is provided with an elongated, substantially cylindrical cover sheath 4 made of a biocompatible material such as silicone rubber. A lumen (internal unit insertion space) 5 through which the energy radiating device 3 is inserted is provided at the axis of the cover sheath 4. Further, a lumen closing portion 6 that closes the distal end of the lumen 5 is formed at the distal end of the catheter means 2 as shown in FIG.

The distal end of the lumen 5 is formed with a tapered tapered surface 5a. This tapered surface 5a
A substantially ring-shaped engagement groove (positioning portion) 5b is formed in the middle of the cover sheath 4 and extends in the radial direction of the cross section of the cover sheath 4. Further, an inclined surface 5c that is inclined in substantially the same direction as the tapered surface 5a is adjacent to the rear end side of the engagement groove portion 5b.

An anchor balloon 7 formed integrally with the cover sheath 4 is provided on the outer peripheral surface of the distal end portion of the catheter means 2. Further, an anchor balloon lumen 8 which is a fluid conduit for inflating the balloon is formed in the sheath wall of the cover sheath 4 so as to extend along the axis of the cover sheath 4 as shown in FIG. Have been. The distal end of the anchor balloon lumen 8 communicates with the inside of the anchor balloon 7.

On the surface of the cover sheath 4, two temperature sensors 10 are located behind the anchor balloon 7.
a, 10b are provided respectively. These two temperature sensors 10a, 10b
The temperature sensing sections 10a1 and 10b1 are arranged at a predetermined gap before and after the cover sheath 4. Further, the temperature sensors 10a1 and 10b1 of the temperature sensors 10a and 10b
Is coated with a temperature sensor coating 11.

The temperature sensing portions 10a1 and 10b1 of the temperature sensors 10a and 10b have temperature sensor leads 12a as sensor signal lines disposed inside the cover sheath 4, respectively.
12b are connected to each other. These temperature sensor leads 12 a and 12 b are inserted into the inside of the cover sheath 4, and the base end side extends to the rear end side of the catheter means 2.

An operating end 13 on the proximal side is formed on the rear end side of the catheter means 2. The operating end 13 of the catheter means 2 includes a sheath flange 14 connected to the base end of the cover sheath 4, a communication tube 15 for the anchor balloon connected to the rear end of the anchor balloon lumen 8, Sensor cables 16 are provided respectively. Here, the communication tube 15 for the anchor balloon is used.
An anchor balloon port 17 which is a stopcock is disposed at the base end of the base. Further, a temperature sensor connector 18 is provided at a base end of the temperature sensor cable 16. The temperature sensor connector 18 has sensor leads 12a, 1
The rear end of 2b is connected.

As shown in FIG. 3 (C), a locking member 19 for connection with the energy radiating device 3 is provided on the outer peripheral surface of the sheath flange 14. The locking member 19 is provided with a rotating lever 21 supported on the sheath flange 14 so as to be rotatable around a support shaft 20. A locking claw 22 is formed at one end of the rotating lever 21. Further, the rotating lever 21 is provided with a spring member 23 for urging the locking claw 22 in a direction for locking the energy radiating device 3.

The energy radiating device 3 has an elongated shaft portion 24 inserted into the lumen 5 of the cover sheath 4 of the catheter means 2, and a grip portion on the proximal side connected to the base end of the shaft portion 24. 25 are provided. Further, FIG.
A coaxial cable 26 is provided as shown in FIGS. An antenna portion (energy radiating element) 27 formed into an antenna shape for radiating electromagnetic waves is formed at a distal end portion of the coaxial cable 26.

On the outside of the coaxial cable 26, there is provided a pipeline partition wall 28 made of a tube material having lubricity such as FEP or PTFE. The inner diameter of the conduit wall 28 is set to be larger than the outer diameter of the coaxial cable 26. Then, the pipe partition wall 28 is held so as to be able to accommodate the coaxial cable 26 while keeping a space between the pipe partition wall 28 and the inner coaxial cable 26, and an inner cooling water channel 29 is formed between the pipe partition wall 28 and the coaxial cable 26. Is formed. It should be noted that a pipe partition wall 28 is provided at the tip of the pipe partition wall 28.
The communication hole 30 which connects the inside and the outside of is formed.

Further, an antenna cap 31 for integrally fixing the distal end of the coaxial cable 26 and the distal end of the pipe partition wall 28 is provided at the distal end of the shaft portion 24. A tapered tapered surface 31 a corresponding to the tapered surface 5 a at the distal end of the lumen 5 is formed on the outer peripheral surface of the distal end portion of the antenna cap 31. In the middle of the tapered surface 31a of the antenna cap 31, a lumen 5 is provided.
A substantially ring-shaped flange portion 31b is formed to engage with the engaging groove portion 5b. The flange 31b of the antenna cap 31 is engaged with the engagement groove 5 of the lumen 5.
By engaging with b, the energy radiating device 3 is positioned.

Note that, for example, FE
A spacer 32 composed of a spiral tube material having lubricity such as P or PTFE is wound and fixed. When the shaft portion 24 is inserted into the lumen 5 of the cover sheath 4, an outer cooling water passage 33 is formed between the inner peripheral surface of the cover sheath 4 and the spacer 32 on the pipe partition 28. It has become.

Further, as shown in FIG.
A through-hole 25a for accommodating the coaxial cable 26 and the pipeline partition wall 28 is formed in the axial center portion. This through hole 25
A ring-shaped partition wall fixing member 34 for fixing the pipeline partition wall 28 inside the grip portion 25 is provided at a.

The partition wall fixing member 34 has a tapered tapered surface 34a at the tip end. Also, the gripper 2
In the through hole 25a, an engagement recess 25b having a shape corresponding to the tapered surface 34a of the partition wall fixing member 34 is formed. Then, the tapered surface 34 of the partition wall fixing member 34
a, and the base end of the pipeline partition wall 28 is fixed between the holding portion 25 and the engaging recess 25b of the through hole 25a of the grip portion 25. The base end side of the coaxial cable 26 passes through the through-hole 25 a of the grip 25, inside the ring of the partition wall fixing member 34, and inside the ring of a screw member 35 behind the partition wall fixing member 34, which will be described later. Is extended to the side.

Further, a communication hole 36 penetrating in the radial direction is formed at an intermediate portion of the partition wall fixing member 34. A ring-shaped screwing member 35 screwed into the grip 25 is screwed behind the partition wall fixing member 34. An O-ring mounting groove 35a is formed in the inner peripheral surface of the distal end portion of the screwing member 35. Then, an O-ring 37 pressed and fixed in the O-ring mounting groove 35a of the screwing member 35 is sandwiched between the rear end of the partition wall fixing member 34 and the O-ring 37 fixes the coaxial cable 26 in a watertight manner. It has become.

The rear end of the grip 25 has a grip 25
A protective covering member 38 for protecting the coaxial cable 26 extending to the rear side beyond and a buckling prevention member 39 are provided. Further, a microwave connector 40 is connected to the rear end of the coaxial cable 26.

Further, a cooling water inlet connector 41 and a cooling water outlet connector 42 are provided at the rear end of the grip 25. Here, the cooling water inlet connector 41 is connected to the water supply passage 4.
3. A drainage channel 44 is formed in the cooling water outlet connector 42. When the catheter means 2 and the energy radiating device 3 are assembled, the water supply passage 43 of the cooling water inlet connector 41 is communicated with the outer cooling water passage 33 formed between the inner peripheral surface of the cover sheath 4 and the shaft portion 24. The drain passage 44 of the cooling water outlet connector 42 is connected to the inner cooling water passage 29 between the conduit wall 28 and the coaxial cable 26 through the communication hole 36 of the partition wall fixing member 34.

Further, an engagement recess 45 is formed on the outer peripheral surface of the front end of the grip 25. When assembling the catheter means 2 and the energy radiating device 3, the shaft portion 24 of the energy radiating device 3 is inserted into the lumen 5 of the cover sheath 4 of the catheter means 2, and the tapered surface 5 a of the lumen 5 has the taper of the antenna cap 31. Surface 31a
While the flange 31b of the antenna cap 31 is engaged with the engagement groove 5b of the lumen 5,
The locking claw 22 of the rotating lever 21 of the locking member 19 of the operating end 13 of the catheter means 2 is releasably engaged with the engaging recess 45 of the grip 25 so that the catheter means 2 and the energy radiating device 3 Are detachably connected.

A through hole 25 is provided at the front end of the gripper 25.
A substantially ring-shaped protruding portion 46 protrudes forward from the periphery of a. A tapered tapered surface 46 a is formed on the outer peripheral surface of the projecting portion 46. An engaging recess 47 having a shape corresponding to the projecting portion 46 of the grip portion 25 is formed at the axial center of the rear end surface of the sheath flange 14. And
At the time of connection between the catheter means 2 and the energy radiating device 3, the engaging portion 47 of the sheath flange 14 is engaged with the protruding portion 46 of the grip portion 25 in contact therewith.

Next, the operation of the above configuration will be described.
The urethral applicator 1 of the present embodiment is separated into a catheter means 2 shown in FIG. 2A and an energy radiating device 3 shown in FIG. 2B. During treatment, the urethral applicator 1 inserts the energy radiating device 3 as a reusable part into the newly prepared catheter means 2 and uses it in combination.

When assembling the catheter means 2 and the energy radiating device 3, the shaft portion 24 of the energy radiating device 3 is inserted into the lumen 5 of the cover sheath 4 of the catheter means 2. At this time, the energy radiating device 3
Is pushed in the lumen 5 toward the distal end. Then, the flange portion 31b on the antenna cap 31 at the tip of the shaft portion 24 pushes and spreads the inclined surface 5c of the lumen 5, and is advanced until it is fitted into the engagement groove portion 5b.

Further, when the flange 31b on the antenna cap 31 is fitted into the engagement groove 5b of the lumen 5, the tapered surface 31a at the tip of the antenna cap 31 abuts against the tapered surface 5a at the tip of the lumen 5. In this state, the antenna section 27 of the coaxial cable 26 is positioned in the longitudinal direction and the radial direction of the catheter means 2 respectively. At the same time, the sheath flange 14
The projecting portion 46 of the grip 25 is abutted against and engaged with the engaging recess 47 of the gripper 25, and the locking claw 22 of the rotating lever 21 at the operation end 13 of the catheter means 2 is engaged with the grip 25.
Is engaged with the engaging recess 45 so as to be detachable.
4 is fixed to the grip 25. Thereby, the catheter means 2 and the energy radiating device 3 are detachably connected to each other even on the hand side.

The urethral applicator 1 in which the catheter means 2 and the energy emitting device 3 are combined is then inserted into the urethra of the patient. At this time, the urethral applicator 1 inserted through the urethra from the external urethral opening is pushed until the anchor balloon 7 reaches the inside of the bladder.
Then, in this bladder, the anchor balloon 7 is expanded and lightly pulled to the outer urethral opening side to position the urethral applicator 1. At this position, the microwave antenna portion 27 at the end of the coaxial cable 26 is in a state of matching the prostate, and the antenna portion 27 and the temperature sensor 10
The positions of a and 10b are respectively positioned with respect to the treatment site.

Further, the microwave connector 40 and the temperature sensor connector 18 are connected to a microwave oscillation device (not shown), and the cooling water inlet connector 41 and the cooling water outlet connector 42 are connected to a cooling water supply device (not shown). In this state, the microwave oscillating device is driven, microwaves are output from the microwave antenna section 27 at the end of the coaxial cable 26, and the prostate tissue is heated by the microwave energy.

During the heating treatment period by the microwave, the cooling water is kept flowing into the water supply channel 43 through the cooling water inlet connector 41. At this time, the cooling water flows from the water supply passage 43 to the inner peripheral surface of the cover sheath 4 and the shaft portion 2.
4 and flows into the inside cooling water passage 29 from the communication hole 30 at the front end of the pipe partition wall 28 through the inside of the outside cooling water passage 33 formed therebetween. Further, the inner cooling water passage 29
Flows toward the base end side, and the communication hole 3 of the partition wall fixing member 34
6 flows out to the drainage channel 44 side of the cooling water outlet connector 42. This allows the flow of the cooling water to effectively cool the urethral mucosa and protect it from thermal damage due to overheating during the treatment of heating the prostate tissue with microwave energy.

In addition, during the heating treatment period by the microwave, the temperature sensors 10a, 10a,
By 10b, the temperature of the outer surface of the urethral mucosa is measured. Then, the temperature information from each of the temperature sensors 10a and 10b is sent to the cooling water supply device or the microwave oscillation device, so that the heating temperature is controlled. With the above system, it is possible to heat the prostate tissue with microwave energy and to protect the urethral mucosa from thermal damage due to excessive heating.

After the treatment, the urethral applicator 1
Is removed from the urethra, and the locking claw 22 is released from the engaging concave portion 45 of the grip portion 25 by operating the rotating lever 21 of the locking member 19 at the operating end portion 13 of the catheter means 2. The engagement between the means 2 and the energy radiating device 3 on the hand side is released. Subsequently, the energy radiating device 3 is pulled toward the user, and the energy radiating device 3 is pulled until the flange portion 31b on the antenna cap 31 of the energy radiating device 3 gets over the inclined surface 5c in the catheter lumen 5. Thereby, the engagement of the distal end side between the catheter means 2 and the energy radiating device 3 is released. In this state, the catheter means 2 and the energy emitting device 3 can be separated again.

At this time, it is possible to discard only the catheter means 2 which is a living body contact portion. Furthermore, the energy emitting device 3 can be reused and can be used in combination with the newly prepared catheter means 2.

Therefore, the above configuration has the following effects. That is, according to the urethral applicator 1 of the present embodiment, the catheter means 2 shown in FIG.
Since the energy radiating device 3 shown in FIG. 2B is detachably connected, the catheter unit 2 and the energy radiating device 3 are separated after the treatment, and only the catheter unit 2 is separated and replaced for each treatment and discarded. Thereby, the relatively expensive energy radiating device 3 can be reused. Therefore, there is an effect that it is possible to reduce the treatment cost as compared with the case where the components of the energy radiating device 3 are discarded only by one use.

In the present embodiment, the catheter means 2
With the energy radiating device 3 inserted in the lumen 5 of
When assembling, positioning is performed by engaging the flange portion 31b of the antenna cap 31 at the distal end of the energy radiating device 3 with the engaging groove 5b near the distal end of the lumen 5 of the catheter means 2, thereby positioning the longitudinal direction. To prevent relative movement to Therefore, when microwave energy is radiated to the treatment site by the antenna unit 27 of the energy radiating device 3 to perform heating treatment, the antenna unit 27 of the energy radiating device 3 can be accurately positioned with respect to the treatment region. Therefore, it is possible to efficiently radiate the microwave energy to the treatment site to perform the heating treatment.

Further, in the present embodiment, the position of the antenna section 27 of the energy radiating device 3 is
a, 10b and the portion close to the balloon 7, it is possible to reduce the difference in elasticity between the catheter means 2 and the energy radiating device 3 and the movement of the antenna section 27 with respect to the treatment site due to movement of the patient. Thus, accurate heating is possible.

FIGS. 4A, 4B and 6 show a second embodiment of the present invention. In the present embodiment, the configuration of the urethral applicator 1 of the first embodiment (see FIGS. 1 to 3A to 3C) is changed as follows.

That is, in the present embodiment, FIG.
As shown in (B), projections 51 are projected from the antenna cap 31 at the tip of the shaft portion 24 in the energy radiation device 3 at four positions along the circumferential direction. Further, as shown in FIG. 5, a slit 52 through which each projection 51 can pass is provided on the inclined surface 5c of the lumen 5 of the catheter means 2 at four positions along the circumferential direction. The configuration of the other parts is the same as that of the urethral applicator 1 of the first embodiment, and a description thereof will be omitted.

Next, the operation of the present embodiment having the above configuration will be described. At the time of assembling the energy emitting device 3 and the catheter means 2 when using the urethral applicator 1 of the present embodiment, the shaft portion 24 of the energy emitting device 3 is inserted into the lumen 5 of the cover sheath 4 of the catheter means 2. . At this time, the shaft portion 24 of the energy radiating device 3 is pushed into the lumen 5 toward the distal end. Then, when the antenna cap 31 at the tip of the shaft portion 24 hits the inclined surface 5c of the lumen 5,
The shaft portion 24 is further pushed while being rotated around the long axis. Thereby, when the position of each projection 51 on the antenna cap 31 matches the position of each slit 52 on the inclined surface 5c of the catheter means 2, each projection 51 on the antenna cap 31 passes through each slit 52. . Subsequently, when the distal end of the antenna cap 31 comes into contact with the tapered surface 5a at the distal end of the lumen 5 of the catheter means 2, each projection 51 is inserted into the engagement groove 5b of the lumen 5. In this state, by further rotating the energy radiating device 3 in the axial direction, the gap between the antenna cap 31 and the catheter means 2 is engaged and fixed.

When the urethral applicator 1 is disassembled after use, the rotating claw 22 of the locking member 19 at the operating end 13 of the catheter means 2 is operated to move the locking claw 22 to the engaging recess of the grip 25. By releasing from 45, the proximal engagement between the catheter means 2 and the energy emitting device 3 is released. Subsequently, the energy radiating device 3 is rotated in the axial direction so that the position of each projection 51 on the antenna cap 31 and the position of each slit 52 of the inclined surface 5c of the catheter means 2 are matched. In this state, the energy radiating device 3 is pulled toward the hand side, and each projection 51 on the antenna cap 31 passes through each slit 52, so that the distal end side of the catheter means 2 and the energy radiating device 3 can be engaged. Is released. Further, by pulling out the energy radiating device 3 from the catheter means 2 in this state, the catheter means 2 and the energy radiating device 3 can be separated again. The other operations are the same as those of the first embodiment, and the description is omitted here.

Therefore, in the present embodiment, the same effects as those of the first embodiment can be obtained. In the present embodiment, the antenna cap 31 at the tip of the shaft portion 24 in the energy radiating device 3 is particularly provided in the circumferential direction. The projections 51 are respectively provided at four divided positions along the
Is provided with a slit 52 through which each projection 51 can pass, so that the energy radiating device 3 is rotated in the axial direction, and the position of each projection 51 on the antenna cap 31 and the inclined surface 5c of the catheter means 2 are adjusted. The position of each slit 52 is matched with each projection 5 on the antenna cap 31.
By passing 1 through each slit 52, the distal end side of the catheter means 2 and the energy radiating device 3 can be engaged and disengaged. Therefore, the engagement between the catheter means 2 and the energy radiating device 3 is elastically deformed, so that the antenna cap 31 and the catheter tip can be easily attached to and detached from the lumen 5 as compared with the case where the engagement operation is performed. There is an effect.

FIGS. 7A, 7B and 9 show a third embodiment of the present invention. This embodiment is a modification of the configuration of the second embodiment (see FIGS. 4A, 4B and 6) as follows.

That is, in the present embodiment, FIG.
As shown in (B), two projections 51 are provided on the antenna cap 31 at the tip of the shaft portion 24 in the energy radiating device 3. These two projections 51 are respectively arranged at positions divided into two along the circumferential direction of the antenna cap 31.

Also, as shown in FIG.
The inclined surface 5c of the lumen 5 is provided with two slits 52 through which each projection 51 can pass. These two slits 52 are respectively arranged at positions divided into two along the circumferential direction. Further, an engagement groove 53 bent in the circumferential direction is formed at the tip of each slit 52. These engagement grooves 53 extend at an angle of about 45 ° along the circumferential direction of the lumen 5.

Next, the operation of the present embodiment having the above configuration will be described. In the urethral applicator 1 of the present embodiment, when assembling the energy emitting device 3 and the catheter means 2, the shaft portion 24 of the energy emitting device 3 is inserted into the lumen 5 of the cover sheath 4 of the catheter means 2. At this time, the shaft portion 24 of the energy radiation device 3
Is pushed into the lumen 5 toward the distal end. Then, when the antenna cap 31 at the tip of the shaft portion 24 abuts against the inclined surface 5c of the lumen 5, the shaft portion 24 is further pushed while rotating about the long axis thereof.
Thereby, the position of each projection 51 on the antenna cap 31 and each slit 52 of the inclined surface 5c of the catheter means 2
When the positions coincide with each other, each projection 51 on the antenna cap 31 is inserted into each slit 52. Subsequently, when each projection 51 on the antenna cap 31 is pushed into the tip of each slit 52 and abuts on the engagement groove 53 of each slit 52, the energy radiating device 3 is rotated in the axial direction, Each projection 51 on the antenna cap 31 is inserted into the engagement groove 53 of each slit 52. Then, the antenna cap 31 and the catheter means 2 are engaged and fixed by rotating until each projection 51 on the antenna cap 31 comes into contact with the end of the engagement groove 53 of each slit 52. Note that other operations are the same as those of the second embodiment, and a description thereof will be omitted.

Therefore, in this embodiment, the same effects as those of the second embodiment can be obtained, and in this embodiment, in particular, each projection 51 can pass through the inclined surface 5c of the lumen 5 of the catheter means 2. Since two slits 52 are provided, and an engagement groove 53 bent in the circumferential direction is provided at the tip of each slit 52, each work on the antenna cap 31 at the time of assembling the energy radiating device 3 and the catheter means 2 is performed. When the projections 51 are pushed into the leading ends of the slits 52 and hit the engaging grooves 53 of the slits 52, the energy radiating device 3 is rotated in the axial direction. Engagement groove 53
By rotating the antenna cap 31 until the antenna cap 31 and the catheter means 2 are engaged with each other, the antenna cap 31 and the catheter means 2 can be engaged and fixed. Therefore, the antenna cap 31
The fixed position between the catheter means 2 and the inner surface of the catheter means 2 can be recognized by the feel of the hand, so that the catheter means 2 and the energy radiating device 3
This has the effect of facilitating assembly.

In the above embodiment, the engagement recess 45 of the grip 25 of the energy radiating device 3 and the locking claw 22 of the rotating lever 21 of the locking member 19 at the operation end 13 of the catheter means 2 are used. Instead of fixing, a fixing part such as a ratchet mechanism may be used.

FIGS. 10A and 10B and FIG.
Shows a fourth embodiment of the present invention. In the present embodiment, the configuration of the treatment apparatus 1 of the third embodiment (see FIGS. 7A to 7C to 9) is changed as follows.

That is, in the present embodiment, FIG.
As shown in (A) and (B), each slot 61 provided on the outer surface of the antenna cap 31 is formed with a linear front guide portion 61a along the axial direction of the shaft portion 24 on the tip end side. Further, a bent portion 61b bent in a direction deviated from the axial direction of the shaft portion 24 is formed at the rear end of the front guide portion 61a.

The tapered surface 5a at the distal end in the lumen 5 of the catheter means 2 is provided with two substantially pin-shaped projections 62 which engage with the respective slots 61 of the antenna cap 31, as shown in FIG. I have.

Next, the operation of the present embodiment having the above configuration will be described. In the urethral applicator 1 of the present embodiment, when assembling the energy radiating device 3 and the catheter means 2, the shaft portion 24 of the energy radiating device 3 is inserted into the lumen 5 of the cover sheath 4 of the catheter means 2. At this time, the shaft portion 24 of the energy radiation device 3
Is inserted with the slot 61 on the antenna cap 31 aligned with the projection 62 on the inner surface of the catheter means 2.

Then, the shaft portion 24 of the energy radiating device 3 is pushed into the lumen 5 toward the distal end, and the front guide portion 6 of the slot 61 on the antenna cap 31 is pushed.
After the projection 62 of the catheter means 2 is inserted into 1a,
When the projection 62 hits the rear end of the front guide 61a, the energy radiating device 3 is rotated in the axial direction. As a result, the projection 62 is moved along the bent portion 61b of the slot 61, and is rotated until it abuts against the end of the bent portion 61b, whereby the antenna cap 31 and the catheter means 2 are engaged and fixed.

Therefore, the present embodiment also provides the same effects as the second embodiment. In this embodiment, particularly, in order to further facilitate disassembly and assembly of the catheter means 2 and the energy radiating device 3, an engaging portion between the grip portion 25 of the energy radiating device 3 and the sheath flange 14 of the catheter means 2 is preferred. May be provided in the vicinity of the indicator indicating the rotation direction when the catheter means 2 and the energy radiating device 3 are fixed, and the fixed / separated position.

FIGS. 12A and 12B show a fifth embodiment of the present invention. This embodiment is the first
The configuration of the treatment apparatus 1 of the embodiment (see FIGS. 1 to 3A to 3C) is changed as follows.

That is, in this embodiment, FIG.
As shown in FIG.
A ring-shaped engagement groove 71 is provided on the outer surface of the antenna cap 31 at the end of the fourth.

As shown in FIG. 12B, an elliptical ring 72 made of an elastic resin material such as silicon is mounted on the engagement groove 5b at the distal end of the lumen 5 of the catheter means 2.

Next, the operation of the above configuration will be described.
In the urethral applicator 1 of the present embodiment, when assembling the energy radiating device 3 and the catheter means 2, the shaft portion 24 of the energy radiating device 3 is inserted into the lumen 5 of the cover sheath 4 of the catheter means 2, and the energy is radiated. The shaft portion 24 of the device 3 is pushed into the lumen 5 toward the distal end. At this time, before the distal end of the antenna cap 31 at the distal end of the shaft portion 24 abuts against the tapered surface 5a at the distal end of the lumen 5, the distal end of the antenna cap 31 is inserted into the ring 72 in the engagement groove 5b. The tip of the antenna cap 31 is a ring 72
After pressing, the tapered surface 5 at the tip of the lumen 5
a. As a result, the ring 72 is engaged with the engagement groove 71 of the antenna cap 31, whereby the antenna cap 31 and the catheter means 2 are engaged and fixed.

When disassembling the urethral applicator 1 after use, the portion of the catheter means 2 where the ring 72 is located is pressed from the outside to deform the ring 72 into a circular shape. Thereby, the ring 72 and the antenna cap 3
The engagement with the first engagement groove 71 is released. In this state, the catheter means 2 and the energy emitting device 3 can be separated again.

Therefore, in this embodiment, the same effects as those of the first embodiment can be obtained, and in this embodiment, the elastic resin is particularly provided in the engagement groove 5b at the distal end in the lumen 5 of the catheter means 2. A ring-shaped engaging groove 71 is provided in the antenna cap 31 of the shaft portion 24 of the energy radiating device 3 while the elliptical ring 72 made of a material is mounted.
, The engagement between the antenna cap 31 and the catheter means 2 is fixed so that when disassembling the urethral applicator 1 after use, the portion where the ring 72 of the catheter means 2 is located Is pressed from the outside, the ring 72 is deformed into a circular shape, and the engagement between the ring 72 and the engagement groove 71 of the antenna cap 31 can be released. Therefore, there is an effect that the work at the time of disassembling the urethral applicator 1 is facilitated.

Further, the present invention is not limited to the above-described embodiment, and it goes without saying that various modifications can be made without departing from the spirit of the present invention. Next, other characteristic technical matters of the present application will be additionally described as follows. (Additional Item 1) In a prostate warming treatment apparatus comprising a catheter means which can be inserted into the urethra and an energy radiating element which is detachably disposed inside the catheter, means for positioning the energy radiating element near the distal end inside the catheter. The treatment device characterized by having provided.

(Additional Item 2) In the additional item 1, the positioning means regulates movement of the catheter in the longitudinal direction.

(Additional Item 3) In the above-mentioned additional item 1, the positioning means is characterized by comprising a locking mechanism between the catheter lumen and the tip of the energy radiating element.

(Additional Item 4) In the above additional item 3, the locking mechanism is characterized by comprising an annular elastic member inside the catheter and a convex portion on the outer surface of the tip end of the energy radiating element.

(Additional Item 5) In the additional item 4, the positioning means comprises a catheter lumen expanding portion and a convex portion at the tip of the energy radiating element.

(Additional Item 6) In the additional item 1, the temperature measuring means and the in-vivo indwelling mechanism are provided on the outer surface near the distal end of the catheter.

(Additional Item 7) In the additional item 6, the indwelling mechanism in the body is a balloon.

(Appendix 8) Tubular catheter means,
An energy radiating element that is inserted from the proximal end side of the catheter and emits electromagnetic wave energy to a treatment site to perform treatment, wherein a means for removably positioning the distal end of the energy radiating element is provided by the catheter means. A treatment device provided at the distal end of a lumen.

(Technical field to which the inventions of Supplementary Items 1 to 8 belong)
TECHNICAL FIELD The present invention relates to a thermal treatment apparatus that emits electromagnetic wave energy such as microwaves to a treatment target site of a prostate and heats and treats the treatment target site.

(Conventional Techniques of Supplementary Items 1 to 8) Various treatment apparatuses using RF waves, microwave lasers, ultrasonic waves, and the like have been developed for heating treatment of malignant tumors and benign tumors. In particular, as a method for treating benign prostatic hyperplasia, the prostate to be treated is treated at a temperature of 45 ° C. or higher for 3 hours.
A warming treatment in which the warming treatment is performed for about 0 minute to 1 hour is known, and this is called high temperature treatment (thermotherapy).

Among these warming treatments, transurethral treatment using microwaves in particular is being established as an outpatient treatment in general public hospitals and clinics in Japan. Normal,
The applicator used for this heating treatment includes an energy radiating means mounted inside the applicator, and a cover sheath (catheter) which is an outer skin portion which covers the outer periphery and comes into contact with the urethral mucosa of the patient.

Apparatuses for performing these heating treatments are disclosed in JP-A-9-122260 and JP-A-7-116274. Japanese Patent Application Laid-Open No. Hei 9-122260 discloses an apparatus having a fixing means for positioning a removable brachytherapy catheter with respect to an intraluminal applicator.
No. 4 discloses an apparatus having two temperature sensors for controlling heating on an outer surface of the applicator in contact with a heating treatment part.

(Problems to be Solved by Additional Items 1 to 8)
In Japanese Patent Application Laid-Open No. Hei 7-116274, the applicator is integrally formed with a microwave antenna and a cover sheath which is an outer sheath. Normally, the applicator is desirably used after being re-sterilized for reuse, but is often discarded after a single use because of the resistance of the outer sheath and structural reasons.

The energy radiating element as a component of this applicator is generally an expensive component. For example, as a microwave antenna, a helical antenna, a slot antenna, a diball antenna, or the like obtained by finely processing a coaxial cable is used. Further, the microwave is supplied to the microwave antenna from the microwave oscillator. Generally, SMA type connectors, BNC type connectors, and N type connectors are used as microwave connectors for transmitting microwave energy, and thus are not inexpensive components. Therefore, the cost for one heating treatment becomes expensive, and the economic burden on the patient increases.

Japanese Patent Application Laid-Open No. 9-122260 discloses that although an intraluminal applicator and a brachytherapy catheter as an energy radiating element are detachable, a fixing mechanism is provided at a base end thereof.
Due to expansion and contraction of the applicator in the long axis direction and patient movement,
The positioning accuracy of the brachytherapy source radiating section at the distal end heating section with respect to the treatment site was not good.

(Objects of Supplementary Items 1 to 8) Due to the above problems, an object of the present invention is to provide a heating treatment for heating treatment which is inexpensive and can position the energy radiating portion with respect to the treatment site with high accuracy. The purpose is to supply the applicator.

(Means and Action for Solving the Problem of Additional Item 1) In a heating treatment apparatus having a catheter means insertable into a body cavity and an energy radiating means detachably disposed in the catheter, a catheter A fixing means for preventing relative movement of the means and the energy emitting means in the long axis direction is provided at the distal end portion of the catheter lumen.

Before use, the catheter means and the energy emitting means are assembled. During the treatment, the treatment is performed by radiating energy to the treatment site while positioning the tip of the energy radiating means and the tip of the catheter by the fixing means. After the treatment, the catheter means and the energy emitting means are separated, the energy emitting means is reused, and the catheter means is discarded.

(Effects of Additional Items 1 to 8) According to the present invention, it is possible to remove a relatively expensive energy emitting means from a catheter and reuse it, which leads to a reduction in treatment cost. Further, since the energy radiating means is detachably attached to the catheter means in a sealing manner, only the catheter radiating means can be used after being sterilized and sterilized.

In addition, since the energy radiating portion of the energy radiating element can be positioned with respect to the catheter tip, it is possible to more accurately radiate energy to the treatment site, thereby reducing treatment time and invasion to the patient. Can be achieved.

[0085]

According to the present invention, an insertion portion is formed by an internal unit in which an energy radiating element is provided and an exterior unit having an internal unit insertion space into which the internal unit is inserted. Since it was detachably connected to the internal unit, the energy radiating element, which is a relatively expensive component, was removed from the exterior unit,
It can be reused, leading to lower treatment costs.
In addition, since only the exterior unit can be disinfected and sterilized with the expensive internal unit removed from the exterior unit, the operation of disinfecting and sterilizing the exterior unit is facilitated and usable.

Also, since the positioning unit for positioning the internal unit is provided at a position near the tip of the internal unit insertion space of the external unit, the energy radiating element of the internal unit can be precisely positioned with respect to the internal unit insertion space of the external unit. Can be positioned. As a result, it is possible to more accurately radiate energy to the treatment site, which has the effect of shortening the treatment time and reducing invasion to the patient.

[Brief description of the drawings]

FIG. 1 is a side view showing a part of a urethral applicator according to a first embodiment of the present invention in a longitudinal section.

FIGS. 2A and 2B show a urethral applicator according to the first embodiment, in which FIG. 2A is a side view showing a part of a catheter means in a longitudinal section, and FIG. 2B is a side view showing an energy emitting device.

FIGS. 3A and 3B show a main configuration of the urethral applicator according to the first embodiment, in which FIG. 3A is a longitudinal sectional view showing a distal end structure of an insertion portion, and FIG. Sectional drawing, (C) is a longitudinal cross-sectional view which shows the structure of a hand part.

FIG. 4 shows a tip of an energy emitting device in a urethral applicator according to a second embodiment of the present invention;
(A) is a front view, (B) is a side view.

FIG. 5 is a longitudinal sectional view of a main part showing a main part configuration of a catheter means in the urethral applicator of the second embodiment.

FIG. 6 is a sectional view taken along line VI-VI of FIG. 5;

FIG. 7 shows a tip of an energy emitting device in a urethral applicator according to a third embodiment of the present invention;
(A) is a front view, (B) is a side view.

FIG. 8 is a longitudinal sectional view of a main part showing a main part configuration of a catheter means in a urethral applicator of a third embodiment.

FIG. 9 is a sectional view taken along line IX-IX of FIG. 8;

FIGS. 10A and 10B show a front end of an energy emitting device in a urethral applicator according to a fourth embodiment of the present invention, wherein FIG. 10A is a front view and FIG.

FIG. 11 is a longitudinal sectional view of a main part showing a main part configuration of a catheter means in a urethral applicator of a fourth embodiment.

FIG. 12 shows a positioning portion between a catheter means and an energy radiating device in a urethral applicator according to a fifth embodiment of the present invention.
(B) is a sectional view taken along line 12B-12B in (A).

[Explanation of symbols]

 Reference Signs List 1 urethral applicator 2 catheter means (exterior unit) 3 energy radiating device (internal unit) 5 lumen (internal unit insertion space) 5b engaging groove (positioning portion) 27 antenna portion (energy radiating element)

 ──────────────────────────────────────────────────続 き Continued on the front page (72) Inventor Toru Nagase 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Takefumi Uesugi 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Inventor Yoshimitsu Inoue 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. F-term (reference) 4C060 JJ29 MM24 MM27 4C082 MA02 MC01 ME02 4C099 AA01 CA18 JA11

Claims (1)

[Claims] 1. A treatment apparatus in which an energy radiating element for heating treatment is disposed in an insertion portion insertable into a body cavity of a patient, an internal unit in which the energy radiating element is disposed, and the internal unit. The insertion unit is formed by an exterior unit having an interior unit insertion space into which the interior unit is inserted, and the exterior unit and the interior unit are detachably connected to each other. A therapeutic device comprising a positioning portion for positioning the internal unit at a position near a distal end portion.