JP2018033831A - Catheter and catheter system - Google Patents

Abstract

To provide a catheter and a catheter system capable of maintaining an information detection means such as a sensor provided on the catheter in a state where it is in contact with an inner wall of a body cavity accurately and continuously. A temperature sensor 10c is provided that includes a catheter body 10 that extends in a long and straight line along a central axis X, and is disposed on a part of the catheter body 10 to detect tissue information in the body. And a balloon 10b that is disposed in a part of the catheter main body 10 and expands eccentrically in the radial direction of the catheter main body 10. [Selection] Figure 2

Description

  The present invention relates to a catheter and a catheter system that are used for detecting tissue information in the body. The catheter described in the present application refers to a long member that is inserted into a living body lumen and used for measurement of an affected area.

  In recent years, ablation treatment in which a causative target tissue is cauterized has been performed for the treatment of tachyarrhythmia in the heart, treatment of treatment-resistant hypertension, and the like. In general, this ablation involves cauterizing the target tissue by irradiation with high frequency, ultrasonic waves, radio waves, laser light, infrared rays, etc. and heat generation, or conversely, by destroying the nerve cells of the target tissue by cooling at low temperature. Is done by shutting off.

The ablation apparatus as described above may cause damage due to transmission of heat of ablation to other adjacent organs during ablation of various organs. Therefore, a catheter provided with a temperature sensor that measures the temperature of the organs. Has been proposed.
This prior art catheter, for example when the ablation treatment is performed on the left atrium, heats and treats the diseased tissue of the heart, but is adjacent to the left atrium of the heart due to the heat generated during ablation. The esophagus is also heated and can damage the esophagus.
In ablation treatment to prevent this esophagus from being damaged, the temperature is measured at multiple locations on the esophageal wall with a catheter equipped with a temperature sensor during ablation treatment, and any of the locations may be damaged. When the temperature sensor detects that it has approached a certain temperature, it is necessary to temporarily interrupt the ablation and cool the heated part of the esophagus.

  The following Patent Document 1 is cited as a document describing a technique related to temperature measurement in this ablation treatment. In this Patent Document 1, the tip of a catheter (temperature probe) provided with a temperature sensor is meandered, looped, A catheter (temperature probe) is described which measures the temperature in the esophagus by being formed in a spiral shape and disposed in the esophagus.

Special table 2011-517417 gazette

  The sensor catheter for esophagus described in Patent Document 1 is held in a state where the sensor is in contact with the inner wall of the body cavity because the serpentine convex portion and the portion swirled in a coil shape are crushed in the tube and the shape collapses. However, there was a problem that accurate and continuous temperature measurement was difficult.

  An object of the present invention has been made in view of such circumstances, and provides a catheter and a catheter system capable of maintaining a state in which information detecting means such as a sensor provided on the catheter is in contact with the inner wall of a body cavity accurately and continuously. It is to be.

  In order to achieve the above object, a catheter having a catheter main body extending in a flexible manner in a long straight line along a central axis, which is disposed in a part of the catheter main body and detects tissue information in the body. And a balloon that is arranged on a part of the catheter body and is eccentrically expanded in the radial direction of the catheter body.

  Further, the present invention may include a parallel straight portion that is a part of the catheter body and is bent so as to be parallel to the central axis of the catheter body, and a balloon may be disposed on the parallel straight portion. The balloon may be inflated eccentrically in the direction opposite to the bending direction of the catheter body.

  In addition, the present invention includes a linear extension portion that is a part of the elongated shape of the catheter body, is positioned on the distal end side of the parallel straight portion, and is bent so as to be parallel to the parallel straight portion. A part of the linear extension may be provided with a balloon eccentric in the radial direction of the linear extension, and the balloon is eccentric in the opposite direction to the parallel linear part across the central axis of the catheter body. You may make it expand | swell.

  In the present invention, two or more balloons may be attached in the longitudinal direction across the contact portion of the catheter body, and the information detecting means may be a temperature sensor for measuring temperature. Good. Moreover, it is good also as a catheter system provided with the said catheter and the elongate and hollow sheath which can be accommodated in the inside from the front end side, and can be exposed outside.

  A catheter and a catheter system according to the present invention are catheters having a catheter main body that extends in a long and straight line along a central axis, and are disposed on a part of the catheter main body to receive information on tissues in the body. A contact portion including an information detecting means for detecting, and a balloon which is disposed in a part of the catheter body and is eccentrically expanded in the radial direction of the catheter body, so that the eccentrically inflating balloon is an inner wall of the body cavity When the catheter main body positioned in the direction opposite to the eccentric direction of the balloon is pressed against the inner wall of the body cavity, the information detecting means such as a temperature sensor provided on the catheter main body is in contact with the inner wall of the body cavity accurately and continuously. Can be held.

1 is an overall view of a catheter according to a first embodiment of the present invention. The enlarged view and AA expanded sectional view of the front-end | tip part of the catheter by 1st Example of this invention. The figure for demonstrating the usage method of the catheter of this invention. The whole figure of the catheter guide applied to the catheter of 2nd Example of this invention. The enlarged view of the front-end | tip part of the catheter of the 3rd, 4th, 5th Example of this invention.

  Hereinafter, an embodiment when the catheter according to the present invention is applied to a temperature sensor catheter for measuring the temperature of the esophagus by inserting the catheter into a body cavity will be described.

  The temperature sensor catheter 100 according to the present embodiment is a catheter for measuring the temperature in the esophagus, is inserted into the esophagus, and ablation technique is used for the left atrium adjacent to the esophagus, so that a diseased tissue of the heart is detected. It is a catheter for measuring temperature at a plurality of locations on the inner wall of the esophagus when heated.

[Constitution]
As shown in FIG. 1, the entire structure of the temperature sensor catheter 100 is a long and plural hole in which a contact portion 10 a that is in contact with the inner wall of a living body lumen (in this embodiment, the esophagus) is formed on the distal end side. A hollow catheter body 10 opened in a direction, a catheter operation part 11 for operating the catheter body 10, and an inflatable balloon 10b attached to the distal end side from the contact part 10a.

As shown in FIGS. 2A and 2B, the distal end side of the catheter main body 10 is a straight line portion that is substantially parallel to the central axis X at a position shifted outward from the central axis X on the proximal end side of the catheter main body 10. Is formed in a substantially crank shape having a bent portion so as to form a parallel straight portion 10g, and a contact portion 10a for contacting the body cavity is formed in the parallel straight portion 10g.
The contact portion 10a is provided with a plurality of temperature sensors 10c (six in this embodiment) as information detection means, and the temperature detected by the temperature sensors 10c is opened in the longitudinal direction of the catheter body 10. The information is displayed on a monitor mounted on a sensor power supply (not shown) via the holes 10f, the catheter operation unit 11, and the wires passing through the cable 11b.

A balloon 10b is provided on the distal end side of the contact portion 10a as shown in FIG. 2C showing a cross section AA in FIG. 2A, and a fluid (not shown) supplied from a fluid supply device (not shown). For example, air) from the fluid inlet 11a (FIG. 1) to the inside of the balloon 10b from the fluid outlet 10e located inside the balloon 10b through the fluid supply path 10d which is a hole opened in the longitudinal direction of the catheter body 10. The balloon 10b is deflated by discharging the fluid.
As shown in FIG. 3, the balloon 10b is inflated with a balloon 10b attached so as to be inflated eccentrically in the radial direction of the parallel straight portion 10g including the contact portion 10a, thereby causing the temperature sensor 10c to be an esophagus which is a living body lumen. It can be pressed against the esophageal inner wall E of D. That is, in this embodiment, the balloon 10b is attached eccentrically so as to expand in the direction from the contact portion 10a toward the central axis X.
In the present application, the “radial direction of the catheter body” is a direction from the diameter that is the cross-sectional diameter of the cylindrical catheter to the outside, and “eccentric and inflated” is deviated in one direction in the radial direction. That means.

[Use of temperature sensor catheter 100]
Next, an example of how to use the temperature sensor catheter 100 according to the present embodiment will be described with reference to FIGS.
First, the catheter body 10 of the temperature sensor catheter 100 with the balloon 10b shown in FIG. 2A in a deflated state is inserted into the esophagus D, and the distal end of the catheter body 10 reaches an arbitrary position inside the esophagus D.
Next, a fluid is supplied from the fluid supply device (not shown) into the balloon 10b through the fluid inlet 11a, the fluid supply passage 10d, and the fluid outlet 10e, so that the inflated state shown in FIG.

  When the balloon 10b is inflated, as shown in FIG. 3, the balloon 10b is pressed against the esophageal inner wall E opposite to the contact portion 10a, and the contact portion 10a is pressed against the esophageal inner wall E. Thereby, the contact part 10a can be stuck to the esophageal inner wall E, and the temperature sensor 10c can be made to contact the esophageal inner wall E reliably.

  After the temperature sensor 10c contacts the esophageal inner wall E, the temperature of the esophageal inner wall E is measured by supplying power to the sensor 10c from a sensor power source (not shown) via an electric wire arranged inside the catheter body 10. The temperature is displayed on a monitor mounted on a sensor power supply (not shown). There are various methods for displaying the temperature. For example, by displaying the highest temperature among a plurality of sensors 10c, when one of the sensors 10c approaches a temperature that may cause esophageal damage, If the practitioner stops ablation to the heart, esophageal damage can be avoided.

  After the temperature measurement is completed, the fluid is discharged from the balloon 10b through the fluid outlet 10e, the fluid supply path 10d, and the fluid inlet 11a to be in a contracted state as shown in FIG. 100 is discharged.

  As described above, a substantially crank shape having a bent portion is formed on the distal end side of the catheter body 10 so as to form a parallel straight portion 10g that is a straight portion substantially parallel to the central axis X on the proximal end side of the catheter body 10. At the same time, the temperature sensor 10c is arranged on the parallel straight portion 10g to form a contact portion 10a, which is eccentric so as to expand in the radial direction of the catheter body and in the direction from the contact portion 10a of the catheter body 10 toward the central axis X. By attaching the balloon 10b to the distal end side of the catheter body 10, the inflated balloon can be pressed against the esophageal inner wall E opposite to the contact portion 10a, and the contact portion 10a can be pressed against the esophageal inner wall E. The temperature can be measured by bringing 10c into contact with the inner wall E of the esophagus reliably and continuously.

The temperature sensor catheter 100 according to the present embodiment may constitute a catheter system in combination with the catheter guide 300 shown in FIG.
As shown in FIG. 4, the catheter guide 300 includes a guide operation unit 34 and a hollow sheath 31 extending in the longitudinal direction. By rotating a guide bending dial 33 provided in the guide operation unit 34, the sheath 31 is provided. The bending portion 31a, which is a flexible portion on the distal end side, can be bent.
In addition, a hole 34 a is formed in the guide operation portion 34 in the longitudinal direction so as to communicate with the sheath 31, and the catheter body 10 of the temperature sensor catheter 100 can be inserted, and the catheter body 10 can be inserted from the distal end side of the sheath 31. It is possible to project the tip side.

  Although the structure for bending the bending portion 31a of the catheter guide 300 is not illustrated, for example, a hole is formed in the longitudinal direction of the sheath 31, a wire is disposed in the hole, and the distal end of the wire is fixed to the distal end of the sheath 31. The base end of the wire is wound around a pulley fixed coaxially with the bending dial 33, and the guide bending dial 33 is rotated to pull the wire, whereby the bending portion 31a is placed on the side where the pulled wire is disposed. Can be curved.

  At the time of use, the catheter main body 10 is inserted into the hole 34a after the catheter guide 300 described above reaches an arbitrary position in the esophagus D, or an arbitrary position in the esophagus D with the catheter main body 10 inserted into the hole 34a. Then, the catheter guide 300 is caused to reach, and then the catheter body 10 is protruded from the distal end of the catheter guide 300 into the esophagus D to measure the temperature.

  As described above, the catheter system according to the present embodiment can reach the inside of the esophagus D in a state where the distal end side of the temperature sensor catheter 100 is housed by combining the temperature sensor catheter 100 and the catheter guide 300. It is safe to prevent the tip of the arm from striking the esophagus.

  In the present embodiment, an example in which the temperature sensor catheter 100 and the catheter guide 300 are combined has been shown, but it is only necessary to reach an arbitrary position in the esophagus D with the catheter body 10 covered, For example, a hollow elongate sheath is provided so as to cover the catheter main body 10 directly on the temperature sensor catheter 100 without using the catheter guide 300, and the longitudinal direction between the sheath and the catheter main body is controlled by operating the operation unit. By changing the relative position, the distal end side of the catheter body may protrude from the sheath. That is, the catheter system may be configured by combining the catheter body 10 and the hollow long sheath.

Next, a second embodiment will be described with reference to FIG.
In the embodiment described above, a substantially crank shape having a bent portion so as to form a parallel straight portion 10g, which is a straight portion substantially parallel to the central axis X, at a position shifted outward from the central axis X of the catheter body 10. In this example, the contact portion 10a for contacting the body cavity is formed on the parallel straight portion 10g. However, the present invention is not limited to this, and as shown in FIG. A balloon 50b that is eccentric with respect to the central axis of the catheter body, that is, decentered in the radial direction of the catheter body, may be attached to the tip of the linear catheter body 50.
The configurations of the balloon 50b, the temperature sensor 50c, and the contact portion 50a are the same as those in the first embodiment.

  In this way, by attaching the balloon 50b to the distal end of the catheter body 50, when the balloon 50b is inflated in the esophagus D, the balloon's expansion eccentric portion is pressed against the inner wall E of the esophagus, and the portion facing the expansion eccentric portion It is possible to press the contact portion 50a arranged on the straight portion that is against the inner wall E of the esophagus.

Next, a fourth embodiment will be described with reference to FIG.
In the third embodiment, the example in which the balloon 50b is attached to the catheter main body 50 has been shown. However, the present invention is not limited to this. For example, as shown in FIG. Two (or more) balloons 51b that are eccentric in the radial direction of the catheter body 51 and expand in the same direction may be attached.
The configurations of the balloon 51b, the temperature sensor 51c, and the contact portion 51a are the same as those in the first embodiment.

  In this way, by attaching two to the catheter body 51 so as to sandwich the contact portion 51a, the two balloons 51b press the straight portion on which the contact portions are arranged against the inner wall, so the contact portions 51a disposed between the balloons 51b. Can be more reliably pressed against the esophageal inner wall E than in the third embodiment.

Next, a fifth embodiment will be described with reference to FIG.
In the first embodiment described above, a parallel straight line that is a straight line portion that is substantially parallel to the central axis X at a position where the distal end side of the catheter main body 10 is shifted outward from the central axis X on the proximal end side of the catheter main body 10. Although an example in which the balloon 10b is formed at the tip and formed in a substantially crank shape having a bent portion so as to form the portion 10g is shown, the present invention is not limited thereto, and as shown in FIG. In addition to the parallel straight part 52g similar to the parallel straight part 10g, the distal end side of the contact part 52a of the catheter body 52 is closer to the central axis than the contact part 52a, and on the central axis or on the opposite side across the central axis (this In the embodiment, on the central axis), a substantially crank shape having a bent portion is formed so as to form a linear extension portion 52h which is a linear portion substantially parallel to the parallel linear portion 52g, and the diameter of the linear extension portion 52h is formed. Biased in direction It may be attached to balloon 52b to. That is, the contact portion 52a of the catheter main body 52 may be formed so as to protrude in the radial direction, and may be attached eccentrically so that the balloon 52b expands in a direction opposite to the protruding direction.
The configurations of the balloon 52b, the temperature sensor 52c, and the contact portion 52a are the same as those in the first embodiment.

  As described above, the contact portion 52a of the catheter body 52 is configured to be convex in the radial direction and the balloon is arranged, so that the contact portion 10a can be more reliably pressed against the esophageal inner wall E.

  Although not shown, the shape of the distal end side of the catheter body and the position of the balloon are not limited to those described above, and may be a combination of the above-described embodiments. For example, the catheter body described in the second embodiment (FIG. 2 The balloon of the fourth embodiment (FIG. 5B) is combined with (a)), or the balloon of the fourth embodiment (FIG. 5B) is added to the catheter body (FIG. 5C) of the fifth embodiment. May be combined.

  Further, the catheter according to the present invention can be applied to other than the esophageal sensor described above. For example, in the treatment of cancer such as the liver, a heating medium is introduced while monitoring the temperature of the tube wall, and the cancer tissue is made apoptotic. In order to heat and treat the prostate, the extension with a temperature sensor and a cooling tube is applied to the wall, and the prostate is intensively heat-treated while protecting the inner surface of the urethra, the prostate treatment that contracts the tissue, etc. Widely applicable.

10 catheter body, 10a contact part, 10b balloon, 10c temperature sensor, 11 catheter operation part, 11a fluid inlet 100 temperature sensor catheter,

Claims (9)

A catheter comprising a catheter body extending in a linear manner along a central axis in a flexible manner,
A contact part that is arranged on a part of the catheter body and includes information detecting means for detecting information of tissue in the body;
A balloon disposed on a portion of the catheter body and inflated eccentrically in the radial direction of the catheter body;
A catheter comprising: A catheter comprising a catheter body extending in a linear manner along a central axis in a flexible manner,
A parallel straight portion that is a part of the catheter body and is bent so as to be parallel to the central axis of the catheter body;
A contact part that is arranged in a part of the parallel straight line part and includes an information detection means for detecting information of tissue in the body;
A balloon disposed on a portion of the catheter body and inflated eccentrically in the radial direction of the catheter body;
A catheter comprising: A catheter according to claim 2,
The balloon is disposed on a parallel straight portion of the catheter body. The catheter according to claim 2 or 3,
The catheter is characterized in that it expands eccentrically in a direction opposite to the bending direction of the catheter body. A catheter comprising a catheter body extending in a linear manner along a central axis in a flexible manner,
An information detection means for detecting information on the tissue in the body, which is arranged in a parallel straight line portion which is a part of the long linear shape of the catheter body and is bent so as to be parallel to the central axis of the catheter body. Including a contact portion;
A linear extension that is a part of the elongated shape of the catheter body, is located on the distal end side of the parallel linear portion, and is bent so as to be parallel to the parallel linear portion;
A balloon disposed in a part of the linear extension and attached eccentrically in the radial direction of the linear extension;
A catheter comprising: A catheter according to claim 5,
The balloon is inflated eccentrically in a direction opposite to the parallel linear portion across the central axis of the catheter body. The catheter according to any one of claims 1 to 6,
Two or more balloons are attached in the longitudinal direction across the contact portion of the catheter body. The catheter according to any one of claims 1 to 7,
The catheter according to claim 1, wherein the information detection means is a temperature sensor for measuring temperature. A catheter according to any of claims 1 to 8,
An elongated and hollow sheath capable of accommodating the catheter body from the distal end side to the inside and exposing the catheter body to the outside;
A catheter system comprising:

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